Drug consumption rooms (DCR)
Drug Consumption Rooms are also known as 'medically supervised injecting centres', ‘safe injecting facilities’, ‘safe injecting sites’ or 'drug injection rooms', or ‘drug fixing rooms’. Some provide space for safe injection only, while majority of DCRs also provide places to smoke or snort drugs. There are even 'smoking only' consumption rooms.
Injecting-related injury and disease among clients of a supervised injecting facility
BACKGROUND: The process of drug injection may give rise to vascular and soft tissue injuries and infections. The social and physical environments in which drugs are injected play a significant role in these and other morbidities. Supervised injecting facilities (SIFs) seek to address such issues associated with public injecting drug use.
AIMS: Estimate lifetime prevalence of injecting-related problems, injury and disease and explore the socio-demographic and behavioral characteristics associated with the more serious complications.
DESIGN, SETTING, PARTICIPANTS: Self-report data from 9552 injecting drug users (IDUs) registering to use the Sydney Medically Supervised Injecting Centre (MSIC).
FINDINGS: Lifetime history of either injecting-related problems (IRP) or injecting-related injury and disease (IRID) was reported by 29% of the 9552 IDUs; 26% (n=2469) reported ever experiencing IRP and 10% (n=972) reported IRID. Prevalence of IRP included difficulties finding a vein (18%), prominent scarring or bruising (14%) and swelling of hands or feet (7%). Prevalence of IRID included abscesses or skin infection (6%), thrombosis (4%), septicaemia (2%) and endocarditis (1%). Females, those who mainly injected drugs other than heroin, and those who reported a history of drug treatment, drug overdose, and/or sex work, were more likely to report lifetime IRID. Frequency and duration of injecting, recent public injecting, and sharing of needles and/or syringes were also independently associated with IRID.
CONCLUSIONS: IRPs and IRIDs were common. Findings support the imperative for education and prevention activities to reduce the severity and burden of these preventable injecting outcomes. Through provision of hygienic environments and advice on venous access, safer injecting techniques and wound care, SIFs have the potential to address a number of risk factors for IRID.
Process and predictors of drug treatment referral and referral uptake at the Sydney Medically Supervised Injecting Centre
INTRODUCTION AND AIMS: Low-threshold drug services such as drug consumption rooms (DCRs) have been posited as referral gateways to drug treatment for injecting drug users (IDUs). We examined the process and predictors of drug treatment referral and referral uptake at an Australian DCR.
DESIGN AND METHODS: We undertook behavioural surveillance of the Sydney Medically Supervised Injecting Centre (MSIC) client cohort between May 2001 and October 2002. Data were collected for 3715 IDUs on demographics, injecting and drug use behaviours at registration and all subsequent MSIC service utilisation, including referrals. Referral uptake (defined as presentation for assessment at the relevant agency) was traced via reply-paid postcards included with written referrals.
RESULTS: Sixteen per cent of clients who received written referrals to drug treatment had confirmed drug treatment referral uptake. Factors associated with drug treatment referral were frequent MSIC attendance [adjusted odds ratios (AOR = 9.4], receipt of written health (AOR = 4.8) or psychosocial (AOR = 4.3) referrals, heroin as main drug injected (AOR = 1.9) and completion of high school education (AOR = 1.6). Factors associated positively with drug treatment referral uptake were recent sex work (AOR = 2.6) and at least daily injection (AOR = 2.3). Previous psychiatric illness or self-harm was associated negatively with drug treatment referral uptake (AOR = 0.2).
DISCUSSION AND CONCLUSIONS: MSIC engaged IDUs successfully in drug treatment referral and this was associated with presentation for drug treatment assessment and other health and psychosocial services. To improve rates of drug treatment referral and uptake, those with a history of mental health issues may require more intensive referral and case management.
The case for a second safe injecting facility (SIF) in Sydney
Sydney’s Medically Supervised Injecting Centre in Kings Cross has been a major national and global example of successful harm reduction in relation to illicit drug use ever since it opened its doors 18 years ago. However, since then Sydney has undergone significant transformations as a city, including gentrification of the inner Sydney suburbs where the injecting centre operates and expansions to its Western and South Western suburbs where many of its injecting drug-using population reside. Furthermore, Australia is seeing growing public health concerns about steady increases in opioid overdose deaths worth comparing to the opioid crisis in the United States. Using data from the National Coronial Information System, we explore the distribution of overdose deaths across Sydney and in doing so make the case for the establishment of a second medically supervised injecting centre in Sydney’s outer suburbs.
The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia
AIMS: Supervised injecting facilities (SIFs) are effective in reducing the harms associated with injecting drug use among their clientele, but do SIFs ease the burden on ambulance services of attending to overdoses in the community? This study addresses this question, which is yet to be answered, in the growing body of international evidence supporting SIFs efficacy.
DESIGN: Ecological study of patterns in ambulance attendances at opioid-related overdoses, before and after the opening of a SIF in Sydney, Australia.
SETTING: A SIF opened as a pilot in Sydney's 'red light' district with the aim of accommodating a high throughput of injecting drug users (IDUs) for supervised injecting episodes, recovery and the management of overdoses.
MEASUREMENTS: A total of 20,409 ambulance attendances at opioid-related overdoses before and after the opening of the Sydney SIF. Average monthly ambulance attendances at suspected opioid-related overdoses, before (36 months) and after (60 months) the opening of the Sydney Medically Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the rest of New South Wales (NSW).
RESULTS: The burden on ambulance services of attending to opioid-related overdoses declined significantly in the vicinity of the Sydney SIF after it opened, compared to the rest of NSW. This effect was greatest during operating hours and in the immediate MSIC area, suggesting that SIFs may be most effective in reducing the impact of opioid-related overdose in their immediate vicinity.
CONCLUSIONS: By providing environments in which IDUs receive supervised injection and overdose management and education SIF can reduce the demand for ambulance services, thereby freeing them to attend other medical emergencies within the community.
The impact of OxyContin reformulation at the Sydney Medically Supervised Injecting Centre: Pros and cons
Increases in the prescription of pharmaceutical opioids have coincided with an epidemic of drug overdose in the US, with evidence of similar effects in other jurisdictions including Australia (Dart et al., 2015; Pilgrim, Yafistham, Gaya, Saar, & Drummer, 2015). Oxycodone is implicated in a large number of deaths (Blanch, Pearson, & Haber, 2014; Dhalla et al., 2009; Roxburgh, Bruno, Larance, & Burns, 2011), a significant proportion of which involve intravenous administration of preparations designed for oral administration (Blanch et al., 2014).
Salas de Consumo de Drogas: situando o debate no Brasil
Este estudo apresenta um plano de discussão para a implementação das SCD no Brasil, tendo como referência as experiências dos países que optaram por incluir as SCD em suas políticas nacionais sobre drogas.
A Community Based Report on Alberta’s Supervised Consumption Service Effectiveness
This report provides an analysis of the effectiveness of the current SCS/OPS sites approved and operating in Alberta.
Acceptability and design preferences of supervised injection services among people who inject drugs in a mid-sized Canadian City
BACKGROUND: Supervised injection services (SIS) have been shown to reduce the public- and individual-level harms associated with injection drug use. While SIS feasibility research has been conducted in large urban centres, little is known about the acceptability of these services among people who inject drugs (PWID) in mid-sized cities. We assessed the prevalence and correlates of willingness to use SIS as well as design and operational preferences among PWID in London, Canada.
METHODS: Between March and April 2016, peer research associates administered a cross-sectional survey to PWID in London. Socio-demographic characteristics, drug-use patterns, and behaviours associated with willingness to use SIS were estimated using bivariable and multivariable logistic regression models. Chi-square tests were used to compare characteristics with expected frequency of SIS use among those willing to use SIS. Design and operational preferences are also described.
RESULTS: Of 197 PWID included in this analysis (median age, 39; interquartile range (IQR), 33-50; 38% female), 170 (86%) reported willingness to use SIS. In multivariable analyses, being female (adjusted odds ratio (AOR) 0.29; 95% confidence interval (CI) 0.11-0.75) was negatively associated with willingness to use, while public injecting in the last 6 months (AOR 2.76; 95% CI 1.00-7.62) was positively associated with willingness to use. Participants living in unstable housing, those injecting in public, and those injecting opioids and crystal methamphetamine daily reported higher expected frequency of SIS use (p < 0.05). A majority preferred private cubicles for injecting spaces and daytime operational hours, while just under half preferred PWID involved in service operations.
CONCLUSIONS: High levels of willingness to use SIS were found among PWID in this setting, suggesting that these services may play a role in addressing the harms associated with injection drug use. To maximize the uptake of SIS, programme planners and policy makers should consider the effects of gender and views of PWID regarding SIS design and operational preferences.
Ambivalence about supervised injection facilities among community stakeholders
BACKGROUND: Community stakeholders express a range of opinions about supervised injection facilities (SIFs). We sought to identify reasons for ambivalence about SIFs amongst community stakeholders in two Canadian cities.
FINDINGS: We used purposive sampling methods to recruit various stakeholder representatives (n = 141) for key informant interviews or focus group discussions. Data were analyzed using a thematic process. We identified seven reasons for ambivalence about SIFs: lack of personal knowledge of evidence about SIFs; concern that SIF goals are too narrow and the need for a comprehensive response to drug use; uncertainty that the community drug problem is large enough to warrant a SIF(s); the need to know more about the “right” places to locate a SIF(s) to avoid damaging communities or businesses; worry that a SIF(s) will renew problems that existed prior to gentrification; concern that resources for drug use prevention and treatment efforts will be diverted to pay for a SIF(s); and concern that SIF implementation must include evaluation, community consultation, and an explicit commitment to discontinue a SIF(s) in the event of adverse outcomes.
CONCLUSIONS: Stakeholders desire evidence about potential SIF impacts relevant to local contexts and that addresses perceived potential harms. Stakeholders would also like to see SIFs situated within a comprehensive response to drug use. Future research should determine the relative importance of these concerns and optimal approaches to address them to help guide decision-making about SIFs.
