33, 34 SIF staff also offer general medical advice and referrals to drug treatment and other social programs. Facility staff do not directly assist in injection, but rather provide sterile injection supplies, answer questions on vein care and safer injection methods, administer first aid, and monitor for overdose. 31, 32Ī SIF is a place supervised by licensed health personnel where IDUs inject drugs they obtain elsewhere. 29, 30 Recognizing this unmet need, some 40 cities worldwide have introduced safe injection facilities (SIFs) as one way to address unsafe drug consumption environments.
25 – 28 These interventions do not address the lack of a safe and hygienic setting for injection, nor are they sufficient to overcome the behavioral influence of relationships and other factors present in informal injecting milieus. Syringe access and disposal, outreach, and drug treatment programs help reduce these risks. 22, 23 Lack of proper syringe disposal facilities and legal disincentives to safe disposal increase the risk that used syringes will be improperly discarded, creating public anxiety and some risk of accidental disease transmission. 18, 21 Although opiate overdose is typically reversible through the administration of naloxone (an opiate antagonist), witnesses often hesitate to summon first responders out of fear of legal consequences. 14, 16 – 20 The likelihood that IDUs will contract a blood-borne disease increases significantly when they inject in public spaces or “shooting galleries” (structures such as homes-privately owned, abandoned, and otherwise-that are frequented by IDUs for the purpose of injecting). 12 – 15 Anxiety about social rejection and arrest deter use of health and preventative services and force IDUs into hidden locations that are poorly suited for hygienic injection. Many of the harms associated with injection drug use stem from the scarcity of sterile injection equipment and users’ fear of the criminal justice system.
8 A recent wave of fentanyl-related overdose deaths has called attention to the high number of fatal overdoses among IDUs. 4 – 7 Skin abscesses and endocarditis can result from unsterile injection. 3 Injection drug users (IDUs) are at high risk of acquiring hepatitis and HIV. 1, 2 It accounts for the cause of one third of this country’s cumulative AIDS cases. INJECTION DRUG USE HAS been a public health problem in the United States for many decades.
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