Supervised injection site

Last updated

Cubicles for drug injection at a supervised injection site in Strasbourg SCMR Argos Strasbourg novembre 2016-4.jpg
Cubicles for drug injection at a supervised injection site in Strasbourg

Supervised injection sites (SIS) [1] [2] [3] or drug consumption rooms (DCRs) are a health and social response to drug-related problems. They are fixed or mobile spaces where people who use drugs are provided with sterile drug use equipment and can use illicit drugs under the supervision of trained staff. They are usually located in areas where there is an open drug scene and where injecting in public places is common. The primary target group for DCR services are people who engage in risky drug use.

Contents

The geographical distribution of DCRs is uneven, both at the international and regional levels. In 2022, there were over 100 DCRs operating globally, with services in Belgium, Denmark, France, Germany, Greece, Luxembourg, the Netherlands, Norway, Portugal and Spain, as well as in Switzerland, Australia, Canada, Mexico and the USA.

Primarily, DCRs aim to prevent drug-related overdose deaths, reduce the acute risks of disease transmission through unhygienic injecting, and connect people who use drugs with addiction treatment and other health and social services. They can also aim to minimise public nuisance. [4]

Proponents say they save lives and connect users to services, while opponents believe they promote drug use and attract crime to the community around the site. [5] Supervised injection sites are part of a harm reduction approach towards drug problems.

Terminology

Supervised injection sites are also known as overdose prevention centers (OPCs), [6] supervised injection facilities, [7] safe consumption rooms, [8] safe injection sites, [1] safe injection rooms, [9] fix rooms, [10] fixing rooms, [11] safer injection facilities (SIF), drug consumption facilities (DCF), [2] drug consumption rooms (DCRs), [12] medically supervised injecting centres (MSICs) and medically supervised injecting rooms (MSIRs). [13]

Facilities

Australia

This "You Talk, We Die" mural was painted to advocate for a safe injecting facility in the North Richmond area of Melbourne, known for the heroin trade. The campaign was successful and a facility opened in 2018. "You Talk, We Die" mural in North Richmond area of Melbourne, Australia.jpg
This "You Talk, We Die" mural was painted to advocate for a safe injecting facility in the North Richmond area of Melbourne, known for the heroin trade. The campaign was successful and a facility opened in 2018.

The legality of supervised injection is handled on a state-by state basis. New South Wales trialed a supervised injection site in Sydney in 2001, which was made permanent in 2010. [14] After several years of community activism, Victoria agreed to open a supervised injection site in Melbourne's North Richmond neighbourhood in 2018 on a trial basis. In 2020 the trial was extended for a further three years, and the site remains open as of 2024.

A second site for Melbourne's CBD was approved [15] and was to be placed in a building on Flinders Street which had previously housed Yooralla. [16] However, as of 2024, the site has been rejected by Premier Jacinta Allan who cited disagreements over location, preferring to set up a new community health and pharmacotherapy centre instead.

Europe

During the 1990s legal facilities emerged in cities in Switzerland, Germany and the Netherlands. [2] [17] In the first decade of 2000, facilities opened in Spain, Luxembourg, and Norway. [2]

Naloxone, a drug on hand at clinics used to administer in cases of opioid overdose NaloxoneKit.jpg
Naloxone, a drug on hand at clinics used to administer in cases of opioid overdose

Whereas injection facilities in Europe often evolved from something else, such as different social and medical outreaches or perhaps a homeless shelter, the degree and quality of actual supervision varies. The history of the European centers also mean that there have been no or little systematic collection of data needed to do a proper evaluation of effectiveness of the scheme. At the beginning of 2009 there were 92 facilities operating in 61 cities, including 30 cities in the Netherlands, 16 cities in Germany and 8 cities in Switzerland. Denmark passed a law allowing municipalities to run "fix rooms" in 2012, and by the end of 2013 there were three open.

To date in July 2022, according to European Monitoring Centre for Drugs and Drug Addiction Belgium has one facility, Denmark five, France two, Germany 25, Greece one, Luxembourg two, Netherlands 25, Norway two, Portugal two, Spain 13, and Switzerland 14. [18]

Ireland

Ireland has legislation to permit the opening of a service (as of May 2017) in the Misuse of Drugs (Supervised Injecting Facilities) Bill 2017; however, it has been halted by planning concerns. [19]

Netherlands

The first professionally staffed service where drug injection was accepted emerged in the Netherlands during the early 1970s as part of the "alternative youth service" provided by the St. Paul's church in Rotterdam. At its peak it had two centers that combined an informal meeting place with a drop-in center providing basic health care, food and a laundering service. One of the centers was also a pioneer in providing needle-exchange. Its purpose was to improve the psychosocial function and health of its clients. The centers received some support from law enforcement and local government officials, although they were not officially sanctioned until 1996. [17]

Switzerland

The first modern supervised consumption site was opened in Bern, Switzerland in June, 1986. [20] Part of a project combatting HIV, the general concept of the café was a place where simple meals and beverages would be served, and information on safe sex, safe drug use, condoms and clean needles provided. Social workers providing counselling and referrals were also present. An injection room was not originally conceived, however, drug users began to use the facility for this purpose, and this soon became the most attractive aspect of the café. After discussions with the police and legislature, the café was turned into the first legally sanctioned drug consumption facility provided that no one under the age of 18 was admitted. [21]

United Kingdom

The United Kingdom opened one (officially unsanctioned) facility in Glasgow in September 2020. It was opened by Peter Krykant, a local drugs worker; [22] however, lack of funding and support led to its closure in May 2021. [23] [24] In nine months of operation, 894 injection events were recorded at the facility and volunteers reported attending to nine overdose events, seven opioid overdoses, and two involving powder cocaine; but there were no fatalities. [25]

In 2023, the Lord Advocate—Scotland's chief legal officer—announced that the Crown Office and Procurator Fiscal Service would institute a policy of not criminally prosecuting those using approved supervised drug consumption sites. Police Scotland have also confirmed they will exercise discretion in not prosecuting those using such a facility. [26] An official facility is planned to open in Glasgow in October [27]

Latin America

The first site opened in Latin American was in Bogota, Colombia during October 2024. [28] [29]

North America

Canada

Insite in 2008 Controversial Safe Injection Site.jpg
Insite in 2008

There are 39 government authorized SCS in Canada as of July 2019: 7 in Alberta, 9 in British Columbia, 19 in Ontario, and 4 in Quebec. [30] An exemption to controlled substances law under Canadian Criminal Code is granted inside the facilities, but drug possession remains illegal outside the facility and there is no buffer zone around the facility. [30] Canada's first SCS, Insite in Downtown Eastside of Vancouver, commenced operation in 2003. [31]

In August 2020, ARCHES Lethbridge in Lethbridge, Alberta, the largest SCS in North America, closed shortly after Alberta revoked their grant for misuse of grant funds. [32] Shortly after opening in February 2018, [33] ARCHES Lethbridge found itself repetitively necessitating police intervention and/or emergency medical services for opioid-related issues; [34] indeed, three weeks after its closure, the city noted a 36% decline in opioid-related EMS requests. [35] The average per-capita operating cost of government sanctioned sites are reported to be CAD$600 per unique-client, with the exception of the ARCHES Lethbridge which had a disproportionately high cost of CAD $3,200 per unique client. [34]

In September 2020, a group in Lethbridge, Alberta led by an ARCHES employee started hosting an unauthorized SCS in public places in a tent. [36] [37] The group did not have authorizations to operate an SCS or a permit to pitch a tent in the park. The organizer was issued citations for the tent; and the Lethbridge Police Service advised that users utilizing the unauthorized SCS would be arrested for drug possession, because exemptions do not apply to unauthorized sites. [38] [39] [40] This opening of this illegal drug consumption tent was controversial and became a subject of discussion at the City Council meeting. [41] [42]

United States

Clandestine injection sites have existed for years. A New England Journal of Medicine study from July 2020 reports that an illegal supervised consumption site has been operating at an "undisclosed" city in the U.S. since 2014 where over 10,000 doses of illegal drugs have been injected over a five-year period. [43] Supervised consumption sites with some degree of official sanction from a state or local government have been contemplated, but are rare due to the federal regulation of drugs and the explicit opposition of federal law enforcement to any form of decriminalization. [44]

Local governments in Seattle, Boston, Vermont, Delaware, and Portland, Oregon have considered opening safe injection sites as well. [45] [46] Plans to open an injection site in Somerville, Massachusetts in 2020 were delayed by the COVID-19 pandemic. [47]

The governors of California and Vermont both vetoed supervised consumption site bills in 2022, and Pennsylvania's Senate voted for a ban on them in 2023. [48]

Denver (2018)

In November, 2018, Denver city council approved a pilot program for a safe injection site with a 12-to-1 vote. The Drug Enforcement Administration's Denver field office and the United States Attorney's office for the District of Colorado issued a statement together on the proposed site stating that "the operation of such sites is illegal under federal law. 21 U.S.C. Sec. 856 prohibits the maintaining of any premises for the purpose of using any controlled substance." [49]

New York City (2021)

The first government-authorized supervised injection sites in the US (operated by OnPoint NYC) began operating in New York City in November 2021. [50]

A peer-reviewed study of the first two months of the OPC's operation has been published in JAMA. [51] News media have been allowed access to the OPC sites as well. [52] [53] [54]

Public criticism of the New York City OPC's has so far been limited. One problem brought up by the leadership of the Metropolitan Transportation Authority is how use migrates from the centers to nearby New York City Subway stations when the OPC's are closed. [55] In response Mayor Eric Adams called for the centers to be funded to operate continuously. [55]

Though sanctioned by the city, the sites arguably remain illegal under federal law, and rely on non-enforcement by federal officials to keep operating. [56] The United States Department of Justice, during the Presidency of Joe Biden, has signaled some openness and stated that it is "evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety." [57]

Pennsylvania

An organization called Safehouse was hoping to open a safe consumption site in Philadelphia in February 2020 with the support of the city government. Immediate neighbors strongly objected to the site, and the owner of the first proposed location withdraw a lease offer under pressure. [58] [59] [60] United States District Attorney William McSwain sued to stop the Safehouse project, losing in district court in October 2019, but winning an injunction in January 2021 from a 3-judge panel of the United States Court of Appeals for the Third Circuit. [61] Safehouse said its proposed operation was "a legitimate medical intervention, not illicit drug dens" and claimed protection under the Free Exercise Clause because "religious beliefs compel them to save lives at the heart of one of the most devastating overdose crises in the country". [62]

In May 2023, Pennsylvania senate passed a bill to ban supervised injection sites anywhere within the State of Pennsylvania with a 41-9 vote and it is pending house approval. The Pennsylvania governor Josh Shapiro expressed support for the bill. [63]

San Francisco, California

For 11 months between January and December 2022, there had been drug addicts using within the center established by the health department. [64] The center "morphed" from a social services linking service to a drug usage site. [65]

Virtual overdose monitoring services / non physical site

Virtual overdose monitoring services are similar to safe consumption rooms. These programs use phone lines or smartphone apps to monitor clients while they use drugs, contacting emergency services if the caller becomes unresponsive. These services include the National Overdose Response Service in Canada [66] and Never Use Alone in the US, as well as the smartphone apps Canary and Brave. [67]

Evaluations

In the late 1990s there were a number of studies available on consumption rooms in Germany, Switzerland and the Netherlands. "The reviews concluded that the rooms contributed to improved public and client health and reductions in public nuisance but stressed the limitations of the evidence and called for further and more comprehensive evaluation studies into the impact of such services." [68] To that end, the two non-European injecting facilities, Australia's Sydney Medically Supervised Injecting Centre (MSIC) and Canada's Vancouver Insite Supervised Injection Site have had more rigorous research designs as a part of their mandate to operate. [69]

The NSW state government has provided extensive funding for ongoing evaluations of the Sydney MSIC, with a formal comprehensive evaluation produced in 2003, 18 months after the centre was opened. Other later evaluations studied various aspects of the operation –service provision (2005), community attitudes (2006), referral and client health (2007) and a fourth (2007) service operation and overdose related events. [70] Other evaluations of drug-related crime in the area were completed in 2006, 2008 and 2010, the SAHA International cost-effectiveness evaluation in 2008 and a final independent KPMG evaluation in 2010.

The Vancouver Insite facility was evaluated during the first three years of its operation by researchers from the BC Center for Excellence in HIV/AIDS with published and some unpublished reports available. In March 2008 a final report was released that evaluated the performance of the Vancouver Insite against its stated objectives.

Some posit that safe injection sites help reduce improperly discarded needles in public. [71] [72] [73] [74] This was found to be the case in a report by the Canadian Mental Health Association in 2018. [75] Prior to the establishment of a supervised injection site in Vesterbro, Copenhagen in Denmark in 2012, up to 10,000 syringes were found on its streets each week. Within a year of the supervised injection site opening this number fell to below 1,000. [11]

There has been some attempt to standardise evaluation reporting across supervised injection sites in a type of Core outcome set with researchers from the United States funded by Drug Policy Alliance available; [76] however, the intermediary process of how this consensus set was generated is unpublished.

The Expert Advisory Committee found that Insite had referred clients such that it had contributed to an increased use of detoxification services and increased engagement in treatment. Insite had encouraged users to seek counseling. Funding has been supplied by the Canadian government for detoxification rooms above Insite. [77]

SIS sites and social disorder

A longitudinal study –Urban Social Issues Study (USIS) –from January 2018 and February 2019 –undertaken by University of Lethbridge's professor Em M. Pijl and commissioned by the City of Lethbridge, Alberta, Canada explore "any unintended consequences" of supervised consumption services (SCS) within the "surrounding community". [33] : 16  The USIS study was undertaken in response to a drug crisis in Lethbridge that impacted "many neighbourhoods in many different ways." Researchers studied the "perceptions and observations of social disorder by business owners and operators" in a neighborhood where SCS was introduced. [33] : 16  The report cautioned, that drug abuse-related antisocial behavior in Lethbridge, in particular, and in cities, in general, has increased, as the "quantity and type of drugs in circulation" increases. As the use of crystal meth eclipses the use of opiates, users exhibit more "erratic behavior". Crystal meth and other "uppers" also "require more frequent use" than "downers" like opiates. [33] : 11  The report also notes that not all social disorder in communities that have a SCS, can be "unequivocally and entirely attributed" to the SCS, partly because of the "ongoing drug epidemic." [33] : 11  Other variables that explain increased anti-social behaviour includes an increase in the number of people aggregating outdoors as part of seasonal trends with warmer temperatures. [33] : 16 

Philadelphia's WPVI-TV Action News team traveled to Toronto, Canada in 2018 to make first hand field observations of several safe consumption sites already in operation. A drug addict interviewed by the reporter said she visits the site to obtain supply, but did not stick around and used the supplies to shoot up drugs elsewhere and acknowledged the site attracts drug users and drug dealers. A neighbor interviewed by the reporter said there was drug use before, but he reports it has increased since the site opened. [78]

WPVI-TV's Chad Pradelli narrated the news team's observation as:

Over the two days we sat outside several of Toronto's safe injection facilities, we witnessed prevalent drug use out front, drug deals, and even violence. We watched as one man harassed several people passing by on the sidewalk, even putting one in a chokehold. One guy decided to fight back and security arrived. [78]

Sydney, Australia

The Sydney MSIC client survey conducted in 2005, found that public injecting (defined as injecting in a street, park, public toilet or car), which is a high risk practice with both health and public amenity impacts, was reported as the main alternative to injecting at the MSIC by 78% of clients. 49% of clients indicated resorting to public injection if the MSIC was not available on the day of registration with the MSIC. From this, the evaluators calculated a total 191,673 public injections averted by the centre. [79]

Vancouver, Canada

Observations before and after the opening of the Vancouver, British Columbia, Canada Insite facility indicated a reduction in public injecting. "Self-reports" of INSITE users and "informal observations" at INSITE, Sydney and some European SISs suggest that SISs "can reduce rates of public self-injection." [77] [ quantify ]

Alberta, Canada

In response to the opioid epidemic in the province of Alberta, the Alberta Health Services's (AHS), Alberta Health, Indigenous Relations, Justice and Solicitor General including the Office of the Chief Medical Examiner, and the College of Physicians and Surgeons of Alberta met to discuss potential solutions. In the November 2016 Alberta Health report that resulted from that meeting, the introduction of supervised consumption services, along with numerous other responses to the crisis, was listed as a viable solution. [80] : 1  The 2016 Alberta Health report stated that, SIS, "reduce overdose deaths, improve access to medical and social supports, and are not found to increase drug use and criminal activity." [80] : 3 

According to January 2020 Edmonton Journal editorial, by 2020 Alberta had seven SIS with a "100-per-cent success rate at reversing the more than 4,300 overdoses" that occurred from November 2017 –when the first SIS opened in the province –until August 2019. [81]

Calgary: Safeworks Supervised Consumption Services (SCS)

Safeworks was located at the Sheldon M. Chumir Health Centre, which operated for several months, as a temporary facility, became fully operational starting April 30, 2018 with services available 24 hours, 7 days a week. [82] : 1  From the day it initially launched in October 30, 2017 to March 31, 2019, 71,096 people had used its services [82] : 1  The staff "responded to a total of 954 overdoses." [82] : 2  In one month alone, "848 unique individuals" made 5,613 visits to the SCS. [82] : 1  Its program is monitored by the Province of Alberta in partnership with the Institute of Health Economics. [82] : 2 

In the City of Lethbridge's commissioned 2020 102-page report, the author noted that "Calgary's Sheldon Chumir SCS has received considerable negative press about the "rampant" social disorder around the SCS, a neighbourhood that is mixed residential and commercial." [33] : 15  According to a May 2019 Calgary Herald article, the 250 meter radius around the safe consumption site Safeworks in Calgary located within the Sheldon M. Chumir Centre has seen a major spike in crime since its opening and described in a report by the police as having become "ground zero for drug, violent and property crimes in the downtown." Within this zone, statistics by the police in 2018 showed a call volume increase to the police by 276% for drug related matters 29% overall increase relative to the three-year average statistics. [83] In May 2019, the Calgary Herald, said that Health Canada announced in February 2019 of approval for Siteworks to operate for another year, conditional to addressing neighborhood safety issues, drug debris and public disorder. [84] There has been a plan for mobile safe consumption site intending to operate in the Forest Lawn, Calgary, Alberta, however in response to the statistics at the permanent site at the Sheldon M. Chumir Centre, community leaders have withdrawn their support. [85]

By September 2019, the number of overdose treatment at Safeworks spiked. The staff were overwhelmed and 13.5% of their staff took psychological leave. They have had dealt with 134 overdose reversals in 2019 which was 300% more than the same time period from the previous year. The center's director reported they're dealing with an average of one overdose reversal every other day. [86]

Lethbridge: ARCHES (Closed August 2020)

In response to the mounting death toll of drug overdose in Lethbridge, the city opened its first SCS in February, 2018. [33] : 15  The controversial [87] SCS, known as ARCHES was once the busiest SCS in North America. [88]

The province defunded ARCHES after an audit ordered by government discovered misuse and mismanagement of public monies. Around 70% of ARCHES funding comes from the province, [89] and it chose to shut it down on August 31, 2020 after the funding was revoked. [88] The audit found “funding misappropriation, non-compliance with grant agreement [and] inappropriate governance and organizational operations.” [89] The Alberta government requested that the site be investigated for possible criminal misuse of funds. [90] Shortly afterwards, Lethbridge Police Service announced that the funds, which had previously been reported as missing, had been present and accounted for in bank accounts belonging to the SCS. Acting Inspector Pete Christos stated that the initial auditors did not have the means to determine whether money was missing, and confirmed that, during police interviews with Arches staff, all spent funds had been accounted for. Police Chief Shahin Mehdizadeh told reporters that the Alberta Justice Specialized Prosecutions Branch supported the police's findings and were not recommending criminal charges. [91]

The City of Lethbridge commissioned a report that included an Urban Social Issues Study (USIS) which examined unintended consequences of the SIS site in Lethbridge. [33] The research found that in smaller cities, such as Lethbridge, that in communities with a SCS, social disorder may be more noticeable. The report's author, University of Lethbridge's Em M. Pijl, said that news media tended to the "personal experiences of business owners and residents who work and/or live near an SCS", which contrasts with "scholarly literature that demonstrates a lack of negative neighbourhood impacts related to SCSs." [33] : 14 

Impact on community levels of overdose

Over a nine-year period the Sydney MSIC managed 3,426 overdose-related events with not one fatality [92] while Vancouver’s Insite had managed 336 overdose events in 2007 with not a single fatality.

The 2010 MSIC evaluators found that over 9 years of operation it had made no discernible impact on heroin overdoses at the community level with no improvement in overdose presentations at hospital emergency wards. [93] : 19–20 

Research by injecting room evaluators in 2007 presented statistical evidence that there had been later reductions in ambulance callouts during injecting room hours, [94] [95] [96] but failed to make any mention of the introduction of sniffer dog policing, introduced to the drug hot-spots around the injecting room a year after it opened. [97]

Site experience of overdose

While overdoses are managed on-site at Vancouver, Sydney and the facility near Madrid, German consumption rooms are forced to call an ambulance due to naloxone being administered only by doctors. A study of German consumption rooms indicated that an ambulance was called in 71% of emergencies and naloxone administered in 59% of cases. The facilities in Sydney and Frankfurt indicate 2.2-8.4% of emergencies resulting in hospitalization. [98]

Vancouver’s Insite yielded 13 overdoses per 10,000 injections shortly after commencement, [99] but in 2009 had more than doubled to 27 per 10,000. [100] The Sydney MSIC recorded 96 overdoses per 10,000 injections for those using heroin. [101] Commenting on the high overdose rates in the Sydney MSIC, the evaluators suggested that,

“In this study of the Sydney injecting room there were 9.2 (sic) heroin overdoses per 1000 heroin injections in the centre. This rate of overdose is higher than amongst heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room. [102]

People living with HIV/AIDS

The results of a research project undertaken at the Dr. Peter Centre (DPC), a 24-bed residential HIV/AIDS care facility located in Vancouver, were published in the Journal of the International AIDS Society in March 2014, stating that the provision of supervised injection services at the facility improved health outcomes for DPC residents. The DPC considers the incorporation of such services as central to a "comprehensive harm reduction strategy" and the research team concluded, through interviews with 13 residents, that "the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services", in addition to creating a setting in which drug use could be discussed honestly. Highly active antiretroviral therapy (HAART) medication adherence and survival are cited as two improved health outcomes. [103]

Crime

The Sydney MSIC was judged by its evaluators to have caused no increase in crime [104] and not to have caused a ‘honey-pot effect’ of drawing users and drug dealers to the Kings Cross area. [105]

Observations before and after the opening of Insite indicated no increases in drug dealing or petty crime in the area. There was no evidence that the facility influenced drug use in the community, but concerns that Insite ‘sends the wrong message’ to non-users could not be addressed from existing data. [106] The European experience has been mixed. [107]

Financial impropriety by SCS service providers

An audit of Lethbridge ARCHES SCS by accounting firm Deloitte, ordered by the Alberta provincial government, found the SCS had $1.6 million in unaccounted funds between 2017 and 2018; additionally they found that led[ clarification needed ] $342,943 of grant funds had been expended on senior executive compensation despite the grant agreement allowing only $80,000. Beyond this, an additional $13,000 was spent on parties, staff retreats, entertainment and gift cards, [90] and numerous other inappropriate expenditures. [90]

The Lethbridge Police Service and Alberta Justice Specialized Prosecutions Branch later contradicted these findings, stating that all funds were present and accounted for in accounts belonging to the agency. When asked why these funds had previously been reported as missing, LPS Acting Inspector Pete Christos stated that the initial auditors did not have the means to investigate the agency's finances, and that all spending had been accounted for during the criminal probe.

Premier Jason Kenney did not dispute the results of the investigation, but declined to reinstate funding, claiming that the site's management had lost the confidence of his government. [91]

Community perception

The Expert Advisory Committee for Vancouver’s Insite found that health professionals, local police, the local community and the general public have positive or neutral views of the service, with opposition decreasing over time. [106]

Predicted cost effectiveness

The cost of running Insite per annum is CA$3 million. Mathematical modeling showed cost to benefit ratios of one dollar spent ranging from 1.5 to 4.02 in benefit. However, the Expert Advisory Committee expressed reservation about the certainty of Insite’s cost effectiveness until proper longitudinal studies had been undertaken. Mathematical models for HIV transmissions foregone had not been locally validated and mathematical modeling from lives saved by the facility had not been validated. [77]

See also

Related Research Articles

<span class="mw-page-title-main">Harm reduction</span> Public health policies which lessen negative aspects of problematic activities

Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.

<span class="mw-page-title-main">Naloxone</span> Opioid receptor antagonist

Naloxone is an opioid antagonist: a medication used to reverse or reduce the effects of opioids. For example, it is used to restore breathing after an opioid overdose. It is also known as Narcan. Effects begin within two minutes when given intravenously, five minutes when injected into a muscle, and ten minutes as a nasal spray. Naloxone blocks the effects of opioids for 30 to 90 minutes.

<span class="mw-page-title-main">Lethbridge</span> City in Alberta, Canada

Lethbridge is a city in the province of Alberta, Canada. With a population of 106,550 in the 2023 municipal census, Lethbridge became the fourth Alberta city to surpass 100,000 people. The nearby Canadian Rocky Mountains contribute to the city's warm summers, mild winters, and windy climate. Lethbridge lies approximately 215 km (134 mi) southeast of Calgary on the Oldman River and 105 km (65 mi) northwest of the Canada–United States border at the Sweetgrass–Coutts Border Crossing.

Needle sharing is the practice of intravenous drug-users by which a needle or syringe is shared by multiple individuals to administer intravenous drugs such as heroin, steroids, and hormones. This is a primary vector for blood-borne diseases which can be transmitted through blood. People who inject drugs (PWID) are at an increased risk for Hepatitis C (HCV) and HIV due to needle sharing practices. From 1933 to 1943, malaria was spread between users in the New York City area by this method. Afterwards, the use of quinine as a cutting agent in drug mixes became more common. Harm reduction efforts including safe disposal of needles, supervised injection sites, and public education may help bring awareness on safer needle sharing practices.

<span class="mw-page-title-main">Kings Cross, New South Wales</span> Place in New South Wales, Australia

Kings Cross is an inner-eastern locality of Sydney, New South Wales, Australia. It is located approximately 2 kilometres east of the Sydney central business district, in the local government area of the City of Sydney. It is bounded by the suburbs of Potts Point, Elizabeth Bay, Rushcutters Bay and Darlinghurst.

<span class="mw-page-title-main">Insite</span> Safe drug injection facility in Vancouver, B.C., Canada

Insite is a supervised drug injection site in the Downtown Eastside (DTES) neighbourhood of Vancouver, British Columbia, Canada The DTES had 4,700 chronic drug users in 2000 and has been considered to be the centre of an "injection drug epidemic". The site provides a supervised and health-focused location for injection drug use, primarily heroin. The clinic does not supply any drugs. Medical staff are present to provide addiction treatment, mental health assistance, and first aid in the event of an overdose or wound. In 2017, the site recorded 175,464 visits by 7,301 unique users; 2,151 overdoses occurred with no fatalities, due to intervention by medical staff. The site also offers a free checking service so clients can check their substances for fentanyl and carfentanil. Health Canada has provided $500,000 per year to operate the site, and the BC Ministry of Health contributed $1,200,000 to renovate the site and cover operating costs. Insite also serves as a resource for those seeking to use a harm reduction approach for people who inject drugs around the world. In recent months and years, delegations from a number of countries are on record touring the facility, including various U.S. states, Colombia and Brazil. 95% of drug users who use Insite also inject on the street according to a British Columbia health official.

Illicit drug use in Australia is the recreational use of prohibited drugs in Australia. Illicit drugs include illegal drugs, pharmaceutical drugs when used for non-medical purposes, and other substances used inappropriately. According to government and community organisations, the use and abuse, and the illegality, of illicit drugs is a social, health and legal issue that creates an annual illegal market estimated to be worth A$6.7 billion. Estimates made in 2022 place the figure at A$11.3 billion per year.

<span class="mw-page-title-main">Sheldon M. Chumir Centre</span> Hospital in Alberta, Canada

The Sheldon M. Chumir Centre is a health centre located in Calgary, Alberta. The facility is administered by the Calgary Zone of Alberta Health Services. The centre provides 24/7 Urgent Care services but is not a full-service hospital and does not admit any patients for overnight stays.

<span class="mw-page-title-main">Vancouver Area Network of Drug Users</span> Organization

The Vancouver Area Network of Drug Users or VANDU is a not-for-profit organization and advocacy group based in Vancouver, British Columbia, Canada. The group believes that all drug users should have their own rights and freedoms. The group's members have been actively involved in lobbying for support of Insite, North America's first safe injection site, located in the Downtown Eastside of Vancouver.

Heroin-assisted treatment (HAT), or diamorphine-assisted treatment, refers to a type of Medication-Assisted Treatment (MAT) where semi-synthetic heroin is prescribed to opiate addicts who do not benefit from, or cannot tolerate, treatment with one of the established drugs used in opiate replacement therapy such as methadone or buprenorphine. For this group of patients, heroin-assisted treatment has proven superior in improving their social and health situation. Heroin-assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Canada, and Denmark. Additional trials are being carried out in the United Kingdom, Norway, and Belgium.

Responsible drug use seeks to maximize the benefits and minimize the risks associated with psychoactive drug use. For illegal psychoactive drugs that are not diverted prescription controlled substances, some critics believe that illegal recreational drug use is inherently irresponsible, due to the unpredictable and unmonitored strength and purity of the drugs and the risks of addiction, infection, and other side effects.

Portland Hotel Society (PHS) is a Canadian non-profit society created in 1993 to provide advocacy, housing, services, and opportunities, for Vancouver's Downtown Eastside. Its staff support thousands of supportive housing rooms and operate North America's first legal supervised-injection site, Insite, a Downtown Eastside credit union branch, a food service that feeds people in single-room occupancy residences, and other social services and enterprises.

Perry Kendall, is a Canadian Public health physician who was Provincial Health Officer (PHO) for the Canadian province of British Columbia's health ministry from 1999-2018 and was awarded the Order of British Columbia for contributions to Public health field and to harm reduction policy and practice.

<span class="mw-page-title-main">Opioid epidemic</span> Deaths due to abuse of opioid drugs

The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.

<span class="mw-page-title-main">Uniting Medically Supervised Injecting Centre</span> Hospital in New South Wales, Australia

The Uniting Medically Supervised Injecting Centre Kings Cross is a state government-supported facility in Kings Cross, New South Wales that provides safe injecting rooms, sterile equipment and medical supervision for individuals who wish to administer an illicit drug intravenously.

<span class="mw-page-title-main">Heroin in Australia</span>

Heroin is classified as an opioid drug produced from the opium poppy. The illicit use of heroin in Australia emerged during the 1960s. Its origins have been linked to American troops stationed in major cities such as Melbourne and Sydney, who introduced the drug to the red-light districts whilst on their recreational leave.

<span class="mw-page-title-main">ARCHES Lethbridge</span> Non-profit organization

ARCHES is a non-profit organization based in Lethbridge, Alberta, that works to reduce the harm associated with HIV/AIDS and Hepatitis C, known for operating the province-funded Lethbridge Supervised Consumption Site from February 2018 until closing in August 2020. ARCHES started in 1986, specifically focused on helping the gay community. Over time, ARCHES became a community-based organization. The SCS it operated was the busiest drug consumption site in North America. It decided to close the site following the withdrawal of government funding after an initial audit found evidence of various misappropriation of funds and lack of accounting for more than a million dollars of its funding. The concerns around unaccounted funds were investigated by Lethbridge Police Service Economics Crimes Unit, which located the missing financial records, resulting in no criminal charges. While criminally not charged, funding to the organization remains withheld as some of their spending did not comply with grant agreement.

Liz Evans is a Canadian nurse and harm reduction pioneer. She is the founder of the nonprofit Portland Hotel Society and a cofounder of North America's first sanctioned supervised-injection facility, Insite.

Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.

<span class="mw-page-title-main">OnPoint NYC</span> New York City nonprofit that operates safe injection sites

OnPoint NYC is a New York City nonprofit that operates two privately run safe injection sites in East Harlem and Washington Heights. Placed at the sites of existing syringe service programs, these were America's first safe injection facilities when they opened in November 2021.

References

  1. 1 2 Alan Ogborne; et al. (March 31, 2008). "Vancouver's INSITE service and other Supervised injection sites: What has been learned from research? - Final report of the Expert Advisory Committee". Health Canada.
  2. 1 2 3 4 Dagmar Hedrich; et al. (April 2010). "Chapter 11: Drug consumption facilities in Europe and beyond". Harm reduction: evidence, impacts and challenges. EMCDDA.
  3. ↑ Oladipo, Gloria (30 November 2021). "New York to open supervised injection sites in bid to curb overdose deaths". The Guardian. Retrieved 6 March 2022.
  4. ↑ "New report presents latest overview on drug consumption rooms in Europe". European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). 19 December 2023. Retrieved 22 December 2023.
  5. ↑ Gordon, Elana (September 7, 2018). "What's The Evidence That Supervised Drug Injection Sites Save Lives?". NPR .
  6. ↑ "Overdose Prevention Centers (OPCs)". Drug Policy Alliance.
  7. ↑ Academies, Committee on the Prevention of HIV Infection Among Injecting Drug Users in High-Risk Countries, Board on Global Health, Institute of Medicine of the National (2007). Preventing HIV infection among injecting drug users in high-risk countries an assessment of the evidence. Washington, D.C.: National Academies Press. doi:10.17226/11731. ISBN   978-0-309-10280-3.{{cite book}}: CS1 maint: multiple names: authors list (link)[ dead link ]
  8. ↑ Learmonth, Andrew (17 December 2020). "Boris Johnson pledges to discuss safe drug consumption rooms for users". The National. Retrieved 21 January 2021.
  9. ↑ Townsend, Mark (17 August 2019). "Safe injection rooms are key to halting rise in drug deaths – expert". The Guardian. Retrieved 21 January 2021.
  10. ↑ "Denmark's 'Fix Rooms' Give Drug Users a Safe Haven". NPR .
  11. 1 2 Busby, Mattha (21 November 2018). "How 'fixing rooms' are saving the lives of drug addicts in Europe". The Guardian. Retrieved 28 January 2021.
  12. ↑ Easton, Mark (12 October 2017). "Are UK drug consumption rooms likely?". BBC News. Retrieved 21 January 2021.
  13. ↑ "Medically supervised injecting centres save lives". Alcohol and Drug Foundation. 14 Aug 2023.
  14. ↑ Thomas, Matthew. "Sydney's Medically Supervised Injecting Centre". Australian Parliamentary Library. Retrieved 28 October 2020.
  15. ↑ "Medically supervised injecting room". Health.vic. Retrieved 28 October 2020.
  16. ↑ Eddie, Rachel; Waters, Cara (7 March 2023). "Second Melbourne injecting room in limbo as Andrews walks back commitment". The Age. Retrieved 7 March 2023.
  17. 1 2 Dolan, Kate; Kimber, Jo; Fry, Craig; Fitzgerald, John; Mcdonald, David; Trautman, Franz (2000). "Drug consumption facilities in Europe and the establishment of supervised injection centres in Australia" (PDF). Drug and Alcohol Review. 19 (3): 337–346. doi:10.1080/713659379. Archived from the original (PDF) on 2004-09-24.
  18. ↑ EMCDDA. "Infographic. Location and number of drug consumption facilities throughout Europe | www.emcdda.europa.eu". www.emcdda.europa.eu. Retrieved July 26, 2022.
  19. ↑ McCann, Eugene; Duffin, Tony (January 20, 2022). "Opinion: Supervised drug injecting in Ireland – 10 years of advocacy, legislation and delays". TheJournal.ie. Retrieved July 26, 2022.
  20. ↑ Hedrich, Dagmar (February 2004). "European report on drug consumption rooms" (PDF). European Monitoring Centre for Drugs and Drug Addiction. Archived from the original (PDF) on March 26, 2020. Retrieved October 5, 2020.
  21. ↑ Haemmig, Robert; Ingrid van Beek (2005). "13 Supervised Injecting Room". In Richard Pates; Andrew McBride; Karin Arnold (eds.). Injecting Illicit Drugs. Blackwell Publishing. pp. 160–169. ISBN   978-1-4051-1360-1.
  22. ↑ Livingston, Eve (19 September 2020). "'It's a lifesaver': Glasgow drug users and MP hail safe-injecting space". the Guardian. Retrieved July 26, 2022.
  23. ↑ Shorter, Gillian W; Harris, Magdalena; McAuley, Andrew; Trayner, Kirsten MA; Stevens, Alex (June 2022). "The United Kingdom's first unsanctioned overdose prevention site; A proof-of-concept evaluation". International Journal of Drug Policy. 104: 103670. doi: 10.1016/j.drugpo.2022.103670 . PMID   35523063. S2CID   248553098.
  24. ↑ Davies, Natalie (26 July 2022). "Inside the UK's first unsanctioned drug consumption room". SSA. Retrieved July 26, 2022.
  25. ↑ "The United Kingdom's first unsanctioned overdose prevention site; A proof-of-concept evaluation". International Journal of Drug Policy, Volume 104. 4 May 2022. Retrieved 23 December 2023.
  26. ↑ "No prosecution plan for drug consumption rooms". BBC News. 2023-09-11. Retrieved 2023-10-13.
  27. ↑ "UK's first drugs consumption room to open in October". BBC News. 2024-08-21. Retrieved 2024-08-21.
  28. ↑ "La titánica labor de acompañar a usuarios de heroína: "Le hacemos la tarea a salud pública"". 7 October 2024.
  29. ↑ Espectador, El. "ELESPECTADOR.COM". ELESPECTADOR.COM (in Spanish). Retrieved 2024-12-02.
  30. 1 2 "Debate over supervised consumption sites ramps up across Alberta". Global News. Retrieved 2020-10-07.
  31. ↑ Van Beek, Ingrid (2004). In the eye of the needle: Diary of medically supervised injecting centre. Crows Nest: Allen & Unwin. ISBN   978-1-74114-381-2. OCLC   57515258.
  32. ↑ Roulston, Tom; Nixon, Liam (July 23, 2020). "ARCHES audit findings turned over to Lethbridge police for investigation". Global News. Retrieved 2020-09-27.
  33. 1 2 3 4 5 6 7 8 9 10 Pijl, Em M. (January 13, 2020). Urban social issues study: Impacts of the Lethbridge supervised consumption site on the local neighbourhood (PDF) (Report). University of Lethbridge for the City of Lethbridge. p. 102. Retrieved January 26, 2020. Report commissioned by the City of Lethbridge
  34. 1 2 Vogt, Terry (2020-03-05). "Government review says Lethbridge SCS has 'most problems in the province'". Calgary. Retrieved 2020-10-07.
  35. ↑ Labby, Bryan (September 26, 2020). "3 weeks after province ends funding for injection site, unsanctioned space opens in Lethbridge". CBC News.
  36. ↑ Gunn, Connor. "Galt Gardens pop-up injection site moves location on 2nd night". Lethbridge News Now. Retrieved 2020-09-27.
  37. ↑ "Unsanctioned injection site sets up in Galt Gardens". The Lethbridge Herald – News and Sports from around Lethbridge. 2020-09-26. Retrieved 2020-09-27.
  38. ↑ Ferris, Danica (September 29, 2020). "Pop-up overdose prevention site operators fined $300 by City of Lethbridge". Global News. Retrieved 2020-10-03.
  39. ↑ "Lethbridge group sets up unsanctioned overdose prevention site in Galt Gardens". Global News. Retrieved 2020-09-27.
  40. ↑ Korol, Todd (October 5, 2020). "Lethbridge drug-consumption site seeks Health Canada's permission to operate". The Globe and Mail. Retrieved 2020-10-07.
  41. ↑ Goulet, Justin (September 29, 2020). "Organizer of pop-up injection site issued fine". Lethbridge News Now. Retrieved 2020-10-01.
  42. ↑ Barrow, Tyler (2020-09-28). "Protestors gather outside Lethbridge city hall frustrated over pop-up overdose prevention site". Calgary. Retrieved 2020-09-29.
  43. ↑ Kral, Alex H.; Lambdin, Barrot H.; Wenger, Lynn D.; Davidson, Pete J. (2020-08-06). "Evaluation of an Unsanctioned Safe Consumption Site in the United States". New England Journal of Medicine. 383 (6): 589–590. doi: 10.1056/NEJMc2015435 . ISSN   0028-4793. PMID   32640126.
  44. ↑ "Deputy Attorney General Jeffrey A. Rosen Delivers Remarks at Wake Forest School of Law". www.justice.gov. 2019-11-08. Retrieved 2022-07-25.
  45. ↑ "Cities Planning Supervised Drug Injection Sites Fear Justice Department Reaction". NPR . Archived from the original on 2023-05-13.
  46. ↑ Hayes, Elizabeth (March 15, 2018). "A legal site in Portland to inject heroin? Elected officials, advocates explore the idea". Portland Business Journal. Retrieved April 28, 2019.
  47. ↑ Somerville Delays Plan To Open First Supervised Drug Use Clinic In Massachusetts
  48. ↑ "Effectiveness of safe injection sites to be evaluated in government-backed study". PBS NewsHour. 2023-05-08. Retrieved 2023-09-05.
  49. ↑ KKTV (December 4, 2018). "DEA responds to proposed safe injection site in Colorado for illegal drugs". KKTV. Retrieved 2019-04-20.
  50. ↑ Kim, Phenix (2022-12-03). "New York City's first safe injection sites avert 633 drug overdoses on anniversary". NYN Media. Retrieved 2023-06-15.
  51. ↑ Harocopos, Alex; Gibson, Brent E.; Saha, Nilova; McRae, Michael T.; See, Kailin; Rivera, Sam; Chokshi, Dave A. (2022-07-15). "First 2 Months of Operation at First Publicly Recognized Overdose Prevention Centers in US". JAMA Network Open. 5 (7): e2222149. doi:10.1001/jamanetworkopen.2022.22149. ISSN   2574-3805. PMC   9287749 . PMID   35838672. S2CID   250559693.
  52. ↑ Moraff, Christopher (2022-02-18). "The Radical Experiment Saving the Lives of Drug Users". Intelligencer. Retrieved 2022-07-25.
  53. ↑ Lewis, Caroline (2021-12-17). "A Look Inside NYC's Supervised Drug-Injection Sites, The First In The Nation". Gothamist. Retrieved 2022-07-25.
  54. ↑ Mays, Jeffery C.; Newman, Andy (2021-11-30). "Nation's First Supervised Drug-Injection Sites Open in New York". The New York Times. ISSN   0362-4331 . Retrieved 2022-07-25.
  55. 1 2 "When Safe Injection Sites Close, Subway Becomes Next Best Stop". The City. 2022-05-17. Retrieved 2022-07-25.
  56. ↑ Mann, Brian; Lewis, Caroline (2021-11-30). "New York City allows the nation's 1st supervised consumption sites for illegal drugs". All Things Considered. Retrieved 2022-07-25– via NPR.org.
  57. ↑ "Justice Department Signals it May Allow Safe Injection Sites". WTTW News. Retrieved 2022-07-25.
  58. ↑ "Safehouse drops South Philly plans, looks to Kensington after judge suspends launch". Billy Penn. 26 June 2020. Retrieved 2020-10-07.
  59. ↑ Lauren del Valle and Dakin Andone (28 February 2020). "Plans are on hold for a Philadelphia safe-injection site to combat overdoses". CNN. Retrieved 2020-10-07.
  60. ↑ Tanenbaum, Michael (February 26, 2020). "Safehouse's plan to open overdose prevention site in South Philly sparks contentious reaction". www.phillyvoice.com. Retrieved 2020-10-07.
  61. ↑ In Philadelphia, Judges Rule Against Opening 'Supervised' Site To Inject Opioids
  62. ↑ Whelan, Aubrey (April 3, 2019). "Supervised injection site supporters countersue feds, saying their Philly mission comes from religious and medical imperatives". The Inquirer Daily News. Retrieved 2019-04-20.
  63. ↑ Whelan, Aubrey; McGoldrick, Gillian (2023-05-01). "State Senate approves ban of supervised injection sites in Pa". Philadelphia Inquirer. Retrieved 2023-09-03.
  64. ↑ "Advocates, SF supervisors push back on Tenderloin safe injection site closure - CBS San Francisco". www.cbsnews.com. 2022-12-13. Retrieved 2023-08-13. He said the plan was for the Tenderloin Center to be a resource center while the Department of Public Health created a number of so-called "wellness hubs" around the city where addicts could consume their drugs, while being monitored to prevent overdoses. In its eleven months of operation as a consumption site, the Tenderloin Center reportedly prevented more than 300 deaths. But now that the facility has closed, Seymour—and a lot of other people—feel betrayed.
  65. ↑ Sjostedt, David (May 11, 2022). "'Tenderloin Linkage Center' Morphs into Safe Consumption Site, Despite Legal Risks". The San Francisco Standard. Retrieved 2023-08-13.
  66. ↑ Matskiv, G.; Marshall, T.; Krieg, O.; Viste, D.; Ghosh, S. M. (2022). "Virtual overdose monitoring services: A novel adjunctive harm reduction approach for addressing the overdose crisis". Canadian Medical Association Journal. 194 (46): E1568–E1572. doi:10.1503/cmaj.220579. PMC   9828965 . PMID   36442886.
  67. ↑ "When naloxone isn't enough: How technology can save lives when people use drugs alone". 8 June 2023.
  68. ↑ EMCDDA "European report on drug consumption rooms" (PDF). 2004. p. 27. Archived from the original (PDF) on 2020-03-26. Retrieved 2010-04-28.
  69. ↑ EMCDDA "Harm Reduction: Evidence, Impacts and Challenges". 2010. p. 308. Retrieved 2010-06-09.
  70. ↑ "MSIC Evaluations". 2008. Retrieved 2010-01-09.
  71. ↑ Townsend, Mark (17 August 2019). "Safe injection rooms are key to halting rise in drug deaths – expert". The Guardian. Retrieved 1 December 2021.
  72. ↑ Holpuch, Amanda (8 August 2017). "Secret supervised drug injection facility has been operating at US site for years". The Guardian. Retrieved 1 December 2021.
  73. ↑ Smith, Callum (9 August 2019). "Discarded needles prompt calls for safe injection sites, more addictions supports in N.B." Global News. Retrieved 1 December 2021.
  74. ↑ Dubinski, Kate (2 May 2018). "Why this children's mentoring program is supporting supervised consumption sites". CBC. Retrieved 1 December 2021.
  75. ↑ MacLean, Cameron (18 April 2018). "Supervised injection site needed for drug users in Manitoba: Canadian Mental Health Association report". CBC News. Retrieved 1 December 2021.
  76. ↑ here.
  77. 1 2 3 see "Final Report of the Vancouver Insite Expert Advisory Committee". 2008-04-03. Retrieved 2010-04-19.
  78. 1 2 Pradelli, Chad (July 18, 2018). "Opioid Crisis: Action News investigates safe injection sites in Canada". WPVI-TV Action News. Retrieved March 22, 2020.
  79. ↑ NCHECR, "Sydney Medically Supervised Injecting Centre Evaluation Report No. 4" (PDF). Archived (PDF) from the original on 2018-04-17. Retrieved 2019-02-06. 2007 pp. 7, 39
  80. 1 2 "Responding to Alberta's Opioid Crisis" (PDF). Alberta Health Services (AHS), Office of the Chief Medical Officer of Health. Public progress report: 9. November 30, 2016. Retrieved January 26, 2020.
  81. ↑ McGarrigle, Colin; Breakenridge, Dave; Mah, Bill (January 24, 2020). "Balanced view of consumption sites required". Edmonton Journal . Editorial. Retrieved January 26, 2020.
  82. 1 2 3 4 5 "March 2019: Supervised Consumption Services" (PDF), Alberta Health Services (AHS), Safeworks Monthly Report, p. 4, April 11, 2019, retrieved January 26, 2020
  83. ↑ Hudes, Sammy (May 21, 2019). "Crime near Calgary's only safe consumption site remains a concern". Calgary Herald. Retrieved January 26, 2020.
  84. ↑ Breakenridge, Rob (2019-02-05). "Breakenridge: Fix crime issues around Safeworks or risk losing it | Calgary Herald" . Retrieved 2019-10-11.
  85. ↑ Logan, Shawn (2019-02-05). "Forest Lawn withdraws support for mobile safe consumption vehicle | Calgary Herald" . Retrieved 2019-10-11.
  86. ↑ Villani, Mark (September 12, 2019). "Spike in overdose treatments overwhelms staff at Calgary shelters". CTV News Calgary. Retrieved October 25, 2019.
  87. ↑ Goulet, Justin. "ARCHES ceases supervised consumption services in Lethbridge". Lethbridge News Now. Retrieved 2020-09-26.
  88. 1 2 Fletcher, Robson (September 23, 2020). "Opioid overdoses spike amid COVID-19 pandemic, with more than 3 Albertans dying per day". CBC.
  89. 1 2 "MLA Shannon Phillips and others react to ARCHES losing provincial funding after government-ordered audit". Global News. Retrieved 2020-09-26.
  90. 1 2 3 Bourne, Kirby; Therien, Eloise (July 16, 2020). "Government pulls grant funding from Lethbridge safe consumption site citing fund mismanagement". Globalnews.ca. Retrieved 2020-09-26.
  91. 1 2 Vogt, Terry (December 22, 2020). "Missing ARCHES funds accounted for: Lethbridge police". CTV News Calgary. CTV News. Retrieved 25 April 2023.
  92. ↑ name=KPMG "Further Evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011)" (PDF). Retrieved 2010-10-23. p. 2
  93. ↑ "Further Evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011)" (PDF). Retrieved 2010-10-23.
  94. ↑ Salmon, Allison; Van Beek, Ingrid; Amin, Janaki; Kaldor, John; Maher, Lisa (February 2010). "The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia". Addiction. 105 (4): 676–683. doi:10.1111/j.1360-0443.2009.02837.x. PMID   20148794. Archived from the original on 2013-01-05.
  95. ↑ Beletsky, Leo; Davis, Corey S; Anderson, Evan; Burris, Scott (February 2008). "The law (and politics) of safe injection facilities in the United States". American Journal of Public Health. 98 (2): 231–7. doi:10.2105/AJPH.2006.103747. PMC   2376869 . PMID   18172151.
  96. ↑ Kerr, Thomas; Kimber, Jo; Rhodes, Tim (January 2007). "Drug use settings: an emerging focus for research and intervention". The International Journal on Drug Policy. 18 (1): 1–4. doi:10.1016/j.drugpo.2006.12.016. PMID   17689337.
  97. ↑ "Police to crack down on Kings Cross drug trade". Australian Broadcasting Corporation . Retrieved 2010-01-09. 2003
  98. ↑ Hedrich, D "A Report on European Consumption Rooms" (PDF). Archived from the original (PDF) on 2020-03-26. Retrieved 2010-05-28. EMCDDA 2004 p. 46
  99. ↑ Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E. "Drug-related overdoses within a medically supervised safer injection facility" (PDF). 2008. Retrieved 2010-05-01.
  100. ↑ see "User Statistics". 2009. Retrieved 2010-05-01.
  101. ↑ 2003 MSIC Evaluation Committee "Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre" (PDF). Archived from the original (PDF) on 2009-10-29. Retrieved 2010-01-09. 2003 p. 24
  102. ↑ 2003 MSIC Evaluation Committee "Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre" (PDF). Archived from the original (PDF) on 2009-10-29. Retrieved 2010-01-09. 2003 p. 59
  103. ↑ McNeil, R; et al. (13 March 2014). "Impact of supervised drug consumption services on access to and engagement with care at a palliative and supportive care facility for people living with HIV/AIDS: a qualitative study". Journal of the International AIDS Society. 17 (1): 18855. doi:10.7448/IAS.17.1.18855. PMC   3955762 . PMID   24629844.
  104. ↑ 2003 MSIC Evaluation Committee "Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre" (PDF). Archived from the original (PDF) on 2009-10-29. Retrieved 2010-01-09. 2003 p. xvi
  105. ↑ 2003 MSIC Evaluation Committee "Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre" (PDF). Archived from the original (PDF) on 2009-10-29. Retrieved 2010-01-09. 2003 p. 204
  106. 1 2 see Executive Summary of "Final Report of the Vancouver Insite Expert Advisory Committee". 2008-04-03. Retrieved 2010-04-19.
  107. ↑ see Sections A7 to A9 of Appendix B "Final Report of the Vancouver Insite Expert Advisory Committee". 2008-04-03. Retrieved 2010-04-19.

Commons-logo.svg Media related to Safe injection sites at Wikimedia Commons

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.