Indigenous populations
Indigenous peoples who use illicit drugs and/or alcohol commonly experience vulnerability and a disproportionate burden of harm related to substance use.
Public support for safe consumption sites and syringe services programs to combat the opioid epidemic
We examine Americans' support for two evidence-based harm reduction strategies – safe consumption sites and syringe exchange programs – and their attitudes about individuals who use opioids. We conducted a web-based survey of a nationally representative sample of U.S. adults in July–August 2017 (N = 1004). We measured respondents' support for legalizing safe consumption sites and syringe services programs in their communities and their attitudes toward people who use opioids. We used ordered logistic regression to assess how stigmatizing attitudes toward people who use opioids, political party identification, and demographic characteristics correlated with support for the two harm reduction strategies. Twenty-nine percent of Americans supported legalizing safe consumption sites and 39% supported legalizing syringe services programs. Respondents reported high levels of stigmatizing attitudes toward people who use opioids: 16% of respondents were willing to have a person using opioids marry into their family and 28% were willing to have a person using opioids start working closely with them on a job, and 27% and 10% of respondents rated persons who use opioids as deserving (versus worthless) and strong (versus weak). Stigmatizing attitudes were associated with lower support for legalizing safe consumption sites and syringe services programs. Democrats and Independents were more likely than Republicans to support both strategies. Stigmatizing attitudes toward people who use opioids are a key modifiable barrier to garnering the public support needed to fully implement evidence-based harm reduction strategies to combat the opioid epidemic. Dissemination and evaluation of stigma reduction campaigns are a public health priority.
Research on Supervised Injection Facilities: A Review of the Literature
What is a supervised injection facility? SIFs can… What is Harm Reduction? What does public injection drug use look like in New York City? Implications of Public Injection Drug Use.
Safe and unsafe spaces: Non-fatal overdose, arrest, and receptive syringe sharing among people who inject drugs in public and semi-public spaces in Baltimore City
The spaces in which drug use occurs constitutes a key aspect of the “risk environment” of people who inject drugs (PWID). We aimed to add nuance to the characterization of “safe” and “unsafe” spaces in PWID’s environments to further understand how these spaces amplify the risk of morbidities associated with injection drug use. PWID were recruited through the Baltimore City syringe service program and through peer referral. Participants completed a socio-behavioral survey. Multivariable logistic regression was used to identify associations between utilization of public, semi-public and private spaces with arrest, non-fatal overdose, and receptive syringe sharing. The sample of PWID (N = 283) was mostly 45 years and older (54%), male (69%), Black (55%), and heroin users (96%). Compared to PWID who primarily used private settings, the adjusted odds of recent overdose were greater among PWID who mostly used semi-public and public locations to inject drugs. We also found independent associations between arrest and semi-public spaces, and between receptive syringe sharing and public spaces (all p < 0.05). This study highlights the need for safe spaces where PWID can reduce their risk of overdose, likelihood of arrest and blood-borne diseases, and the dual potential of the environment in promoting health and risk.
Safe Drug Consumption Spaces - Implications for Baltimore City
This Abell Report, written by Dr. Susan Sherman, a professor in the Bloomberg School of Public Health’s Department of Health Behavior and Society, explains what safe consumption spaces are, the research behind them, and the challenges they face. It calls for creating two safe consumption spaces, one on the east side of the city and one on the west side.
Safer Consumption Spaces in the United States: Uniting for a national Movement
The following report provides a summary of a think tank that Project Inform held in Baltimore on September 27-28, 2016 with 49 advocates to discuss issues related to safer consumption advocacy.
The report reviews key issues related to safe consumption sites, and lists some of the best practices and lessons learned for advocacy and educating people around SCSs to teach the value and benefits these sites provide to people who use drugs and the communities where they live.
Supervised Consumption Facilities - Review of the Evidence
The intent of this document is to:
- Describe literature related to supervised consumption facilities as harm-reduction strategies in addressing overdose deaths, infections and community harms from heroin and other opioid use.
- Apply estimates of outcomes from other communities to the City of Philadelphia’s data, where data are available, to approximate the possible impact of a supervised consumption facility located where deaths from overdose have been most likely to occur.
Supervised Injection Facilities: Recommendations for action
America’s opioid epidemic continues to cause unprecedented overdose deaths and fuel increases in new cases of hepatitis B and C, and HIV. According to the CDC, in 2016 over 64,000 people died of accidental overdose and over 60% of new hepatitis C cases and approximately 10% of new HIV cases were related to injection drug use. From 2004-2014 there was a 400% increase in acute hepatitis C among 18-29-year olds that is correlated with dramatic increases in heroin and prescription opioid injection. Overall, among people who inject drugs, prevalence of HCV is estimated to be as high as 80%. Hepatitis B is also increasing as a result of the opioid epidemic. From 2006-2013 the number of new hepatitis B infections in three states (Kentucky, Tennessee, and West Virginia) increased among young PWID by 114%. In terms of scale of the opioid crisis, recent numbers from SAMHSA indicate that in 2015, 11.8 million people misused prescription opiates or heroin and 2.4 million, or 20%, of those met diagnostic criteria for an opioid use disorder. This leaves millions of people actively using opioids and at risk of overdose and HIV and HCV transmission while not yet engaged in or ready for treatment.
As the nation grapples with how to effectively respond to these epidemics, NASTAD urges policymakers, public health and safety leaders, and impacted communities to embrace a comprehensive approach to end these intersecting epidemics. As one element of a comprehensive strategy, NASTAD supports Supervised Injection Facilities (SIFs) as an important, evidence-based, intervention. These programs operate with legal sanction in 11 countries and number well over 100 worldwide. SIFs have been shown to reduce HCV/HIV transmission risks and link participants to testing, infectious disease treatment, medication-assisted treatment, and physical and behavioral health services. Studies of SIFs have shown that they do not lead to increases in drug use, frequency of injection, or levels of drug-related crime while effectively reducing overdose death and occurrence.
We recognize that stakeholders may have differing roles in these efforts. Herein, we outline potential avenues to support these lifesaving programs and opportunities for engagement and education among various stakeholder groups.
Supervised Injection Facilities. Legal and Policy Reforms
The US Centers for Disease Control and Prevention reported that more than 70 000 deaths from drug overdoses occurred in 2017, including prescription and illicit opioids, representing a 6-fold increase since 1999.1 Innovative harm-reduction solutions are imperative. Supervised injection facilities (SIFs) create safe places for drug injection, including overdose prevention, counseling, and treatment referral services. Supervised injection facilities neither provide illicit drugs nor do their personnel inject users. Supervised injection facilities are effective in reducing drug-related mortality, morbidity, and needle-borne infections. Yet their lawfulness remains uncertain. The Department of Justice (DOJ) recently threatened criminal prosecution for SIF operators, medical personnel, and patrons.
The Case for Supervised Consumption Services
In the United States, people who use drugs (PWUD) continue to be at elevated risk for HIV, according to the Centers for Disease Control and Prevention. At the same time, a surging epidemic of overdoses from heroin and prescription painkillers (i.e., opioids) claimed nearly 50,000 lives in 2014 alone. To save lives, there is a pronounced need to implement scientifically validated harm reduction programs, which reduce the risks associated with drug use and facilitate access to addiction treatment and medical care. Among the newest and most innovative interventions to reduce overdoses are supervised consumption services.
The Controlled Substances Act and safe consumption facilities
Safe consumption facilities (SCFs) are effective at preventing overdose fatalities and reducing transmission of infectious diseases, like HIV and Hepatitis C. The city of Philadelphia is moving forward with plans to open the first SCF in the United States; however, the U.S. Attorneys’ Office has filed a lawsuit to stop these plans from moving forward. Estimates predict that >24 overdose deaths per year will be prevented in Philadelphia if the proposed SCF is opened while also connecting drug users to treatment and social services. It is also expected to save the city millions of dollars in hospitalizations, ambulance rides, and emergency room visits. SCFs reduce public nuisances like public injecting and littered syringes, and do not increase local crime or the number of people who are addicted to drugs. Despite these benefits, SCFs are illegal under 21 U.S.C. §856 of the Controlled Substances Act according to the Department of Justice. We propose that Congress amend the Controlled Substances Act such that federal law cannot be interpreted to prohibit localities from opening and operating Safe Consumption Facilities.
