Potential role of safer injection facilities in reducing HIV and Hepatitis C infections and overdose mortality in the United States

Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, GA 30322, USA.
Drug and alcohol dependence (Impact Factor: 3.42). 04/2011; 118(2-3):100-10. DOI: 10.1016/j.drugalcdep.2011.03.006
Source: PubMed


Safer injection facilities (SIFs) reduce risks associated with injecting drugs, particularly public injection and overdose mortality. They exist in many countries, but do not exist in the United States. We assessed several ethical, operational, and public health considerations for establishing SIFs in the United States.
We used the six-factor Kass framework (goals, effectiveness, concerns, minimization of concerns, fair implementation, and balancing of benefits and concerns), summarized needs of persons who inject drugs in the United States, and reviewed global evidence for SIFs.
SIFs offer a hygienic environment to inject drugs, provide sterile injection equipment at time of injection, and allow for safe disposal of used equipment. Injection of pre-obtained drugs, purchased by persons who inject drugs, happens in a facility where trained personnel provide on-site counseling and referral to addiction treatment and health care and intervene in overdose emergency situations. SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality) without evidence for negative health or social consequences. SIFs serve most-at-risk persons, including those who inject in public or inject frequently, and those who do not use other public health programs. It is critical to address legal, ethical, and local concerns, develop and implement relevant policies and procedures, and assess individual- and community-level needs and benefits of SIFs given local epidemiologic data.
SIFs have the potential to reduce viral and bacterial infections and overdose mortality among those who engage in high-risk injection behaviors by offering unique public health services that are complementary to other interventions.

1 Follower
41 Reads
  • Source
    • "Due to inherent issues associated with the legality of injection drug use in many countries around the world, few SIFs have been put into practice [14]. Consequently, research examining the cost-benefit and cost-effectiveness characteristics of SIFs is very limited [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper will determine whether expanding Insite (North America's first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users. By analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal. With very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV. Funding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.
    Substance Abuse Treatment Prevention and Policy 07/2013; 8(1):25. DOI:10.1186/1747-597X-8-25 · 1.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Illicit drug overdose is a leading cause of premature mortality. We sought to examine fatal overdose trends from 2001 to 2005 in urban and nonurban areas of British Columbia, Canada. We conducted a review of all provincial coroner files in which drug overdose was the cause of death between January 1, 2001, and December 31, 2005. We compared cocaine and non-cocaine-related overdoses and examined temporal changes in cocaine-related mortality rates in urban and nonurban areas. Multilevel mixed effects models were used to determine the independent risk factors for cocaine-related death. Spatial analyses were conducted to identify clusters of these cases. During the study period, 904 illicit drug overdoses were recorded, including 369 (40.8%) in nonurban areas and 532 (58.9%) related to cocaine consumption. In a multilevel model, we observed a significant interaction (p = .010) between population density and year, indicating a considerable and differential increase in the likelihood of cocaine-related deaths in nonurban areas. Cocaine-related deaths were clustered in the southeast region of the province. Cocaine-related overdoses in nonurban areas should be a public health concern. Evidence-based interventions to reduce the risks associated with cocaine consumption and reach drug users in nonurban settings are needed.
    Annals of epidemiology 03/2012; 22(3):198-206. DOI:10.1016/j.annepidem.2011.12.004 · 2.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Results are presented of enrolling HIV+ active-injection drug users (IDUs) into a peer-driven intervention (PDI) to improve their adherence to medical care. Using respondent-driven sampling (RDS), which evolved out of the PDI model, the authors recruited and tested 1,097 IDUs, of whom 145 were confirmed to be HIV+. Despite promises of confidentiality, increased social supports, and direct cash rewards for participating, only 78 (54%) of the HIV+ IDUs enrolled in the subsequent adherence study. Correlates of participation as well as interviews with respondents who declined participating are presented. The seemingly negative findings have important implications for future adherence studies. RDS provided a powerful mechanism for recruiting HIV+ IDUs. But selection biases were revealed to favor sicker yet more socially connected respondents, which resulted in more conservative outcomes with regard to social supports and positive health-seeking behaviors. The analysis may help streamline future efforts using the PDI, which harnesses IDUs’ abilities to help one another, by underscoring some of the mechanism’s limitations.
    Journal of drug issues 06/2012; 42(2):127-146. DOI:10.1177/0022042612446581 · 0.38 Impact Factor
Show more