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Wikipedia

Supervised injection site

January 01, 1970

Supervised injection sites (SIS)[1][2][3] or drug consumption rooms (DCRs) are a health and social response to drug-related problems. They are fixed or mobile spaces where people who use drugs are provided with sterile drug use equipment and can use illicit drugs under the supervision of trained staff. They are usually located in areas where there is an open drug scene and where injecting in public places is common. The primary target group for DCR services are people who engage in risky drug use.

Cubicles for drug injection at a supervised injection site in Strasbourg

The geographical distribution of DCRs is uneven, both at the international and regional levels. In 2022, there were over 100 DCRs operating globally, with services in Belgium, Denmark, France, Germany, Greece, Luxembourg, the Netherlands, Norway, Portugal and Spain, as well as in Switzerland, Australia, Canada, Mexico and the USA.

Primarily, DCRs aim to prevent drug-related overdose deaths, reduce the acute risks of disease transmission through unhygienic injecting, and connect people who use drugs with addiction treatment and other health and social services. They can also aim to minimise public nuisance.[4]

Proponents say they save lives and connect users to services, while opponents believe they promote drug use and attract crime to the community around the site.[5] Supervised injection sites are part of a harm reduction approach towards drug problems.

Terminology

Supervised injection sites are also known as overdose prevention centers (OPCs),[6] supervised injection facilities,[7] safe consumption rooms,[8] safe injection sites,[1] safe injection rooms,[9] fix rooms,[10] fixing rooms,[11] safer injection facilities (SIF), drug consumption facilities (DCF),[2] drug consumption rooms (DCRs),[12] medically supervised injecting centres (MSICs) and medically supervised injecting rooms (MSIRs).[13]

Facilities

Australia

The legality of supervised injection is handled on a state-by state basis. New South Wales trialed a supervised injection site in Sydney in 2001, which was made permanent in 2010.[14] Victoria also opened a supervised injection site in Melbourne in 2018 on a trial basis; in 2020 the trial was extended for a further three years and a second site approved.[15] The second site in Melbourne has now been delayed pending a review. The second site was slated to be placed in a building on Flinder's street which had previously housed Yooralla.[16]

Europe

During the 1990s legal facilities emerged in cities in Switzerland, Germany and the Netherlands.[2][17] In the first decade of 2000, facilities opened in Spain, Luxembourg, and Norway.[2]

 
Naloxone, a drug on hand at clinics used to administer in cases of opioid overdose

Whereas injection facilities in Europe often evolved from something else, such as different social and medical outreaches or perhaps a homeless shelter, the degree and quality of actual supervision varies. The history of the European centers also mean that there have been no or little systematic collection of data needed to do a proper evaluation of effectiveness of the scheme. At the beginning of 2009 there were 92 facilities operating in 61 cities, including 30 cities in the Netherlands, 16 cities in Germany and 8 cities in Switzerland. Denmark passed a law allowing municipalities to run "fix rooms" in 2012, and by the end of 2013 there were three open.

To date in July 2022, according to European Monitoring Centre for Drugs and Drug Addiction Belgium has one facility, Denmark five, France two, Germany 25, Greece one, Luxembourg two, Netherlands 25, Norway two, Portugal two, Spain 13, and Switzerland 14.[18]

Netherlands

The first professionally staffed service where drug injection was accepted emerged in the Netherlands during the early 1970s as part of the "alternative youth service" provided by the St. Paul's church in Rotterdam. At its peak it had two centers that combined an informal meeting place with a drop-in center providing basic health care, food and a laundering service. One of the centers was also a pioneer in providing needle-exchange. Its purpose was to improve the psychosocial function and health of its clients. The centers received some support from law enforcement and local government officials, although they were not officially sanctioned until 1996.[17]

Switzerland

The first modern supervised consumption site was opened in Bern, Switzerland in June, 1986.[19] Part of a project combatting HIV, the general concept of the café was a place where simple meals and beverages would be served, and information on safe sex, safe drug use, condoms and clean needles provided. Social workers providing counselling and referrals were also present. An injection room was not originally conceived, however, drug users began to use the facility for this purpose, and this soon became the most attractive aspect of the café. After discussions with the police and legislature, the café was turned into the first legally sanctioned drug consumption facility provided that no one under the age of 18 was admitted.[20]

United Kingdom

The United Kingdom opened one (officially unsanctioned) facility in Glasgow in September 2020. It was opened by Peter Krykant, a local drugs worker;[21] however, lack of funding and support led to its closure in May 2021.[22][23] In nine months of operation, 894 injection events were recorded at the facility and volunteers reported attending to nine overdose events, seven opioid overdoses, and two involving powder cocaine; but there were no fatalities.[24]

In 2023, the Lord Advocate—Scotland's chief legal officer—announced that the Crown Office and Procurator Fiscal Service would institute a policy of not criminally prosecuting those using approved supervised drug consumption sites. Police Scotland have also confirmed they will exercise discretion in not prosecuting those using such a facility. Glasgow intends to open a supervised injection site following these policy changes.[25]

Ireland

Ireland has legislation to permit the opening of a service (as of May 2017) in the Misuse of Drugs (Supervised Injecting Facilities) Bill 2017; however, it has been halted by planning concerns.[26]


Canada

 
Insite in 2008

There are 39 government authorized SCS in Canada as of July 2019: 7 in Alberta, 9 in British Columbia, 19 in Ontario, and 4 in Quebec.[27] An exemption to controlled substances law under Canadian Criminal Code is granted inside the facilities, but drug possession remains illegal outside the facility and there is no buffer zone around the facility.[27] Canada's first SCS, Insite in Downtown Eastside of Vancouver, commenced operation in 2003.[28]

In August 2020, ARCHES Lethbridge in Lethbridge, Alberta, the largest SCS in North America, closed shortly after Alberta revoked their grant for misuse of grant funds.[29] Shortly after opening in February 2018,[30] ARCHES Lethbridge found itself repetitively necessitating police intervention and/or emergency medical services for opioid-related issues;[31] indeed, three weeks after its closure, the city noted a 36% decline in opioid-related EMS requests.[32] The average per-capita operating cost of government sanctioned sites are reported to be CAD$600 per unique-client, with the exception of the ARCHES Lethbridge which had a disproportionately high cost of CAD $3,200 per unique client.[31]

In September 2020, a group in Lethbridge, Alberta led by an ARCHES employee started hosting an unauthorized SCS in public places in a tent.[33][34] The group did not have authorizations to operate an SCS or a permit to pitch a tent in the park. The organizer was issued citations for the tent; and the Lethbridge Police Service advised that users utilizing the unauthorized SCS would be arrested for drug possession, because exemptions do not apply to unauthorized sites.[35][36][37] This opening of this illegal drug consumption tent was controversial and became a subject of discussion at the City Council meeting.[38][39]

United States

Clandestine injection sites have existed for years. A New England Journal of Medicine study from July 2020 reports that an illegal supervised consumption site has been operating at an "undisclosed" city in the U.S. since 2014 where over 10,000 doses of illegal drugs have been injected over a five-year period.[40] Supervised consumption sites with some degree of official sanction from a state or local government have been contemplated, but are rare due to the federal regulation of drugs and the explicit opposition of federal law enforcement to any form of decriminalization.[41]

Local governments in Seattle, Boston, Vermont, Delaware, and Portland, Oregon have considered opening safe injection sites as well.[42][43] Plans to open an injection site in Somerville, Massachusetts in 2020 were delayed by the COVID-19 pandemic.[44]

The governors of California and Vermont both vetoed supervised consumption site bills in 2022, and Pennsylvania's Senate voted for a ban on them in 2023.[45]

Denver (2018)

In November, 2018, Denver city council approved a pilot program for a safe injection site with a 12-to-1 vote. The Drug Enforcement Administration's Denver field office and the United States Attorney's office for the District of Colorado issued a statement together on the proposed site stating that "the operation of such sites is illegal under federal law. 21 U.S.C. Sec. 856 prohibits the maintaining of any premises for the purpose of using any controlled substance."[46]

Pennsylvania

An organization called Safehouse was hoping to open a safe consumption site in Philadelphia in February 2020 with the support of the city government. Immediate neighbors strongly objected to the site, and the owner of the first proposed location withdraw a lease offer under pressure.[47][48][49] United States District Attorney William McSwain sued to stop the Safehouse project, losing in district court in October 2019, but winning an injunction in January 2021 from a 3-judge panel of the United States Court of Appeals for the Third Circuit.[50] Safehouse said its proposed operation was "a legitimate medical intervention, not illicit drug dens" and claimed protection under the Free Exercise Clause because "religious beliefs compel them to save lives at the heart of one of the most devastating overdose crises in the country".[51]

In May 2023, Pennsylvania senate passed a bill to ban supervised injection sites anywhere within the State of Pennsylvania with a 41-9 vote and it is pending house approval. The Pennsylvania governor Josh Shapiro expressed support for the bill.[52]

New York City (2021)

The first government-authorized supervised injection sites in the US (operated by OnPoint NYC) began operating in New York City in November 2021.[53]

A peer-reviewed study of the first two months of the OPC's operation has been published in JAMA.[54] News media have been allowed access to the OPC sites as well.[55][56][57]

Public criticism of the New York City OPC's has so far been limited. One problem brought up by the leadership of the Metropolitan Transportation Authority is how use migrates from the centers to nearby New York City Subway stations when the OPC's are closed.[58] In response Mayor Eric Adams called for the centers to be funded to operate continuously.[58]

Though sanctioned by the city, the sites arguably remain illegal under federal law, and rely on non-enforcement by federal officials to keep operating.[59] The United States Department of Justice, during the Presidency of Joe Biden, has signaled some openness and stated that it is "evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety."[60]

San Francisco, California

For 11 months between January 2022 to December 2022, there had been drug addicts using within the center established by the health department.[61] The center "morphed" from a social services linking service to a drug usage site.[62]

Virtual overdose monitoring services / non physical site

Virtual overdose monitoring services are similar to safe consumption rooms. These programs use phone lines or smartphone apps to monitor clients while they use drugs, contacting emergency services if the caller becomes unresponsive. These services include the National Overdose Response Service in Canada[63] and Never Use Alone in the US, as well as the smartphone apps Canary and Brave.[64]

Evaluations

In the late 1990s there were a number of studies available on consumption rooms in Germany, Switzerland and the Netherlands. "The reviews concluded that the rooms contributed to improved public and client health and reductions in public nuisance but stressed the limitations of the evidence and called for further and more comprehensive evaluation studies into the impact of such services."[65] To that end, the two non-European injecting facilities, Australia's Sydney Medically Supervised Injecting Centre (MSIC) and Canada's Vancouver Insite Supervised Injection Site have had more rigorous research designs as a part of their mandate to operate.[66]

The NSW state government has provided extensive funding for ongoing evaluations of the Sydney MSIC, with a formal comprehensive evaluation produced in 2003, 18 months after the centre was opened. Other later evaluations studied various aspects of the operation – service provision (2005), community attitudes (2006), referral and client health (2007) and a fourth (2007) service operation and overdose related events.[67] Other evaluations of drug-related crime in the area were completed in 2006, 2008 and 2010, the SAHA International cost-effectiveness evaluation in 2008 and a final independent KPMG evaluation in 2010.

The Vancouver Insite facility was evaluated during the first three years of its operation by researchers from the BC Center for Excellence in HIV/AIDS with published and some unpublished reports available. In March 2008 a final report was released that evaluated the performance of the Vancouver Insite against its stated objectives.

Some posit that safe injection sites help reduce improperly discarded needles in public.[68][69][70][71] This was found to be the case in a report by the Canadian Mental Health Association in 2018.[72] Prior to the establishment of a supervised injection site in Vesterbro, Copenhagen in Denmark in 2012, up to 10,000 syringes were found on its streets each week. Within a year of the supervised injection site opening this number fell to below 1,000.[11]

There has been some attempt to standardise evaluation reporting across supervised injection sites in a type of Core outcome set with researchers from the United States funded by Drug Policy Alliance available;[73] however, the intermediary process of how this consensus set was generated is unpublished.

The Expert Advisory Committee found that Insite had referred clients such that it had contributed to an increased use of detoxification services and increased engagement in treatment. Insite had encouraged users to seek counseling. Funding has been supplied by the Canadian government for detoxification rooms above Insite.[74]

SIS sites and social disorder

A longitudinal study – Urban Social Issues Study (USIS) – from January 2018 and February 2019 – undertaken by University of Lethbridge's professor Em M. Pijl and commissioned by the City of Lethbridge, Alberta, Canada explore "any unintended consequences" of supervised consumption services (SCS) within the "surrounding community".[30]: 16  The USIS study was undertaken in response to a drug crisis in Lethbridge that impacted "many neighbourhoods in many different ways." Researchers studied the "perceptions and observations of social disorder by business owners and operators" in a neighborhood where SCS was introduced.[30]: 16  The report cautioned, that drug abuse-related antisocial behavior in Lethbridge, in particular, and in cities, in general, has increased, as the "quantity and type of drugs in circulation" increases. As the use of crystal meth eclipses the use of opiates, users exhibit more "erratic behavior". Crystal meth and other "uppers" also "require more frequent use" than "downers" like opiates.[30]: 11  The report also notes that not all social disorder in communities that have a SCS, can be "unequivocally and entirely attributed" to the SCS, partly because of the "ongoing drug epidemic."[30]: 11  Other variables that explain increased anti-social behaviour includes an increase in the number of people aggregating outdoors as part of seasonal trends with warmer temperatures.[30]: 16 

Philadelphia's WPVI-TV Action News team traveled to Toronto, Canada in 2018 to make first hand field observations of several safe consumption sites already in operation. A drug addict interviewed by the reporter said she visits the site to obtain supply, but did not stick around and used the supplies to shoot up drugs elsewhere and acknowledged the site attracts drug users and drug dealers. A neighbor interviewed by the reporter said there was drug use before, but he reports it has increased since the site opened.[75]

WPVI-TV's Chad Pradelli narrated the news team's observation as:

Over the two days we sat outside several of Toronto's safe injection facilities, we witnessed prevalent drug use out front, drug deals, and even violence. We watched as one man harassed several people passing by on the sidewalk, even putting one in a chokehold. One guy decided to fight back and security arrived.[75]

Sydney, Australia

The Sydney MSIC client survey conducted in 2005, found that public injecting (defined as injecting in a street, park, public toilet or car), which is a high risk practice with both health and public amenity impacts, was reported as the main alternative to injecting at the MSIC by 78% of clients. 49% of clients indicated resorting to public injection if the MSIC was not available on the day of registration with the MSIC. From this, the evaluators calculated a total 191,673 public injections averted by the centre.[76]

Vancouver, Canada

Observations before and after the opening of the Vancouver, British Columbia, Canada Insite facility indicated a reduction in public injecting. "Self-reports" of INSITE users and "informal observations" at INSITE, Sydney and some European SISs suggest that SISs "can reduce rates of public self-injection."[74][quantify]

Alberta, Canada

In response to the opioid epidemic in the province of Alberta, the Alberta Health Services's (AHS), Alberta Health, Indigenous Relations, Justice and Solicitor General including the Office of the Chief Medical Examiner, and the College of Physicians and Surgeons of Alberta met to discuss potential solutions. In the November 2016 Alberta Health report that resulted from that meeting, the introduction of supervised consumption services, along with numerous other responses to the crisis, was listed as a viable solution.[77]: 1  The 2016 Alberta Health report stated that, SIS, "reduce overdose deaths, improve access to medical and social supports, and are not found to increase drug use and criminal activity."[77]: 3 

According to January 2020 Edmonton Journal editorial, by 2020 Alberta had seven SIS with a "100-per-cent success rate at reversing the more than 4,300 overdoses" that occurred from November 2017 – when the first SIS opened in the province – until August 2019.[78]

Calgary
Safeworks Supervised Consumption Services (SCS)

Safeworks was located at the Sheldon M. Chumir Health Centre, which operated for several months, as a temporary facility, became fully operational starting April 30, 2018 with services available 24 hours, 7 days a week.[79]: 1  From the day it initially launched in October 30, 2017 to March 31, 2019, 71,096 people had used its services[79]: 1  The staff "responded to a total of 954 overdoses."[79]: 2  In one month alone, "848 unique individuals" made 5,613 visits to the SCS.[79]: 1  Its program is monitored by the Province of Alberta in partnership with the Institute of Health Economics.[79]: 2 

In the City of Lethbridge's commissioned 2020 102-page report, the author noted that "Calgary’s Sheldon Chumir SCS has received considerable negative press about the "rampant" social disorder around the SCS, a neighbourhood that is mixed residential and commercial."[30]: 15  According to a May 2019 Calgary Herald article, the 250 meter radius around the safe consumption site Safeworks in Calgary located within the Sheldon M. Chumir Centre has seen a major spike in crime since its opening and described in a report by the police as having become "ground zero for drug, violent and property crimes in the downtown." Within this zone, statistics by the police in 2018 showed a call volume increase to the police by 276% for drug related matters 29% overall increase relative to the three-year average statistics.[80] In May 2019, the Calgary Herald, said that Health Canada announced in February 2019 of approval for Siteworks to operate for another year, conditional to addressing neighborhood safety issues, drug debris and public disorder.[81] There has been a plan for mobile safe consumption site intending to operate in the Forest Lawn, Calgary, Alberta, however in response to the statistics at the permanent site at the Sheldon M. Chumir Centre, community leaders have withdrawn their support.[82]

By September 2019, the number of overdose treatment at Safeworks spiked. The staff were overwhelmed and 13.5% of their staff took psychological leave. They have had dealt with 134 overdose reversals in 2019 which was 300% more than the same time period from the previous year. The center's director reported they're dealing with an average of one overdose reversal every other day.[83]

Lethbridge
ARCHES (Closed August 2020)

In response to the mounting death toll of drug overdose in Lethbridge, the city opened its first SCS in February, 2018.[30]: 15  The controversial[84] SCS, known as ARCHES was once the busiest SCS in North America.[85]

The province defunded ARCHES after an audit ordered by government discovered misuse and mismanagement of public monies. Around 70% of ARCHES funding comes from the province,[86] and it chose to shut it down on August 31, 2020 after the funding was revoked.[85] The audit found “funding misappropriation, non-compliance with grant agreement [and] inappropriate governance and organizational operations.”[86] The Alberta government requested that the site be investigated for possible criminal misuse of funds.[87] Shortly afterwards, Lethbridge Police Service announced that the funds, which had previously been reported as missing, had been present and accounted for in bank accounts belonging to the SCS. Acting Inspector Pete Christos stated that the initial auditors did not have the means to determine whether money was missing, and confirmed that, during police interviews with Arches staff, all spent funds had been accounted for. Police Chief Shahin Mehdizadeh told reporters that the Alberta Justice Specialized Prosecutions Branch supported the police's findings and were not recommending criminal charges.[88]

The City of Lethbridge commissioned a report that included an Urban Social Issues Study (USIS) which examined unintended consequences of the SIS site in Lethbridge.[30] The research found that in smaller cities, such as Lethbridge, that in communities with a SCS, social disorder may be more noticeable. The report's author, University of Lethbridge's Em M. Pijl, said that news media tended to the "personal experiences of business owners and residents who work and/or live near an SCS", which contrasts with "scholarly literature that demonstrates a lack of negative neighbourhood impacts related to SCSs."[30]: 14 

Impact on community levels of overdose

Over a nine-year period the Sydney MSIC managed 3,426 overdose-related events with not one fatality[89] while Vancouver’s Insite had managed 336 overdose events in 2007 with not a single fatality.

The 2010 MSIC evaluators found that over 9 years of operation it had made no discernible impact on heroin overdoses at the community level with no improvement in overdose presentations at hospital emergency wards.[90]: 19–20 

Research by injecting room evaluators in 2007 presented statistical evidence that there had been later reductions in ambulance callouts during injecting room hours,[91][92][93] but failed to make any mention of the introduction of sniffer dog policing, introduced to the drug hot-spots around the injecting room a year after it opened.[94]

Site experience of overdose

While overdoses are managed on-site at Vancouver, Sydney and the facility near Madrid, German consumption rooms are forced to call an ambulance due to naloxone being administered only by doctors. A study of German consumption rooms indicated that an ambulance was called in 71% of emergencies and naloxone administered in 59% of cases. The facilities in Sydney and Frankfurt indicate 2.2-8.4% of emergencies resulting in hospitalization.[95]

Vancouver’s Insite yielded 13 overdoses per 10,000 injections shortly after commencement,[96] but in 2009 had more than doubled to 27 per 10,000.[97] The Sydney MSIC recorded 96 overdoses per 10,000 injections for those using heroin.[98] Commenting on the high overdose rates in the Sydney MSIC, the evaluators suggested that,

“In this study of the Sydney injecting room there were 9.2 (sic) heroin overdoses per 1000 heroin injections in the centre. This rate of overdose is higher than amongst heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room.[99]

People living with HIV/AIDS

The results of a research project undertaken at the Dr. Peter Centre (DPC), a 24-bed residential HIV/AIDS care facility located in Vancouver, were published in the Journal of the International AIDS Society in March 2014, stating that the provision of supervised injection services at the facility improved health outcomes for DPC residents. The DPC considers the incorporation of such services as central to a "comprehensive harm reduction strategy" and the research team concluded, through interviews with 13 residents, that "the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services", in addition to creating a setting in which drug use could be discussed honestly. Highly active antiretroviral therapy (HAART) medication adherence and survival are cited as two improved health outcomes.[100]

Crime

The Sydney MSIC was judged by its evaluators to have caused no increase in crime[101] and not to have caused a ‘honey-pot effect’ of drawing users and drug dealers to the Kings Cross area.[102]

Observations before and after the opening of Insite indicated no increases in drug dealing or petty crime in the area. There was no evidence that the facility influenced drug use in the community, but concerns that Insite ‘sends the wrong message’ to non-users could not be addressed from existing data.[103] The European experience has been mixed.[104]

Financial impropriety by SCS service providers

Audit of Lethbridge ARCHES SCS by Deloitte accounting firm ordered by the Alberta provincial government found the SCS had $1.6 million in unaccounted funds between 2017 and 2018; additionally they've found led $342,943 of grant funds had been expended on senior executive compensation despite the grant agreement allowing only $80,000. Beyond this, an additional $13,000 was spent on parties, staff retreats, entertainment and gift cards,[87] and numerous other inappropriate expenditures.[87]

The Lethbridge Police Service and Alberta Justice Specialized Prosecutions Branch later contradicted these findings, stating that all funds were present and accounted for in accounts belonging to the agency. When asked why these funds had previously been reported as missing, LPS Acting Inspector Pete Christos stated that the initial auditors did not have the means to investigate the agency's finances, and that all spending had been accounted for during the criminal probe.

Premier Jason Kenney did not dispute the results of the investigation, but declined to reinstate funding, claiming that the site's management had lost the confidence of his government.[88]

Community perception

The Expert Advisory Committee for Vancouver’s Insite found that health professionals, local police, the local community and the general public have positive or neutral views of the service, with opposition decreasing over time.[103]

Predicted cost effectiveness

The cost of running Insite per annum is CA$3 million. Mathematical modeling showed cost to benefit ratios of one dollar spent ranging from 1.5 to 4.02 in benefit. However, the Expert Advisory Committee expressed reservation about the certainty of Insite’s cost effectiveness until proper longitudinal studies had been undertaken. Mathematical models for HIV transmissions foregone had not been locally validated and mathematical modeling from lives saved by the facility had not been validated.[74]

See also

References

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External links

  Media related to Safe injection sites at Wikimedia Commons

January 01, 1970
supervised, injection, site, drug, consumption, rooms, dcrs, health, social, response, drug, related, problems, they, fixed, mobile, spaces, where, people, drugs, provided, with, sterile, drug, equipment, illicit, drugs, under, supervision, trained, staff, the. Supervised injection sites SIS 1 2 3 or drug consumption rooms DCRs are a health and social response to drug related problems They are fixed or mobile spaces where people who use drugs are provided with sterile drug use equipment and can use illicit drugs under the supervision of trained staff They are usually located in areas where there is an open drug scene and where injecting in public places is common The primary target group for DCR services are people who engage in risky drug use Cubicles for drug injection at a supervised injection site in Strasbourg The geographical distribution of DCRs is uneven both at the international and regional levels In 2022 there were over 100 DCRs operating globally with services in Belgium Denmark France Germany Greece Luxembourg the Netherlands Norway Portugal and Spain as well as in Switzerland Australia Canada Mexico and the USA Primarily DCRs aim to prevent drug related overdose deaths reduce the acute risks of disease transmission through unhygienic injecting and connect people who use drugs with addiction treatment and other health and social services They can also aim to minimise public nuisance 4 Proponents say they save lives and connect users to services while opponents believe they promote drug use and attract crime to the community around the site 5 Supervised injection sites are part of a harm reduction approach towards drug problems Contents 1 Terminology 2 Facilities 2 1 Australia 2 2 Europe 2 2 1 Netherlands 2 2 2 Switzerland 2 2 3 United Kingdom 2 2 4 Ireland 2 3 Canada 2 4 United States 2 4 1 Denver 2018 2 4 2 Pennsylvania 2 4 3 New York City 2021 2 4 4 San Francisco California 2 5 Virtual overdose monitoring services non physical site 3 Evaluations 3 1 SIS sites and social disorder 3 1 1 Sydney Australia 3 1 2 Vancouver Canada 3 1 3 Alberta Canada 3 1 3 1 Calgary 3 1 3 1 1 Safeworks Supervised Consumption Services SCS 3 1 3 2 Lethbridge 3 1 3 2 1 ARCHES Closed August 2020 3 2 Impact on community levels of overdose 3 3 Site experience of overdose 3 4 People living with HIV AIDS 3 5 Crime 3 5 1 Financial impropriety by SCS service providers 3 6 Community perception 3 7 Predicted cost effectiveness 4 See also 5 References 6 External linksTerminologySupervised injection sites are also known as overdose prevention centers OPCs 6 supervised injection facilities 7 safe consumption rooms 8 safe injection sites 1 safe injection rooms 9 fix rooms 10 fixing rooms 11 safer injection facilities SIF drug consumption facilities DCF 2 drug consumption rooms DCRs 12 medically supervised injecting centres MSICs and medically supervised injecting rooms MSIRs 13 FacilitiesAustralia The legality of supervised injection is handled on a state by state basis New South Wales trialed a supervised injection site in Sydney in 2001 which was made permanent in 2010 14 Victoria also opened a supervised injection site in Melbourne in 2018 on a trial basis in 2020 the trial was extended for a further three years and a second site approved 15 The second site in Melbourne has now been delayed pending a review The second site was slated to be placed in a building on Flinder s street which had previously housed Yooralla 16 Europe During the 1990s legal facilities emerged in cities in Switzerland Germany and the Netherlands 2 17 In the first decade of 2000 facilities opened in Spain Luxembourg and Norway 2 nbsp Naloxone a drug on hand at clinics used to administer in cases of opioid overdose Whereas injection facilities in Europe often evolved from something else such as different social and medical outreaches or perhaps a homeless shelter the degree and quality of actual supervision varies The history of the European centers also mean that there have been no or little systematic collection of data needed to do a proper evaluation of effectiveness of the scheme At the beginning of 2009 there were 92 facilities operating in 61 cities including 30 cities in the Netherlands 16 cities in Germany and 8 cities in Switzerland Denmark passed a law allowing municipalities to run fix rooms in 2012 and by the end of 2013 there were three open To date in July 2022 according to European Monitoring Centre for Drugs and Drug Addiction Belgium has one facility Denmark five France two Germany 25 Greece one Luxembourg two Netherlands 25 Norway two Portugal two Spain 13 and Switzerland 14 18 Netherlands The first professionally staffed service where drug injection was accepted emerged in the Netherlands during the early 1970s as part of the alternative youth service provided by the St Paul s church in Rotterdam At its peak it had two centers that combined an informal meeting place with a drop in center providing basic health care food and a laundering service One of the centers was also a pioneer in providing needle exchange Its purpose was to improve the psychosocial function and health of its clients The centers received some support from law enforcement and local government officials although they were not officially sanctioned until 1996 17 Switzerland The first modern supervised consumption site was opened in Bern Switzerland in June 1986 19 Part of a project combatting HIV the general concept of the cafe was a place where simple meals and beverages would be served and information on safe sex safe drug use condoms and clean needles provided Social workers providing counselling and referrals were also present An injection room was not originally conceived however drug users began to use the facility for this purpose and this soon became the most attractive aspect of the cafe After discussions with the police and legislature the cafe was turned into the first legally sanctioned drug consumption facility provided that no one under the age of 18 was admitted 20 United Kingdom The United Kingdom opened one officially unsanctioned facility in Glasgow in September 2020 It was opened by Peter Krykant a local drugs worker 21 however lack of funding and support led to its closure in May 2021 22 23 In nine months of operation 894 injection events were recorded at the facility and volunteers reported attending to nine overdose events seven opioid overdoses and two involving powder cocaine but there were no fatalities 24 In 2023 the Lord Advocate Scotland s chief legal officer announced that the Crown Office and Procurator Fiscal Service would institute a policy of not criminally prosecuting those using approved supervised drug consumption sites Police Scotland have also confirmed they will exercise discretion in not prosecuting those using such a facility Glasgow intends to open a supervised injection site following these policy changes 25 Ireland Ireland has legislation to permit the opening of a service as of May 2017 in the Misuse of Drugs Supervised Injecting Facilities Bill 2017 however it has been halted by planning concerns 26 Canada nbsp Insite in 2008 There are 39 government authorized SCS in Canada as of July 2019 7 in Alberta 9 in British Columbia 19 in Ontario and 4 in Quebec 27 An exemption to controlled substances law under Canadian Criminal Code is granted inside the facilities but drug possession remains illegal outside the facility and there is no buffer zone around the facility 27 Canada s first SCS Insite in Downtown Eastside of Vancouver commenced operation in 2003 28 In August 2020 ARCHES Lethbridge in Lethbridge Alberta the largest SCS in North America closed shortly after Alberta revoked their grant for misuse of grant funds 29 Shortly after opening in February 2018 30 ARCHES Lethbridge found itself repetitively necessitating police intervention and or emergency medical services for opioid related issues 31 indeed three weeks after its closure the city noted a 36 decline in opioid related EMS requests 32 The average per capita operating cost of government sanctioned sites are reported to be CAD 600 per unique client with the exception of the ARCHES Lethbridge which had a disproportionately high cost of CAD 3 200 per unique client 31 In September 2020 a group in Lethbridge Alberta led by an ARCHES employee started hosting an unauthorized SCS in public places in a tent 33 34 The group did not have authorizations to operate an SCS or a permit to pitch a tent in the park The organizer was issued citations for the tent and the Lethbridge Police Service advised that users utilizing the unauthorized SCS would be arrested for drug possession because exemptions do not apply to unauthorized sites 35 36 37 This opening of this illegal drug consumption tent was controversial and became a subject of discussion at the City Council meeting 38 39 United States Clandestine injection sites have existed for years A New England Journal of Medicine study from July 2020 reports that an illegal supervised consumption site has been operating at an undisclosed city in the U S since 2014 where over 10 000 doses of illegal drugs have been injected over a five year period 40 Supervised consumption sites with some degree of official sanction from a state or local government have been contemplated but are rare due to the federal regulation of drugs and the explicit opposition of federal law enforcement to any form of decriminalization 41 Local governments in Seattle Boston Vermont Delaware and Portland Oregon have considered opening safe injection sites as well 42 43 Plans to open an injection site in Somerville Massachusetts in 2020 were delayed by the COVID 19 pandemic 44 The governors of California and Vermont both vetoed supervised consumption site bills in 2022 and Pennsylvania s Senate voted for a ban on them in 2023 45 Denver 2018 In November 2018 Denver city council approved a pilot program for a safe injection site with a 12 to 1 vote The Drug Enforcement Administration s Denver field office and the United States Attorney s office for the District of Colorado issued a statement together on the proposed site stating that the operation of such sites is illegal under federal law 21 U S C Sec 856 prohibits the maintaining of any premises for the purpose of using any controlled substance 46 Pennsylvania An organization called Safehouse was hoping to open a safe consumption site in Philadelphia in February 2020 with the support of the city government Immediate neighbors strongly objected to the site and the owner of the first proposed location withdraw a lease offer under pressure 47 48 49 United States District Attorney William McSwain sued to stop the Safehouse project losing in district court in October 2019 but winning an injunction in January 2021 from a 3 judge panel of the United States Court of Appeals for the Third Circuit 50 Safehouse said its proposed operation was a legitimate medical intervention not illicit drug dens and claimed protection under the Free Exercise Clause because religious beliefs compel them to save lives at the heart of one of the most devastating overdose crises in the country 51 In May 2023 Pennsylvania senate passed a bill to ban supervised injection sites anywhere within the State of Pennsylvania with a 41 9 vote and it is pending house approval The Pennsylvania governor Josh Shapiro expressed support for the bill 52 New York City 2021 The first government authorized supervised injection sites in the US operated by OnPoint NYC began operating in New York City in November 2021 53 A peer reviewed study of the first two months of the OPC s operation has been published in JAMA 54 News media have been allowed access to the OPC sites as well 55 56 57 Public criticism of the New York City OPC s has so far been limited One problem brought up by the leadership of the Metropolitan Transportation Authority is how use migrates from the centers to nearby New York City Subway stations when the OPC s are closed 58 In response Mayor Eric Adams called for the centers to be funded to operate continuously 58 Though sanctioned by the city the sites arguably remain illegal under federal law and rely on non enforcement by federal officials to keep operating 59 The United States Department of Justice during the Presidency of Joe Biden has signaled some openness and stated that it is evaluating supervised consumption sites including discussions with state and local regulators about appropriate guardrails for such sites as part of an overall approach to harm reduction and public safety 60 San Francisco California For 11 months between January 2022 to December 2022 there had been drug addicts using within the center established by the health department 61 The center morphed from a social services linking service to a drug usage site 62 Virtual overdose monitoring services non physical site Virtual overdose monitoring services are similar to safe consumption rooms These programs use phone lines or smartphone apps to monitor clients while they use drugs contacting emergency services if the caller becomes unresponsive These services include the National Overdose Response Service in Canada 63 and Never Use Alone in the US as well as the smartphone apps Canary and Brave 64 EvaluationsIn the late 1990s there were a number of studies available on consumption rooms in Germany Switzerland and the Netherlands The reviews concluded that the rooms contributed to improved public and client health and reductions in public nuisance but stressed the limitations of the evidence and called for further and more comprehensive evaluation studies into the impact of such services 65 To that end the two non European injecting facilities Australia s Sydney Medically Supervised Injecting Centre MSIC and Canada s Vancouver Insite Supervised Injection Site have had more rigorous research designs as a part of their mandate to operate 66 The NSW state government has provided extensive funding for ongoing evaluations of the Sydney MSIC with a formal comprehensive evaluation produced in 2003 18 months after the centre was opened Other later evaluations studied various aspects of the operation service provision 2005 community attitudes 2006 referral and client health 2007 and a fourth 2007 service operation and overdose related events 67 Other evaluations of drug related crime in the area were completed in 2006 2008 and 2010 the SAHA International cost effectiveness evaluation in 2008 and a final independent KPMG evaluation in 2010 The Vancouver Insite facility was evaluated during the first three years of its operation by researchers from the BC Center for Excellence in HIV AIDS with published and some unpublished reports available In March 2008 a final report was released that evaluated the performance of the Vancouver Insite against its stated objectives Some posit that safe injection sites help reduce improperly discarded needles in public 68 69 70 71 This was found to be the case in a report by the Canadian Mental Health Association in 2018 72 Prior to the establishment of a supervised injection site in Vesterbro Copenhagen in Denmark in 2012 up to 10 000 syringes were found on its streets each week Within a year of the supervised injection site opening this number fell to below 1 000 11 There has been some attempt to standardise evaluation reporting across supervised injection sites in a type of Core outcome set with researchers from the United States funded by Drug Policy Alliance available 73 however the intermediary process of how this consensus set was generated is unpublished The Expert Advisory Committee found that Insite had referred clients such that it had contributed to an increased use of detoxification services and increased engagement in treatment Insite had encouraged users to seek counseling Funding has been supplied by the Canadian government for detoxification rooms above Insite 74 SIS sites and social disorder A longitudinal study Urban Social Issues Study USIS from January 2018 and February 2019 undertaken by University of Lethbridge s professor Em M Pijl and commissioned by the City of Lethbridge Alberta Canada explore any unintended consequences of supervised consumption services SCS within the surrounding community 30 16 The USIS study was undertaken in response to a drug crisis in Lethbridge that impacted many neighbourhoods in many different ways Researchers studied the perceptions and observations of social disorder by business owners and operators in a neighborhood where SCS was introduced 30 16 The report cautioned that drug abuse related antisocial behavior in Lethbridge in particular and in cities in general has increased as the quantity and type of drugs in circulation increases As the use of crystal meth eclipses the use of opiates users exhibit more erratic behavior Crystal meth and other uppers also require more frequent use than downers like opiates 30 11 The report also notes that not all social disorder in communities that have a SCS can be unequivocally and entirely attributed to the SCS partly because of the ongoing drug epidemic 30 11 Other variables that explain increased anti social behaviour includes an increase in the number of people aggregating outdoors as part of seasonal trends with warmer temperatures 30 16 Philadelphia s WPVI TV Action News team traveled to Toronto Canada in 2018 to make first hand field observations of several safe consumption sites already in operation A drug addict interviewed by the reporter said she visits the site to obtain supply but did not stick around and used the supplies to shoot up drugs elsewhere and acknowledged the site attracts drug users and drug dealers A neighbor interviewed by the reporter said there was drug use before but he reports it has increased since the site opened 75 WPVI TV s Chad Pradelli narrated the news team s observation as Over the two days we sat outside several of Toronto s safe injection facilities we witnessed prevalent drug use out front drug deals and even violence We watched as one man harassed several people passing by on the sidewalk even putting one in a chokehold One guy decided to fight back and security arrived 75 Sydney Australia The Sydney MSIC client survey conducted in 2005 found that public injecting defined as injecting in a street park public toilet or car which is a high risk practice with both health and public amenity impacts was reported as the main alternative to injecting at the MSIC by 78 of clients 49 of clients indicated resorting to public injection if the MSIC was not available on the day of registration with the MSIC From this the evaluators calculated a total 191 673 public injections averted by the centre 76 Vancouver Canada Observations before and after the opening of the Vancouver British Columbia Canada Insite facility indicated a reduction in public injecting Self reports of INSITE users and informal observations at INSITE Sydney and some European SISs suggest that SISs can reduce rates of public self injection 74 quantify Alberta Canada In response to the opioid epidemic in the province of Alberta the Alberta Health Services s AHS Alberta Health Indigenous Relations Justice and Solicitor General including the Office of the Chief Medical Examiner and the College of Physicians and Surgeons of Alberta met to discuss potential solutions In the November 2016 Alberta Health report that resulted from that meeting the introduction of supervised consumption services along with numerous other responses to the crisis was listed as a viable solution 77 1 The 2016 Alberta Health report stated that SIS reduce overdose deaths improve access to medical and social supports and are not found to increase drug use and criminal activity 77 3 According to January 2020 Edmonton Journal editorial by 2020 Alberta had seven SIS with a 100 per cent success rate at reversing the more than 4 300 overdoses that occurred from November 2017 when the first SIS opened in the province until August 2019 78 Calgary Safeworks Supervised Consumption Services SCS Safeworks was located at the Sheldon M Chumir Health Centre which operated for several months as a temporary facility became fully operational starting April 30 2018 with services available 24 hours 7 days a week 79 1 From the day it initially launched in October 30 2017 to March 31 2019 71 096 people had used its services 79 1 The staff responded to a total of 954 overdoses 79 2 In one month alone 848 unique individuals made 5 613 visits to the SCS 79 1 Its program is monitored by the Province of Alberta in partnership with the Institute of Health Economics 79 2 In the City of Lethbridge s commissioned 2020 102 page report the author noted that Calgary s Sheldon Chumir SCS has received considerable negative press about the rampant social disorder around the SCS a neighbourhood that is mixed residential and commercial 30 15 According to a May 2019 Calgary Herald article the 250 meter radius around the safe consumption site Safeworks in Calgary located within the Sheldon M Chumir Centre has seen a major spike in crime since its opening and described in a report by the police as having become ground zero for drug violent and property crimes in the downtown Within this zone statistics by the police in 2018 showed a call volume increase to the police by 276 for drug related matters 29 overall increase relative to the three year average statistics 80 In May 2019 the Calgary Herald said that Health Canada announced in February 2019 of approval for Siteworks to operate for another year conditional to addressing neighborhood safety issues drug debris and public disorder 81 There has been a plan for mobile safe consumption site intending to operate in the Forest Lawn Calgary Alberta however in response to the statistics at the permanent site at the Sheldon M Chumir Centre community leaders have withdrawn their support 82 By September 2019 the number of overdose treatment at Safeworks spiked The staff were overwhelmed and 13 5 of their staff took psychological leave They have had dealt with 134 overdose reversals in 2019 which was 300 more than the same time period from the previous year The center s director reported they re dealing with an average of one overdose reversal every other day 83 Lethbridge ARCHES Closed August 2020 In response to the mounting death toll of drug overdose in Lethbridge the city opened its first SCS in February 2018 30 15 The controversial 84 SCS known as ARCHES was once the busiest SCS in North America 85 The province defunded ARCHES after an audit ordered by government discovered misuse and mismanagement of public monies Around 70 of ARCHES funding comes from the province 86 and it chose to shut it down on August 31 2020 after the funding was revoked 85 The audit found funding misappropriation non compliance with grant agreement and inappropriate governance and organizational operations 86 The Alberta government requested that the site be investigated for possible criminal misuse of funds 87 Shortly afterwards Lethbridge Police Service announced that the funds which had previously been reported as missing had been present and accounted for in bank accounts belonging to the SCS Acting Inspector Pete Christos stated that the initial auditors did not have the means to determine whether money was missing and confirmed that during police interviews with Arches staff all spent funds had been accounted for Police Chief Shahin Mehdizadeh told reporters that the Alberta Justice Specialized Prosecutions Branch supported the police s findings and were not recommending criminal charges 88 The City of Lethbridge commissioned a report that included an Urban Social Issues Study USIS which examined unintended consequences of the SIS site in Lethbridge 30 The research found that in smaller cities such as Lethbridge that in communities with a SCS social disorder may be more noticeable The report s author University of Lethbridge s Em M Pijl said that news media tended to the personal experiences of business owners and residents who work and or live near an SCS which contrasts with scholarly literature that demonstrates a lack of negative neighbourhood impacts related to SCSs 30 14 Impact on community levels of overdose Over a nine year period the Sydney MSIC managed 3 426 overdose related events with not one fatality 89 while Vancouver s Insite had managed 336 overdose events in 2007 with not a single fatality The 2010 MSIC evaluators found that over 9 years of operation it had made no discernible impact on heroin overdoses at the community level with no improvement in overdose presentations at hospital emergency wards 90 19 20 Research by injecting room evaluators in 2007 presented statistical evidence that there had been later reductions in ambulance callouts during injecting room hours 91 92 93 but failed to make any mention of the introduction of sniffer dog policing introduced to the drug hot spots around the injecting room a year after it opened 94 Site experience of overdose While overdoses are managed on site at Vancouver Sydney and the facility near Madrid German consumption rooms are forced to call an ambulance due to naloxone being administered only by doctors A study of German consumption rooms indicated that an ambulance was called in 71 of emergencies and naloxone administered in 59 of cases The facilities in Sydney and Frankfurt indicate 2 2 8 4 of emergencies resulting in hospitalization 95 Vancouver s Insite yielded 13 overdoses per 10 000 injections shortly after commencement 96 but in 2009 had more than doubled to 27 per 10 000 97 The Sydney MSIC recorded 96 overdoses per 10 000 injections for those using heroin 98 Commenting on the high overdose rates in the Sydney MSIC the evaluators suggested that In this study of the Sydney injecting room there were 9 2 sic heroin overdoses per 1000 heroin injections in the centre This rate of overdose is higher than amongst heroin injectors generally The injecting room clients seem to have been a high risk group with a higher rate of heroin injections than others not using the injection room facilities They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room 99 People living with HIV AIDS The results of a research project undertaken at the Dr Peter Centre DPC a 24 bed residential HIV AIDS care facility located in Vancouver were published in the Journal of the International AIDS Society in March 2014 stating that the provision of supervised injection services at the facility improved health outcomes for DPC residents The DPC considers the incorporation of such services as central to a comprehensive harm reduction strategy and the research team concluded through interviews with 13 residents that the harm reduction policy altered the structural environmental context of healthcare services and thus mediated access to palliative and supportive care services in addition to creating a setting in which drug use could be discussed honestly Highly active antiretroviral therapy HAART medication adherence and survival are cited as two improved health outcomes 100 Crime The Sydney MSIC was judged by its evaluators to have caused no increase in crime 101 and not to have caused a honey pot effect of drawing users and drug dealers to the Kings Cross area 102 Observations before and after the opening of Insite indicated no increases in drug dealing or petty crime in the area There was no evidence that the facility influenced drug use in the community but concerns that Insite sends the wrong message to non users could not be addressed from existing data 103 The European experience has been mixed 104 Financial impropriety by SCS service providers Audit of Lethbridge ARCHES SCS by Deloitte accounting firm ordered by the Alberta provincial government found the SCS had 1 6 million in unaccounted funds between 2017 and 2018 additionally they ve found led 342 943 of grant funds had been expended on senior executive compensation despite the grant agreement allowing only 80 000 Beyond this an additional 13 000 was spent on parties staff retreats entertainment and gift cards 87 and numerous other inappropriate expenditures 87 The Lethbridge Police Service and Alberta Justice Specialized Prosecutions Branch later contradicted these findings stating that all funds were present and accounted for in accounts belonging to the agency When asked why these funds had previously been reported as missing LPS Acting Inspector Pete Christos stated that the initial auditors did not have the means to investigate the agency s finances and that all spending had been accounted for during the criminal probe Premier Jason Kenney did not dispute the results of the investigation but declined to reinstate funding claiming that the site s management had lost the confidence of his government 88 Community perception The Expert Advisory Committee for Vancouver s Insite found that health professionals local police the local community and the general public have positive or neutral views of the service with opposition decreasing over time 103 Predicted cost effectiveness The cost of running Insite per annum is CA 3 million Mathematical modeling showed cost to benefit ratios of one dollar spent ranging from 1 5 to 4 02 in benefit However the Expert Advisory Committee expressed reservation about the certainty of Insite s cost effectiveness until proper longitudinal studies had been undertaken Mathematical models for HIV transmissions foregone had not been locally validated and mathematical modeling from lives saved by the facility had not been validated 74 See also nbsp Law portal nbsp Medicine portal Biomedical waste Drug disposal Drug liberalization Drug policy reform Infection prevention and control Needle and syringe programmes Needle remover Needle sharing Needlestick injury Prevention of HIV AIDS Preventive healthcare Responsible drug use Trip sitterReferences a b Alan Ogborne et al March 31 2008 Vancouver s INSITE service and other Supervised injection sites What has been learned from research Final report of the Expert Advisory Committee Health Canada a b c d Dagmar Hedrich et al April 2010 Chapter 11 Drug consumption facilities in Europe and beyond Harm reduction evidence impacts and challenges EMCDDA Oladipo Gloria 30 November 2021 New York to open supervised injection sites in bid to curb overdose deaths The Guardian Retrieved 6 March 2022 New report presents latest overview on drug consumption rooms in Europe European Monitoring Centre for Drugs and Drug Addiction EMCDDA 19 December 2023 Retrieved 22 December 2023 Gordon Elana September 7 2018 What s The Evidence That Supervised Drug Injection Sites Save Lives NPR Overdose Prevention Centers OPCs Drug Policy Alliance Academies Committee on the Prevention of HIV Infection Among Injecting Drug Users in High Risk Countries Board on Global Health Institute of Medicine of the National 2007 Preventing HIV infection among injecting drug users in high risk countries an assessment of the evidence Washington D C National Academies Press doi 10 17226 11731 ISBN 978 0 309 10280 3 a href Template Cite book html title Template Cite book cite book a CS1 maint multiple names authors list link dead link Learmonth Andrew 17 December 2020 Boris Johnson pledges to discuss safe drug consumption rooms for users The National Retrieved 21 January 2021 Townsend Mark 17 August 2019 Safe injection rooms are key to halting rise in drug deaths expert The Guardian Retrieved 21 January 2021 Denmark s Fix Rooms Give Drug Users a Safe Haven NPR a b Busby Mattha 21 November 2018 How fixing rooms are saving the lives of drug addicts in Europe The Guardian Retrieved 28 January 2021 Easton Mark 12 October 2017 Are UK drug consumption rooms likely BBC News Retrieved 21 January 2021 Medically supervised injecting centres save lives Alcohol and Drug Foundation 14 Aug 2023 Thomas Matthew Sydney s Medically Supervised Injecting Centre Australian Parliamentary Library Retrieved 28 October 2020 Medically supervised injecting room Health vic Retrieved 28 October 2020 Eddie Rachel Waters Cara 7 March 2023 Second Melbourne injecting room in limbo as Andrews walks back commitment The Age Retrieved 7 March 2023 a b Dolan Kate Kimber Jo Fry Craig Fitzgerald John Mcdonald David Trautman Franz 2000 Drug consumption facilities in Europe and the establishment of supervised injection centres in Australia PDF Drug and Alcohol Review 19 3 337 346 doi 10 1080 713659379 Archived from the original PDF on 2004 09 24 EMCDDA Infographic Location and number of drug consumption facilities throughout Europe www emcdda europa eu www emcdda europa eu Retrieved July 26 2022 Hedrich Dagmar February 2004 European report on drug consumption rooms PDF European Monitoring Centre for Drugs and Drug Addiction Archived from the original PDF on March 26 2020 Retrieved October 5 2020 Haemmig Robert Ingrid van Beek 2005 13 Supervised Injecting Room In Richard Pates Andrew McBride Karin Arnold eds Injecting Illicit Drugs Blackwell Publishing pp 160 169 ISBN 978 1 4051 1360 1 Livingston Eve 19 September 2020 It s a lifesaver Glasgow drug users and MP hail safe injecting space the Guardian Retrieved July 26 2022 Shorter Gillian W Harris Magdalena McAuley Andrew Trayner Kirsten MA Stevens Alex June 2022 The United Kingdom s first unsanctioned overdose prevention site A proof of concept evaluation International Journal of Drug Policy 104 103670 doi 10 1016 j drugpo 2022 103670 PMID 35523063 S2CID 248553098 Davies Natalie 26 July 2022 Inside the UK s first unsanctioned drug consumption room SSA Retrieved July 26 2022 The United Kingdom s first unsanctioned overdose prevention site A proof of concept evaluation International Journal of Drug Policy Volume 104 4 May 2022 Retrieved 23 December 2023 No prosecution plan for drug consumption rooms BBC News 2023 09 11 Retrieved 2023 10 13 McCann Eugene Duffin Tony January 20 2022 Opinion Supervised drug injecting in Ireland 10 years of advocacy legislation and delays TheJournal ie Retrieved July 26 2022 a b Debate over supervised consumption sites ramps up across Alberta Global News Retrieved 2020 10 07 Van Beek Ingrid 2004 In the eye of the needle Diary of medically supervised injecting centre Crows Nest Allen amp Unwin ISBN 978 1 74114 381 2 OCLC 57515258 Roulston Tom Nixon Liam July 23 2020 ARCHES audit findings turned over to Lethbridge police for investigation Global News Retrieved 2020 09 27 a b c d e f g h i j Pijl Em M January 13 2020 Urban social issues study Impacts of the Lethbridge supervised consumption site on the local neighbourhood PDF Report University of Lethbridge for the City of Lethbridge p 102 Retrieved January 26 2020 Report commissioned by the City of Lethbridge a b Vogt Terry 2020 03 05 Government review says Lethbridge SCS has most problems in the province Calgary Retrieved 2020 10 07 Labby Bryan September 26 2020 3 weeks after province ends funding for injection site unsanctioned space opens in Lethbridge CBC News Gunn Connor Galt Gardens pop up injection site moves location on 2nd night Lethbridge News Now Retrieved 2020 09 27 Unsanctioned injection site sets up in Galt Gardens The Lethbridge Herald News and Sports from around Lethbridge 2020 09 26 Retrieved 2020 09 27 Ferris Danica September 29 2020 Pop up overdose prevention site operators fined 300 by City of Lethbridge Global News Retrieved 2020 10 03 Lethbridge group sets up unsanctioned overdose prevention site in Galt Gardens Global News Retrieved 2020 09 27 Korol Todd October 5 2020 Lethbridge drug consumption site seeks Health Canada s permission to operate The Globe and Mail Retrieved 2020 10 07 Goulet Justin September 29 2020 Organizer of pop up injection site issued fine Lethbridge News Now Retrieved 2020 10 01 Barrow Tyler 2020 09 28 Protestors gather outside Lethbridge city hall frustrated over pop up overdose prevention site Calgary Retrieved 2020 09 29 Kral Alex H Lambdin Barrot H Wenger Lynn D Davidson Pete J 2020 08 06 Evaluation of an Unsanctioned Safe Consumption Site in the United States New England Journal of Medicine 383 6 589 590 doi 10 1056 NEJMc2015435 ISSN 0028 4793 PMID 32640126 Deputy Attorney General Jeffrey A Rosen Delivers Remarks at Wake Forest School of Law www justice gov 2019 11 08 Retrieved 2022 07 25 Cities Planning Supervised Drug Injection Sites Fear Justice Department Reaction NPR Archived from the original on 2023 05 13 Hayes Elizabeth March 15 2018 A legal site in Portland to inject heroin Elected officials advocates explore the idea Portland Business Journal Retrieved April 28 2019 Somerville Delays Plan To Open First Supervised Drug Use Clinic In Massachusetts Effectiveness of safe injection sites to be evaluated in government backed study PBS NewsHour 2023 05 08 Retrieved 2023 09 05 KKTV December 4 2018 DEA responds to proposed safe injection site in Colorado for illegal drugs KKTV Retrieved 2019 04 20 Safehouse drops South Philly plans looks to Kensington after judge suspends launch Billy Penn 26 June 2020 Retrieved 2020 10 07 Lauren del Valle and Dakin Andone 28 February 2020 Plans are on hold for a Philadelphia safe injection site to combat overdoses CNN Retrieved 2020 10 07 Tanenbaum Michael February 26 2020 Safehouse s plan to open overdose prevention site in South Philly sparks contentious reaction www phillyvoice com Retrieved 2020 10 07 In Philadelphia Judges Rule Against Opening Supervised Site To Inject Opioids Whelan Aubrey April 3 2019 Supervised injection site supporters countersue feds saying their Philly mission comes from religious and medical imperatives The Inquirer Daily News Retrieved 2019 04 20 Whelan Aubrey McGoldrick Gillian 2023 05 01 State Senate approves ban of supervised injection sites in Pa Philadelphia Inquirer Retrieved 2023 09 03 Kim Phenix 2022 12 03 New York City s first safe injection sites avert 633 drug overdoses on anniversary NYN Media Retrieved 2023 06 15 Harocopos Alex Gibson Brent E Saha Nilova McRae Michael T See Kailin Rivera Sam Chokshi Dave A 2022 07 15 First 2 Months of Operation at First Publicly Recognized Overdose Prevention Centers in US JAMA Network Open 5 7 e2222149 doi 10 1001 jamanetworkopen 2022 22149 ISSN 2574 3805 PMC 9287749 PMID 35838672 S2CID 250559693 Moraff Christopher 2022 02 18 The Radical Experiment Saving the Lives of Drug Users Intelligencer Retrieved 2022 07 25 Lewis Caroline 2021 12 17 A Look Inside NYC s Supervised Drug Injection Sites The First In The Nation Gothamist Retrieved 2022 07 25 Mays Jeffery C Newman Andy 2021 11 30 Nation s First Supervised Drug Injection Sites Open in New York The New York Times ISSN 0362 4331 Retrieved 2022 07 25 a b When Safe Injection Sites Close Subway Becomes Next Best Stop The City 2022 05 17 Retrieved 2022 07 25 Mann Brian Lewis Caroline 2021 11 30 New York City allows the nation s 1st supervised consumption sites for illegal drugs All Things Considered Retrieved 2022 07 25 via NPR org Justice Department Signals it May Allow Safe Injection Sites WTTW News Retrieved 2022 07 25 Advocates SF supervisors push back on Tenderloin safe injection site closure CBS San Francisco www cbsnews com 2022 12 13 Retrieved 2023 08 13 He said the plan was for the Tenderloin Center to be a resource center while the Department of Public Health created a number of so called wellness hubs around the city where addicts could consume their drugs while being monitored to prevent overdoses In its eleven months of operation as a consumption site the Tenderloin Center reportedly prevented more than 300 deaths But now that the facility has closed Seymour and a lot of other people feel betrayed Sjostedt David May 11 2022 Tenderloin Linkage Center Morphs into Safe Consumption Site Despite Legal Risks The San Francisco Standard Retrieved 2023 08 13 Matskiv G Marshall T Krieg O Viste D Ghosh S M 2022 Virtual overdose monitoring services A novel adjunctive harm reduction approach for addressing the overdose crisis Canadian Medical Association Journal 194 46 E1568 E1572 doi 10 1503 cmaj 220579 PMC 9828965 PMID 36442886 When naloxone isn t enough How technology can save lives when people use drugs alone 8 June 2023 EMCDDA European report on drug consumption rooms PDF 2004 p 27 Archived from the original PDF on 2020 03 26 Retrieved 2010 04 28 EMCDDA Harm Reduction Evidence Impacts and Challenges 2010 p 308 Retrieved 2010 06 09 MSIC Evaluations 2008 Retrieved 2010 01 09 Townsend Mark 17 August 2019 Safe injection rooms are key to halting rise in drug deaths expert The Guardian Retrieved 1 December 2021 Holpuch Amanda 8 August 2017 Secret supervised drug injection facility has been operating at US site for years The Guardian Retrieved 1 December 2021 Smith Callum 9 August 2019 Discarded needles prompt calls for safe injection sites more addictions supports in N B Global News Retrieved 1 December 2021 Dubinski Kate 2 May 2018 Why this children s mentoring program is supporting supervised consumption sites CBC Retrieved 1 December 2021 MacLean Cameron 18 April 2018 Supervised injection site needed for drug users in Manitoba Canadian Mental Health Association report CBC News Retrieved 1 December 2021 here a b c see Final Report of the Vancouver Insite Expert Advisory Committee 2008 04 03 Retrieved 2010 04 19 a b Pradelli Chad July 18 2018 Opioid Crisis Action News investigates safe injection sites in Canada WPVI TV Action News Retrieved March 22 2020 NCHECR Sydney Medically Supervised Injecting Centre Evaluation Report No 4 PDF Archived PDF from the original on 2018 04 17 Retrieved 2019 02 06 2007 pp 7 39 a b Responding to Alberta s Opioid Crisis PDF Alberta Health Services AHS Office of the Chief Medical Officer of Health Public progress report 9 November 30 2016 Retrieved January 26 2020 McGarrigle Colin Breakenridge Dave Mah Bill January 24 2020 Balanced view of consumption sites required Edmonton Journal Editorial Retrieved January 26 2020 a b c d e March 2019 Supervised Consumption Services PDF Alberta Health Services AHS Safeworks Monthly Report p 4 April 11 2019 retrieved January 26 2020 Hudes Sammy May 21 2019 Crime near Calgary s only safe consumption site remains a concern Calgary Herald Retrieved January 26 2020 Breakenridge Rob 2019 02 05 Breakenridge Fix crime issues around Safeworks or risk losing it Calgary Herald Retrieved 2019 10 11 Logan Shawn 2019 02 05 Forest Lawn withdraws support for mobile safe consumption vehicle Calgary Herald Retrieved 2019 10 11 Villani Mark September 12 2019 Spike in overdose treatments overwhelms staff at Calgary shelters CTV News Calgary Retrieved October 25 2019 Goulet Justin ARCHES ceases supervised consumption services in Lethbridge Lethbridge News Now Retrieved 2020 09 26 a b Fletcher Robson September 23 2020 Opioid overdoses spike amid COVID 19 pandemic with more than 3 Albertans dying per day CBC a b MLA Shannon Phillips and others react to ARCHES losing provincial funding after government ordered audit Global News Retrieved 2020 09 26 a b c Bourne Kirby Therien Eloise July 16 2020 Government pulls grant funding from Lethbridge safe consumption site citing fund mismanagement Globalnews ca Retrieved 2020 09 26 a b Vogt Terry December 22 2020 Missing ARCHES funds accounted for Lethbridge police CTV News Calgary CTV News Retrieved 25 April 2023 name KPMG Further Evaluation of the Medically Supervised Injecting Centre during its extended Trial period 2007 2011 PDF Retrieved 2010 10 23 p 2 Further Evaluation of the Medically Supervised Injecting Centre during its extended Trial period 2007 2011 PDF Retrieved 2010 10 23 Salmon Allison Van Beek Ingrid Amin Janaki Kaldor John Maher Lisa February 2010 The impact of a supervised injecting facility on ambulance call outs in Sydney Australia Addiction 105 4 676 683 doi 10 1111 j 1360 0443 2009 02837 x PMID 20148794 Archived from the original on 2013 01 05 Beletsky Leo Davis Corey S Anderson Evan Burris Scott February 2008 The law and politics of safe injection facilities in the United States American Journal of Public Health 98 2 231 7 doi 10 2105 AJPH 2006 103747 PMC 2376869 PMID 18172151 Kerr Thomas Kimber Jo Rhodes Tim January 2007 Drug use settings an emerging focus for research and intervention The International Journal on Drug Policy 18 1 1 4 doi 10 1016 j drugpo 2006 12 016 PMID 17689337 Police to crack down on Kings Cross drug trade Australian Broadcasting Corporation Retrieved 2010 01 09 2003 Hedrich D A Report on European Consumption Rooms PDF Archived from the original PDF on 2020 03 26 Retrieved 2010 05 28 EMCDDA 2004 p 46 Kerr T Tyndall MW Lai C Montaner JSG Wood E Drug related overdoses within a medically supervised safer injection facility PDF 2008 Retrieved 2010 05 01 see User Statistics 2009 Retrieved 2010 05 01 2003 MSIC Evaluation Committee Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre PDF Archived from the original PDF on 2009 10 29 Retrieved 2010 01 09 2003 p 24 2003 MSIC Evaluation Committee Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre PDF Archived from the original PDF on 2009 10 29 Retrieved 2010 01 09 2003 p 59 McNeil R et al 13 March 2014 Impact of supervised drug consumption services on access to and engagement with care at a palliative and supportive care facility for people living with HIV AIDS a qualitative study Journal of the International AIDS Society 17 1 18855 doi 10 7448 IAS 17 1 18855 PMC 3955762 PMID 24629844 2003 MSIC Evaluation Committee Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre PDF Archived from the original PDF on 2009 10 29 Retrieved 2010 01 09 2003 p xvi 2003 MSIC Evaluation Committee Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre PDF Archived from the original PDF on 2009 10 29 Retrieved 2010 01 09 2003 p 204 a b see Executive Summary of Final Report of the Vancouver Insite Expert Advisory Committee 2008 04 03 Retrieved 2010 04 19 see Sections A7 to A9 of Appendix B Final Report of the Vancouver Insite Expert Advisory Committee 2008 04 03 Retrieved 2010 04 19 External links nbsp Media related to Safe injection sites at Wikimedia Commons Retrieved from https en wikipedia org w index php title Supervised injection site amp oldid 1217402293, wikipedia, wiki, book, books, library,

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