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Overview of international literature - supervised injecting facilities & drug consumption rooms - Issue 1.

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Abstract

This Overview of International Literature collates what we understand to be a full list of the relevant published papers and reports on drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) internationally (for definitions, see next section). This Overview updates the overview provided by the Drug Policy Modelling Program, University of New South Wales (deVel-Palumbo, Matthew-Simmons, Shanahan & Ritter, 2013) ; and updates the categories that classify the main areas of evidence provided by the research to date. We included papers and reports where SIFs/DCRs were the main topic or where SIF/DCR clients were the population studied. The aim of this document is to provide an exhaustive, easy to read overview of scientific literature pertaining to SIFs/DCRs internationally that would facilitate scholars in summarizing main research areas, as well as identifying the key scientific contributions and in preparation of advocacy materials.
... The report aimed to provide some meta-analytic data, but inconsistent outcomes restricted the application to only economic impact. Belackova and Salmon (117) (Narrative review) ...
... Authors found reductions in overdose, fewer risky injection episodes, improved access to treatment, health and welfare services, improvements in public amenity and crime reduction primarily from Sydney and Vancouver locations. It was later expanded, see (117). Most studies were feasibility or needs assessment papers (80%). ...
... OPC operation, for some sites, remains under continued and ongoing political challenge despite evaluations of their effectiveness e.g., (100,117,487). Persistent myths need to be challenged and addressed. ...
... There is a large body of research on the effectiveness of OPCs. The previously reviewed evidence suggests that OPCs are cost-effective, reduce overdose-related mortality, as well as HIV and HCV infections, reduce the number of ambulance call outs, decrease public nuisance, disorder, and drugrelated litter, and support people who use drugs to enter treatment [10][11][12][13][14][15][16][17]. Qualitative studies in this field show that people who use drugs support the use of OPCs; they also show these places offer refuge from street violence and adverse police contact, and a safer place to consume drugs leading to a reduction in injection-related risks [18][19][20][21][22][23]. ...
... Our initial programme theory of OPCs (see Appendix 1) was informed by previous reviews of the literature [9][10][11][12][13][14][15][16], and refined in consultation with key stakeholders, including people who use drugs, academics, practitioners in drug treatment and harm reduction services, and advocacy experts, across Europe and internationally. The group included members of the European Network of People who Use Drugs, who also discussed our initial theory and findings with peers in their network. ...
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Background Overdose prevention centres (OPCs) are spaces where people can consume previously obtained illicit drugs under the supervision of staff who can intervene to prevent and manage overdose. They have been provided in Europe and elsewhere for nearly 40 years, initially in response to the epidemic of HIV/AIDS. We can learn from their operation history to inform future developments in harm reduction services. Methods We carried out a realist review of 391 documents, reported according to the RAMESES I guidelines, and carried out realist synthesis of these documents. Results We present a full realist programme theory of OPCs, with a diagrammatic logic model, of how the contexts and mechanisms of OPCs combine to produce various outcomes for service users and their communities in different settings. Three specific causal pathways were evidenced through which OPCs produce their outcomes for particular groups in specific contexts of housing status, gender identity and ethnicity, and local drug markets, with frequency of use, legal and political contexts, and stigma as overlapping contextual factors. Key OPC interventions include the provision of a safe and hygienic consumption space, safe consumption education, timely overdose response, and protection from drug scene and gender-based violence. These can trigger the underlying mechanisms of safety, trust, social inclusion, engagement, autonomy, and empowerment when supported with health care and other services, including detoxification and opioid agonist treatment. The combinations of these contexts and mechanisms create important outcomes for individual service users, for the communities they live in, and for wider society. We also describe causal pathways that can lead to unintended, adverse outcomes. Conclusion This review provides useful information for policy makers, practitioners, and researchers on how to implement and evaluate OPCs in future to maximise their benefits; an important task in the context of the ongoing public health crises of drug poisoning deaths in North America and the UK, and the possibility of increasing deaths from synthetic opioids in Europe and elsewhere.
... Internationally, SIFs have been introduced in several locations such as Canada, 55,56 Australia 57 and Germany.58 Extensive evidence supports the effectiveness of supervised injecting facilities.[57][58][59] In Ireland, despite the passing of the Misuse of Drugs (Supervised Injecting Facilities) Act 2017, there have been delays in establishing a pilot supervised injection facility. ...
Article
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Background: The changing drug situation in Ireland has led to the development of various drug policies. This paper aims to use Limerick City as a case study to examine approaches to policy development. Methodology: The study is qualitative and uses a hybrid technique that combines document, content, and stake-holder analysis. Kingdon's multiple streams model underpins this study. In addition, guidelines for the systematicsearch for grey literature were adopted as the searchstrategy. Results: Problem Stream: Illicit drug use and its relatedproblems have changed. The increasing availability ofdrugs, increasing usage and changes in the types of drugs being used have led to increased drug‐related crimes,adverse health outcomes and elevated demand for treatment services. Local drug policies and initiatives emerge by recognising drug‐related problems in the region. Policy Stream: The current national drug strategy 2017–2025 which informs action plans in Limerick is the first tofocus on a unified health approach. Some national policies have evolved to ensure that guidelines meet current service needs. However, these changes have occurred in some cases with no clear actions. Political Stream: Statutory, voluntary and community stakeholders provide drug addiction and drug addiction‐related services, which have evolved rapidly since theirfirst introduction. The Mid‐West Regional Drug Task Force was identified as essential in coordinating stakeholders locally. One area for improvement is limited evidence of the voices of persons who take drugs included in service/policy development. This regional analysis also suggests that local implementation of policies concerning dual diagnosis and supervised injection facilities can be further expanded. Despite the challenges experienced by stakeholders in Limerick, a hands‐on approach has been adopted in the creation of strategies to tackle the drug problem. Conclusion: The approaches to drug policy development have delivered continuous development of services. However, services remain underdeveloped in areas removed from the capital city of Dublin. Navigating the complex drug landscape reveals that inclusivity, adaptation, and ongoing research are critical components of successful and long‐lasting drug policies.
... (OPS), are places where people who use drugs (PWUD) can go to safely consume pre-obtained substances under supervision [3]. SCS staff also offer life-saving support in the event of overdose and referrals to external services [17]. ...
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Background Supervised consumption sites (SCS) and overdose prevention sites (OPS) have been increasingly implemented in response to the ongoing overdose epidemic in Canada. Although there has been a dramatic increase in overdose deaths since the start of the SARS-CoV 2 (COVID-19) pandemic, little is known about how SCS access may have been affected by this pandemic. Therefore, we sought to characterize potential changes in access to SCS during the COVID-19 pandemic among people who use drugs (PWUD) in Vancouver, Canada. Methods Between June and December 2020, data were collected through the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS), two cohort studies involving people who use drugs. Multivariable logistic regression was used to examine individual, social and structural factors associated with self-reported reduced frequency of SCS/OPS use since COVID-19. Results Among 428 participants, 223 (54.7%) self-identified as male. Among all individuals surveyed, 63 (14.8%) reported a decreased frequency of use of SCS/OPS since COVID-19. However, 281 (66%) reported that they “did not want to” access SCS in the last 6 months. In multivariable analyses, younger age, self-reported fentanyl contamination of drugs used and reduced ease of access to SCS/OPS since COVID-19 were positively associated with a decreased frequency of use of SCS/OPS since COVID-19 (all p < 0.05). Conclusions Approximately 15% of PWUD who accessed SCS/OPS reported reduced use of these programs during the COVID-19 pandemic, including those at heightened risk of overdose due to fentanyl exposure. Given the ongoing overdose epidemic, efforts must be made to remove barriers to SCS access throughout public health crises.
... These sites were originally established, the MISC in 2001 and Insite in 2003, as research studies and were well-funded for the purpose. This has not been the case with all SIFs (but for summaries of the global evidence see Belackova & Salmon, 2017; EMCDDA [European Monitoring Centre for Drugs and Drug Addiction], 2018). The research indicates that SIFs may improve hygienic drug use, without increasing frequency of use, they may ameliorate access to health and social services, and they reduce the prevalence of street-based drug use. ...
Article
Using the case of the campaign to establish a Supervised drug Injecting Facility (SIF) for people who use illicit drugs in Dublin, Ireland, this paper makes three related contributions to contemporary literatures. First, by detailing the history of the campaign and paying particular attention to the ways it was influenced by learning from models elsewhere in the world, the paper adds a spatial perspective to research on the intersections of public health and politics. Second, the paper addresses the policy mobilities literature’s minimal engagement with the role of counterhegemonic ideas and national states in shaping inter‐local policy circulations. It provides detailed empirical analysis of the influence of counterhegemonic ideas and how activists reference those ideas through appeals to empathy, expert evidence, and experience as they build coalitions to influence formal state institutions, including the legal system and the national government. This discussion supports a call for engagement between policy mobilities and counterhegemonic social movement scholars. Third, the paper addresses ongoing discussions of ‘failure’ in policy‐making by arguing for a critical, contextual approach to the spatialities and temporalities of attempts to change entrenched policy and regulatory models. The case study is based on one author’s direct involvement in the campaign for a SIF and on semi‐structured research interviews with twelve key actors conducted since 2015. The research also involved an analysis of relevant documentary materials spanning the period 2012‐2021 and both authors’ participation in a drug policy forum in Dublin in January 2017, involving local and international actors.
... Toward this end, some countries have implemented facilities with specialized professional support (physicians, nurses, and psychosocial professionals) to minimize the impact of illicit drugs on the health of the drug addict and the transmission of vectors associated with infectious diseases (Belackova and Salmon 2017). However, the implementation of these drug consumption rooms (i.e., supervised injection centers) has generated some concern for two reasons: First, it is now proven that a policy to reduce illicit drug use rests essentially on preventive strategies during childhood and adolescence. ...
... This movement subscribes strongly to the goal of evidencebased policy-making. Evidence for the effectiveness of SIFs has been developed through numerous research studies, published in a range of international peer-reviewed journals and in evaluation reports (Belackova and Salmon 2017), most notably referring to Sydney's Medically Supervised Injecting Centre (MSIC) (KPMG 2010) and Vancouver's Insite (Urban Health Research Initiative 2009). The evidentiary imperative was apparent to Ana Liffey from early in the campaign. ...
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Using the case of the campaign to establish a Supervised Injecting Facility (SIF) and reduce harm for people who use illicit drugs in Dublin, Ireland, this paper makes three related contributions to contemporary literatures. First, by detailing the history of the campaign and paying particular attention to the ways it was influenced by learning from models elsewhere in the world, the paper adds a spatial perspective to research on the intersections of public health and social movements. Second, the paper addresses the policy mobilities literature’s minimal engagement with the role of counter-hegemonic ideas and national states in shaping inter-local policy circulations. It provides detailed empirical analysis of the influence of counterhegemonic ideas and activists’ referencing of those ideas through appeals to empathy, expert evidence, and experience to influence formal state institutions, including the legal system and the national state. Third, the paper addresses ongoing discussions of ‘failure’ in policy-making by arguing for a critical, contextual approach to the spatialities and temporalities of attempts to change entrenched policy and regulatory models. The case study is based on one author’s direct involvement in the campaign for a SIF and on semi-structured research interviews with twelve key actors conducted since 2015. The research also involved an analysis of relevant documentary materials spanning the period 2012-2021 and both authors’ participation in a drug policy forum in Dublin in January 2017, involving local and international actors.
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Koncepční příloha Metodiky prevence kriminality v sociálně vyloučených lokalitách
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Dieser Bericht ist im Rahmen des Projekts SO-PREP entstanden, das mit Mitteln des Criminal Justice Programme der Europäis- chen Union finanziert wurde. Der Inhalt dieses Berichts gibt aus- schließlich die Meinung der Autor:innen wieder und obliegt allein ihrer Verantwortung; er spiegelt nicht die Meinung der Europäis- chen Kommission und/oder der Exekutivagentur für Verbraucher, Gesundheit, Landwirtschaft und Lebensmittel oder einer anderen Einrichtung der Europäischen Union wider. Die Europäische Kom- mission und die Agentur übernehmen keinerlei Verantwortung für die eventuelle Nutzung der darin enthaltenen Informationen. Unter Mitarbeit von: Katri Abel-Ollo, Rosa Andree, Charlotte Colman, Kristel Kivimets, John-Peter Kools, Aljona Kurbatova, Babak Moazen, Mikk Oja, Renée Pattyn, Roberto Pérez Gayo, Rafaela Rigoni, Laura Smit Rigter, Lisa Strada, Heino Stöver, Tuukka Tammi, Daan van der Gouwe, Inari Viskari
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