Spotlight on supervised drug consumption rooms as the USA looks to open its first facility

31 January 2017

As news hits that the USA is to open up its first safer injecting facility – where else in the world do they exist and why are they important for improving health outcomes?

Used needles on the streets
Safer injecting facilities provide health and social support services for people who use drugs while also keeping discarded needles off the street.

Authorities in Seattle and King County in the state of Washington, USA, last week (27 January) authorised the opening of two safer injecting facilities. These are safe havens where people can access clean injecting equipment and support, while taking illegal and prescription drugs under the supervision of trained healthcare professionals.

The aim of the centres, also known as drug consumption rooms, or supervised injecting facilities, are to reduce harm to people who use drugs and the surrounding communities by reducing the burden of HIV and hepatitis C, and preventing drug overdoses by monitoring drug taking and providing naloxone, a drug overdose antidote, when necessary.

The centres also aim to provide people who inject drugs and their partners with health and other social support services that they would not otherwise access. Often highly marginalised within society, drug users are hard to reach, and the reasons why they enter into drug use often linked to a lack of social support and poor mental wellbeing.

Safer injecting facilities also take drug-taking off the street and have been shown to reduce crime.

“We see this as a public health emergency,” said Jeff Duchin, the health officer for Seattle and King County to the Washington Post. “Clearly the status quo isn’t working anywhere, and clearly we need to look at new tools.”

The USA is grappling with a rising epidemic of opioid use according to the Centers for Disease Control (CDC). From 2002 to 2013, heroin use grew by 63% among white men and women in most age groups and across all income levels. In the decade from 2002, deaths from heroin overdose also quadrupled. In 2014, 9% of all new HIV infections resulted from injecting drug use.

Seattle Mayor Ed Murray said in a statement: “Like many places across our nation, Seattle and King County are experiencing an epidemic of heroin and prescription opiate use unlike any we’ve seen before. Over the last two years, the Seattle Fire Department responded to more than 3,700 incidents related to drug overdoses, as this crisis has affected every community in our city.”

Other USA cities are considering implementing the centres, including Boston, Ithaca, San Francisco and New York City.

While supervised injecting facilities are often not legal, forming alliances with the police on the basis of public health is proving a good workaround. Police in Vancouver, Canada, don’t target people who use Insite – the first safer injecting facility in North America.

Randy Fincham, a staff sergeant at the Vancouver Police Department, told the New York Times, “It’s hard for police officers to look the other way if someone’s going to consume [...] It’s not the be-all and end-all. It’s a Band-aid for opioid consumption until other solutions are introduced. It’s taken a few years, but now our members are fully supportive — because of the need.”

Seattle Mayor Murray continued, “My visit to Insite, Vancouver, Canada’s safe consumption site, made clear these sites save lives and that is our goal in Seattle/King County. Keeping people alive gives them the opportunity to get treatment and begin their path to recovery.”

Since Insite was opened in 2003, it has intervened in nearly 5,000 overdoses, with no deaths. In 2015, it made 464 referrals to onsite detox services out of 6,532 unique visits.

Western Europe have already been leading the way for drug consumptions rooms. In 2016, 90 consumption rooms were in operation worldwide according to Harm Reduction International's Global State of Harm Reduction Report, including in Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland, as well as in Canada and Australia.

Both Ireland and Scotland have plans to open up clinics in 2017.

Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health