Training Guide

Alternatives to Public Injections

Alternatives to Public Injecting

The current prescription opioid and heroin overdose epidemic has brought greater attention to injection drug use in public spaces. A recent New York Times article noted incidents of public injecting reported by local media in several states, stating: 

“With heroin cheap and widely available on city streets throughout the country, users are making their buys and shooting up as soon as they can, often in public places. Police officers are routinely finding drug users — unconscious or dead — in cars, in the bathrooms of fast-food restaurants, on mass transit and in parks, hospitals and libraries.” / Source

Public injecting poses a significant policy challenge for public health and safety. Injecting in public spaces has been associated with greater risk of overdose and HIV transmission. Many people who use drugs are unable to use them in safe and private environments but instead must turn to venues such as public bathrooms, empty warehouses, and parks. The reasons are complex. Drug use is both illegal and stigmatized; some people who use drugs are homeless, unstably housed or risk loss of housing if found using drugs. This lack of privacy and dignity, particularly when drugs are injected, compromises the health, wellbeing and safety of the people injecting the drugs and of the surrounding community. 

Reducing public injection of drugs requires a multipronged approach ranging from accessible drug treatment to affordable supportive housing. This consultation on Alternatives to Public Injection was focused on one solution that has been implemented in a number of countries: supervised injection facilities (SIFs), also known as drug consumption rooms. Supervised injection facilities have received increased attention and consideration in recent months. Legislation to support the establishment of SIFs has been introduced in Maryland and California. SIF proposals are actively under discussion in Seattle, WA and Ithaca, NY. Outside of the United States, new SIFs are expected to open in France, Ireland and Canada. 

Currently, there are nearly 100 SIFs in operation outside the United States, but as yet no U.S. jurisdiction has established a supervised injection facility. In light of growing policy interest in this strategy, Harm Reduction Coalition collaborated with Open Society Foundation and amFAR, The Foundation for AIDS Research to convene a consultation on Alternatives to Public Injection on September 30, 2015. Representatives from the NYS Department of Health AIDS Institute and the New York City Department of Health and Mental Hygiene participated in the consultation, along with stakeholders representing harm reduction, drug user health advocates, law enforcement and social service providers. Harm Reduction Coalition invited experts from several countries to share their various SIF models, planning and policy development process, implementation challenges, and evaluation results. 

This report is a summary of the proceedings of the consultation. The report provides insights on the potential role of supervised injection facilities in the United States, and considerations for advancing policy, planning and implementation of SIFs based on experiences in other countries.