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.
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.
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.