Overdose Prevention Sites, also known as Supervised Consumption Sites or Safe Injection Facilities

Related Chapters:

Page last updated July 8, 2020 by Doug McVay, Editor/Senior Policy Analyst.

21. United States Law

Law & Policies

"States have clear legal authority to authorize SIFs, just as they can legalize the cultivation, distribution, and possession of marijuana for medical purposes.76 State authorization could make a SIF legal under state law and prevent state law enforcement officials from taking action against it. It is equally clear, however, that state authorization cannot nullify federal drug laws, and so does not protect a SIF against being shut down by federal law enforcement agencies through raids, arrests, or other legal proceedings.
"There are at least 2 sections of the federal Controlled Substances Act that could be interpreted to bar a SIF. Section 844 prohibits drug possession and so is violated by every client who appears at the clinic with drugs.77 Although federal law enforcement officials rarely if ever target simple possession by individuals,78 the law would allow them to do so if they wished to interfere with the operation of a SIF.
"A SIF authorized at the state or local level could also be deemed to violate Section 856, known as the Crack House Statute. This law makes it illegal to 'knowingly open or maintain . . . [or] manage or control any place . . . for the purpose of unlawfully . . . using a controlled substance.'"

Leo Beletsky, Corey S. Davis, Evan Anderson, and Scott Burris, "The Law (and Politics) of Safe Injection Facilities in the United States," American Journal of Public Health, (Vol. 98, No. 2) February 2008, p. 234.

22. Republic of Ireland Approves Supervised Injection Facilities

"Minister for Health Simon Harris and Minister of State for Communities and the National Drugs Strategy, Catherine Byrne today (Tuesday) welcomed the Government’s decision to approve the publication of the Misuse of Drugs (Supervised Injecting Facilities) Bill 2017.
"The Bill, which was approved by Cabinet at its meeting this morning, will allow the Minister for Health to issue a licence, with conditions, to operate a supervised injecting facility. This is a controlled environment where drug users may self-administer, by injection, drugs they have brought with them. Such facilities will provide access to clean, sterile injecting equipment and have trained staff on hand to provide emergency care in the event of an overdose, as well as advice on treatment and rehabilitation. They will also help alleviate the problems associated with injecting on the street, including drug-related litter.
"Minister Harris said that he is, 'delighted to be bringing forward this important legislation that adopts a health-led approach to drugs-use by those in our society who have been marginalised as a result of their addictions.'
"The provisions of the Bill would also:
"Exempt authorised users from the offence of possession when in the facility, and with the permission of the licence holder;
"It would provide an exemption for licensed providers whereby it is currently an offence to permit the preparation or possession of a controlled substance in premises;
"It would enable the Minister to consult with the HSE, An Garda Síochána, or others on matters relating to a supervised injecting facility, and enable the Minister to make regulations relating to the operation of such facilities.
"It is important to note that possession of controlled drugs will continue to be an offence outside a supervised injecting facility. Possession for sale or supply will remain an offence both inside and outside a supervised injecting facility.
"Minister of State for Communities and the National Drugs Strategy, Catherine Byrne, who attended Cabinet today alongside Minister Harris, afterwards said that the facilities – the first of which will be run on a pilot basis – will be a safe harbour for chronic drug users. 'They will provide a controlled place for people to inject, but will be much more than that – a place to rest, have a chat and access the services people need. I believe in a health-led and person-centred approach to the drug problem. For me this is all about people and looking after the most vulnerable and marginalised in our society. The human cost of public injecting is clear and keeps adding up – the lack of dignity, the effect it has on people’s health, wellbeing and safety. We know that these facilities are not the sole solution to the drugs problem and many other steps are needed, but I am committed to doing everything we can to help those who need it most.'
"The Bill does not establish a location for a supervised injecting facility, but a pilot facility is planned for Dublin city centre. The HSE have established a working group to gather data, consider possible options and to undertake consultation before any decision is made."

Department of Health, Government of Ireland, Press Release: "Ireland’s first Supervised Injecting Facility to provide safe harbour and medical help for chronic drug users," February 7, 2017.

23. Safe Injection Sites and International Drug Control Treaties

"23. It might be claimed that this approach [drug injection rooms] is incompatible with the obligations to prevent the abuse of drugs, derived from article 38 of the 1961 Convention and article 20 of the 1971 Convention. It should not be forgotten, however, that the same provisions create an obligation to treat, rehabilitate and reintegrate drug addicts, whose implementation depends largely on the interpretation by the Parties of the terms in question. If, for example, the purpose of treatment is not only to cure a pathology, but also to reduce the suffering associated with it (like in severe-pain management), then reducing IV drug abusers exposure to pathogen agents often associated with their abuse patterns (like those causing HIV-AIDS, or hepatitis B) should perhaps be considered as treatment. In this light, even supplying a drug addict with the drug he depends on could be seen as a sort of rehabilitation and social reintegration, assuming that once his drug requirements are taken care of, he will not need to involve himself in criminal activities to finance his dependence."

"Flexibility of Treaty Provisions as Regards Harm Reduction Approaches," Legal Affairs Section UNDCP (Vienna, Austria: International Narcotics Control Board, September 30, 2002), p. 5.

24. SIFs in the US

"A ruling by the Supreme Court of Canada will not only have ramifications across Canada but will also likely have an impact in the United States, which has taken an active role in debating Canadian drug issues.40 A review of the legal framework in the United States concluded that states and municipalities have some authority to regulate safe injection facilities, but federal agencies could supervene under the Controlled Substances Act.41 Local public health activists have investigated the establishment of safe injection facilities in San Francisco and New York City.42 There are no official facilities in the United States, but anecdotally, some agencies do informally provide safer environments for drug injection."

Dooling, Kathleen and Rachlis, Michael, "Vancouver’s supervised injection facility challenges Canada’s drug laws," Canadian Medical Association Journal (Ottawa, Ontario: September 21, 2010), Vol. 182, Issue 13, p. 1443.

25. Australia - Evaluation

"The only comprehensive evaluation of a medically supervised injecting centre was conducted during the 18 month trial of the Sydney centre. Staff intervened in 329 overdoses over one year with an estimate of at least four lives saved a year. There was no increase in reported hepatitis B or C infections in the area that the medically supervised injecting centre served despite an increase elsewhere in Sydney.
"The report described a decreased frequency of injecting related problems among clients. Half the centre's clients reported that their injecting practices had become less risky since using the centre. Furthermore, clients were more likely than other injectors to report that they had started treatment for their drug use; 11% of clients were referred to treatment for drug dependence. An economic evaluation of deaths averted by intervention of the medically supervised injecting centre showed that costs were comparable to those of other widely accepted public health measures.
"The centre also had benefits for the local community. Residents and business respondents reported fewer sightings of public injection and syringes discarded in public places, and syringe counts in the vicinity of the centre were lower after it opened than before. In addition, there was no evidence of an increased number of theft and robbery incidents in the area. Acceptance of the medically supervised injecting centre increased among both businesses and residents over the study period."

Wright, Nat M.J., Charlotte N.E. Tompkins, "Supervised Injecting Centres," British Medical Journal, Vol. 328, Jan. 10, 2004, p. 100.

26. Crime Near SIFs

"There is no evidence that the operation of consumption rooms leads to more acquisitive crime. There is small-scale drug dealing in the vicinity of many services, which is not surprising given their location."

Hedrich, Dagmar, "European Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring Centre on Drugs and Drug Addiction, February 2004), p. 82.

27. SIF User Population

"Consumption rooms reach a population of often older, long-term users some of whom have had no previous treatment contact. Services appear particularly successful in attracting groups that are difficult to reach. No evidence was found to suggest that naive users are initiated into injecting as a result of the presence of consumption rooms."

Hedrich, Dagmar, "European Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring Centre on Drugs and Drug Addiction, February 2004), p. 41.

28. SIFs Don't Encourage Use

"There is no evidence that consumption rooms encourage increased drug use or initiate new users. There is little evidence that by providing better conditions for drug consumption they perpetuate drug use in clients who would otherwise discontinue consuming drugs such as heroin or cocaine, nor that they undermine treatment goals.
"When managed in consultation with local authorities and police, they do not increase public order problems by increasing local drug scenes or attracting drug users and dealers from other areas. If consultation and cooperation between key actors does not take place, then there can be a risk of a'pull effect' and consumption rooms run the risk of being blamed for aggravating local problems of public order including drug dealing."

Hedrich, Dagmar, "European Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring Centre on Drugs and Drug Addiction, February 2004), p. 83.

29. SIFs and Public Consumption

"Consumption rooms can reduce significantly the level of drug use in public. The extent to which this is achieved depends on their accessibility, opening hours and capacity to accommodate drug consumptions that would otherwise occur in public.
"The location of consumption rooms needs to be compatible with the needs of drug users but also to take account of the needs and expectations of local residents. A reduction in the number of public consumptions can contribute to improvements in the neighbourhood by helping to reduce public nuisance associated with open drug scenes. However, facilities near illicit drug markets are not able to solve wider nuisance problems that result from these markets.
"Police actions against drug markets and drug scenes in other neighbourhoods may sometimes increase public order problems near consumption rooms. This implies that, if rooms are to contribute to reducing public nuisance rather than be blamed for aggravating it, there needs to be consultation not only with local residents but also with police, so that action to discourage open drug scenes does not at the same time deter drug users from making use of the facilities."

Hedrich, Dagmar, "European Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring Centre on Drugs and Drug Addiction, February 2004), p. 82.

30. Effectiveness

"Evidence indicates SIFs [Safe Injection Facilities] are uniquely effective in sustaining contact with the most marginalised and chaotic users who inject drugs in public places. These users are at the greatest risk for disease and death, and are also the least likely to engage directly in a traditional abstinence-based health services. Evidence indicates that SIFs can reduce drug overdose deaths; minimize risks for abscesses, bacterial infections and endocarditis; minimise the risk of HIV, hepatitis C and hepatitis B transmission; and increase referral to drug treatment and other health services, while improving public order."

Barbara Tempalski and Hilary McQuie, "Drugscapes and the role of place and space in injection drug use-related HIV risk environments," International Journal of Drug Policy, (2009), p. 9.