Injection Facilities

Introduction Many cities in the United States and Canada are dealing with an epidemic of infectious diseases and overdoses by intravenous drug users. Vancouver, Canada developed a plan to help reduce these numbers by opening a facility where drug users may inject previously purchased drugs under the close supervision of medical staff. The facility was granted legal exemption by the Canadian government so that an intensive three-year study could be conducted and the results may be helpful in determining if this pilot program could be implemented in other cities, including the United States. The facility offered sterile syringes, emergency care in the event of an overdose, primary care and referrals to addiction treatment programs.
Participants
The participants in this study were any intravenous drug users who chose to use the facility.
That study points out to gain a better understanding as to if the injection facility was curbing publicly discarded syringes, drug related crimes, use of addiction treatment services and HIV risk behavior, the intravenous drug users should have been randomly assigned complete access and no access to the facility, this was deemed unethical. Also, the evaluators were completely external to the facility operations.
Methods
The Vancouver safer injection facility has twelve stalls where users may inject and is under the supervision of nurses. The nurses respond to overdoses and address other health needs, treating injection-site abscesses. There is also an addiction counselor and other support staff to help the users with community based needs such as housing and mental health treatment. While the evaluators were external from the facility operations they conducted surveys and interviews with the drug users who used the facility and those who did not.
Procedures The key concern was attracting the target population, high-risk intravenous drug users. About a year before the facility opened, a study was conducted to learn the behaviors of drug users and try to find the likelihood they would use the facility. Also, during this initial study, they were able to examine drug use patterns to measure against when the facility opened. The behaviors were assessed by a questionnaire distributed just before the facility opened. The frequency of using the facility was obtained by another questionnaire immediately after it opened. They also studied how often a user was using, if they had an unintentional overdose. Meanwhile, the facility kept track of overdoses inside the facility, and the police department kept track of drug related crimes and the data was compiled from all the different sources.
Findings
After the first year of operation, an analysis of data revealed that 5000 unique drug users utilized the facility.
It was discovered that heroin was used in 40% of the injections, cocaine was in 30% and other illicit drugs or combinations were used in the remaining 30%. While there were 1.3 overdoses per 1000 injections, only 40% required an ambulance and 60% were successfully managed by the medical staff. The police department reported that drug deals had not increased in the neighborhood around the facility and that public drug use had gone down after the first year that facility was in operation. There has also been an increase in drug users seeking addiction treatment and similarly with the new facility there has not been an increase in the relapse rates. While the study points out that the findings a mainly observational and to keep that in mind when making evaluations, overall, the facility has accomplished what it set out to
do.

Conclusions The Vancouver safer injection facility has documented a great number of community benefits and there has been no indication of harms to the community. Addicted individuals are usually crying for help, so if this facility allows them to use in a safe environment while offering referrals for treatment it is very beneficial to any community. While the needle exchange program has been mildly successful in controlling infectious diseases, the safer injection facility has nurses there handing clean needles to everyone and treating any drug related health issues. After the initial three-year study the facility was granted an additional sixteen months to continue to serve the public and it will be re-evaluated. Also, San Francisco has a similar epidemic as Vancouver and is petitioning to open a similar facility. Given there are twelve facilities throughout Europe and one in Australia this program must be working and it would be beneficial for the United States to consider opening comparable facilities in areas with a high population of high-risk intravenous drug users.