International literature

Ahmed M Bayoumi and Carol J Strike, Making the case for supervised injection services, The Lancet, Volume 387, No. 10031, p1890–1891, 7 May 2016.

More than 90 supervised injection services (SIS) operate globally, most within eight European countries, one in Australia, and two in Vancouver, Canada. SIS are legally sanctioned spaces where people can inject illegal drugs, typically heroin or cocaine, under the supervision of trained health staff and without fear of prosecution. These services allow safer injection, are associated with decreased overdoses, facilitate referrals for drug treatment, and benefit public order. In response to the increase in opioid use and associated harms, activists and officials in Canada, the USA, Scotland, and Ireland are exploring supervised injection services, but implementation is controversial.

Eugene McCan and Cristina Temenos, Mobilizing drug consumption rooms: inter-place networks and harm reduction drug policy, Health & Place, Volume 31, January 2015.

This article discusses the learning and politics involved in spreading Drug Consumption Rooms (DCRs) globally. DCRs are health facilities, operating under a harm reduction philosophy, where people consume illicit drugs in a supervised setting. Approximately 90 are located in almost 60 cities in 11 countries. They are intensely local attempts to improve the lives of specific populations and urban neighborhoods. DCRs are also global models that travel. This article examines the relationship between DCRs as facilities that are fixed in place and DCRs as globally-mobilized models of drug policy and public health practice. Drawing on research from seven countries, we apply concepts from the policy mobilities literature to analyze the travels of the DCR model and the political strategies involved in the siting of these public health service facilities. We detail the networked mobilization of the DCR model from Europe to Canada and Australia, the learning among facilities, the strategies used to mold the DCR model to local contexts, and the role of DCR staff in promoting continued proliferation of DCRs. We conclude by identifying some immobilities of DCRs to identify questions about practices, principles and future directions of harm reduction.

Dr. Mehmet Zülfü ÖNER, An Overview Of Drug Consumption Rooms, Human Rights Review, Year 4, Issue 8, December 2014.

In response to growing concerns about the public health and public order problems related to drug use, countries use a comprehensive approach to the drug problem, which includes prevention, harm reduction, treatment, and enforcement. Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. Drug consumption rooms are an example of a harm reduction programme and are a component of some drug strategies in some countries. Drug consumption rooms (DCRs) are legally sanctioned public health facilities that offer a hygienic environment where people can use drugs under the supervision of trained staff. The overall rationale for consumption rooms is to reach and address the problems of specific, high-risk populations of drug users, especially injectors and those who consume in public. Drug consumption rooms aim to reduce the risk of transmission of blood-borne infections, in particular HIV (Human Immunodeficiency Virus) and hepatitis; to reduce the likelihood of illness and death resulting from overdose; and to help people who use drugs avoid other harms associated with drug consumption under unhygienic or unsafe conditions. This article looks at the experiences with drug consumption rooms describes the general features and analyzes them from a historical point of view. This article also explores the position of these rooms in international law..

Chloé Potier, Vincent Laprevote, Françoise Dubois-Arber and al., Supervised injection services: what has been demonstrated? A systematic literature review, Drug and Alcohol Dependence, 23 October 2014.

SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence. [Résumé en français]

Supervised Injection Sites: A Bibliography, Canadian Centre on Substance Abuse, Novembre 2013.

Tara Marie Watson, Carol Strike, Gillian Kolla ans al., Design considerations for supervised consumption facilities (SCFs): Preferences for facilities where people can inject and smoke drugs, International Journal of Drug Policy, Volume 24, Issue 2, Pages 156-163, March 2013.

People who use drugs see SSFs as offering public health and safety benefits, while other stakeholders were more sceptical about the need for SSFs. People who use drugs provided insights into how a facility might be designed to accommodate supervised injection and supervised smoking. Their strongest preference would allow both methods of drug use within the same facility with some form of physical separation between the two based on different highs, comfort regarding exposure to different methods of drug administration, and concerns about behaviours often associated with smoking crack cocaine. Other stakeholders raised a number of SSF implementation challenges worthy of consideration.

Supervised Injecting Facilities – Annotated Bibliography, DPMP, January 2013.

Melissa de Vel-Palumbo, Francis Matthew-Simmons, Marian Shanahan & Alison Ritter, Supervised Injecting Facilities: What the literature tells us, DPMP, Bulletin No.22, January 2013.

The Drug Policy Modelling Program has prepared an annotated bibliography of published research concerned with Supervised Injecting Facilities, as at April 2012. We hope it will provide a useful resource for policy makers, clinicians and researchers interested in gaining an overview of the literature on this topic.

Melissa de Vel-Palumbo, Francis Matthew-Simmons, Marian Shanahan & Alison Ritter, Supervised Injecting Facilities: What the literature tells us, DPMP, Bulletin No.22, January 2013.

The Drug Policy Modelling Program has prepared an annotated bibliography of published research concerned with Supervised Injecting Facilities, as at April 2012. We hope it will provide a useful resource for policy makers, clinicians and researchers interested in gaining an overview of the literature on this topic.

Astrid Leicht, Xavier Majó i Roca and M. Teresa Brugal, Mobile safe injecting facilities in Barcelona and Berlin, International Journal of Drug Policy, 23 (2012), Editorial p. 257–260.

Dans son dernier éditorial, l'International Journal Of Drug Policy, s'intéresse au salles d'injection mobiles, un dispositif qui n'a été que peu développé contrairement aux salles d'injection fixes. Il fournit une description préliminaire des principales caractéristiques des salles d'injection mobiles dans deux villes, Barcelone et Berlin, et demande que quelques-unes des questions sur leur fonctionnement soient approfondies dans des études ultérieures.

Salaam Semaan, Haley Stolp, Paul Fleming and al., Scientific and programmatic implications of safer injection facilities for persons who inject drugs illicitly, XIX International AIDS Conference, Washington, DC, July25, 2012.

Persons who inject drugs (PWID), particularly those who inject in streets, alleys, and parks, use needles and syringes used by others, or use unclean drug-preparation equipment (cotton, cookers, or water) are at risk for HIV, HBV, and HCV infections. To reduce risk for infectious diseases and improve health outcomes, cities in Australia, Canada, Germany, Luxembourg, Netherlands, Norway, Spain, and Switzerland established safer injection facilities (SIFs) following establishment of legal support. SIFs provide clean injection environments, sterile injection equipment, and clean drug-preparation equipment at the time of injection.

Eberhard Schatz et Marie Nougier, Document d'information de l'IDPC, Salles de consommation à moindre risque : les preuves et la pratique, IDPC, Juin 2012.

Depuis une dizaine voire une vingtaine d'années, les salles de consommation à moindre risque (SCMR) font partie intégrante des stratégies de traitement de la dépendance aux drogues et de réduction des risques dans plusieurs pays en Europe de l'Ouest, en Amérique du Nord et en Australie. Cependant, une majorité de pays ne les ont pas encore mis en place. Ce rapport de synthèse présente le contexte, l'histoire et les objectifs des SCMR et analyse les preuves disponibles quant à leur impact. La deuxième partie de ce rapport fournit un aperçu des SCMR dans différents pays, avec un accent particulier placé sur les concepts utilisés pour développer ces espaces en fonction du contexte politique, culturel et social de chaque pays. 

Eberhard Schatz and Marie Nougier, IDPC Briefing Paper, Drug consumption rooms: Evidence and practice, IDPC, June 2012.

La guerre aux drogues. Rapport de la commission mondiale pour la politique des drogues. Juin 2011. Version française Septembre 2011.

Charlie Lloyd and Christine Godfre, Commentary on Pinkerton (2010): Drug consumption rooms—time to accept their worth, Addiction. 2010 Aug;105(8):1437-8.

Bernard Bertrand, Droit international & Salles de consommation à moindre risque, Mars 2009.

Adaptation de : Richard Elliott, Ian Malkin, et Jennifer Gold, Créer des lieux sécuritaires pour l’injection au Canada : questions juridiques et éthiques, Réseau juridique canadien VIH/Sida, 2002, p.27-40 : Adaptation de l’article : Ian Malkin, Establishing supervised injecting facilities: A responsible way to help minimise, Melbourne University Law Review, 2001, Volume 25, n°3, p. 680.

Donald MacPherson, Insite withstands test of international drug control conventions, Canadian Drug Policy Coalition, April 2, 2012

Julie Savignac, Isabelle Lelandais et Valérie Sagant, Nuisances publiques liées aux drogues et à la prostitution : Manuel pratique pour l’action locale, Centre International pour la Prévention de la Criminalité, 2007.

Ce manuel pratique pour l’action locale s’adresse aux villes et à tous les acteurs désirant développer et s’impliquer dans une démarche de gestion des nuisances liées à la drogue et la prostitution dans l’espace public. Ce manuel s’adresse autant à des intervenants cumulant plusieurs années d’expérience qu’à ceux qui en sont à leur première action. Il s’agit d’un outil visant à proposer une méthodologie commune applicable et transférable dans différentes villes.

Home

Garth Davies, A Critical Evaluation of the Effects of Safe Injection Facilities. Simon Fraser University. Juillet 2007.

Research has overwhelmingly supported the proposition that safe injection facilities (SIFs) are successful in meeting their stated objectives. However, the methodological and analytic approaches used in these studies have not been scrutinized to any significant degree. Previous studies are compromised by an array of deficiencies, including a lack of baseline data, insufficient conceptual and operational clarity, inadequate evaluation criteria, absent statistical controls, dearth of longitudinal designs, and inattention to intrasite variation. This review suggests that much of the commonly-cited evidence regarding the effects of SIFs cannot be substantiated. Disentangling complicated casual mechanisms first requires that the identified shortcomings be addressed.

Home

18e conférence internationale sur la réduction des risques en direction des consommateurs de produits psychoactifs. Varsovie 13 - 17 mai 2007.

Richard Pearshouse and al., Legislating for Health and Human Rights: Model Law on Drug Use and HIV/AIDS, Module 4: Supervised drug consumption facilities, Canadian HIV/AIDS Legal Network, 2006.

Many countries with injection-driven HIV/AIDS epidemics continue to emphasize criminal enforcement of drug laws over public health approaches, thereby missing or even hindering effective responses to HIV/AIDS. There is considerable evidence that numerous interventions to prevent HIV transmission and reduce other harms associated with injection drug use are feasible, effective as public health measures and cost-effective. Despite such evidence, millions of people around the world who use drugs do not have access to such services because of legal and social barriers.

Marcus Roberts, Axel Klein et Mike Trace, Drug consumption room, n°3, The Beckley Foundation, 2004.

The defining characteristic of Drug Consumption Rooms (DCRs) is that they are legally sanctioned environments where people can take illegal drugs. Their purpose is to reduce drug-related harms. The underlying assumption is that if problem drug users are provided with safe private environments within which to administer drugs there will be a reduction in unsafe public drug use. Drug Consumption Rooms have developed in their modern form since the mid-1980s. For most of this period they have operated in a handful of countries in Western Europe, but in the last few years new facilities have opened in Australia and Canada, and some more rigorous evaluations of their impact have been produced. While the benefits of DCRs should not be exaggerated – and they raise issues of ethical and legal principle that cannot be resolved easily - evidence is emerging that these facilities can make a positive contribution to reducing drug-related harms where they have the support of local services and communities.

Benedikt Fischer, Sarah Turnbull, Blake Poland et Emma Haydon, Drug use, risk and urban order: examining supervised injection sites (SISs) as ‘governmentality', International Journal of Drug Policy 15 (2004) 357–365.

This paper problematises the emergence and functioning of the recent phenomenon of ‘supervised injection sites' (SISs) as a case study of post-welfarist governmentality. We propose that SISs arose as an unprecedented intervention in the late 20th century to deal with the increasing challenge of ‘urban drug scenes' towards public order interests ‘entrepreneurial city'. Under predominant discourses of ‘public health' and ‘harm reduction', SISs became possible within a wide variety of political interests as a technology for purifying public spaces of ‘disorderly' drug users to present the ‘new city' as an attractive consumption space. Thus, SISs can be meaningfully understood as one element of socio-spatial ‘exclusion' of marginalised populations from urban cores to ghettoised, peripheral spaces, even as they more benignly seek to better meet the unique needs of drug user populations. Further, the inner workings of SISs illustrate these facilities as powerful surveillance and discipline sites, defining the drug user as an agent of omnipresent risk being responsibilized in the care of the self and body, but also multiple aspects of behaviour and lifestyle reaching beyond drug use; thus construing the drug user as a ‘normalised' citizen/consumer. We suggest that pressures to answer to powerful interests promoting ‘order' are concretised as practices of ‘risk management' ‘on the shop floor', raising serious questions about the extent to which the ability to meet user needs is compromised in the interest of social control, surveillance, ‘management', ‘education', and ‘rehabilitation', particularly in the current socio-political context (characterised as it is by a persistence, and indeed concomitant hardening, of repressive measures ‘on the street').

Alfred Springer, Konsumräume. Expertise im Auftrag des Fonds Soziales Wien, Ludwig-Boltzmann-Institut für Suchtforschung, November 2003.

Carrier N., Une dépolitisation hygiénique : les lieux d'injection de drogues illicites comme stratégie de réduction des méfaits, Déviance et Société 2003/1, 27, p. 59-76.

Au Canada, depuis la fin des années 1990, la mise en place de lieux où il serait possible de s'injecter des drogues interdites sans craindre d'autre intervention étatique que le contrôle médical est revendiquée par plusieurs acteurs sociaux. Le fait qu'il n'aura fallu que quelques années pour que cette stratégie de « réduction des méfaits» soit envisagée politiquement dans un Canada pourtant toujours attaché à son régime prohibitif appelle une interprétation sociologique. Examinant les motifs utilisés pour justifier la mise en place éventuelle de tels lieux par les acteurs des champs universitaire, journalistique et politique, on constate que ces motifs prennent pour axe majeur la dimension socio-sanitaire de l'usage. Une dépolitisation hygiénique: la tension prohibition-légalisation a disparue.

PNUCID, Flexibility of treaty provisions as regards harm reduction approaches, OICS, 15 novembre 2002.

the legal advice given is that "even supplying a drug addict with the drug he depends on could be seen as a sort of rehabilitation and social reintegration, assuming that once his drug requirements are taken care of, he will not need to involve himself in criminal activities to finance his dependence" and that it "would be difficult to assert that, in establishing drug-injection rooms, it is the intent of Parties to actually incite to or induce the illicit use of drugs, or even more so, to associate with, aid, abet or facilitate the possession of drugs. [..] On the contrary, it seems clear that in such cases the intention of governments is to provide healthier conditions for IV drug abusers, thereby reducing their risk of infection with grave transmittable diseases and, at least in some cases, reaching out to them with counselling and other therapeutic options. Albeit how insufficient this may look from a demand reduction point of view, it would still fall far from the intent of committing an offence as foreseen in the 1988 Convention."

OICS, Aperçu de la situation dans les différentes régions, Rapport annuel, Communiqué de presse n°3, 27 février 2002.

L'Europe reste une importante source de drogues synthétiques de fabrication illicite, comme la MDMA (ecstasy). Ces drogues peuvent être obtenues facilement et sont largement consommées par des jeunes dans la région et ailleurs. En 2001, des cultures illicites de pavot à opium ont été découvertes pour la première fois en Albanie. Dans d'autres pays d'Europe centrale et orientale, le pavot à opium est cultivé à une petite échelle. Certains pays d'Europe occidentale ont dépénalisé la possession et l'abus de drogues placées sous contrôle et tolèrent ouvertement un tel abus, en particulier s'agissant du cannabis et de la MDMA (ecstasy). Aucun des gouvernements des pays concernés n'a été en mesure de fournir à l'Organe des informations démontrant que de telles mesures permettent de réduire la demande de drogues illicites. En Europe centrale et orientale, l'abus et le trafic de drogues ont beaucoup augmenté. En particulier, la fabrication illicite et l'abus de stimulants de type amphétamine gagnent du terrain. En Fédération de Russie, on a constaté une augmentation des quantités d'héroïne en provenance d'Afghanistan. La plupart des pays d'Europe centrale et orientale, qui servent de points de transit aux trafiquants de drogue, sont actuellement aux prises avec de graves problèmes d'abus d'héroïne. Dans de nombreux pays, les cas d'infection par le VIH et par le virus de l'hépatite C se multiplient parmi les toxicomanes qui s'injectent des drogues.

Alan C. Ogborne et al., Réduction des méfaits et utilisation des drogues injectables : étude comparative internationale des facteurs contextuels influençant l'élaboration et la mise en oeuvre de politique et de programmes adaptés, CCLAT, Septembre 2001.

Malkin I., Establishing supervised injecting facilities: A responsible way to help minimise, Melbourne University Law Review, 2001, Volume 25, n°3, p. 680.

The trial of supervised injecting facilities is one of a number of strategies that should be employed to address the problems associated with street-based injection drug use in Australia. In this article, it is proposed that these facilities should be trialled in view of their success overseas in lowering the incidence of drug overdose, in preventing the transmission of blood-borne diseases and in reducing public nuisance. It is argued that Australia's health-related human rights obligations under international law require the trial of supervised injecting facilities. Contrary to the arguments of some, the various drug-related treaties to which Australia is a party accommodate the establishment of supervised injecting facilities. The early success of a supervised injecting facility in New South Wales augurs well for the prospects of decreasing the incidence of overdose and blood-borne disease among street-based injecting drug-users by adopting an approach to drug policy that is based on principles of harm minimisation.

OICS, Les salles d'injection sont contraires aux conventions internationales, Rapport annuel, Communiqué de presse n°5, 23 février 2000.

L'Organe international de contrôle des stupéfiants, basé à Vienne, voit dans l'accord explicite ou tacite donné par les pouvoirs publics aux salles d'injection ("piqueries") un pas dans la direction de la légalisation des drogues. Dans le rapport annuel qu'il vient de publier, l'OICS souligne que le fait d'autoriser ou de tolérer de telles salles, où les toxicomanes peuvent s'injecter eux-mêmes des substances illicites, non seulement favorise la toxicomanie et le trafic de drogues, mais va aussi à l'encontre des traités internationaux relatifs au contrôle des drogues.

Bertil COTTIER et Martin SYCHOLD, Use of Narcotic Drugs in Public Injection Rooms under Public International Law, Swiss Institute of comparative Law, Avis 99-121c january 7 2000.

The texts of the relevant international conventions do not provide any guidance on the essential question of whether or not public injection rooms are in fact conducive to the rehabilitation and social reintegration of drug addicts in the short term and to the reduction of human suffering and the elimination of financial incentives for illicit traffic in the long term. The actual practice of States Parties in this respect could provide some guidance, if it is substantially uniform. If not, it must be concluded that States Parties retain the freedom to make their own policy choices on the tolerance of Fixer-Stübli. States Parties are not obliged by the conventions to prosecute and punish the possession and consumption of drugs (other than those psychotropic substances which are listed in Schedule I to the 1971 Convention) by addicts in Fixer-Stübli. This conclusion is subject only to the caveat that activities which counteract the object and purpose of the conventions must not be tollerated, but that is simply to restate the question of the underlying socio-medical utility of public injection rooms. We hope that the above observations will be of assistance to you. We would be very interested in seeing the results of your enquiries as to the relevant socio-medical policies adopted in other countries. Should you require any clarification of the legal aspects of the subject, please do not hesitate to contact us again.

Consumption rooms as a professional service in addictions health : International conference for the development of guidelines, Guidelines for the operation and use of Consumption Rooms, Hannover, 18-19 November 1999.

At the conference 'Consumption rooms as a professional service in addictions-health : International conference for the development of guidelines', 180 participants from Germany, the Netherlands, Switzerland, Austria, France, and Australia came together to discuss the low-threshold and acceptance-orientated facilities, known as 'consumption rooms. Conference participants came from agencies operating and wishing to operate these services, social and health authorities, the police and justice system, and from policy making and administrative authorities active in the area of low-threshold and acceptance-orientated drug assistance. Many professional groups were represented : social workers, psychologists, nurses, doctors, public prosecutors, lawyers and police officers. As well as a general exchange of experience, working groups developed guidelines on six specific topic areas. These covered planning, realisation, operation, documentation/data collection, and the political acceptability of these services. These Guidelines are intended to serve as a professional orientation for existing facilities as well as for those being planned. They should also inform decision making by those responsible for policy and adminstration.