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© 2003 by the Journal of
Drug Issues Robert S. Broadhead Supervised
Injection Facilities And International Law Thomas Kerr, Evan Wood, Anita Palepu, Dean Wilson, Martin T. Schechter, Mark W. Tyndall Although there have been repeated calls for the establishment of safe injection facilities (SIFs) in Vancouver since the early 1990s, questions remain concerning the feasibility of SIFs due to the high prevalence of injection cocaine and the concomitant problems cocaine use presents. Therefore, we determined the prevalence of willingness to attend SIFs among cocaine injectors in Vancouver and explored the factors associated with this willingness, using data from the Vancouver Injection Drug Users Study. After considering the results derived from this analysis, additional qualitative methods were employed to explore further willingness to use SIFs, barriers and facilitators of uptake of SIFs, and methods of maximizing uptake among selected subpopulations of cocaine injectors. The results suggest that a high proportion of cocaine injectors, including some of those most at risk, would attend an SIF if one were available. However, in order to better accommodate cocaine injectors, several modifications could be made to conventional SIF service design and delivery. The vast majority of these modifications relate to ensuring effective responses to cocaine toxicity. Given the acceptability of SIFs among cocaine injectors, it appears that an SIF pilot could result in significant and immediate benefits in terms of public health and community safety. Alex Wodak, Ann Symonds, Ray Richmond In "Shooting Galleries," drug users are able to illegally rent cubicles to inject drugs. Established in Kings Cross, Sydney in the early 1990s, police grudgingly tolerated several such galleries. In 1997, a Royal Commission recommended that a parliamentary enquiry consider establishing an official medically supervised injecting centre (MSIC). Despite strong evidence supporting MSIC, a majority of the committee voted against a trial facility. As an act of civil disobedience, a group of concerned citizens established an unsanctioned MSIC. However, police soon closed the facility. At a subsequent Parliamentary drug summit, delegates voted to support an official trial of an MSIC and invited a congregation of Roman Catholic nuns to establish the facility. When the nuns were instructed to withdraw, the Uniting Church was invited to establish the project. The MSIC opened in May 2001. It can be concluded that public health practitioners wishing to improve appalling outcomes from drug policies sometimes have to resort to civil disobedience in order to achieve their goals. The Sydney Medically Supervised Injecting Centre: A Clinical Model Ingrid van Beek The Sydney Medically Supervised Injecting Centre (MSIC) is the first supervised injecting facility (SIF) in Australia and the English-speaking world. It commenced operations in May 2001 as a trial to be independently evaluated. The MSIC was to be the only SIF in Sydney's Kings Cross, a "red-light" area where the drug-using population had previously injected in public or in illegal "shooting galleries" that had proliferated in nearby commercial sex premises since 1990. The aim of the MSIC is to reduce the public health and public order issues arising from unsupervised and public injecting at a local community level. A clinical service model was developed, which would maximize the number of injecting episodes accommodated in a professionally supervised setting and integrate with the other harm reduction services nearby. In its first two years of operation 4,719 registered IDUs made 88,324 visits to inject at the MSIC. There were 553 drug overdoses (81% heroin) managed on site, with no fatalities. Among 1,852 client referrals made for further assistance, 44% were for the treatment of drug dependence. This early experience suggests that the MSIC's clinical model has been acceptable to a significant number of the street-based drug injecting population in this setting. Jo Kimber, Margaret Macdonald, Ingrid Van Beek, John Kaldor, Don Weatherburn, Helen Lapsley, Richard P. Mattick This paper describes characteristics of clients registered in the first 12 months of the Sydney Medically Supervised Injecting Centre’s (MSIC) operation, as well as predictors of frequent attendance. The study is based on information collected from clients at their initial registration and subsequent service utilization. Most of the 2,719 clients were male (71%), almost half had previously experienced at least one nonfatal heroin overdose, and one quarter had accessed formal drug treatment in the previous 12 months. Characteristics associated with frequent attendance at the MSIC were reporting previous attendance at the local primary health service for injecting drug users (IDU), injecting drugs other than amphetamine, reporting sex work, injecting at least daily, and injection in a public place in the month before registration. The large number of registrations and return visits suggests there is demand for a service of this kind in the study area and that the MSIC is being utilized by high-risk IDU subpopulations. Drug Consumption Facilities In The Netherlands Judith Wolf, Loes Linssen And Ireen De Graaf Drug users in many Dutch cities
are no longer condemned to use their drugs in abandoned alleys,
dark doorways or the toilets of drop-in centers. In recent years,
special drug consumption facilities have been created where hard-drug
users can administer their drugs in relative peace and quiet.
At the time of this writing, more than 20 such drug consumption
facilities are now operating in nine Dutch cities – Amsterdam,
Apeldoorn, Arnhem, Den Bosch, Groningen, Heerlen, Maastricht,
Rotterdam and Venlo. Other cities, including Utrecht, Flushing,
The Hague, Zwolle, Nijmegen, and Alkmaar, are keenly debating
whether to open such venues in their cities. The notable emergence
of drug consumption facilities in the 1990s coincided with national
and local efforts to curb the nuisance caused by drug users. The
assumption has been that such facilities play a significant role
in combating this nuisance (Nota Overlast, 1993; Broër &
Noyon, 1999). However, curbing nuisance is not the only perceived
benefit of the facilities. Social addiction care programs also
attach great importance to low-threshold care services, including
drug consumption facilities, as part of their effort to improve
the care provision to long-term drug addicts and to encourage
the safer use of drugs. Now that the first drug consumption facilities
have been in operation for several years, it is interesting to
investigate how such services exactly work, how the facilities
differ from one another, and what aspects of these facilities
may need improvement. These were the key questions in a practical
study we conducted on drug consumption facilities from October
2000 to March 2001. Along with this exploratory research, we also
conducted a literature review on drug consumption facilities that
was commissioned by the Social Addiction Policy Development Centre
(Linssen, de Jong, & Wolf, 2001). Later, in the practical
study, we visited a total of 13 facilities1, interviewed their
staff and clients, performed observations and carried out a telephone
survey of all 21 facilities (18 of which responded). This article
reports our findings on the actual functioning of the drug consumption
facilities. Data relating to the setting-up phase of drug-consumption
facilities is not addressed in this report. Heike Zurhold, Peter Degkwitz, Uwe Verthein, Christian Haasen In order to evaluate the impact of consumption rooms (CRs) on the promotion of health among drug users and the reduction of the public nuisance of drug use, a study examining CRs in three countries was carried out in 2000. The study, supported by the European Commission, examined CRs in Rotterdam (The Netherlands), Innsbruck (Austria), and Hamburg (Germany). This paper evaluates the findings from the study of Hamburg CRs. In order to get evidence-based information on the effects of CRs, 616 drug users in the Hamburg drug scene or in the vicinity of low-threshold institutions were investigated with a standardized questionnaire. Qualitative problem-centered interviews were also carried out with staff members of the CRs, and representatives from the community, including neighborhood residents, business people, police, and politicians. Research findings show that the Hamburg CRs reached the target group of drug users who practice risky behaviors and engage in public drug use. Findings also show that the Hamburg CRs lead to positive changes in health-related behavior for drug users. In addition, the findings indicate that the Hamburg CRs played an important role in the reduction of public disturbances in the vicinity of open drug scenes. Barcelona’s
Safer Injection Facility - Eva: A Harm Reduction Program Lacking
Official Support EVA – Espacio de Venopunción
higiénica Asistida – is the first safe injection
facility (SIF) in Barcelona, Spain. Started on September 12, 2001,
it began as a “poor relative” of DAVE –Dispositivo
Asistencial de Venopunción – in Madrid. EVA suffers
from the general underfunding of its parent program, the Can Tunis
outreach program, and it has no formal or material support from
municipal authorities. This SIF can accommodate five drug injectors
at one time and also operates as a mobile room for shelter, contact,
and health education, addressing mainly those drug users who are
at highest risk of overdose, HIV infection, violence, and death.
The project offers consistent services provided by an array of
health care and welfare professionals, and it is ready to intervene
in overdose and/or crisis situations. To date, it has an excellent
record in providing a safe environment for both its staff of health
care professionals and its clients. Below the Can Tunis area in
general, the outreach program, and EVA are described. The advantages,
disadvantages, and what has been learned from working in this
quarter of Barcelona with the injection drug using community is
discussed. In closing, questions and proposals for future efforts
are addressed. Traci Green, Catherine Hankins, Darlène Palmer, Jean-François Boivin, Robert Platt Empirical evidence suggests that a key prerequisite for a supervised injection facility (SIF) utilization is the existence of an "open drug scene," where users publicly inject drugs. This study seeks to determine the extent and profile of public injecting among injecting drug users (IDUs) in Montreal, Canada, where pilot SIFs are under consideration. A cross-sectional study of IDUs who injected publicly at least once in the previous month was appended to an HIV-risk surveillance study among Montreal IDUs (SurvUDI study). Of 650 SurvUDI participants interviewed between June 2001 and February 2002, 59% were eligible. A dose-response relationship emerged between intensity of public injecting and several drug-use and risk-related characteristics. Regardless of housing stability, IDUs persistently and, often preferably, publicly injected due to habit, dependence, or need to conceal their status. Despite lacking a classical open drug scene, public injecting is common among Montreal IDUs, warranting the consideration of an SIF for this population. Safer Injection Sites in New York City: A Utilization Survey of Injection Drug Users Robert S. Broadhead, Casey A. Borch, Yael van Hulst, Jason Farrell, Wayne J. Villemez, Frederick L. Altice HIV, hepatitis B & C, drug overdose, and other drug-related health problems still pose significant health risks to injection drug users (IDUs) and their sexual partners, indicating the need for further development of innovative public health interventions. A relatively new intervention implemented in many municipalities throughout the world is the “safer injection site” (SIS). An SIS is a legal facility that allows people to prepare and inject pre-obtained drugs in a hygienic, anxiety-free atmosphere under the supervision of health personnel. This paper examines the responses of a sample of IDUs in New York City to whether they would use an SIS should one be implemented in mid-town Manhattan. The SIS would be part of a comprehensive harm reduction project that already offers needle-exchange, street outreach, testing and counseling, support groups, referral services including drug treatment, and on-site primary medical and dental services. The results of our study indicate that a large majority of the IDUs sampled would utilize an SIS should one be implemented, and that those most likely to use it are IDUs at the highest risk for contracting or spreading blood-borne diseases such as HIV and hepatitis, and for experiencing a drug overdose. Shooting Gallery Users and HIV Risk Hugh Klein, Judith A. Levy Recognizing that HIV transmission occurs within situated interactions between two or more people, prevention research has increasingly begun to focus on identifying the influence of situations and settings on the spread of HIV. Examination of the social geography of risk has emerged as a powerful tool for understanding where and among whom risky practices occur. In this regard, shooting galleries represent interactional territories where the normative expectations of participation within their spatial boundaries can both encourage and reinforce sex and drug-related risky behavior. Indeed, research shows that those who inject in shooting galleries tend to be at a higher risk of transmitting HIV than those who inject elsewhere. Drawing upon data from a sample of 1,113 active injecting drug users, we examined the demographic and psychosocial factors that predict shooting gallery use. Next, we compared shooting gallery users with nonusers in terms of drug use, followed by an examination of differences in sex and drug-related HIV risk behaviors. Then, we explored preventive practices that possibly differentiate those who use shooting galleries from those who do not. We end our analysis by discussing the implications of our results for HIV prevention and social policy.
JDI is a publication of the School of Criminology & Criminal Justice.
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