A critical evaluation of the effects of safe injection facilities

Research has overwhelmingly supported the proposition that safe injection facilities (SIFs) are successful in meeting their stated objectives. However, the methodological and analytic approaches used in these studies have not been scrutinized to any significant degree. Previous studies are compromised by an array of deficiencies, including a lack of baseline data, insufficient conceptual and operational clarity, inadequate evaluation criteria, absent statistical controls, dearth of longitudinal designs, and inattention to intrasite variation. This review suggests that much of the commonly-cited evidence regarding the effects of SIFs cannot be substantiated. Disentangling complicated casual mechanisms first requires that the identified shortcomings be addressed.