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.

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    • "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]. "
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