The H17 supervised consumption venue, Copenhagen
“Insite (Vancouver SIF) saves lives. Its benefits have been proven.” Supreme Court of Canada, 2011
UK drug related death rates are among the highest in Europe, and are increasing dramatically - reaching record levels for three years in a row. Supervised Injection Facilities (SIFs) significantly reduce: fatal overdoses and needle sharing that can lead to infections, including HIV and hepatitis; high risk public injecting; and discarded needles, while increasing numbers entering treatment.
What is a Supervised Injection Facility?
SIFs (or colloquially ‘fix rooms’ or ‘shooting galleries’) are legally sanctioned facilities where people can inject their own pre-obtained drugs, under medical supervision. Many also allow smoking of drugs (including heroin and crack cocaine), and so are called ‘drug consumption rooms’. They can be in permanent clinics, mobile ambulance style units or temporary structures. They typically provide people who use drugs with:
sterile injecting equipment
a hygienic space to use drugs under medical supervision that they have bought illicitly
primary medical care, and emergency care in the event of overdose
counselling services and referral to social, health-care and treatment services
The UK government’s official advisers - the Advisory Council on the Misuse of Drugs (ACMD) - supports the setting up of supervised injection facilities. SIFs complement and offer a gateway to drug treatment.
Where are SIFs in operation?
The first professionally staffed service where drug injection was accepted was in the Netherlands in the early 1970s. Now there are more than 100 SIFs operating in at least 66 cities around the world, in 10 countries - Switzerland, Germany, The Netherlands, Norway, France, Luxembourg, Spain, Denmark, Australia and Canada. There are government funded plans to open a SIF in Dublin, in 2017, and similar plans are in train in Glasgow – destined to become the first in the UK. Some US cities are also exploring this option.
Are SIFs Effective?
The evidence is clear: SIFs reduce needle sharing that can lead to transmission of HIV and hepatitis (e.g. research predicts Insite in Canada will prevent between 1191-1517 HIV infections over a 10 year period); prevent overdose deaths (in the area where Insite is located these fell 35% vs 9% in the rest of Vancouver after it opened1); reduce public injecting and discarded syringes, and can reduce street disorder and encounters with the police. They also increase the number of people accessing primary health care and drug treatment, especially among the hard to reach homeless populations most likely to be injecting in public. Evaluation studies have found an overall positive impact on the communities where these facilities are located.
While 1571 people died from a heroin overdose in the UK in 2015, no one has ever died from an overdose in a SIF anywhere - despite the many thousands of overdoses that have occurred in them. Opiate overdose is easily reversed if attended to quickly, only becoming deadly if people don’t have rapid access to emergency care.
Are there downsides?
Although they can require significant funds to set up and run (depending on what form they take, hours of operation etc), numerous cost benefit analyses have shown they are very good value for money compared to other measures. In particular, given the high life-time cost of treating diseases like HIV (about £380,000 per person) and hepatitis, avoiding even a small number of infections from needle sharing can mean a SIF pays for itself rapidly. A recent assessment for a proposed SIF in San Francisco suggested savings of $2.33 for every $1 spent.2
Concerns that SIFs may encourage drug use or increase crime have proven unfounded. Use is restricted to existing dependent users, and a review by the European Monitoring Centre for Drugs & Drug Addiction (EMCDDA) concluded: “There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”
To be effective, SIFs have to be sited where a public injecting problem already exists. And where they have been established, they have soon won support from the public and authorities.
Space does not allow us to list all references here, but we recommend the below for an indepth look at the issues and literature around SIFs. Or contact Transform for more details.
“Drug consumption rooms: an overview of provision and evidence”, European Monitoring Centre on Drugs and Drug Addiction http://www.emcdda.europa.eu/topics/pods/drug-consumption-rooms
Transform Drug Policy Foundation www.tdpf.org.uk 0117 325 0295 firstname.lastname@example.org
1 Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study.” Marshall BD et al Lancet. 2011 Apr 23 https://www.ncbi.nlm.nih.gov/pubmed/21497898
2‘A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA’ Dec 2016Amos Irwin, Ehsan Jozaghi, Ricky N. Bluthenthal, Alex H. Kral http://journals.sagepub.com/doi/full/10.1177/0022042616679829