American literature

Safer Consumption Spaces in the United States: Uniting for a national Movement, Project Inform, June 2017.
This report provides a summary of the think tank (September 27–28, 2016. Baltimore, MD) review of key issues related to Safer Consumption Spaces (SCS), and lists some of the best practices and lessons learned for advocacy and educating people around SCS to teach the value and benefits these sites provide to people who use drugs and the communities where they live.

Derek Hodel, The Case for Supervised Consumption Services, amfAR Public Policy Office, Issue Brief, June 2017.
In the United States, people who use drugs (PWUD) continue to be at elevated risk for HIV, according to the Centers for Disease Control and Prevention. At the same time, a surging epidemic of overdoses from heroin and prescription painkillers (i.e., opioids) claimed nearly 50,000 lives in 2014 alone. To save lives, there is a pronounced need to implement scientically validated harm reduction programs, which reduce the risks associated with drug use and facilitate access to addiction treatment and medical care. Among the newest and most innovative interventions to reduce overdoses are supervised consumption services.

FAQ: Supervised Injection Facility, Massachusetts Medical Society, 2017.

Amos Irwin, Ehsan Jozaghi, Brian W. Weir and al., Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility, Harm Reduction Journal, 2017.

Supervised injection facility, Supervised consumption rooms, Cost-benefit, Cost-effectiveness, People who inject drugs, Harm reduction, Opiate overdose, Heroin, Baltimore, Maryland.

Mayor James F. Kennedy, The Mayor’s Task Force to Combat The Opioide Epidemic In Philadelphia, Final Report & Recommendations, City of Philadelphia, May 19, 2017.

Sarah E. Wakeman, M.D., Another Senseless Death — The Case for Supervised Injection Facilities, The News England Journal of Medecine, 376:1011-1013, March 16, 2017.

Many heroin users abstain from use while taking buprenorphine, but the daily decision to take it is tough. Supervised injection facilities can save lives, improve health, increase neighborhood safety, reduce cost, and ultimately increase engagement in treatment.

Dr. Susan Sherman, Kyle Hunter and Saba Rouhani, Safe Drug Consumption Spaces-Implications for Baltimore City, Abell Foundation, February 2017.

This Abell Report, written by Dr. Susan Sherman, a professor in the Bloomberg School of Public Health’s Department of Health Behavior and Society, explains what safe consumption spaces are, the research behind them, and the challenges they face. It calls for creating two safe consumption spaces, one on the east side of the city and one on the west side.

Benjamin A. Bouvier, Beth Elston, Scott E. Hadland and al., Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study, Harm Reduction Journal, 2017, 14:13.

Background: Supervised injection facilities (SIFs) are legally sanctioned environments for people to inject drugs under medical supervision. SIFs currently operate in ten countries, but to date, no SIF has been opened in the USA. In light of increasing overdose mortality in the USA, this study evaluated willingness to use a SIF among youth who report non-medical prescription opioid (NMPO) use. Methods: Between January 2015 and February 2016, youth with recent NMPO use were recruited to participate in the Rhode Island Young Adult Prescription Drug Study (RAPiDS). We explored factors associated with willingness to use a SIF among participants who had injected drugs or were at risk of initiating injection drug use (defined as having a sex partner who injects drugs or having a close friend who injects). Results: Among 54 eligible participants, the median age was 26 (IQR=24–28), 70.4% were male, and 74.1% were white. Among all participants, when asked if they would use a SIF, 63.0% answered “Yes”, 31.5% answered “No”, and 5. 6% were unsure. Among the 31 participants reporting injection drug use in the last six months, 27 (87.1%) reported willingness to use a SIF; 15 of the 19 (78.9%) who injected less than daily reported willingness, while all 12 (100.0%) of the participants who injected daily reported willingness. Compared to participants who were unwilling or were unsure, participants willing to use a SIF were also more likely to have been homeless in the last six months, have accidentally overdosed, have used heroin, have used fentanyl non-medically, and typically use prescription opioids alone. Conclusions: Among young adults who use prescription opioids non-medically and inject drugs or are at risk of initiating injection drug use, more than six in ten reported willingness to use a SIF. Established risk factors for overdose, including homelessness, history of overdose, daily injection drug use, heroin use, and fentanyl misuse, were associated with higher SIF acceptability, indicating that young people at the highest risk of overdose might ultimately be the same individuals to use the facility. Supervised injection facilities merit consideration to reduce overdose mortality in the USA.

Mary Clare Kennedy and Thomas Kerr, Overdose Prevention in the United States: A Call for Supervised Injection Sites, American Journal of Public Health: January 2017, Vol. 107, No. 1, pp. 42-43. 

Amos Irwin, Ehsan Jozaghi, Ricky N. Bluthenthal and Alex H. Kral, A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA, Journal of Drug Issues, December 2016.

Supervised injection facilities (SIFs) have been shown to reduce infection, prevent overdose deaths, and increase treatment uptake. The United States is in the midst of an opioid epidemic, yet no sanctioned SIF currently operates in the United States. We estimate the economic costs and benefits of establishing a potential SIF in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing SIFs. We consider potential savings from five outcomes: averted HIV and hepatitis C virus (HCV) infections, reduced skin and soft tissue infection (SSTI), averted overdose deaths, and increased medication-assisted treatment (MAT) uptake. We find that each dollar spent on a SIF would generate US$2.33 in savings, for total annual net savings of US$3.5 million for a single 13-booth SIF. Our analysis suggests that a SIF in San Francisco would not only be a cost-effective intervention but also a significant boost to the public health system.

Brett Wolfson-Stofko,  Ric Curtis, Faustino Fuentes and al., The Portapotty Experiment: Neoliberal approaches to the intertwined epidemics of opioid-related overdose and HIV/HCV, and why we need cultural anthropologists in the South Bronx, Springer Science+Business Media Dordrecht, November 2016.

The following report from the field focuses on the authors' collective efforts to operate an ad hoc safer injection facility (SIF) out of portapotties (portable toilets) in an area of the South Bronx that has consistently experienced some of the highest overdose morbidity and mortality rates in New York City over the past decade (New York City Department of Health and Mental Hygiene, 2011, 2015, 2016). Safer injection facilities (also known as supervised injection facilities, drug consumption rooms, etc.) operating outside the US provide a legal, hygienic, and supervised environment for individuals to use drugs in order to minimize the likelihood of fatal overdose and the spread of blood-borne infections while reducing public injection. In the US, the operation of SIFs is federally prohibited by the federal "Crack House" statute though federal, state, and local elected officials can sanction their operation to various degrees (Beletsky, Davis, Anderson, & Burris, 2008). The activists, researchers, undergraduate students and peers from syringe exchange programs who came together to operate the portapotties discovered that they were, in many ways, emblematic of neoliberal solutions to disease prevention: primarily focused on auditing individual risk behaviors and virtually blind to the wider social context that shapes those lives. That social context - the culture of drug injection - was and is out in the open for all of us to see. Going forward, the cultural anthropologist's toolbox will be opened up and used by large groups of undergraduate students to better understand the culture of drug use and how it is changing.

King County, Heroin and Prescription Opiate Addiction Task Force, Final Report and Recommendations, September 2016. 

Task Force recommends establishing, on a pilot program basis, at least two Community Health Engagement Locations (CHEL sites) where supervised consumption occurs for adults with substance use disorders in the Seattle and King County region. Given the distribution of drug use across King County, one of the CHEL sites should be located outside of Seattle. 

Alternatives to Public Injecting, Harm Reduction Coalition, 2016.

This report explores the international experience with supervised injection facilities (SIFs) and evidence supporting their role as a bridge to health and recovery.

JK Costello, Paving The Policy Parkway For The Nation's First Supervised Injection Facility, Harm Reduction Action Center, August 2016.

Supervised injection is a contemporary harm reduction measure that aims to reduce the adverse effects of injection drug use. Such facilities have successfully reduced overdoses and public injection in Europe, Australia, and Canada. There currently exist no supervised injection facilities (SIFs) in the USA, although they are now part of the conversation on overdose reduction in this country. This project is a mixed-methods survey assessing the potential to establish a SIF in Denver, Colorado. Denver possesses several attributes making it a candidate for supervised injection, including a robust harm reduction organization, liberal social policies, and a prominent public drug use scene. Unfortunately, drug overdose is also on the rise in Denver. Supervised injection could help alleviate the latter two problems in a cost-effective manner. This project aims to inform the research question, “Can Denver establish a supervised injection facility?” The research involves a semi-structured interview with quantitative variables including Likert scale ratings and discrete frequencies. Subjects include a broad sample of people who inject drugs (PWID) as well as community stakeholders from the business, health care, and municipal realms. Analyses include statistical comparisons, qualitative analysis of interview data, mapping, geospacial mapping, costeffectiveness analysis, and cost-benefit analysis. Following are recommendations on the next steps in the push for a SIF in Denver.

Supervised Injection Facilitie, Drug Policy Alliance, New York, February 2016.

Supervised injection facilities (SIFs) are controlled health care settings where people can more safely inject drugs under clinical supervision and receive health care, counseling and referrals to health and social services, including drug treatment. There is overwhelming evidence that SIFs are effective in reducing new HIV infections, overdose deaths and public nuisance – and that they do not increase drug use or criminal activity. There are currently about 100 such facilities operating in more than 65 cities around the world in nine countries – but none in the U.S.

David Monico, Out of the Alley: Lessons from Safe Injecting Facilities (SIF), Graduate Annual, 2015, Vol. 3.

Injecting drug use is a public health problem in need of novel intervention. Heroin and cocaine, two commonly injected drugs, highly contribute to overdose death. Overdose is now the number one cause of unintentional death in the United States. Those who inject drugs are also at risk of infectious diseases such as HIV and HCV. Current methods to reduce the harms associated with injecting drug use are not meeting the needs of injecting drug users (IDUs). In many parts of the world, injecting drug use is tolerated and permitted at supervised facilities where medical staff are available as needed. To determine if such facilities are possible in the United States this literature review of research related to safe injecting facilities (SIF) was conducted. The databases PsychInfo and CINAHL Complete were utilized in this review. Thirty-two articles were considered, and five were excluded. Twenty-seven comprised the final literature review. It is clear that SIF will be utilized by IDUs. These facilities will serve to reduce risk of overdose, reduce disease transmission, increase treatment access, and provide a valuable service to the neighboring community. Further research and education are needed to gain public support for these lifesaving community interventions in the United States.

Report of the medically assisted injection drug facility feasibility Subcommittee, p.14 in William Wiese, Report compiled on behalf of the Senate Memorial 45 Harm Reduction Study Group by the Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, December 2012, Re-edited February 20, 2013.

An Introduction to Safer Injecting Facilities, Harm Reduction Action Center, November 2012.

Supervised Injection Facilities (SIFs) are controlled health care settings in which participants can more safely inject illicit drugs under clinical supervision. They are legally sanctioned facilities designed to reduce the negative health and public order issues often associated with public injection drug use by providing a safe, hygienic, and supervised space for consumers to inject pre-obtained drugs. In addition, SIFs serve as points of referral for consumers into health and social services including medical treatment, detoxification services, and substance abuse treatment. The primary aims of SIFs are to reduce personal health risks and public disturbance associated with injection drug use and to increase engagement of injection drug users (IDUs) in medical and social services through appropriate referrals. SIFs are designed to complement—not replace—existing prevention, harm reduction, and treatment interventions. 

Lynn D. Wenger and Alex H. Kral, Acceptability of a Safer Injection Facility in San Francisco : Community Stakeholder Perspectives, RTI, 2009.

Leo Beletsky and al., The Law (and Politics) of Safe Injection Facilities in the United States, Temple University, 2008.