Reducing Risks – How do SIFs help?

Reducing Risk in Drug and Alcohol Misuse – Supervised Injecting Facilities how do SIFs help?

Saving lives by preventing overdoses

Trained staff supervise drug injecting that may otherwise happen in public places and under more dangerous conditions. When an overdose or other health issue occurs at a SIF, staff can give immediate emergency care, including the reversal of overdoses.

To date, there have been no reported deaths within SIFs around the world.9,10,11,12

“Successful treatment and rehabilitation is only possible if someone is still alive. My son died in 1997, before the Uniting Medically Supervised Injecting Centre opened, and I will always wonder what may have been.”13

Tony Trimingham OAM, founder and CEO of Family Drug Support and author of ‘Not my family, never my child’.

Reducing harms associated with drug use

SIFs’ staff provide advice and education around safer and more hygienic injecting practices, as well as providing clients with clean equipment, reducing the chances of:

  • blood-borne infections such as HIV or hepatitis C and other health issues associated with the use of non-sterile injecting equipment or needle sharing
  • rushed injections, resulting in injured or damaged veins – rushed injections often happen in public places when someone is afraid of being seen
  • injecting in public which is commonly associated with bacterial infection
  • unsafe disposal of needles and syringes.14-17

Providing pathways to support services

SIFs are well placed to recognise and respond to the complex needs of people who visit the centre.8

Staff are able to engage and build trust with people who use the service and can help them access a range of wrap-around support services, such as referrals to drug treatment, physical and mental health services and employment, housing and financial supports.8,7,10,11

“The MSIR has helped me a lot. Not just because I am able to safely inject, but you guys talk to me and help me with all kinds of things. I can even have something to eat and drink. I really trust the staff, I’ve had a few very low moments and the staff here has really helped me”18

North Richmond MSIR client

Doctor comforting patient

Who uses SIFs?

SIFs attract some of the most vulnerable members of the community, with many attendees considered ‘high-risk’.

These attendees may come from more marginalised population groups, have a history of unsafe injecting practices, and might be experiencing complex social and mental health issues.8, 19, 20

Clients attending a supervised injecting service in Germany reported histories of public injecting, imprisonment, sharing injecting equipment and unstable accommodation.21, 22

A surveyed group of frequent attendees to the Sydney SIF found that 82% of them had a mental health diagnoses; 96% had a history of trauma; 54% had attempted suicide; and a third had a history of self-harm.20

“Our centre reaches out to some of the most disengaged and disadvantaged members of our community who often live life on the street.”13

Dr Marianne Jauncey, Medical Director, Uniting Medically Supervised Injecting Centre (Sydney)

SIFs are a ‘low-threshold’ health service, meaning people can access full health care through them, even if they choose to continue using alcohol or other drugs.

Where a barrier to using other health care services can be the stigma experienced by clients 23-25, SIFs are a safe, non-stigmatising space. People who attend report social acceptance, safety and refuge.26-28

“I can’t really compare it to anything else, ’cause I’ve never really gotten any help anywhere else, other than there.”29

Client of Insite, Vancouver’s injecting centre

There is growing evidence that SIFs can have a positive impact on:

  • social connectedness and community
  • emotional support and stress reduction
  • safety and security
  • current shelter status and search for housing
  • health service access and use.26

Jauncey M. What goes on inside a medically supervised injection facility? : The Conversation; 2017 [cited 2021 February 12].
Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E. Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy. 2006;17(5):436-41.
Markwick N, Ti L, Callon C, Feng C, Wood E, Kerr T. Willingness to engage in peer-delivered HIV voluntary counselling and testing among people who inject drugs in a Canadian setting. Journal of Epidemiology and Community Health. 2014;68(7):675.
Wood E, Tyndall MW, Stoltz J-A, Small W, Zhang R, O’Connell J, et al. Safer injecting education for HIV prevention within a medically supervised safer injecting facility. International Journal of Drug Policy. 2005;16(4):281-4.
Kimber JO, Mattick RP, Kaldor J, Van Beek I, Gilmour S, Rance JA. Process and predictors of drug treatment referral and referral uptake at the Sydney Medically Supervised Injecting Centre. Drug and Alcohol Review. 2008;27(6):602-12.
Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. Attendance, drug use patterns, and referrals made from North America’s first supervised injection facility. Drug and Alcohol Dependence. 2006;83(3):193-8.
Wood E, Tyndall MW, Zhang R, Montaner JSG, Kerr T. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction. 2007;102(6):916-9.
Belackova V, Silins E, Salmon AM, Jauncey M, Day CA. “Beyond Safer Injecting”—Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility. International Journal of Environmental Research and Public Health,. 2019;16(11).
Clark J, Torrance, J. Drug Consumption Room: Could the provision of a drug consumption room bring significant benefit in reducing drug related deaths and other community harms in Bristol. Transform Drug Policy Foundation; 2018.
Uniting. Uniting Medically Supervised Injecting Centre 2020 [cited 2020 June 16].
Hamilton M. Review of the Medically Supervised Injecting Room. Melbourne: Medically Supervised Injecting Room Review Panel; 2020.
Marshall BDL, Milloy MJ, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. The Lancet. 2011;377(9775):1429-37.
Uniting. Uniting Medically Supervised Injecting Centre – Get to know our story. 2018.
Bravo MJ, Royuela L, De la Fuente L, Brugal MT, Barrio G, Domingo-Salvany A, et al. Use of supervised injection facilities and injection risk behaviours among young drug injectors. Addiction. 2009;104(4):614-9.
Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. The Lancet. 2005;366(9482):316-8.
Kinnard EN, Howe CJ, Kerr T, Skjødt Hass V, Marshall BDL. Self-reported changes in drug use behaviors and syringe disposal methods following the opening of a supervised injecting facility in Copenhagen, Denmark. Harm Reduction Journal. 2014;11(1):29.
Stoltz J-A, Wood E, Small W, Li K, Tyndall M, Montaner J, et al. Changes in injecting practices associated with the use of a medically supervised safer injection facility. Journal of Public Health. 2007;29(1):35-9.
North Richmond Community Health. Changing Lives. 2020 [cited 2021 February 11].
Salmon A, Belackova V, Schwanz RS, Jauncey M, Hiley S, Demirkol A. Homelessness among clients of Sydney’s supervised injecting facility. Drugs and alcohol today. 2017;17(4):258-68.
Goodhew M, Salmon AM, Marel C, Mills KL, Jauncey M. Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC). Harm Reduction Journal. 2016;13(1):29.
Belackova V, Salmon A. Overview of international literature – supervised injecting facilities & drug consumption rooms – Issue 1. Sydney: Uniting Medically Supervised Injecting Centre; 2017.
Scherbaum N, Specka M, Bombeck J, Marrziniak B. Drug consumption facility as part of a primary health care centre for problem drug users—Which clients are attracted? International Journal of Drug Policy. 2009;20(5):447-9.
Biancarelli DL, Biello KB, Childs E, Drainoni M, Salhaney P, Edeza A, et al. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug and Alcohol Dependence. 2019;198:80-6.
Chan Carusone S, Guta A, Robinson S, Tan DH, Cooper C, O’Leary B, et al. “Maybe if I stop the drugs, then maybe they’d care?”—hospital care experiences of people who use drugs. Harm Reduction Journal. 2019;16(1):16.
Paquette CE, Syvertsen JL, Pollini RA. Stigma at every turn: Health services experiences among people who inject drugs. International Journal of Drug Policy. 2018;57:104-10.
Kerman N, Manoni-Millar S, Cormier L, Cahill T, Sylvestre J. “It’s not just injecting drugs”: Supervised consumption sites and the social determinants of health. Drug and Alcohol Dependence. 2020;213:108078.
Fairbairn N, Small W, Shannon K, Wood E, Kerr T. Seeking refuge from violence in street-based drug scenes: Women’s experiences in North America’s first supervised injection facility. Social Science & Medicine. 2008;67(5):817-23.
Boyd J, Lavalley J, Czechaczek S, Mayer S, Kerr T, Maher L, et al. “Bed Bugs and Beyond”: An ethnographic analysis of North America’s first women-only supervised drug consumption site. International Journal of Drug Policy. 2020;78:102733.
British Columbia Centre for Excellence in HIV/AIDS. Findings from the evaluation of Vancouver’s Pilot Medically Supervised Safer Injecting Facility – Insite. 2009.
Andresen MA, Boyd N. A cost-benefit and cost-effectiveness analysis of Vancouver’s supervised injection facility. International Journal of Drug Policy. 2010;21(1):70-6.
Bayoumi AM, Zaric GS. The cost-effectiveness of Vancouver’s supervised injection facility. Canadian Medical Association Journal. 2008;179(11):1143.
Pinkerton SD. Is Vancouver Canada’s supervised injection facility cost-saving? Addiction. 2010;105(8):1429-36.
KPMG. Further evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011). NSW Health; 2010.
Barry CL, Sherman SG, Stone E, Kennedy-Hendricks A, Niederdeppe J, Linden S, et al. Arguments supporting and opposing legalization of safe consumption sites in the U.S. International Journal of Drug Policy. 2019;63:18-22.
Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence. 2014;145:48-68.
Kennedy MC, Karamouzian M, Kerr T. Public Health and Public Order Outcomes Associated with Supervised Drug Consumption Facilities: a Systematic Review. Current HIV/AIDS Reports. 2017;14(5):161-83.
McKnight I, Maas B, Wood E, Tyndall MW, Small W, Lai C, et al. Factors Associated with Public Injecting Among Users of Vancouver’s Supervised Injection Facility. The American Journal of Drug and Alcohol Abuse. 2007;33(2):319-25.
Salmon AM, Thein H-H, Kimber J, Kaldor JM, Maher L. Five years on: What are the community perceptions of drug-related public amenity following the establishment of the Sydney Medically Supervised Injecting Centre? International Journal of Drug Policy. 2007;18(1):46-53.
Thein H-H, Kimber J, Maher L, MacDonald M, Kaldor JM. Public opinion towards supervised injecting centres and the Sydney Medically Supervised Injecting Centre. International Journal of Drug Policy. 2005;16(4):275-80.
Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JSG, et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal. 2004;171(7):731.

Leave a Reply

Your email address will not be published. Required fields are marked *