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.
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.