A Description of a Peer-Run Supervised Injection Site for Injection Drug Users

Kerr, Thomas

doi:10.1093/jurban/jti050

Cited by 61 publications

(51 citation statements)

References 20 publications

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“…Beyond providing a less visible location for injection, shooting galleries also provide a place where syringes can be easily obtained, thus eliminating the need for users to carry their own syringe but increasing the likelihood of syringe sharing. Other studies (Cooper et al 2005;Kerr et al 2005;Rhodes et al 2003;Wood et al 2003) have similarly demonstrated that policing activities can have an adverse effect on IDUs' abilities to adhere to safe injection practices by discouraging sterile syringe seeking, promoting syringe sharing, and rushing injection to avoid detection. In this context, shooting gallery use may be viewed as a practical response to structural level barriers to possession and safe usage of sterile syringes (Celentano et al 1991;Vlahov et al 1990).…”

Section: Discussionmentioning

confidence: 98%

Shooting Gallery Attendance among IDUs in Tijuana and Ciudad Juarez, Mexico: Correlates, Prevention Opportunities, and the Role of the Environment

et al. 2008

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We identified factors associated with shooting gallery attendance among injection drug users (IDUs) in two Mexico-US border cities. IDUs in Tijuana (n=222) and Ciudad Juarez (n=205), Mexico, who were >or=18 years and injected illicit drugs in the last month were recruited using respondent-driven sampling (RDS). An interviewer-administered survey collected sociodemographic and behavioral data. Logistic regression was used to examine correlates of shooting gallery attendance in each of the two cities. Homelessness and being arrested for syringe possession--both structural level factors--were associated with shooting gallery use in both cities. In Ciudad Juarez, younger age and having overdosed were also associated with shooting gallery use. Our study highlights the need for structural interventions that mitigate homelessness among IDUs and facilitate changes in law enforcement practices associated with shooting gallery use. Harm reduction interventions based within shooting galleries should also be considered to prevent transmission of blood-borne pathogens among IDUs.

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Section: Discussionmentioning

confidence: 98%

Shooting Gallery Attendance among IDUs in Tijuana and Ciudad Juarez, Mexico: Correlates, Prevention Opportunities, and the Role of the Environment

et al. 2008

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“…54 Supervised injection facilities exist in over 2 dozen cities in Europe and Australia. [55][56][57] An economic evaluation of the safe injection facility in Sydney, Australia, used a costbenefit approach and estimated that the ratio of benefits to costs may not be favourable at start-up but would probably become so in the future. 58 A previous analysis of Vancouver's facility indicated a favourable cost-benefit ratio and a cost of $52 000-$155 000 per case of HIV infection averted, which is considerably higher than our estimate.…”

Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of Vancouver's supervised injection facility

Bayoumi¹,

Zaric²

2008

Canadian Medical Association Journal

118

123

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Supervised injection sites offer a safe and hygienic environment for people to inject their previously obtained illicit drugs under supervision.1,2 Observational studies from the facility in Vancouver, British Columbia, have demonstrated positive effects: a decrease in needle sharing and reuse of syringes, fewer people injecting drugs in public, an increase in referrals to social services and addiction counselling, a decrease in the number of publicly discarded syringes, no apparent increase in police reports of drug dealing or crime, and no observed increase in new initiates into drug use. [3][4][5] Although an expert advisory committee recently concluded that the Vancouver facility has beneficial effects, prominent law enforcement groups have argued that the resources allocated to the facility would be more effectively spent elsewhere. 6,7 We used computer simulation to estimate the projected impact of Vancouver's supervised injection site on survival, rates of HIV and hepatitis C virus infection, referral to methadone maintenance treatment and associated costs. Our goal was to assess the cost-effectiveness of the facility and thus provide important insights into this policy debate. Methods Simulation modelWe developed a dynamic compartmental model to simulate the population of Vancouver, British Columbia. The population included injection drug users, non-users, persons with HIV and hepatitis C virus infection, and those with combinations of these states. Our model categorized populations into discrete compartments. By defining the probabilities of moving between compartments, we were able to project the prevalence of each model state throughout the time horizon of the simulation. Tracking the time spent in each state allowed us to estimate survival. Assigning a cost to each state allowed us to estimate net costs of treatment. The perspective of the model was that of a health care system. Accordingly, we included direct medical costs but did not include indirect medical costs or other societal costs. We used a time horizon of 10 years and updated the proportion in each model state every 0.1 years. We used a discount rate of 5% for both costs and life expectancy.

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“…Given that requiring help injecting is a robust predictor of injection-related harm, it appears that modifying the regulations governing Insite to better accommodate IDU who rely on assisted injection is warranted. A protocol allowing assisted injection was successfully implemented at an unsanctioned peer-run SIF in Vancouver that operated before the opening of Insite (Kerr, Oleson, Tyndall, Montaner, & Wood, 2005), and these measures allowed assisted injections to occur without compromising the operation or the effectiveness of the facility. Furthermore, some drug consumption rooms in Europe have been able to successfully accommodate assisted injections on site, as these state-run facilities permit assisted injections by other clients (Kimber, Dolan, & Wodak, 2005).…”

Section: Discussionmentioning

confidence: 99%

IDU Perspectives on the Design and Operation of North America's First Medically Supervised Injection Facility

Small

Ainsworth

Wood

2010

Substance Use & Misuse

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While the public health benefits of supervised injection facilities (SIFs) have been well documented, there is a lack of research examining the views of injection drug users (IDU) regarding the operation of these facilities. This study used 50 semistructured qualitative interviews to explore IDU perspectives on the design and operation of an SIF in Vancouver, Canada. Although the environment and operation of the SIF are well accepted, long wait times and limited operating hours, as well as regulations that prohibit sharing drugs and assisted injections, pose barriers to using the SIF. Modifying operating procedures and expanding the capacity of the current facility could address these barriers.

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A Description of a Peer-Run Supervised Injection Site for Injection Drug Users

Cited by 61 publications

References 20 publications

Shooting Gallery Attendance among IDUs in Tijuana and Ciudad Juarez, Mexico: Correlates, Prevention Opportunities, and the Role of the Environment

Shooting Gallery Attendance among IDUs in Tijuana and Ciudad Juarez, Mexico: Correlates, Prevention Opportunities, and the Role of the Environment

The cost-effectiveness of Vancouver's supervised injection facility

IDU Perspectives on the Design and Operation of North America's First Medically Supervised Injection Facility

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