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Training Guide

Alternatives to Public Injections

The Harm Reduction Coalition has partnered for more than two decades with the New York State Department of Health and community-based harm reduction programs to protect the health of people who use drugs, many of whom experience profound marginalization through homelessness and housing instability, unemployment, involvement with the criminal justice system, and histories of trauma. Stigma and marginalization result in a substantial proportion of people who use drugs having little access to medical care and health services outside of hospital emergency rooms and prisons or jails. Harm Reduction Coalition and other community harm reduction programs seek to bridge the healthcare gap and address inequalities in access to basic health care, and have been successful in providing services to many underserved people who cannot, or will not, access traditional health care and social services.

These efforts have been instrumental in dramatically reducing HIV incidence among people who inject drugs (PWID). In 1992, the percentage of newly diagnosed HIV/AIDS cases attributed to injecting drug use was 52% in New York. By 2012, the proportion of newly diagnosed HIV cases attributed to injection drug use dropped to 3%. These programs engage underserved communities through outreach and engagement, access to sterile syringes and other injection equipment, providing education, counseling and case management, and offering basic health and social services in a supportive and non-judgmental way.

New York, along with the rest of the country, is experiencing a public health crisis characterized by a dramatic increase in opioid overdose deaths. Despite scaling up strategies to reduce overdose risk and prevent overdose fatalities, this mortality trend shows little sign of abating. People who have experienced overdoses in the past, people with poor health, and those use drugs alone are among those most at risk for fatal overdose. Further, non-fatal overdose is estimated to be between 20 and 30 times more common than fatal overdose, and is associated with significant morbidity as well. People who inject drugs in public places are especially vulnerable to overdose and other injection-related complications including contracting HIV, hepatitis and other blood-borne infections and soft tissue injuries. Public injection is often a rushed practice in attempt to avoid detection and arrest.

Internationally, close to 100 medically supervised injecting facilities (SIFs), also known as drug consumption rooms (DCRs), have been established in at least eight countries – with more being planned – as one of a number of public health strategies to reduce harms related to drug use, particularly among people who use drugs in public places (source).

SIFs are sanctioned and supervised spaces for the hygienic consumption of pre-obtained drugs in a non-judgmental environment and under the observation of trained staff. SIFs represent a public health intervention operating as part of a wider network of services for people who use drugs, woven into local networks of coordinated strategies to address the individual risks and community impact of drug use. These programs aim to reach underserved and marginalized populations, address health inequities, and resolve public health and safety tensions related to public injecting.

“These programs aim to reach underserved and marginalized populations, address health inequities, and resolve public health and safety tensions related to public injecting.” /source