Safe Injection Rooms

Safe injection sites (SIS) are clinics designed to provide injection drug users (IDUs) clean needles and a sterilized site in order to inject their drugs in a safer manner. The goal of an SIS is to provide individuals a healthier environment in which to inject drugs while also providing related health and social services all in one location. Switzerland, Germany, and the Netherlands adopted the concept of safe injection rooms during the 1970s as a general public health initiative. However, since then the strategy has been demonstrated to also decrease new human immunodeficiency virus (HIV) and hepatitis C infections and reduce the number of overdose-related deaths while providing access to primary and emergency healthcare for a traditionally oppressed population. After the opening of a safe injection site there is generally a decrease in public nuisance issues related to drug use including public injecting, discarded syringes, and injection-related litter.

Supervised injection sites are one component of larger harm reduction and educational strategies for injection drug users. They are safe places that drug-dependent individuals can go to inject drugs under the supervision of trained multidisciplinary staff who can provide education regarding safer injection practices, as well as respond appropriately in the event of an overdose. Each SIS varies in the way it operates, however, in general injection drug users bring pre-obtained illegal drugs to the site, are provided with sterile equipment to use, and inject drugs with nurses and other trained staff nearby. Typically, needles, syringes, candles, sterile water, paper towels, cotton balls, cookers/spoons, ties, alcohol swabs, filters, ascorbic acid, and bandages are available in the injection areas. SIS allow IDUs to have privacy, while also offering the comfort of knowing that trained medical staff are available to respond in case of an emergency. SIS do not allow the sharing of drugs or equipment and prohibit assisted injection.

Supervised injection site use by IDUs leads to a reduction in syringe sharing among users, which also reduces the spread of diseases and infections. It is critical to note how SIS differ markedly from illegal shooting galleries operating in many cities, where drug users pay a small amount of money for a few minutes in a private or semi-private room. The latter are profit motivated, may be littered with trash and/or needles, violent, controlled by drug dealers, allow participants to share dirty needles, and show little regard for the user's health and safety. In contrast, SIS attempt to protect and promote the health of injection drug users by employing a nonjudgmental, client-centered approach rooted in a harm reduction philosophy.

[Page 708]The focus of SIS includes reducing individual harm and addressing the concerns of overdosing, spreading diseases, and infections among IDUs. Overdosing, contracting HIV, hepatitis C, and bacterial infections, such as endocarditis, are common among IDUs. It has been recognized that when injections occur in front of health professionals the risk of disease decreases. As an injection is supervised, trained professionals can offer medical advice on how to inject without damaging the vein or surrounding tissues and encourage users to inject in less dangerous places on their bodies.

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