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Safer Injection Facilities: A Safe Place for People Who Inject Drugs

Safer injection facilities (SIFs), also known as supervised injection facilities, exist in Switzerland, Germany, Spain, the Netherlands, Norway, Canada, Australia, Luxembourg and Denmark.

A SIF is a place where people can inject illicit drugs into themselves under the supervision of nurses/medical professionals.  SIFs are a harm reduction approach aimed to provide a non-judgemental, non-punishing and hygienic place to do drugs.  SIFs want to ensure that those injecting are doing so in the safest way possible and offer treatment referrals and counselling for drug users.

Opinions about SIFs are mixed: some say that SIFs enable and support bad habits that produce unproductive members of society, while others say that it’s not easy for drug users to stop taking drugs and they’re going to continue, so why not give them a safe place to do it and reduce the risk of infection and fatal overdose.  Some are critical about SIFs and their impact financially on governments and say that “doing heroin takes a certain irresponsibility that this city should not support”.

Many may have genuine concerns about SIFs but people often fail to understand how complex drug use is; without the existence of such facilities there can be many negative impacts.

The main aims of SIFs are to cut down on the amount of discarded needles left in public places, to decrease infection by using sterile equipment, to lessen the number of public drug injections, to reduce the amount of fatal overdoses, and to offer support and counselling (includes referrals to social workers, therapists and other organisations) to people who are willing to accept it.

Is there a need for SIFs?  The UK’s Office for National Statistics (ONS) reports that there was 1,492 deaths in 2012 due to drug misuse, and 2,248 such deaths in 2014.  Deaths from heroin/morphine rose from 579 in 2012 to 952 in 2014.

With the increase of drug-related deaths in Britain, don’t SIFs seem like a logical step toward tackling this problem?

In Australia, the Sydney Medically Supervised Injecting Centre (MSIC) opened in 2001 in Kings Cross.

The 2003 evaluation of the Centre showed that 1 in 41 visits resulted in a referral for further assistance (counselling and referrals to health/welfare services) and in total there were 1,385 referrals made for 577 clients during two and a half years.  The MSIC can’t stop overdoses, and 409 overdoses occurred in the Sydney MSIC during this time period, but no fatalities occurred.  Nine cases required hospital treatment, but this could’ve been a very different story if the drug users were injecting in public without medical supervision.  In fact, there has never been a fatality at any SIF in the world.

A misconception may be that SIFs allow anyone to walk in and inject.  People are not allowed into the facility if they don’t meet guidelines.  At the Sydney MSIC, people are turned away if they’re intoxicated, under 18 years old, wishing to share drugs, displaying unacceptable behaviour, or accompanied by children. They are also barred if they are pregnant or possibly pregnant (in Zurich pregnant drug users receive special counselling), if they have no previous drug history, or if they wish to use non-injecting routes.

Although SIFs are targeted at keeping drug users from publicly injecting, some continue to do so. 

Sydney MSIC, for example, has limited opening hours; this may not suit all clients, and the waiting times and distance can be a problem for some people who use the facility.  This could be solved by having longer opening hours and a bigger capacity so that all clients can inject quickly.

In New York, there have been campaigns for the introduction of SIFs to tackle the homelessness and public injecting crisis.  Research was carried out which showed that “homeless people were more than 9 times more likely to report public injecting than those who were stably housed” in New York.

Drug users often see harm reduction organisations as safe havens, so frequently go to the bathrooms in the organisation to inject.  Certain harm reduction agencies in New York have set up ‘safer consumption bathrooms’ in their own bathrooms.  They don’t want to condone drug use, but do want to provide a clean place for users to inject.  Some of the bathrooms have intercoms to communicate with people if necessary, and timers above each bathroom.  Some organizations have equipped bathrooms with clean needles.  These bathrooms are discussed and shown in a short film called Everywhere But Safe – “a documentary film that examines public injection drug use in New York and charts a path toward healthier and safer communities”.

Like SIFs, safer consumption bathrooms try to reduce infection and fatal overdoses by providing sterile equipment and having medical staff on standby. 

Do drug users deserve this facility?  My answer is yes, 100%.  People accessing SIFs are mostly those who use drugs problematically, and they have gone down a path that means they need additional support.  It is estimated that about 90 per cent of people who use drugs do so recreationally and not problematically.   Those who use problematically need to be treated with compassion and respect, especially considering many people who use problematically due to traumatic events in their life.

What about the possibility of SIFs in the UK?  Glasgow drug workers travelled from Scotland to Dublin to find out about plans for a SIF; they‘re now recommending that the Scottish government considers the benefits of SIFs.

There are many legal and moral hurdles for countries to get over if they want to introduce SIFs into their societies.

Aodhán Ó Ríordáin, former Irish Drugs Minister, said in 2015 that SIFs “will happen” in 2016 in Dublin.  The government worked towards knocking down legislative barriers.  In December 2015, the cabinet approved the drafting of legislation to permit licenses to be issued for the establishment of SIFs.  The minister wanted a complete “culture shift” and for the shame put upon drug users to be lifted.

Ríordáin lost his seat in the 2016 general election but health minister, Simon Harris, said that they are proceeding with plans to open a SIF in 2016.

Dundee, a city in Scotland, has high levels of drug use.  The National Drug-related Deaths Database says, 28 people died as a result of drugs in Dundee in 2011.  Dundee was named “Scotland’s drug capital in 2013”.

Glasgow City Alcohol and Drug Partnership (ADP) estimated that there are 5,500 drug users in Glasgow and that “about 500 vulnerable drug users injected in public places”.  ADP chair, Susanne Millar, says communities need to be made safer “for all people living in and visiting the city, including those who publicly inject." 

ADP said there was a “HIV outbreak” in Glasgow in 2015, with 47 new infections in comparison to the previously consistent annual average of 10.

Ultimately, SIFs are aimed at improving the safety of the public (people who use drugs and those who do not), and giving sterile and secure places for people to inject.  Evidence gathered from SIFs across the world suggests that these facilities are successful in reducing the amount of public injections and fatal overdoses.

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