Heller et al. (2009) Harm Reduction Journal, 6:1. 

The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York City 

SIFs should be considered to address the prevalence of public injecting and resolve the ‘syringe gap’ for PWID 

Beletsky et al. (2008) American Journal of Public Health, 98(2):231-237. 

The law (and politics) of safe injection facilities in the United States 

Favorable evaluations of SIFs elsewhere, namely that they improve public health without increasing drug use or crime, have raised the issue of their implementation in the US 

Mutz (2006) University of Kansas Department of Political Science, 2006:Publication No. 1443677. 

The middle of a crossfire: drug policies and injection drug users during the HIV/AIDS epidemic 

The potential for SIFs to reach PWID makes them at the very least worth an attempt in the US 

Broadhead et al. (2003) Journal of Drug Issues, 33(3):733-750. 

Safer injection sites in New York City: a utilization survey of injection drug users 

A large majority of sampled PWID would utilize a SIF, and those at highest risk would be the most likely to use them 

Broadhead et al. (2002) Journal of Drug Issues, 32(1):329-355. 

Safer injection facilities in North America: their place in public policy and health initiatives

The time has come for more North American municipalities to consider SIFs in public policy and health initiatives due to their ability to target public health problems related to injection drug use. 

Gaeta et al. (2018) Annals of Internal Medicine, [Epub ahead of print 6 Feb 2018]. 

New strategies are needed to stop overdose fatalities: the case for supervised injection facilities 

This opinion piece was published by two Boston health professionals that witnessed a PWID plead for a clinic to help him due to fear of OD precipitated by relapse, only to suffer fatal OD ninety minutes after leaving. In this piece, it is argued that SIFs are a necessary intervention to help those suffering from substance use disorder stay alive until they are ready for treatment 

Harris et al. (2018) International Journal of Drug Policy, 52:56-61. 

Perceptions about supervised injection facilities among people who inject drugs in Philadelphia 

Surveyed PWID confirmed that social and environmental factors encourage high risk injection behaviors associated with infections and OD. Participants expressed support for SIFs and believe that such a facility could reduce the harms associated with public injection for both PWID and the community 

León et al. (2018) International Journal of Drug Policy, 53:90-95. 

Changes in public order after the opening of an overdose monitoring facility for people who inject drugs 

The opening of a low-threshold harm reduction program for monitoring PWID at imminent risk of OD in Boston was associated with a significant decrease in observed over-sedated individuals. The difference in study outcomes compared to those analyzing SIFs suggest that a SIF may be a more effective model for improving public order and should be considered as part of a broader approach in US communities most affected by the opioid OD crisis 

León et al. (2018) Substance Abuse, 39(1):95-101.

The willingness of people who inject drugs in Boston to use a supervised injection facility

Results indicate that SIFs would be well utilized by individuals who could most benefit from this intervention. Over 90% of respondents reported willingness to use a SIF, and those with high-risk substance use behaviors and/or with behaviors that contribute to public health burden of injection drug use were significantly more likely to be willing to use a SIF

Shefner et al. (2018) Center for Public Health Initiatives Data Briefs, 3.

Supervised Injection Facilitie

Opening a SIF is an essential component of a broader strategy to reduce injection-related harms, including OD. With the Mayor’s Task Force to Combat the Opioid Epidemic’s recent recommendation to consider SIFs, public health arguments supporting SIF implementation are growing in Philadelphia

NYC Department of Health and Mental Hygiene (2018) NYC Health Publications.

Overdose prevention in New York City: supervised injection as a strategy to reduce opioid overdose and public injection

Results from the three studies included in this report, in addition to comprehensive scientific evidence from other jurisdictions, indicates SIFs are an evidence-based public health intervention that can be included in NYC’s OD prevention agenda as a targeted strategy to reduce the risk of OD and disease transmission among PWID, as well as offering the community-wide benefit of decreasing public injection and reducing crime

Bouvier et al. (2017) Harm Reduction Journal, 14:13. 

Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study

The majority of sampled young adults in the US would be willing to use a SIF, and those at highest risk of OD would be those most likely to use it

Irwin et al. (2017) Harm Reduction Journal, 14:29. 

Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility 

Establishing a SIF in Baltimore would be cost-effective and bring a number of well-established medical, financial, and societal benefits to the city. One SIF would prevent over 200 OD-related incidents annually while bringing over 100 PWID into treatment

Irwin et al. (2017) Journal of Drug Issues, 47(2):164-184. 

A cost-benefit analysis of a potential supervised injection facility in San Francisco, California, USA

A SIF in San Francisco would not only be extremely cost-saving but would present significant public health benefits. SIFs would bring even greater benefits in cities where availability of HIV/ HCV treatment, harm reduction services, and availability of opioid substitution treatment is substantially lower

Kennedy et al. (2017) American Journal of Public Health, 107(1):42-43. 

Overdose prevention in the United States: a call for supervised injection sites 

Given the outstanding harms associated with opioid misuse-- in particular the escalating fatal OD epidemics occurring throughout the US-- facilitating the establishment of SIFs should be an urgent priority of municipal and state officials

Mackesy-Amiti et al. (2017) Journal of Acquired Immune Deficiency Syndromes, 75:S316.

Injection-related risk behavior and engagement in outreach, intervention, and prevention services across 20 US cities 

Increasing syringe access and safer injection skills training are effective in reducing high-risk injection behavior and underscore the need to improve access to these prevention interventions to the southern US

Summers et al. (2017) International Journal of Drug Policy, 39:21-27. 

Injection-site vein loss and soft tissue abscesses associated with black tar heroin injection: a cross-sectional study of two distinct populations in USA 

Access to education and safe injection supplies through community-based harm reduction should be enhanced, and SIFs should be strongly considered, in order to decrease the morbidity, mortality, and cost associated with heroin injection and skin/ soft tissue infection among PWID

Wakeman (2017) The New England Journal of Medicine, 376:11.

Another senseless death-- the case for supervised injection facilities

SIFs would be an invaluable service for heroin-dependent PWID and reduce OD deaths in the US

Wolfson-Stofko et al. (2017) International Journal of Drug Policy, 39:69-77.

Drug use in business bathrooms: an exploratory study of manager encounters in New York City

The number of manager encounters with public bathroom drug injections demonstrate a need to consider SIFs

Cedarbaum et al. (2016) Drug and Alcohol Dependence, 158:102-109. 

Health behaviors of young adult injectors in the Seattle area 

Seattle PWID under age 30 engage in riskier injection practices, are more likely to share/ re-use syringes, and are more likely to report witnessing an OD than older PWID; however, fewer are aware of their HCV status and only one third reported having at-home access to naloxone. Health promotion efforts should focus on reducing these risky behaviors

Ciccarone et al. (2016) Drug and Alcohol Dependence, 163:126-133.

Nationwide increase in hospitalizations for heroin-related soft tissue infections: associations with structural market conditions

Consistent with the increase in reported heroin use is an increase in heroin-related skin/soft tissue infection throughout the US. Offering medical care within SIFs would help reduce the social and structural barriers to infection care

Marshall et al. (2016) International Journal of Drug Policy, 31:25-31.

Harm reduction for young people who use prescription opioids extra-medically: obstacles and opportunities

Research to inform strategies that mitigate particularly high-risk practices and especially in youth is a critical component of the public health response to the US prescription opioid epidemic. SIFs represent an additional, evidence-based harm reduction strategy to engage marginalized and street-based PWID

Wolfson-Stofko et al. (2016) Dialectical Anthropology,40:395-410.The portapotty experiment: neoliberal approaches to the intertwined epidemics of opioid-related overdose and HIV/HCV, and why we need cultural anthropologists in the South BronxPWID face dire circumstances due to their marginalization and the criminalization of drug use, which perpetuates the use of risky injection locations and practices. SIFs have been shown to be a useful tool in other countries for managing the problems that are associated with injecting drugs, but even a pilot SIF in the USA has yet to be launched

Monico (2015) La Salle University Graduate Annual, 3(12):50-56.Out of the Alley: Lessons from Safe Injecting FacilitiesPWID in the US would clearly utilize SIFs, which would reduce OD risk and disease transmission and increase treatment access

Low (2014) University of Washington Department of Health Services, 2014: Publication No. 1573693.Interest in a safe injection facility among injection drug users in King County, WANearly 90% of surveyed PWID in Washington would be interested in using a SIF if it was available

Öner (2014) Human Rights Review, 4(8):87-135.An overview of drug consumption roomsSIFs are a feasible public health and safety response that is in compliance with international law

Marazzo et al. (2014) The Journal of the American Medical Association, 312(4):390-409.HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-- USA PanelSimultaneous access to antiretroviral therapy, SEPs, SIFs, medicalized heroin and other forms of OST should be provided to HIV-infected PWID in the United States to facilitate risk-reduction counseling and linkages to care

Senate Memorial 45 Study Group (2013) Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, 2013:14.Report of the Medically Assisted Injection Drug Facility Feasibility SubcommitteeSIFs are a feasible service that are urgently needed in New Mexico due to high OD rates

Gowan et al. (2012) Social Science & Medicine, 74:1251-1260.Addiction, agency, and the politics of self-control: Doing harm reduction in a heroin users’ groupPracticing harm reduction in a midwestern SEP heroin users’ group reinforces social citizenship within highly marginalized spaces

Semaan et al. (2011) Drug and Alcohol Dependence, 118:100-110.Potential role of safer injection facilities in reducing HIV and Hepatitis C infections and OD mortality in the United StatesSIFs could reduce viral and bacterial infections and OD mortality among high-risk PWID in the US

Wenger et al. (2011) International Journal of Drug Policy, 22:239-241.The prospect of implementing a Safer Injection Facility in San Francisco: perspectives on community stakeholdersStakeholders are open to discussing how a SIF might support neighborhood goals in San Francisco

Kral et al. (2010) Drug and Alcohol Dependence, 110:160-163.Acceptability of a safer injection facility among injection drug users in San FranciscoOver 80% of San Francisco PWID would attend a SIF if it was available

Burris et al.(2009) Saint Louis University Law Journal, 53:1089-1154.Federalism, Policy Learning, and Local Innovation in Public Health: The Case of the Supervised Injection FacilitySIFs can realistically be implemented in the US through the authors’ described mechanism

Heller et al. (2009) Harm Reduction Journal, 6:1.The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York CitySIFs should be considered to address the prevalence of public injecting and resolve the ‘syringe gap’ for PWID

Beletsky et al. (2008) American Journal of Public Health, 98(2):231-237.The law (and politics) of safe injection facilities in the United StatesFavorable evaluations of SIFs elsewhere, namely that they improve public health without increasing drug use or crime, have raised the issue of their implementation in the US

Mutz (2006) University of Kansas Department of Political Science, 2006:Publication No. 1443677.The middle of a crossfire: drug policies and injection drug users during the HIV/AIDS epidemicThe potential for SIFs to reach PWID makes them at the very least worth an attempt in the US

Broadhead et al. (2003) Journal of Drug Issues, 33(3):733-750.Safer injection sites in New York City: a utilization survey of injection drug usersA large majority of sampled PWID would utilize a SIF, and those at highest risk would be the most likely to use them

Broadhead et al. (2002) Journal of Drug Issues, 32(1):329-355.Safer injection facilities in North America: their place in public policy and health initiativesThe time has come for more North American municipalities to consider SIFs in public policy and health initiatives due to their ability to target public health problems related to injection drug use.

Gaeta et al. (2018) Annals of Internal Medicine, [Epub ahead of print 6 Feb 2018].New strategies are needed to stop overdose fatalities: the case for supervised injection facilitiesThis opinion piece was published by two Boston health professionals that witnessed a PWID plead for a clinic to help him due to fear of OD precipitated by relapse, only to suffer fatal OD ninety minutes after leaving. In this piece, it is argued that SIFs are a necessary intervention to help those suffering from substance use disorder stay alive until they are ready for treatment

Harris et al. (2018) International Journal of Drug Policy, 52:56-61.Perceptions about supervised injection facilities among people who inject drugs in PhiladelphiaSurveyed PWID confirmed that social and environmental factors encourage high risk injection behaviors associated with infections and OD. Participants expressed support for SIFs and believe that such a facility could reduce the harms associated with public injection for both PWID and the community

León et al. (2018) International Journal of Drug Policy, 53:90-95.Changes in public order after the opening of an overdose monitoring facility for people who inject drugsThe opening of a low-threshold harm reduction program for monitoring PWID at imminent risk of OD in Boston was associated with a significant decrease in observed over-sedated individuals. The difference in study outcomes compared to those analyzing SIFs suggest that a SIF may be a more effective model for improving public order and should be considered as part of a broader approach in US communities most affected by the opioid OD crisis

León et al. (2018) Substance Abuse, 39(1):95-101.The willingness of people who inject drugs in Boston to use a supervised injection facilityResults indicate that SIFs would be well utilized by individuals who could most benefit from this intervention. Over 90% of respondents reported willingness to use a SIF, and those with high-risk substance use behaviors and/or with behaviors that contribute to public health burden of injection drug use were significantly more likely to be willing to use a SIF

NYC Department of Health and Mental Hygiene (2018) NYC Health Publications.Overdose prevention in New York City: supervised injection as a strategy to reduce opioid overdose and public injectionResults from the three studies included in this report, in addition to comprehensive scientific evidence from other jurisdictions, indicates SIFs are an evidence-based public health intervention that can be included in NYC’s OD prevention agenda as a targeted strategy to reduce the risk of OD and disease transmission among PWID, as well as offering the community-wide benefit of decreasing public injection and reducing crime

Firestone et al. (2009) International Journal of Drug Policy, 20:90-92.Fentanyl use among street drug users in Toronto, Canada: behavioural dynamics and public health implicationsPrescription opioids are playing an increasing central role in street drug use and related harms in North America, particularly fentanyl. Prevalence and practices of fentanyl use by PWID require closer monitoring, targeted interventions, and further research regarding risks and outcomes

Turock et al. (2009) The American Journal of Emergency Medicine, 27(2):237-239.Fentanyl-laced heroin: a report from an unexpected placeEpidemics of illicit drug toxicity due to the introduction of a new, more potent narcotic are not geographically limited to large urban centers and their surroundings. Areas with historically low heroin-related OD rates appear to have a potentially significant number of heroin-using PWID that do not come into contact with the medical community normally, but who would be at increased risk for OD and thus require medical attention when there is a change in the usual supply of drugs

Denton et al. (2008) Journal of Forensic Science, 53(2):452-454.An epidemic of illicit fentanyl deaths in Cook County, Illinois: September 2005 through April 2007Fentanyl intoxication became a common cause of drug intoxication in the Chicagoland region from late 2005 until early 2007. This report found that there were multiple gaps in surveillance and analysis that allowed fentanyl-related deaths to be misclassified for several months, demonstrating the need for better coordinated efforts to monitor these emerging drug use patterns 

Topolski et al. (2008) The Journal of the American Medical Association, 300(13):1512-1513.Nonpharmaceutical fentanyl-related deaths-- multiple states, April 2005- March 2007The fentanyl outbreak described in this report indicates a need to improve methods of identifying and reporting of drug-related deaths to detect increases in drug ODs and enable prompt response by authorities, including providing intensified outreach to at-risk PWID regarding OD prevention and response

Hughes et al. (2007) Clinical Toxicology, 45:144-151.Active surveillance of abused and misused prescription opioids using poison center data: a pilot study and descriptive comparisonAs explained in this article, there are no monitoring systems that currently provide up-to-date information on opioid misuse in the US. The authors advocate for the use of poison centers as a real-time geographically specific, surveillance system for prescription opioid misuse; however, these data would be limited to people who are compelled to contact poison centers, and the reason for calling and validity of the information cannot be confirmed

Barry (2017) Psychiatric Services, [Epub ahead of print].Fentanyl and the evolving opioid epidemic: what strategies should policy makers consider?The rise in fentanyl-related OD deaths means that new approaches are needed to combat the opioid epidemic, including adoption of harm reduction strategies. Specific strategies that should be considered as part of efforts to combat the opioid crisis include safe drug consumption sites, anonymous drug checking services, and updated naloxone distribution policies

Beletsky et al. (2017) International Journal of Drug Policy, 46:156-159.Today’s fentanyl crisis: Prohibition’s Iron Law, revisitedUnder the Iron Law of Prohibition, the current approach to illicit opioids is likewise doomed to failure. We must shift the focus from supply reduction to demand and harm reduction, including expanding access to naloxone and particularly to those especially vulnerable to OD

Breindahl et al. (2017) Drug Testing and Analysis, 9(415-422).Identification of a new psychoactive substance in seized material: the synthetic opioid N-phenyl-N-[1-(2-phenethyl)piperidin-4-yl]prop-2-enamide (Acrylfentanyl)New synthetic opioids present a serious problem for public health due to their potency and risk of fatal intoxication. Lack of knowledge among PWID about the presence of synthetic opioid contaminants or cutting agents indicate that testing should be carried out for acrylfentanyl in coordination with PWID to monitor its emergence in street samples

Ciccarone et al. (2017) International Journal of Drug Policy, 46:146-155.Heroin uncertainties: exploring users’ perceptions of fentanyl-adulterated and substituted ‘heroin’Given the risks arising from potency variability and the shorter window for intervention, SIFs may be particularly suited to respond to the Massachusetts fentanyl-adulterated and -substituted ‘heroin’ epidemic

Daniulaityte et al. (2017) MMWR: Morbidity & Mortality Weekly Report, 66(34):904-908.Overdose deaths related to fentanyl and its analogs-- Ohio, January- February 2017An analysis of unintentional OD fatalities indicate the increasing and substantial role of illicitly manufactured fentanyl and its analogues and the declining presence of heroin and pharmaceutical opioids. These findings highlight the urgent need to implement harm reduction initiatives to reduce the adverse consequences of fentanyl use and assure sufficient supplies of naloxone are distributed through community OD prevention programs

Diaz Bode et al. (2017) The American Journal of Emergency Medicine, 35(9):1364-1465.Fentanyl laced heroin and its contribution to a spike in heroin overdose in Miami-Dade County.In Miami and elsewhere, community intervention strategies should aim to increase naloxone availability to PWID in order to reverse OD earlier and prevent the accelerated onset of respiratory depression. Harm reduction strategies focused on opioid dosage education should also be provided for PWID to avoid OD

Fairbairn et al. (2017) International Journal of Drug Policy, 46:172-179.Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: challenges and innovations responding to a dynamic epidemicThe changing OD eras underscore naloxone’s crucial role in the OD response and a pressing need to identify areas for further study and innovation to adapt to a changing illicit drug market, including expansion of SIFs

Guerrieri et al. (2017) Forensic Science International, 277:e21-e29.Acrylfentanyl: another new psychoactive drug with fatal consequencesSynthetic opioids are a major problem that worsen the consequences of, and weaken the countermeasures against, the ongoing Western opioid crisis. Acrylfentanyl was one of the most problematic compounds to appear on the scene and-- together with the previous fentanyl analogs-- is a harsh reminder of the need for an ever more expedite identification of the next unscheduled analogs bound to appear soon on the recreational market

Kerr et al. (2017) Harm Reduction Journal, 14:28.Supervised injection facilities in Canada: past, present, and futureThe ongoing fentanyl crisis in British Columbia prompted the opening of low-threshold SIFs (overdose prevention sites) to relieve the only local sanctioned SIF program, which has seen increased demand in light of this increasing number of deaths

Lucyk et al. (2017) International Journal of Drug Policy, 46:168-171.Toxicosurveillance in the US opioid epidemicWe need to expand our harm reduction approach to prevent the opioid public health crisis from worsening, including increased availability of out-of-hospital naloxone. Some regions-- including Vancouver-- have expanded this to offer SIFs and prescription heroin to eliminate the risk of OD fatality for participating PWIDs

Macmadu et al. (2017) Addictive Behaviors, 68:35-38.Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medicallyExposure to fentanyl-contaminated heroin is an emerging trend among young adults who use prescription opioids non-medically, and while users know this additive increases OD risk, the majority of these cases are unaware of the presence of the fentanyl prior to use

Moore et al. (2017) The American Journal of Emergency Medicine [in press].Syndrome surveillance of fentanyl-laced heroin outbreaks: utilization of EMS, medical examiner, and poison center databasesReal-time surveillance mechanisms are necessary tools to monitor changes in the rate of opioid ODs. Coordinating surveillance efforts between multiple levels (emergency response, poison control, medical examiner) would be helpful in identifying, responding to, and mitigating unexpected outbreaks of fentanyl ODs

Pirona et al. (2017) International Journal of Drug Policy, 40:84-92.New psychoactive substances: current health-related practices and challenges in responding to use and harms in EuropeApplying harm reduction concepts to novel psychoactive substance interventions can prevent short- and long-term health and social consequences at the societal level

Quintana et al. (2017) International Journal of Drug Policy, 40:78-83.The hidden web and the fentanyl problem: detection of ocfentanil as an adulterant in heroinAdulteration is a real threat not only at the street level, but also for PWID that buy substances in cryptomarkets. As fentanyl derivatives will certainly emerge in the near future, monitoring systems based on drug testing and providing community-level alerts may be of vital importance to react in a timely matter

Socías et al. (2017) British Medical Journal, 358:j4355.Epidemic of deaths from fentanyl overdoseTo tackle the growing crisis effectively, innovative, science-driven public health solutions are urgently needed. The scaling-up of evidence-based treatment and harm reduction programs such as SIFs, naloxone, and OST are necessary and commendable efforts in addressing the epidemic of fentanyl related ODs

Somerville et al. (2017) CDC Morbidity and Mortality Weekly Report (MMWR), retrieved from: https://www.cdc.gov/mmwr/volumes/66/wr/mm6614a2.htmCharacteristics of Fentanyl OD-- Massachusetts, 2014-2016Existing harm reduction strategies to identify likely fentanyl exposure should be adapted, such as training for bystanders to directly observe anyone using illicit opioids and administer naloxone if necessary, as well as ensuring that there is access to naloxone

Tamburro et al. (2017) Journal of Forensic Science and Medicine, 2(2):111-114.Resurgence of fentanyl as a drug of abuseFentanyl-related fatalities are a continually increasing trend in Oakland County, with a high prevalence of concurrent use of other opioids or benzodiazepines. This concurs with national trends and demonstrates a need to focus long-term efforts on minimizing or eliminating the demand for these identified substances

Thomson et al. (2017) Addiction, 112(11):2068-2070.The lessons learned from the fentanyl overdose crisis in British Columbia, CanadaGovernments need to expand evidence-harm reduction programs, including peer-run SIFs, that include supportive housing and peer-harm reduction engagements

Unick et al. (2017) International Journal of Drug Policy, 46:112-119.US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizationsInterventions should be considered within local and regional contexts that include expanded treatment, wider and ample distribution of naloxone, improved surveillance strategies, and SIFs

Vidal Giné et al. (2017) International Journal of Drug Policy, 45:46-47.The utility of drug checking services as monitoring tools and more: a response to Pirona et al.Recent data provide more concrete evidence that drug checking does result in behavioural modifications that undoubtedly reduce harm, if particularly suspect drug samples are discarded instead of consumed. One UK facility reports a significant number of disposals by PWID after receiving test results

European Monitoring Centre for Drugs and Drug Addiction (2016) EMCDDA, retrieved from: http://www.emcdda.europa.eu/topics/pods/drug-consumption-rooms#sthash.sMenP5Dw.dpuf*Perspectives on drugs: drug consumption rooms: an overview of provision and evidence [update]SIFs can play a central role in the early identification of emerging drug use patterns

Latimer et al. (2016) International Journal of Drug Policy, 37:111-114.Risk of fentanyl ODs among clients of the Sydney medically supervised injecting centreSIFs advise how to use drugs like fentanyl more safely in fast-changing drug markets and can provide real-time data on evolving drug use trends

Ashraf et al. (2015) Harm Reduction Journal, 12:54.Why the FUSS (Fentanyl Urine Screen Study)? A cross-sectional survey to characterize an emerging threat to people who use drugs in British Columbia, CanadaWhile the increase in fentanyl availability and fentanyl-detected deaths is alarming, support of harm reduction strategies can help mitigate the risks. Further engagement-- such as providing street drug checking and increasing access to naloxone-- is necessary to reduce the impact of illicit fentanyl on this vulnerable population

Mounteney et al. (2015) International Journal of Drug Policy, 26:626-631.Fentanyls: Are we missing the signs? Highly potent and on the rise in EuropeEndemic and isolated fentanyl-related death outbreaks across Europe reflect the complexity of the contemporary drug market. Integrated responses are required to ensure the availability of harm reduction to PWID as well as address fentanyl production and diversion

Algren et al. (2013) Journal of Medical Toxicology, 9(1):106-115.Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005- May 2006)OD death epidemics resulting from use of illicit fentanyl and fentanyl analogues have occurred sporadically in the US in the past 25 years. Increasing naloxone access and focusing educational efforts on encouraging bystanders to immediately activate emergency response are critical to successfully prevent fatal ODs

MMWR: Morbidity & Mortality Weekly Report, Aug 30, 2013, 62:34.Acetyl fentanyl overdose fatalities-- Rhode Island, March- May 2013The unusual pattern of acetyl fentanyl-related deaths in Rhode Island and reported elsewhere demonstrates the need for increased access to naloxone in the community and for healthcare providers who administer naloxone in emergencies to increase the amount they keep on hand

Talu et al. (2010) International Journal of Drug Policy, 21(1):56-63.HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: implications for interventionThe ongoing fentanyl injection epidemic in Estonia is the longest reported such epidemic in Europe (over 8 years). This has led to a potential HIV epidemic among PWID and demonstrates a need for appropriate resources to implement an early warning system to detect emerging trends in drug markets

Firestone et al. (2009) International Journal of Drug Policy, 20:90-92.Fentanyl use among street drug users in Toronto, Canada: behavioural dynamics and public health implicationsPrescription opioids are playing an increasing central role in street drug use and related harms in North America, particularly fentanyl. Prevalence and practices of fentanyl use by PWID require closer monitoring, targeted interventions, and further research regarding risks and outcomes

Turock et al. (2009) The American Journal of Emergency Medicine, 27(2):237-239.Fentanyl-laced heroin: a report from an unexpected placeEpidemics of illicit drug toxicity due to the introduction of a new, more potent narcotic are not geographically limited to large urban centers and their surroundings. Areas with historically low heroin-related OD rates appear to have a potentially significant number of heroin-using PWID that do not come into contact with the medical community normally, but who would be at increased risk for OD and thus require medical attention when there is a change in the usual supply of drugs

Denton et al. (2008) Journal of Forensic Science, 53(2):452-454.An epidemic of illicit fentanyl deaths in Cook County, Illinois: September 2005 through April 2007Fentanyl intoxication became a common cause of drug intoxication in the Chicagoland region from late 2005 until early 2007. This report found that there were multiple gaps in surveillance and analysis that allowed fentanyl-related deaths to be misclassified for several months, demonstrating the need for better coordinated efforts to monitor these emerging drug use patterns

Topolski et al. (2008) The Journal of the American Medical Association, 300(13):1512-1513.Nonpharmaceutical fentanyl-related deaths-- multiple states, April 2005- March 2007The fentanyl outbreak described in this report indicates a need to improve methods of identifying and reporting of drug-related deaths to detect increases in drug ODs and enable prompt response by authorities, including providing intensified outreach to at-risk PWID regarding OD prevention and response

Hughes et al. (2007) Clinical Toxicology, 45:144-151.Active surveillance of abused and misused prescription opioids using poison center data: a pilot study and descriptive comparisonAs explained in this article, there are no monitoring systems that currently provide up-to-date information on opioid misuse in the US. The authors advocate for the use of poison centers as a real-time geographically specific, surveillance system for prescription opioid misuse; however, these data would be limited to people who are compelled to contact poison centers, and the reason for calling and validity of the information cannot be confirmed

Barry (2017) Psychiatric Services, [Epub ahead of print].Fentanyl and the evolving opioid epidemic: what strategies should policy makers consider?The rise in fentanyl-related OD deaths means that new approaches are needed to combat the opioid epidemic, including adoption of harm reduction strategies. Specific strategies that should be considered as part of efforts to combat the opioid crisis include safe drug consumption sites, anonymous drug checking services, and updated naloxone distribution policies

Beletsky et al. (2017) International Journal of Drug Policy, 46:156-159.Today’s fentanyl crisis: Prohibition’s Iron Law, revisitedUnder the Iron Law of Prohibition, the current approach to illicit opioids is likewise doomed to failure. We must shift the focus from supply reduction to demand and harm reduction, including expanding access to naloxone and particularly to those especially vulnerable to OD

Breindahl et al. (2017) Drug Testing and Analysis, 9(415-422).Identification of a new psychoactive substance in seized material: the synthetic opioid N-phenyl-N-[1-(2-phenethyl)piperidin-4-yl]prop-2-enamide (Acrylfentanyl)New synthetic opioids present a serious problem for public health due to their potency and risk of fatal intoxication. Lack of knowledge among PWID about the presence of synthetic opioid contaminants or cutting agents indicate that testing should be carried out for acrylfentanyl in coordination with PWID to monitor its emergence in street samples

Ciccarone et al. (2017) International Journal of Drug Policy, 46:146-155.Heroin uncertainties: exploring users’ perceptions of fentanyl-adulterated and substituted ‘heroin’Given the risks arising from potency variability and the shorter window for intervention, SIFs may be particularly suited to respond to the Massachusetts fentanyl-adulterated and -substituted ‘heroin’ epidemic

Daniulaityte et al. (2017) MMWR: Morbidity & Mortality Weekly Report, 66(34):904-908.Overdose deaths related to fentanyl and its analogs-- Ohio, January- February 2017An analysis of unintentional OD fatalities indicate the increasing and substantial role of illicitly manufactured fentanyl and its analogues and the declining presence of heroin and pharmaceutical opioids. These findings highlight the urgent need to implement harm reduction initiatives to reduce the adverse consequences of fentanyl use and assure sufficient supplies of naloxone are distributed through community OD prevention programs

Zajdow (2006) Contemporary Drug Problems, 33: 399-422.The narrative of evaluations: medically supervised injecting centersMultiple studies prove SIFs are a cost-effective way to avoid OD deaths and eliminate public nuisance related to open drug scenes

Ball et al. (2005) International Journal of Drug Policy, 165:S1-S6.Evidence for action: a critical tool for guiding policies and programmes for HIV prevention, treatment, and care among injecting drug usersHarm reduction measures are cost-effective and reduce HIV transmission among PWID

Kuyper et al. (2004) Journal of Urban Health, 81(4):655-660.The cost of inaction on HIV transmission among injection drug users and the potential for effective interventionsGiven the total healthcare costs related to HIV, SIFs and needle distribution services would be highly cost-effective services

Wright (2004) British Medical Journal, 325(7431):100-102.Supervised injecting centresAn economic evaluation of deaths averted with SIFs show that costs are comparable to those of other widely accepted public health measures

MSIC Evaluation Committee (2003) Sydney: MSIC Evaluation Committee, retrieved from: http://www.indro-online.de/sydneyfinalreport.pdfFinal report of the evaluation of the Sydney Medically Supervised Injecting CentreThere are significant cost-benefits to continue operating the SIF

Irwin et al. (2017) Harm Reduction Journal, 14:29.*Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facilityIt is estimated that a single, 13-booth SIF would generate annual net savings of 5.98 million for Baltimore, which is equivalent to 28% of the city health department’s entire budget for harm reduction and disease prevention

Irwin et al. (2017) Journal of Drug Issues, 47(2):164-184.*A cost-benefit analysis of a potential supervised injection facility in San Francisco, California, USAEstablishing one SIF in San Francisco would generate a total annual net savings of 3.5 million dollars for the city by significantly reducing costs associated with health care, emergency services, and crime

Fairbairn et al. (2016) Addiction, 111:490-491.Commentary on Enns et al. (2016): Supervised injection facilities as a cost-effective interventionCost-effectiveness analyses of SIFs project lower net savings than in actuality due to the difficulty of monetizing impacts beyond HIV and HCV risk behaviors

Jozaghi et al. (2015) International Criminal Justice Review, 25(3):233-246.The potential role for supervised injection facilities in Canada’s largest city, TorontoFunding SIFs in Toronto would be an efficient and effective use of financial resources in the public health domain

Jozaghi et al. (2015) International Journal of Health Policy and Management, 4(6):373-379.Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugsOpening a SIF in Saskatoon would be cost-effective in the reduction of taxpayers’ expenses and averting HIV infection rates among PWID

Jozaghi et al. (2015) Urban Geography, 36(8):1241-1255.Is there a role for potential supervised injection facilities in Victoria, British Columbia, Canada?Establishing two SIFs in Victoria would have a benefit-cost ratio of 1.25:1 and offer significant savings for local health care institutions

Jozaghi et al. (2013) Substance Abuse Treatment, Prevention, and Policy, 8:25.A cost-benefit/ cost-effectiveness analysis of proposed supervised injection facilities in Montreal, CanadaFunding SIFs in Montreal is an efficient and effective use of financial resources for public health initiatives

Pinkerton (2011) International Journal of Drug Policy, 22:179-183.How many HIV infections are prevented by Vancouver Canada’s supervised injection facility?The Vancouver SIF is cost saving as a stand-alone operation in drug injection-related HIV risk reduction intervention

Andersen and Boyd. (2010) International Journal of Drug Policy, 21(1):70-76.A cost-benefit and cost effectiveness analysis of Vancouver’s supervised injection facilityThe SIF saves Vancouver $6 million per year

Lloyd et al. (2010) Addiction, 105:1437-1438.Commentary on Pinkerton (2010): Drug consumption rooms-- time to accept their worthSIFs deliver net savings to society through their cost-effectiveness and evidence-based success

Pinkerton (2010) Addiction, 105(8):1429-1436.Is Vancouver Canada’s supervised injection facility cost-saving?The SIF substantially reduces HIV infection incidence of local PWID to save $17.6 million (Canadian) in HIV-related medical care costs

Jozaghi (2010) Simon Fraser University School of Criminology, 2010:Publication No. MS22707.The role of a supervised injection facility in transforming place and its futureThe SIF is a cost-effective facility that impacts the lives of PWIDs positively

Bayoumi et al. (2008) Canadian Medical Association Journal, 179-11.The Cost-effectiveness of the Vancouver Safe Injection FacilityVancouver’s SIF saves the city, government, and health care system money, resulting in $20,100 of saving per averted case of HIV infection

Des Jarlais et al. (2008) Canadian Medical Association Journal, 179(11):1105-1106.Evaluating Vancouver’s supervised injection facility: data and dollars, symbols and ethicsThe Vancouver SIF is cost-effective due to their success at preventing multiple harms related to injection drug use, especially since PWID typically have multiple needs related to health and social services

Wait (2008) Final Report to NSW Health, Saha International Limited.Economic evaluation of the Medically Supervised Injecting Centre at Kings Cross (MSIC): final reportThe health outcomes provided by the SIF come at a lower cost to the government than other services that provide similar results

Zajdow (2006) Contemporary Drug Problems, 33: 399-422.The narrative of evaluations: medically supervised injecting centersMultiple studies prove SIFs are a cost-effective way to avoid OD deaths and eliminate public nuisance related to open drug scenes

Ball et al. (2005) International Journal of Drug Policy, 165:S1-S6.Evidence for action: a critical tool for guiding policies and programmes for HIV prevention, treatment, and care among injecting drug usersHarm reduction measures are cost-effective and reduce HIV transmission among PWID

Wright (2004) British Medical Journal, 325(7431):100-102.Supervised injecting centresAn economic evaluation of deaths averted with SIFs show that costs are comparable to those of other widely accepted public health measures

MSIC Evaluation Committee (2003) Sydney: MSIC Evaluation Committee, retrieved from: http://www.indro-online.de/sydneyfinalreport.pdfFinal report of the evaluation of the Sydney Medically Supervised Injecting CentreThere are significant cost-benefits to continue operating the SIF

Irwin et al. (2017) Harm Reduction Journal, 14:29.*Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facilityIt is estimated that a single, 13-booth SIF would generate annual net savings of 5.98 million for Baltimore, which is equivalent to 28% of the city health department’s entire budget for harm reduction and disease prevention

Irwin et al. (2017) Journal of Drug Issues, 47(2):164-184.*A cost-benefit analysis of a potential supervised injection facility in San Francisco, California, USAEstablishing one SIF in San Francisco would generate a total annual net savings of 3.5 million dollars for the city by significantly reducing costs associated with health care, emergency services, and crime

Fairbairn et al. (2016) Addiction, 111:490-491.Commentary on Enns et al. (2016): Supervised injection facilities as a cost-effective interventionCost-effectiveness analyses of SIFs project lower net savings than in actuality due to the difficulty of monetizing impacts beyond HIV and HCV risk behaviors

Jozaghi (2015) Health and Justice, 3:16.Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injectionFunding peer-operated SIFs is an efficient and effective public health allocation of financial resources due to their impact on mortality rate in this at-risk population

Jozaghi et al. (2015) International Criminal Justice Review, 25(3):233-246.The potential role for supervised injection facilities in Canada’s largest city, TorontoFunding SIFs in Toronto would be an efficient and effective use of financial resources in the public health domain

León et al. (2018) International Journal of Drug Policy, 53:90-95. 

Changes in public order after the opening of an overdose monitoring facility for people who inject drugs 

The opening of a low-threshold harm reduction program for monitoring PWID at imminent risk of OD in Boston was associated with a significant decrease in observed over-sedated individuals. The difference in study outcomes compared to those analyzing SIFs suggest that a SIF may be a more effective model for improving public order and should be considered as part of a broader approach in US communities most affected by the opioid OD crisis 

Kimber et al. (2003) Drug and Alcohol Review, 22:227-233.Drug consumption facilities: an update since 2000SIFs engage with targeted client groups to successfully manage ODs

Hagan (2002) International Journal of Drug Policy, 13:449-451.Supervised injection rooms-- prospects and limitationsSIFs are effective in decreasing ODs and facilitate long-term public health benefits for the community

Stoever (2002) Journal of Drug Issues, 2002:597-606.Consumption rooms-- a middle ground between health and public order concernsSIFs successfully treat ODs and enhance health competencies

Kimber et al. (2000) Drug and Alcohol Review, 19:337-346.Drug consumption facilities in Europe and the establishment of supervised injecting centres in AustraliaAvailable evidence support that SIFs reduce opioid-related OD risk

De Jong et al. (1999), International Journal of Drug Policy, 10:99-108.The professional acceptance of drug use: a closer look at drug consumption rooms in the Netherlands, Germany and SwitzerlandWhile the European drug-related death rates significantly increased between 1985 and 1995, it fell in the two countries that operated SIFs (Switzerland, Netherlands)

Kappel et al. (2016) Harm Reduction Journal, 13:20.A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugsClients and staff agree that SIFs prevent ODs

Hwang et al. (2014) The Lancet, 384(9953):1541-47.Health interventions for people who are homelessA SIF reduces fatal ODs for homeless PWID

Independent Drug Commission for Brighton and Hove. Jan 2013.SIFs are recommended based on international evidence that they significantly reduce OD death rates, whilst not increasing drug use rates

Marshall et al. (2011) Lancet, 377:1429 -1437.Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based studyThe SIF has decreased OD mortality by 35% generally and by nearly 50% among First Nations people and women, making SIFs an important consideration when injection drug use is prevalent and particularly in areas with high densities of overdose

Lloyd-Smith et al. (2008) BMC Public Health, 8:405.Risk factors for developing a cutaneous injection-related infection among injection drug users: a cohort studyThe SIF reduces mortality rates from injection-related infection

Milloy et al. (2008) PLoS ONE, 3:e3351-e3351.Estimated drug OD deaths averted by North America’s first medically-supervised safer injection facilityThe SIF successfully prevents OD deaths

Kerr et al. (2007) International Journal of Drug Policy, 18:37-45.A micro-environmental intervention to reduce harms associated with drug-related OD: evidence from the evaluation of Vancouver’s safer injection facilityThe SIF addresses the social, cultural, and structural factors that contribute to ODs

Lloyd et al. (2007) International Journal of Drug Policy, 18:5-9.Drug consumption rooms: an overdue extension to harm reduction policy in the UK?SIFs are a promising way to work with hard-to-reach PWID to reduce the risk of OD and improve their health

National Centre in HIV Epidemiology and Clinical Research (2007) NSW Health, retrieved from: https://kirby.unsw.edu.au/sites/default/files/hiv/attachment/EvalRep4SMSIC.pdfSydney Medically Supervised Centre evaluation report no. 4: evaluation of service operation and OD-related eventsOpening the SIF resulted in significant decreases in morphine deaths in Kings Cross and the rest of NSW, as well as a significant decrease in publicly discarded syringes

Patel (2007) Journal of Drug Issues, 2007:737-748.Research note: drug consumption rooms and needle and syringe exchange programsSIFs reduce the overall risk of death following OD by providing access to staff trained in cardio-pulmonary resuscitation, either on site or rapidly through local emergency services

Thomas (2008) British Journal of General Practice, 2008:810-811.A drug consumption room in the Spanish Basque countryThe Basque SIF has had zero fatal drug-related ODs

Editorial (2006) The Lancet, 367:1792.A second chance for the UK to reduce drug-misuse deathsSIF trials are a necessary initiative to prevent drug-related deaths

Independent Working Group (2006) Joseph Rowntree Foundation, York, UK.The report of the Independent Working Group on Drug Consumption RoomsA SIF pilot program is recommended in the UK as a way to work with the most problematic PWIDs to reduce OD risk

Hunt (2006) Joseph Rowntree Foundation, York, UK.An overview of models of delivery of drug consumption roomsEfficacy of SIFs in other countries to provide life-saving services to PWID and positively impact their communities demonstrate an analysis of the context is needed to adapt a SIF with locally relevant services in the UK 

Kerr et al (2006) International Journal of Drug Policy, 17:436-441.Drug-related overdoses with a medically supervised safer injection facilitySIFs are effective at preventing OD death 

Zobel et al. (2004), University Institute of Social and Preventative Medicine, Bern, Switzerland.Short appraisal of the role and usefulness of Drug Consumption Facilities (DCF) in the reduction of drug-related problems in Switzerland: appraisal produced at the request of the Swiss Federal Office of Public HealthSIFs reduce fatal ODs in the community

Kimber et al. (2003) Drug and Alcohol Review, 22:227-233.Drug consumption facilities: an update since 2000SIFs engage with targeted client groups to successfully manage ODs

Hagan (2002) International Journal of Drug Policy, 13:449-451.Supervised injection rooms-- prospects and limitationsSIFs are effective in decreasing ODs and facilitate long-term public health benefits for the community

Stoever (2002) Journal of Drug Issues, 2002:597-606.Consumption rooms-- a middle ground between health and public order concernsSIFs successfully treat ODs and enhance health competencies

Kimber et al. (2000) Drug and Alcohol Review, 19:337-346.Drug consumption facilities in Europe and the establishment of supervised injecting centres in AustraliaAvailable evidence support that SIFs reduce opioid-related OD risk

De Jong et al. (1999), International Journal of Drug Policy, 10:99-108.The professional acceptance of drug use: a closer look at drug consumption rooms in the Netherlands, Germany and SwitzerlandWhile the European drug-related death rates significantly increased between 1985 and 1995, it fell in the two countries that operated SIFs (Switzerland, Netherlands)

Kappel et al. (2016) Harm Reduction Journal, 13:20.A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugsClients and staff agree that SIFs prevent ODs 

Hwang et al. (2014) The Lancet, 384(9953):1541-47.Health interventions for people who are homelessA SIF reduces fatal ODs for homeless PWID

Independent Drug Commission for Brighton and Hove. Jan 2013.SIFs are recommended based on international evidence that they significantly reduce OD death rates, whilst not increasing drug use rates

Marshall et al. (2011) Lancet, 377:1429 -1437.Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based studyThe SIF has decreased OD mortality by 35% generally and by nearly 50% among First Nations people and women, making SIFs an important consideration when injection drug use is prevalent and particularly in areas with high densities of overdose 

Lloyd-Smith et al. (2008) BMC Public Health, 8:405.Risk factors for developing a cutaneous injection-related infection among injection drug users: a cohort studyThe SIF reduces mortality rates from injection-related infection

Stoever (2002) Journal of Drug Issues, 2002:597-606.*Consumption rooms-- a middle ground between health and public order concernsSIFs successfully treat ODs, minimize IV disease spread, and enhance health competencies

Wood et al. (2001) Canadian Medical Association Journal, 165:405-410.Unsafe injection practices in cohort of injection drug users in Vancouver: could safer injecting rooms help?Establishing a SIF could alleviate a number of risk behaviors linked to harms such as disease transmission and injury 

Kimber et al. (2000) Drug and Alcohol Review, 19:337-346.*Drug consumption facilities in Europe and the establishment of supervised injecting centres in AustraliaAvailable evidence support that SIFs reduce the risk of blood-borne virus transmission

Jong et al. (1999) International Journal of Drug Policy, 10:99-108.*The professional acceptance of drug use: a closer look at drug consumption rooms in the Netherlands, Germany, and SwitzerlandSIFs successfully reduce PWID health risks and related public issues since they are in tune with users’ needs, have sufficient capacity, and receive adequate political and community support 

Wodak (1992) Forensic Science International 62:83-87.Preventing the spread of HIV among Australian injecting drug usersHIV prevalence will rise if harm reduction policies and programs are not expanded

Voon et al. (2016) BMC Public Health, 16:476.Risky and rushed public crack cocaine smoking: the potential for supervised inhalation facilitiesSupervised inhalation facilities should be implemented and evaluated as a means to reduce the risks and harms associated with smoking crack in public

McCann (2015) Health & Place, 31:216-223.Mobilizing drug consumption rooms: inter-place networks and harm reduction drug policySIFs are an essential development in successful harm reduction policies 

Shaw et al. (2015) Harm Reduction Journal, 12:49.Risk environments facing potential users of a supervised injection site in Ottawa, Canada.A SIF in Ottawa could reach highly marginalized PWID and reduce drug-related harms

Hwang et al. (2014) The Lancet, 384(9953):1541-47.*Health interventions for people who are homelessFor homeless PWID, a SIF decreases needle sharing and promotes client engagement with treatment

Din (2014) Revista de Asistență Socială, anul XIII:159-177.The role of drug consumption rooms in HIV preventionSIFs could play an important role in preventing risks associated with drug use in Romania

Jozaghi et al (2013) Harm Reduction Journal, 10(1):1-9.Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada?InSite has had a positive impact on PWID’s lives (as well as the community) and should be expanded to other cities

Havinga et al. (2014) Harm Reduction Journal, 11:6.Differences in sociodemographic, drug use and health characteristics between never, former and current injecting, problematic hard-drug users in the NetherlandsSIFs have likely contributed to the reduction of risks associated with injecting in public spaces

Handlovsky et al. (2012) Qualitative Health Research, 23(4):450-462.The process of safer crack use among women in Vancouver’s Downtown EastsidePilot studies in a supervised inhalation facility should be considered to address creating a fundamental safe space for women’s safer crack use

Iverson et al. (2012) Drug and Alcohol Dependence, 122:195-200.Individual-level syringe coverage among needle and syringe program attendees in AustraliaEfforts to increase syringe coverage should be scaled up to sustain the HCV epidemic among PWID

Semaan et al. (2012) Center for Disease Control and Prevention: National Center for HIV/AIDS, STD and TB PreventionScientific and programmatic implications of safer injection facilities for persons who inject drugs illicitlySIFs limit transmission of HIV, viral hepatitis, and bacterial infections

Small et al. (2012) Health, Risk & Society, 14(4):307–324.Perceptions of risk and safety within injection settings: injection drug users’ reasons for attending a supervised injecting facility in Vancouver, CanadaPWID believe the Vancouver SIF to provide protection from a broader range of hazards associated with injecting drugs in unregulated settings

Parkin et al. (2011) Health & Place, 17:717-726.Public injecting drug use and the social production of harmful practice in high-rise tower blocks (London, UK): a Lefebvrian analysisProviding “spaces” of harm reduction such as SIFs should be considered to address injecting-related harm

Pinkerton (2011) International Journal of Drug Policy, 22:179-183.How many HIV infections are prevented by Vancouver Canada’s supervised injection facility?SIFs prevent HIV infection

Stinson et al.(2010) International Journal of Drug Policy, 21:91-93.Harm reduction: Moving through the third decadeHarm reduction draws attention to the need to reform drug policy so populations can be properly helped to avoid drug-related harms

Bravo et al. (2009) Addiction, 104(4):614-619.Use of supervised injection facilities and injection risk behaviours among young drug injectorsUsing SIFs was associated independently with not borrowing used syringes

Kerr et al (2009) Urban Health Research Initiative, BC, Canada.Findings from the Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility-- Insite (UHRI Report)Peer-reviewed studies on SIFs indicate they reduce public injection, lower levels of HIV risk behaviors, and increase the number of people seeking addiction treatment

Marshall et al. (2009) Sexually Transmitted Infections, 85:121-126.Condom use among injection drug users accessing a supervised injecting facilityThe SIF supports safer sex practices by providing condoms to clients

Milloy et al. (2009) Addiction, 104(4):620-621.Emerging role of supervised injecting facilities in Human Immunodeficiency Virus preventionSpain and Vancouver sites report a 69% reduction in the likelihood of syringe sharing among SIF attendees

Salmon et al. (2009) Drug and Alcohol Dependence, 101:132-136.Injecting-related injury and disease among clients of a supervised injecting facilitySIFs reduce the severity and burden of injecting-related injuries and diseases

Fairbairn et al (2008) Social Science & Medicine, 67(5):817-823Seeking refuge from violence in street-based drug scenes: women’s experiences in North America’s first supervised injection facilitySIFs provide women who inject drugs refuge from violence, as well as from gendered norms that shape drug use behaviors to thus promote increased control over their usage

Hedrich et al. (2008) Drugs: education, prevention and policy, 15(6):503-517.From margin to mainstream: The evolution of harm reduction responses to problem drug use in EuropeHarm reduction programs reduce health and social damage among PWID with high levels of marginalization and comorbidity

Fast et al. (2008) Harm Reduction Journal, 5:32.The perspectives of injection drug users regarding safer injecting education delivered through a supervised injection facilityThrough regular access to nursing staff, the SIF is successful in educating PWID on safer injection practices

Independent Working Group (2006) Joseph Rowntree Foundation, York, UK.*The report of the Independent Working Group on Drug Consumption RoomsA SIF pilot program is recommended in the UK as a way to work with the most problematic PWIDs to, improve their health and lessen the damage and costs to society

Milloy et al. (2008) Drug and Alcohol Review, 2008:1-7.Incarceration experiences in a cohort of active injection drug usersHarm reduction programming is essential to reducing spread of disease in the Canadian penal system

Neale (2008) International Journal of Drug Policy, 19:429-435.Homelessness, drug use and Hepatitis C: a complex problem explored within the context of social exclusionHomelessness services and prisons should offer harm reduction services to reduce the rate of HCV transmission in these at-risk populations

Fischer et al. (2007) University of Victoria, 2007:2-80.Feasibility study on ‘supervised drug consumption’ options in the city of VictoriaA supervised injection facility initiative should be implemented in Victoria to improve the health and safety of PWID, as well as that of the community at large

Kerr et al. (2007) Current HIV/AIDS Reports, 4(4):158-164.The role of safer injection facilities in the response to HIV/AIDS among injection drug usersSIFs attract high-risk PWIDs and can prevent HIV and other infectious transmission, promote greater stability for PWIDs, and reduce OD risk through its services

Lazarus et al. (2007) International Journal of Drug Policy, 18:426-432.HIV/ hepatitis coinfection in eastern Europe and new pan-European approaches to hepatitis prevention and managementHarm reduction services need to be expanded in order to reduce hepatitis transmission among PWID

National Centre in HIV Epidemiology and Clinical Research (2007) NSW Health, retrieved from: https://kirby.unsw.edu.au/sites/default/files/hiv/attachment/IntEvalReport3SMSIC%2B.pdfSydney Medically Supervised Centre interim evaluation report no. 3: evaluation of client referral and health issuesOver three-quarters of participants reported improvements in injecting practices since registering at the SIF

Maher (2007) Drug and Alcohol Review, 26:351-353.Supervised injecting facilities: how much evidence is enough?SIFs have been shown to be highly effective interventions in reducing the harms associated with injecting drug use

Petrar et al. (2007) Addictive Behaviours, 32:1088-1093.Injection drug users’ perceptions regarding use of a medically supervised safer injecting facilityPWID are more willing to modify unsafe behaviours as a result of the SIF

Stoltz et al. (2007) Journal of Public Health (Oxford), 29(1):35-39.Changes in injecting practices associated with the use of a medically supervised injection facilityOn average, attendees of the SIF are three times more likely to practice safer injection

Rhodes et al. (2006) Addiction, 101:1384-1393.Public injecting and the need for ‘safer environment interventions’ in the reduction of drug-related harm“Safer environment interventions” such as SIFs deserve greater attention for reducing risks related to public injecting

Collins et al. (2005) Canadian Journal of Public Health, 96(5):344-347.Rationale to evaluate medically supervised safer smoking facilities for non-injection illicit drug usersImplementing a supervised inhalation facility would be a public health initiative to improve public order, prevent infectious disease spread and transition to injection drug use, and improve medical care and addiction treatment access

Kerr et al. (2005) Lancet, 366:316-318.Safer injection facility use and syringe sharing among injection drug usersPWID who use the SIF are 70% less likely to share syringes 

Kerr et al (2005) Journal of Urban Health, 82(2):267-275.A description of a peer-run supervised injection site for injection drug usersA low-threshold SIF format provides a sterile environment for injection drug use without negative consequences

Wood et al. (2005) American Journal of Infectious Diseases, 1:50-54.Factors associated with syringe sharing among users of a medically-supervised injecting facilityThe SIF decreases likelihood of syringe sharing among HIV-positive PWID

Wood et al. (2005) American Journal of Preventive Medicine, 29:126-130.Do supervised injecting facilities attract higher-risk injection drug users?SIFs help prevent the spread of HIV and other blood-borne diseases

Wood et al. (2005) International Journal of Drug Policy, 16:281-284.Safer injecting education for HIV prevention within a medically supervised safer injecting facilitySafer injecting education provided at the SIF reduces the spread of HIV

Wood et al. (2005) Public Health, 119:1111-1115.Prevalence and correlates of Hepatitis C among users of North America’s first medically supervised safer injection facilityThe Vancouver SIF reduces the spread of HCV

Hedrich (2004) European Monitoring Centre for Drugs and Drug Addiction, Luxembourg: Office for Official Publications of the European Communities.European report on drug consumption roomsSIFs are effective as specific services aimed to reduce health and social harm problems for high-risk populations PWIDs

Wright et al. (2004) British Medical Journal, 328(7431):100-103.*Supervised injecting centresSIFs can target homeless PWID and minimize the risk of unsafe injection in public

Kimber et al. (2003) Drug and Alcohol Review, 22:227-233.*Drug consumption facilities: an update since 2000SIFs contribute positively to health and risk behaviors and provide linkage to health and social welfare services

Wodak et al. (2003) Journal of Drug Issues, 2003:609-623.The role of civil disobedience in drug policy reform: how an illegal safer injection room led to a sanctioned, medically supervised injection centerSIFs are necessary to improve the health of PWID

Malkin et al. (2003) Journal of Drug Issues, 2003:539-578.Supervised injection facilities and international lawSIFs are appropriate trials to establish elsewhere for states to protect their citizens rights to the highest attainable standard of health

Zurhold et al. (2003b) Journal of Drug Issues, 2003:663-688.*Drug consumption rooms in Hamburg, Germany: evaluation of the effects of harm reduction and the reduction of public nuisanceHamburg SIFs lead to positive changes in health-related behavior in high-risk, publicly-using PWID

Hagan (2002) International Journal of Drug Policy, 13:449-451.*Supervised injection rooms-- prospects and limitationsSIFs are effective in decreasing public injections and ODs and facilitate long-term public health benefits for the community

Stoever (2002) Journal of Drug Issues, 2002:597-606.*Consumption rooms-- a middle ground between health and public order concernsSIFs successfully treat ODs, minimize IV disease spread, and enhance health competencies

Wood et al. (2001) Canadian Medical Association Journal, 165:405-410.Unsafe injection practices in cohort of injection drug users in Vancouver: could safer injecting rooms help?Establishing a SIF could alleviate a number of risk behaviors linked to harms such as disease transmission and injury

Kimber et al. (2000) Drug and Alcohol Review, 19:337-346.*Drug consumption facilities in Europe and the establishment of supervised injecting centres in AustraliaAvailable evidence support that SIFs reduce the risk of blood-borne virus transmission

Jong et al. (1999) International Journal of Drug Policy, 10:99-108.*The professional acceptance of drug use: a closer look at drug consumption rooms in the Netherlands, Germany, and SwitzerlandSIFs successfully reduce PWID health risks and related public issues since they are in tune with users’ needs, have sufficient capacity, and receive adequate political and community support 

Wodak (1992) Forensic Science International 62:83-87.Preventing the spread of HIV among Australian injecting drug usersHIV prevalence will rise if harm reduction policies and programs are not expanded

Voon et al. (2016) BMC Public Health, 16:476.Risky and rushed public crack cocaine smoking: the potential for supervised inhalation facilitiesSupervised inhalation facilities should be implemented and evaluated as a means to reduce the risks and harms associated with smoking crack in public 

McCann (2015) Health & Place, 31:216-223.Mobilizing drug consumption rooms: inter-place networks and harm reduction drug policySIFs are an essential development in successful harm reduction policies

Shaw et al. (2015) Harm Reduction Journal, 12:49.Risk environments facing potential users of a supervised injection site in Ottawa, Canada.A SIF in Ottawa could reach highly marginalized PWID and reduce drug-related harms

Hwang et al. (2014) The Lancet, 384(9953):1541-47.*Health interventions for people who are homelessFor homeless PWID, a SIF decreases needle sharing and promotes client engagement with treatment

Din (2014) Revista de Asistență Socială, anul XIII:159-177.The role of drug consumption rooms in HIV preventionSIFs could play an important role in preventing risks associated with drug use in Romania

Green et al. (2004) Canadian Journal of Public Health, 95(2):110-114.My place, your place, or a safer place: the intention among Montreal injecting drug users to user supervised injecting facilitiesThe vast majority of PWID report interest in attending at least one of the three proposed SIF sites

Zobel et al. (2004), University Institute of Social and Preventative Medicine, Bern, Switzerland.*Short appraisal of the role and usefulness of Drug Consumption Facilities (DCF) in the reduction of drug-related problems in Switzerland: appraisal produced at the request of the Swiss Federal Office of Public HealthSIFs provide access to social and healthcare services and reduce risky behaviors

Anoro et al. (2003) Journal of Drug Issues, 33(3):689-712.Barcelona’s safer injection facility- EVA: a harm reduction program lacking official supportThe SIF provides a fundamental space of shelter for local PWID, particularly those at high-risk, to seek help improving their physical and mental health

Zurhold et al. (2003a) Journal of Drug Issues, 2003:663-688.Drug consumption rooms in Hamburg, Germany: evaluation of the effects of harm reduction and the reduction of public nuisanceHamburg SIFs reach high-risk, publicly-using PWID

Kimber et al. (2000) Drug and Alcohol Review, 19:337-346.*Drug consumption facilities in Europe and the establishment of supervised injecting centres in AustraliaAvailable evidence support that SIFs improve access to/ uptake of health and other services

Gardner (2017) Mount Sinai Graduate School of Biomedical Sciences, 2017:Publication No. 10256673.Supervised injection facilities and social services: an evaluation of service provision and treatment uptake from managerial perspectivesSIFs regularly engage with hard-to-reach PWID, and facilities with more social services are associated with higher daily utilization

Parés-Badell et al. (2017) Journal of Substance Abuse Treatment, 77:13-20.Undiagnosed HIV and Hepatitis C infection in people who inject drugs: from new evidence to better practiceOutreach programmes are essential to provide PWID-- particularly youth-- with access to HIV and HCV services

European Monitoring Centre for Drugs and Drug Addiction (2016) EMCDDA, retrieved from: http://www.emcdda.europa.eu/topics/pods/drug-consumption-rooms#sthash.sMenP5Dw.dpufPerspectives on drugs: drug consumption rooms: an overview of provision and evidence [update]SIFs can reach and maintain contact with high-risk PWID not ready or willing to quit drug use

Goodhew et al. (2016) Harm Reduction Journal, 13:29.Mental health among clients of the Sydney Medically Supervised Injecting CentreIt would be beneficial to employ mental health clinicians in SIFs to address the mental health and psychosocial needs of PWID

Kappel et al. (2016) Harm Reduction Journal, 13:20.*A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugsClients and staff agree that SIFs are a safe haven for clients that provides linkage to health and social services

Middleton et al. (2016) British Medical Journal, 354:i5259.Drug related deaths in England and WalesSIFs should be developed to attract PWID into treatment and protect them from harms related to street drug use

Toth et al. (2016) Harm Reduction Journal, 13:27.A cross-sectional national survey assessing self-reported drug intake behavior, contact with the primary sector and drug treatment among service users of Danish drug consumption roomsDanish SIF staff provide valuable education services to PWID on health-related issues and harm-reducing interventions

Shaw et al. (2015) Harm Reduction Journal, 12:49.Risk environments facing potential users of a supervised injection site in Ottawa, Canada.A SIF in Ottawa would be well-positioned to reach highly marginalized PWID and reduce drug-related harms. Over 75% of PWID reported they would be willing to use a SIF, and those willing were most likely to be publicly injecting, HCV+, and to have suffered a recent OD

Hadland (2014) Journal of Adolescent Health, 55(5): 684-689.Use of a medically supervised facility among street youthThe SIF attracts high-frequency young PWIDs most at risk of blood-borne infection and OD, as well as those who otherwise inject in public spaces

Montaner et al. (2014) PLOS ONE, 9(2):e87872.Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the “HIV treatment as prevention” experience in a Canadian settingThe implementation of a SIF and other low threshold drug treatment services facilitate the expansion of HAART coverage among PWID 

McNeil et al. (2014) Journal of the International AIDS Society, 17(1):608-1081.Impact of supervised drug consumption services on access to and engagement with care at a palliative and supportive care facility for people living with HIV/AIDS: a qualitative studyIntegrating a SIF into an HIV/AIDs care facility altered the structural-environmental context of its healthcare services, thus mediating access to palliative and supportive care services. This approach also fostered an atmosphere in which drug use could be discussed without the risk of punitive action, thus increasing openness between attending PWID and staff 

DeBeck et al. (2012) The American Journal of Drug and Alcohol Abuse, 38(1):55-62.The validity of reporting willingness to use a supervised injecting facility on subsequent program use among people who use injection drugsNearly ¾ of PWID who reported willingness to use the Vancouver SIF prior to its opening are now attending the facility

Dietze et al. (2012) International Journal of Drug Policy, 23:257-260.Mobile safe injecting facilities in Barcelona and BerlinWith local community support, mobile SIFs can clearly provide useful social and health services to PWID

Michels et al. (2012) Substance Use and Misuse, 47(8-9):910-922.Harm reduction-- from the conceptual framework to practical experience: the example of GermanySIFs have initiated contact with otherwise hidden PWID

McNeil et al. (2012) Journal of Palliative Care, 28(3):175.Harm reduction and palliative care: is there a role for supervised drug consumption services?SIFs could increase access to palliative care services for PWID, particularly those lacking in support

Thieme et al. (2012) Suchttherapie, 13:132-137.Drug consumption rooms useful in Bavaria? Characteristics of visitors to low threshold services for drug users in Bavaria and their intentions regarding the use of drug consumption roomsThe majority of sampled Bavarian PWIDs are willing to use SIFs and want more services aimed at reducing harm and aiding with drug withdrawal as supplements at these sites

Reddon et al. (2011) AIDS Education and Prevention, 23(5):412-422.Use of North America’s first medically supervised safer injecting facility among HIV-positive injection drug usersThe SIF appears to have attracted a high-risk subpopulation of HIV-positive youth that inject drugs

KPMG (2010) NSW Health, Sydney, Australia: retrieved from: http://www.health.nsw.gov.au/mhdao/Documents/msic-fr.pdfFurther evaluation of the Medically Supervised Injecting Centre during its extended trial period (2007-2011): final reportFrequent attendance of the SIF was associated with higher likelihood of accepting service referral

Scherbaum et al. (2010) Substance Use and Misuse, 45(1-2):176-189.Longitudinal observation of a sample of German drug consumption facility clientsOver a third of interviewed SIF clients referred and engaged with health insurance addiction treatment system after six months

Krüsi et al. (2009) AIDS Care, 21:638-644.An integrated supervised injecting program within a care facility for HIV-positive individuals: a qualitative evaluationSIFs have a place in comprehensive HIV care models

Lloyd-Smith et al. (2009) Annals of Epidemiology, 19:404-409.Determinants of cutaneous injection-related injection care at a supervised injecting facilityThe SIF provides a variety of integrated health care services

Scherbaum et al. (2009) International Journal of Drug Policy, 20:447-449.Drug consumption facility as part of a primary health care centre for problem drug users-- which clients are attracted?SIFs attract chronic opiate users with high rates of risk behavior

Small et al. (2009) Drug and Alcohol Review, 28(4):341-346.Access to health and social services for IDU the impact of a medically supervised injection facilityThere is a very high potential for SIFs to improve access to health and social services for PWID

Kimber et al. (2008) Addiction, 103:1604-1613.Estimating the size and dynamics of an injecting drug user population and implications for health service coverage: comparison of indirect prevalence estimation methodsThe SIF achieves high coverage of the local injection drug using population

Kimber et al. (2008) Drug and Alcohol Review, 27:602-612.Process and predictors of drug treatment referral and referral uptake at the Sydney Medically Supervised Injecting CentreThe SIF successfully engages PWID in drug treatment referral, including other health and psychosocial services

Wood et al. (2008) International Journal of Drug Policy.Nurse-delivered safer injection education among a cohort of injection drug users: evidence from the evaluation of Vancouver’s supervised injection facilityNurses in the SIF reach high-risk female and younger PWID 

Hunt et al. (2007) International Journal of Drug Policy, 18:62-65.Public injecting and willingness to use a drug consumption room among needle exchange programme attendees in the UKThe majority of publicly-using PWID would use SIFs if available 

O’Shea (2007) Drugs, education, prevention and policy, 14(1):75-88.Introducing safer injecting facilities (SIFs) in the Republic of Ireland: “Chipping away” at policy changeThe majority of publicly-injecting PWID are willing to use safe injection facilities

Stoltz et al. (2007) Addiction Research & Theory.Characteristics of young illicit drug injectors who use North America’s first medically supervised safer injecting facility57% of PWID under 30 years of age use the SIF regularly

Wood et al. (2007) Addiction, 102:916-919.Rate of detoxification service use and its impact among a cohort of supervised injection facility usersThe SIF is instrumental in connecting users to detox services and methadone treatment

Tyndall et al. (2006) Harm Reduction Journal, 3.HIV sero-prevalence among participants at a supervised injection facility in Vancouver, Canada: implications for prevention, care and treatmentThe SIF bridges the gap between hard-to-reach HIV-positive PWID and

Wood et al. (2006) American Journal of Public Health, 96:770-773.Service uptake and characteristics of injection drug users utilizing North America’s first medically supervised safer injection facilityThe Canadian SIF was successful in attracting its target demographic high-risk and outdoor PWID

Wood et al. (2006) New England Journal of Medicine, 354:2512-2514.Attendance at supervised injecting facilities and use of detoxification servicesThe SIF increases the use of addiction treatment and counselling services

Scherbaum (2005) European Psychiatry, 20:S15-S33.Substance related disorders: Evaluation of drug consumption rooms for drug addictsThe SIF successfully reaches PWIDs, with many eventually transferring to addiction treatment

Tyndall et al. (2005) Drug and Alcohol Dependence, 83(3):193-198.Attendance, drug use patterns, and referrals made from North America’s first supervised injection facilityThe SIF successfully connects PWID to detox and other support services

Van Beek et al. (2004) Critical Public Health, 14(4):391-406.The Sydney Medically Supervised Injecting Centre: reducing harm associated with heroin overdoseObserving risk behaviors among PWID gives SIF clinicians the unique opportunity to tailor health messages and identify high-risk clients for counseling

Green et al. (2004) Canadian Journal of Public Health, 95(2):110-114.My place, your place, or a safer place: the intention among Montreal injecting drug users to user supervised injecting facilitiesThe vast majority of PWID report interest in attending at least one of the three proposed SIF sites

Zobel et al. (2004), University Institute of Social and Preventative Medicine, Bern, Switzerland.*Short appraisal of the role and usefulness of Drug Consumption Facilities (DCF) in the reduction of drug-related problems in Switzerland: appraisal produced at the request of the Swiss Federal Office of Public HealthSIFs provide access to social and healthcare services and reduce risky behaviors

Anoro et al. (2003) Journal of Drug Issues, 33(3):689-712.Barcelona’s safer injection facility- EVA: a harm reduction program lacking official supportThe SIF provides a fundamental space of shelter for local PWID, particularly those at high-risk, to seek help improving their physical and mental healt

Zurhold et al. (2003a) Journal of Drug Issues, 2003:663-688.Drug consumption rooms in Hamburg, Germany: evaluation of the effects of harm reduction and the reduction of public nuisanceHamburg SIFs reach high-risk, publicly-using PWID

Kimber et al. (2000) Drug and Alcohol Review, 19:337-346.*Drug consumption facilities in Europe and the establishment of supervised injecting centres in AustraliaAvailable evidence support that SIFs improve access to/ uptake of health and other services

Gardner (2017) Mount Sinai Graduate School of Biomedical Sciences, 2017:Publication No. 10256673.Supervised injection facilities and social services: an evaluation of service provision and treatment uptake from managerial perspectivesSIFs regularly engage with hard-to-reach PWID, and facilities with more social services are associated with higher daily utilization 

Parés-Badell et al. (2017) Journal of Substance Abuse Treatment, 77:13-20.Undiagnosed HIV and Hepatitis C infection in people who inject drugs: from new evidence to better practiceOutreach programmes are essential to provide PWID-- particularly youth-- with access to HIV and HCV services

European Monitoring Centre for Drugs and Drug Addiction (2016) EMCDDA, retrieved from: http://www.emcdda.europa.eu/topics/pods/drug-consumption-rooms#sthash.sMenP5Dw.dpufPerspectives on drugs: drug consumption rooms: an overview of provision and evidence [update]SIFs can reach and maintain contact with high-risk PWID not ready or willing to quit drug use

Goodhew et al. (2016) Harm Reduction Journal, 13:29.Mental health among clients of the Sydney Medically Supervised Injecting CentreIt would be beneficial to employ mental health clinicians in SIFs to address the mental health and psychosocial needs of PWID

Kappel et al. (2016) Harm Reduction Journal, 13:20.*A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugsClients and staff agree that SIFs are a safe haven for clients that provides linkage to health and social services 

Van der Poel et al. (2003) European Addiction Research, 9:94-100.Drug consumption rooms in Rotterdam: an explorative descriptionAccess to SIFs results in less frequent drug use in public places and more time and rest for PWID

Wolf et al. (2003) Journal of Drug Issues, 2003:649-662.Drug consumption facilities in the NetherlandsSIFs have greatly enhanced the Dutch portfolio of addiction-care programs and reduce both the nuisances and health damage related to public drug use

Zurhold et al. (2003c) Journal of Drug Issues, 2003:663-688.*Drug consumption rooms in Hamburg, Germany: evaluation of the effects of harm reduction and the reduction of public nuisanceHamburg SIFs lead to a reduction of public disturbances

Stoever (2002) Journal of Drug Issues, 2002:597-606.*Consumption rooms-- a middle ground between health and public order concernsSIFs successfully contribute to the maintenance of public order

Kimber et al. (2000) Drug and Alcohol Review, 19:337-346.*Drug consumption facilities in Europe and the establishment of supervised injecting centres in AustraliaAvailable evidence support that SIFs reduce public nuisance

Kinnard et al. (2014) Harm Reduction Journal, 11:29.Self-reported changes in drug use behaviors and syringe disposal methods following the opening of a supervised injecting facility in Copenhagen, DenmarkThe Copenhagen SIF successfully engages PWID to adopt safer behaviors to benefit their health and the Vesterbro neighborhood

Independent Drug Commission for Brighton and Hove. Jan 2013.*SIFs are recommended based on international evidence that they significantly reduce the inconvenience associated with public drug use, whilst not increasing drug use rates

Jozaghi et al (2013) Harm Reduction Journal, 10(1):1-9.*Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada?InSite had a positive impact on drug use patterns in the neighborhood

Vecino et al. (2013) Adicciones: Revista de Socidrogalcohol, 25(4):333-338.Safe Injection Rooms and Police Crackdowns in Areas with Heavy Drug Dealing [spanish]The opening of the Barcelona SIF was associated with a significant decrease in the number of discarded syringes in the entire city, along with police interventions

Semaan et al. (2012) Center for Disease Control and Prevention: National Center for HIV/AIDS, STD and TB Prevention*Scientific and programmatic implications of safer injection facilities for persons who inject drugs illicitlySIFs safely dispose of used equipment, prevent accidental needle-stick injuries to community members, and reduce public nuisance and litter

Somaini et al. (2012) Journal of Public Health Policy, 33(3):317-324.Commentary: how and why AIDS changed drug policy in SwitzerlandMultiple cities in Switzerland established SIFs and small-scale needle distribution services to prevent HIV disease transmission within their communities

Salmon et al. (2010) Addiction, 105:676-683.The impact of a supervised injecting facility on ambulance call-outs in Sydney, AustraliaThe SIF reduces the demand for ambulance services

Boyd et al. (2008) Vancouver: Health Canada, 2008:29.Public order and supervised injection facilities: Vancouver’s SISNeighbourhood residents and businesses view the SIF as making a positive contribution to public order

Richardson et al. (2008) American Journal of Drug and Alcohol Abuse, 34(5):519-525.Employment among users of a medically supervised safer injection facilityRegular use of the SIF did not interfere with attendees’ employment

Small et al. (2008) Drug and Alcohol Dependence, 98:159-162.Accessing care for injection-related infections through a medically supervised injection facility: a qualitative studyThe Vancouver SIF reduces strain on the health care system

Kerr et al. (2007) Current HIV/AIDS Reports, 4:158-164.*The role of safer injection facilities in the response to HIV/AIDS among injection drug usersSIFs could provide additional services for the community, such as HIV testing

Lloyd et al. (2007) International Journal of Drug Policy, 18:5-9.*Drug consumption rooms: an overdue extension to harm reduction policy in the UK?SIFs are a promising way to work with hard-to-reach PWID to lessen the damage and costs to society

Wood et al. (2006) Canadian Medical Association Journal, 175:1399-1404.Summary of findings from the evaluation of a pilot medically supervised safer injection facilityThe Vancouver SIF presents a large number of health and community benefits and no indications of community or health-related harms

Zajdow (2006) Contemporary Drug Problems, 33:399-422.*The narrative of evaluations: medically supervised injecting centersMultiple studies prove SIFs eliminate public nuisance related to open drug scenes

Prinzleve et al. (2004) Suchttherapie, 5:83-89.Relief of strain on the city district? The effects of a low-threshold drug help service on the number of drug users in Hamburg St. GeorgA low-threshold drug help service with an integrated SIF contributes to removing strain on the city district

Wood et al. (2004) Canadian Medical Association Journal, 171:731-734.Changes in public order after the opening of a medically supervised safer injection facility for injection drug usersThe SIF improves public order in the community

Zobel et al. (2004), University Institute of Social and Preventative Medicine, Bern, Switzerland*Short appraisal of the role and usefulness of Drug Consumption Facilities (DCF) in the reduction of drug-related problems in Switzerland: appraisal produced at the request of the Swiss Federal Office of Public HealthSIFs reduce public order problems

Green et al. (2003) Journal of Drug Issues, 33:713.Ascertaining the need for a supervised injecting facility (SIF): the burden of public injecting in Montreal, CanadaSIFs are warranted in cities with an established open drug scene

Kimber et al. (2003) Drug and Alcohol Review, 22:227-233.*Drug consumption facilities: an update since 2000SIFs reduce public nuisance associated with open drug scenes and are well accepted in their local communities

Van der Poel et al. (2003) European Addiction Research, 9:94-100.Drug consumption rooms in Rotterdam: an explorative descriptionAccess to SIFs results in less frequent drug use in public places and more time and rest for PWID

Wolf et al. (2003) Journal of Drug Issues, 2003:649-662.Drug consumption facilities in the NetherlandsSIFs have greatly enhanced the Dutch portfolio of addiction-care programs and reduce both the nuisances and health damage related to public drug use

Zurhold et al. (2003c) Journal of Drug Issues, 2003:663-688.*Drug consumption rooms in Hamburg, Germany: evaluation of the effects of harm reduction and the reduction of public nuisanceHamburg SIFs lead to a reduction of public disturbances

Stoever (2002) Journal of Drug Issues, 2002:597-606.*Consumption rooms-- a middle ground between health and public order concernsSIFs successfully contribute to the maintenance of public order

Kimber et al. (2000) Drug and Alcohol Review, 19:337-346.*Drug consumption facilities in Europe and the establishment of supervised injecting centres in AustraliaAvailable evidence support that SIFs reduce public nuisance

Kinnard et al. (2014) Harm Reduction Journal, 11:29.Self-reported changes in drug use behaviors and syringe disposal methods following the opening of a supervised injecting facility in Copenhagen, DenmarkThe Copenhagen SIF successfully engages PWID to adopt safer behaviors to benefit their health and the Vesterbro neighborhood

Independent Drug Commission for Brighton and Hove. Jan 2013.*SIFs are recommended based on international evidence that they significantly reduce the inconvenience associated with public drug use, whilst not increasing drug use rates

Jozaghi et al (2013) Harm Reduction Journal, 10(1):1-9.*Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada?InSite had a positive impact on drug use patterns in the neighborhood

Vecino et al. (2013) Adicciones: Revista de Socidrogalcohol, 25(4):333-338.Safe Injection Rooms and Police Crackdowns in Areas with Heavy Drug Dealing [spanish]The opening of the Barcelona SIF was associated with a significant decrease in the number of discarded syringes in the entire city, along with police interventions

Semaan et al. (2012) Center for Disease Control and Prevention: National Center for HIV/AIDS, STD and TB Prevention*Scientific and programmatic implications of safer injection facilities for persons who inject drugs illicitlySIFs safely dispose of used equipment, prevent accidental needle-stick injuries to community members, and reduce public nuisance and litter

Cohen (2006) Potus Consulting, Royal Canadian Mounted Police.A review of the research: literature on supervised injection sitesCanada’s national policing force concludes that SIFs do not increase crime

Hunt (2006) Joseph Rowntree Foundation, York, UK.The evaluation literature on drug consumption roomsSIFs increase health and decrease public nuisance in a number of ways without increasing crime

Kerr et al. (2006) British Medical Journal, 332:220-222.Impact of a medically supervised safer injection facility on community drug use patterns: a before and after studyThe SIF has not produced adverse changes in community drug use patterns

Wood et al. (2006) Substance Abuse Treatment, Prevention and Policy, 1:1-4.Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crimeThe opening of the SIF did not increase drug trafficking or drug-related crime in the community

Freeman et al. (2005) Drug and Alcohol Review, 24(2):173-184.The impact of the Sydney Medically Supervised Centre (MSIC) on crimeLoitering by PWID or dealers did not increase in the area after the establishment of the SIF

Potier et al. (2014) Drug and Alcohol Dependence, 145:48-68.Supervised injection services: what has been demonstrated? A systematic literature reviewSIFs in places with high rates of injection drug use fulfil their initial objectives without enhancing drug use or drug trafficking

Independent Drug Commission for Brighton and Hove. Jan 2013.*SIFs are recommended based on international evidence that they achieve their objectives while not increasing drug use rates

Hedrich et al. (2010) European Monitoring Centre for Drugs and Drug Addiction, Harm Reduction: Evidence, Impacts, and Challenges Scientific, Monograph Series 10:305-331Drug consumption facilities in Europe and beyondSIFs are associated with reductions in injecting risk behavior and do not result in higher rates of local drug acquisition crime

Milloy et al. (2008) American Journal of Drug and Alcohol Abuse, 34:499-509.Non-fatal OD among a cohort of active injection drug users recruited from a supervised injection facilityThe SIF does not increase rates of OD

Kerr et al. (2007) American Journal of Public Health, 97:1228-1220.Circumstances of first injection among illicit drug users accessing a medically supervised safer injecting facilityThe SIF does not promote drug use

Patel (2007) Journal of Drug Issues, 2007:737-748.*Research note: drug consumption rooms and needle and syringe exchange programsSIFs do not increase crime or illicit drug use by either attracting more PWID to the area, increasing the initiation of intravenous drug use, or increasing injecting behavior in attendants

Cohen (2006) Potus Consulting, Royal Canadian Mounted Police.A review of the research: literature on supervised injection sitesCanada’s national policing force concludes that SIFs do not increase crime

Hunt (2006) Joseph Rowntree Foundation, York, UK.The evaluation literature on drug consumption roomsSIFs increase health and decrease public nuisance in a number of ways without increasing crime

Kerr et al. (2006) British Medical Journal, 332:220-222.Impact of a medically supervised safer injection facility on community drug use patterns: a before and after studyThe SIF has not produced adverse changes in community drug use patterns

Wood et al. (2006) Substance Abuse Treatment, Prevention and Policy, 1:1-4.Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crimeThe opening of the SIF did not increase drug trafficking or drug-related crime in the community

Freeman et al. (2005) Drug and Alcohol Review, 24(2):173-184.The impact of the Sydney Medically Supervised Centre (MSIC) on crimeLoitering by PWID or dealers did not increase in the area after the establishment of the SIF

Potier et al. (2014) Drug and Alcohol Dependence, 145:48-68.Supervised injection services: what has been demonstrated? A systematic literature reviewSIFs in places with high rates of injection drug use fulfil their initial objectives without enhancing drug use or drug trafficking

Independent Drug Commission for Brighton and Hove. Jan 2013.*SIFs are recommended based on international evidence that they achieve their objectives while not increasing drug use rates

Hedrich et al. (2010) European Monitoring Centre for Drugs and Drug Addiction, Harm Reduction: Evidence, Impacts, and Challenges Scientific, Monograph Series 10:305-331Drug consumption facilities in Europe and beyondSIFs are associated with reductions in injecting risk behavior and do not result in higher rates of local drug acquisition crime

Milloy et al. (2008) American Journal of Drug and Alcohol Abuse, 34:499-509.Non-fatal OD among a cohort of active injection drug users recruited from a supervised injection facilityThe SIF does not increase rates of OD

Kerr et al. (2007) American Journal of Public Health, 97:1228-1220.Circumstances of first injection among illicit drug users accessing a medically supervised safer injecting facilityThe SIF does not promote drug use

Cruz et al. (2007) International Journal of Drug Policy, 18(1):54-61.Public opinion towards supervised injection facilities and heroin-assisted treatment in Ontario, CanadaPublic opinion in 2003 vastly agreed with the implementation of a SIF in Ontario

Salmon et al. (2007) International Journal of Drug Policy, 18(1):46-53.Five years on: what are the community perceptions of drug-related public amenity following the establishment of the Sydney medically supervised injecting centre?Local community members perceive significant improvements in public amenity indicators since the opening of the SIF and largely approve of this service

National Centre in HIV Epidemiology and Clinical Research (2006) NSW Health, retrieved from: https://kirby.unsw.edu.au/sites/default/files/hiv/attachment/IntRep2SurveyMSICJul06.pdfSydney Medically Supervised Injecting Center interim evaluation report no. 2: evaluation of community attitudes towards the Sydney MSICThe SIF is well-received by the vast majority of community members

Thein et al. (2005) International Journal of Drug Policy, 16(4):275-280.Public opinion towards supervised injecting centres and the Sydney Medically Supervised Injecting CentreLocal residents and businesses widely support the SIF and have diminished concerns about resulting crime in the area since its implementation

Kimber et al. (2005) Drug and Alcohol Review, 24:21-24.Survey of drug consumption rooms: service delivery and perceived public health and amenity impactSIFs achieve their service delivery objectives with few negative consequences

Kulesza et al. (2015) Substance Abuse Treatment, Prevention, and Policy, 10:25.Correlates of public support toward federal funding for harm reduction strategiesThe majority of interviewees in the US support SIFs and allocating government resources to fund harm reduction programs 

Strike et al. (2014) Addiction, 109:946-953.Increasing public support for supervised injection facilities in Ontario, CanadaSupport for implementation of SIFs in Ontario has increased since 2003

Tzemis et al. (2013) Substance Abuse Treatment, Prevention, and Policy, 8:40.A cross-sectional study of public attitudes towards safer drug use practices in British Columbia, CanadaThe majority of surveyed British Columbians support harm reduction practices in their local community

Jauncey et al. (2011) The Medical Journal of Australia, 195:264.Bipartisan support for Australia’s supervised injecting facility: a decade in the makingPublic and medical opinion widely support the operation of the SIF in Australia

Cruz et al. (2007) International Journal of Drug Policy, 18(1):54-61.Public opinion towards supervised injection facilities and heroin-assisted treatment in Ontario, CanadaPublic opinion in 2003 vastly agreed with the implementation of a SIF in Ontario

Salmon et al. (2007) International Journal of Drug Policy, 18(1):46-53.Five years on: what are the community perceptions of drug-related public amenity following the establishment of the Sydney medically supervised injecting centre?Local community members perceive significant improvements in public amenity indicators since the opening of the SIF and largely approve of this service

National Centre in HIV Epidemiology and Clinical Research (2006) NSW Health, retrieved from: https://kirby.unsw.edu.au/sites/default/files/hiv/attachment/IntRep2SurveyMSICJul06.pdfSydney Medically Supervised Injecting Center interim evaluation report no. 2: evaluation of community attitudes towards the Sydney MSICThe SIF is well-received by the vast majority of community members

Thein et al. (2005) International Journal of Drug Policy, 16(4):275-280.Public opinion towards supervised injecting centres and the Sydney Medically Supervised Injecting CentreLocal residents and businesses widely support the SIF and have diminished concerns about resulting crime in the area since its implementation

Kimber et al. (2005) Drug and Alcohol Review, 24:21-24.Survey of drug consumption rooms: service delivery and perceived public health and amenity impactSIFs achieve their service delivery objectives with few negative consequences

Kulesza et al. (2015) Substance Abuse Treatment, Prevention, and Policy, 10:25.Correlates of public support toward federal funding for harm reduction strategiesThe majority of interviewees in the US support SIFs and allocating government resources to fund harm reduction programs

Strike et al. (2014) Addiction, 109:946-953.Increasing public support for supervised injection facilities in Ontario, CanadaSupport for implementation of SIFs in Ontario has increased since 2003

Tzemis et al. (2013) Substance Abuse Treatment, Prevention, and Policy, 8:40.A cross-sectional study of public attitudes towards safer drug use practices in British Columbia, CanadaThe majority of surveyed British Columbians support harm reduction practices in their local community 

Jauncey et al. (2011) The Medical Journal of Australia, 195:264.Bipartisan support for Australia’s supervised injecting facility: a decade in the makingPublic and medical opinion widely support the operation of the SIF in Australia

Cruz et al. (2007) International Journal of Drug Policy, 18(1):54-61.Public opinion towards supervised injection facilities and heroin-assisted treatment in Ontario, CanadaPublic opinion in 2003 vastly agreed with the implementation of a SIF in Ontario

Heller et al. (2009) Harm Reduction Journal, 6:1. 

The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York City 

SIFs should be considered to address the prevalence of public injecting and resolve the ‘syringe gap’ for PWID 

Beletsky et al. (2008) American Journal of Public Health, 98(2):231-237. 

The law (and politics) of safe injection facilities in the United States 

Favorable evaluations of SIFs elsewhere, namely that they improve public health without increasing drug use or crime, have raised the issue of their implementation in the US 

Mutz (2006) University of Kansas Department of Political Science, 2006:Publication No. 1443677. 

The middle of a crossfire: drug policies and injection drug users during the HIV/AIDS epidemic 

The potential for SIFs to reach PWID makes them at the very least worth an attempt in the US 

Broadhead et al. (2003) Journal of Drug Issues, 33(3):733-750. 

Safer injection sites in New York City: a utilization survey of injection drug users 

A large majority of sampled PWID would utilize a SIF, and those at highest risk would be the most likely to use them 

Broadhead et al. (2002) Journal of Drug Issues, 32(1):329-355. 

Safer injection facilities in North America: their place in public policy and health initiatives

The time has come for more North American municipalities to consider SIFs in public policy and health initiatives due to their ability to target public health problems related to injection drug use. 

Gaeta et al. (2018) Annals of Internal Medicine, [Epub ahead of print 6 Feb 2018]. 

New strategies are needed to stop overdose fatalities: the case for supervised injection facilities 

This opinion piece was published by two Boston health professionals that witnessed a PWID plead for a clinic to help him due to fear of OD precipitated by relapse, only to suffer fatal OD ninety minutes after leaving. In this piece, it is argued that SIFs are a necessary intervention to help those suffering from substance use disorder stay alive until they are ready for treatment 

Harris et al. (2018) International Journal of Drug Policy, 52:56-61. 

Perceptions about supervised injection facilities among people who inject drugs in Philadelphia 

Surveyed PWID confirmed that social and environmental factors encourage high risk injection behaviors associated with infections and OD. Participants expressed support for SIFs and believe that such a facility could reduce the harms associated with public injection for both PWID and the community 

León et al. (2018) International Journal of Drug Policy, 53:90-95. 

Changes in public order after the opening of an overdose monitoring facility for people who inject drugs 

The opening of a low-threshold harm reduction program for monitoring PWID at imminent risk of OD in Boston was associated with a significant decrease in observed over-sedated individuals. The difference in study outcomes compared to those analyzing SIFs suggest that a SIF may be a more effective model for improving public order and should be considered as part of a broader approach in US communities most affected by the opioid OD crisis 

Heller et al. (2009) Harm Reduction Journal, 6:1. 

The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York City 

SIFs should be considered to address the prevalence of public injecting and resolve the ‘syringe gap’ for PWID 

Beletsky et al. (2008) American Journal of Public Health, 98(2):231-237. 

The law (and politics) of safe injection facilities in the United States 

Favorable evaluations of SIFs elsewhere, namely that they improve public health without increasing drug use or crime, have raised the issue of their implementation in the US 

Mutz (2006) University of Kansas Department of Political Science, 2006:Publication No. 1443677. 

The middle of a crossfire: drug policies and injection drug users during the HIV/AIDS epidemic 

The potential for SIFs to reach PWID makes them at the very least worth an attempt in the US 

Broadhead et al. (2003) Journal of Drug Issues, 33(3):733-750. 

Safer injection sites in New York City: a utilization survey of injection drug users 

A large majority of sampled PWID would utilize a SIF, and those at highest risk would be the most likely to use them 

Broadhead et al. (2002) Journal of Drug Issues, 32(1):329-355. 

Safer injection facilities in North America: their place in public policy and health initiatives

The time has come for more North American municipalities to consider SIFs in public policy and health initiatives due to their ability to target public health problems related to injection drug use. 

Gaeta et al. (2018) Annals of Internal Medicine, [Epub ahead of print 6 Feb 2018]. 

New strategies are needed to stop overdose fatalities: the case for supervised injection facilities 

This opinion piece was published by two Boston health professionals that witnessed a PWID plead for a clinic to help him due to fear of OD precipitated by relapse, only to suffer fatal OD ninety minutes after leaving. In this piece, it is argued that SIFs are a necessary intervention to help those suffering from substance use disorder stay alive until they are ready for treatment 

Harris et al. (2018) International Journal of Drug Policy, 52:56-61. 

Perceptions about supervised injection facilities among people who inject drugs in Philadelphia 

Surveyed PWID confirmed that social and environmental factors encourage high risk injection behaviors associated with infections and OD. Participants expressed support for SIFs and believe that such a facility could reduce the harms associated with public injection for both PWID and the community 

León et al. (2018) International Journal of Drug Policy, 53:90-95. 

Changes in public order after the opening of an overdose monitoring facility for people who inject drugs 

The opening of a low-threshold harm reduction program for monitoring PWID at imminent risk of OD in Boston was associated with a significant decrease in observed over-sedated individuals. The difference in study outcomes compared to those analyzing SIFs suggest that a SIF may be a more effective model for improving public order and should be considered as part of a broader approach in US communities most affected by the opioid OD crisis 

Allen et al. (2015). Harm Reduction Journal, 12: 3.

How far will they go?: assessing the travel distance of current and former drug users to access harm reduction services 

Using a geometric point distance estimation technique, researchers found that differences in mean walking distance between current and former PWID were statistically significant with current and former PWID having mean walking distances of 2.75 and 1.80 miles, respectively. 

Archibald et al. (1998). Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 12(2): 160-6. 

Factors associated with frequent needle exchange program attendance in injection drug users in Vancouver, Canada

Using data from a NEP in Vancouver, Canada, researchers found that the NEP attracted IDUs who were frequent injectors (especially men using cocaine) and who engaged in high-risk behaviors. 

Hahn et al. (1997). Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 15(2): 157-64.

Who uses needle exchange? A study of injection drug users in treatment in San Francisco, 1989 – 1990.

A study of the use of the San Francisco needle exchange program showed that the NEP attracted a very-high-risk subgroup of IDUs, as measured by risk behavior and pre-needle exchange HIV-seroconversion rate. 

Treloar et al.(2016). International Journal of Drug Policy, 27: 138-45.

Trust and people who inject drugs: The perspectives of clients and staff of Needle Syringe Programs

NSP participants reported high levels of trust in NSPs, especially when compared with drug treatment services. Trust is acknowledged as essential for effective therapeutic encounters. 

Masson et al. (2007). AIDS Education and Prevention, 19(2): 97-110.

Hospital- versus community-based syringe exchange: a randomized controlled trial

Hospital-based SEP attendees had 83% more inpatient admissions and 22% more ambulatory care visits than those assigned to the community-based SEP condition. Syringe exchange services that are integrated into public hospital settings may serve as a valuable strategy to engage hard to reach IDU population in behavioral interventions designed to reduce HIV risk transmission behaviors and increase access to, or engagement in, the use of secondary and tertiary preventive medical care. 

New Jersey Syringe Access Program Demonstration Project. (2010). 

Interim report: Implementation of P.L. 2006, c.99, “Bloode-borne Disease Harm Reduction Act

More than 22% of the 4,482 people served by New Jersey’s five SEPs from 2007 to 2009 entered a drug treatment program, demonstrating how SEPs can link participants to comprehensive treatment and care 

Paone et al. (2010). AIDS Care, 11(3): 269-280.HIV risk behaviors of current sex workers attending syringe exchange: the experiences of women in five US cities

Data collected from randomly chosen female SEP participants in 5 US cities indicated that current sex workers enrolled in a SEP reported higher levels of risk for every drug risk variable than SEP participants who do not engage in sex work. Thus, SEPs can serve a pivotal role in providing sex workers with services and referrals which could help them reduce risk behaviors 

Des Jarlais et al. (2005) AIDS, 19 Suppl 3: S20-5. 

Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990-2001.

Large scale expansion of syringe exchange in New York City (250,000 to 3,000,000 syringes exchanged annually) was temporally associated with large reductions in both HIV and HCV prevalence. 

Jenness et al. (2016). Substance Use & Misuse, 46(2-3): 192-200. 

Continuing HIV risk in New York City in New York City injection drug users: the association of syringe source and syringe sharing  

In multiple logistic regression, not obtaining all syringes in the past year exclusively from sterile sources was associated with increased syringe sharing.  

Huo et al. (2007). Journal of Acquired Immune Deficiency Syndromes, 45(1): 108-114.

Needle exchange and injection-related risk behaviors in Chicago: A longiitudinal study

NEP use was significantly associated with reduced odds of greater than 60% for receptive needle sharing, 45% for lending used needles, and 30% for sharing other injections paraphernalia as well as approximately a 2-fold increase in the odds of always bleaching used needles. 

NYS Department of Health, AIDS Institute. (2014). 

Comprehensive Harm Reduction Reverses the Trend in New HIV Infections 

Data from the evaluation of the NYS SEP conducted by researchers from the Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center indicated that by 1994, there was a 50% reduction in HIV incidence, a 75% decrease in the buying or renting of syringes, and a 63% decrease in syringe-sharing behaviors. 

Belani, H. K., & Muennig, P. A. (2008) Journal of HIV/AIDS & Social Services, 7(3): 229-240.

Cost-Effectiveness of Needle and Syringe Exchange for the Prevention of HIV in New York City

Evaluation of data from the Lower East Side Harm Reduction Center in New York City demonstrated a cost of $502 per client and a gain of 0.01 quality adjusted life years per client. The program also reduced HIV treatment costs by $325,000 per case of HIV averted, and averted 4-7 HIV infections per 1000 clients, producing a net cost savings. 

Holtgrave et al. (1998). Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18 Suppl 1: S133-8. 

Cost and cost-effectiveness of increasing access to sterile syringes and needles as an HIV prevention intervention in the United States.

Using a mathematical linking programmatic coverage levels with estimates of numbers of HIV infections averted, it was calculated that a policy of funding syringe exchange programs, pharmacy sales, and syringe disposal to cover all illicit drug injections would cost just over $423 million USD for 1 year. Thus, this policy would cost an estimated $34, 278 USD per HIV infection averted, a figure well under the estimated lifetime costs of medical care for a person with HIV infection. Even at high levels of coverage, such funding would save society money. 

Bernard et al. (2017). PLoS Med. 14(5): e1002312. 

Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis

The model based analysis projected that, over 20 years, 50% needle and syringe program coverage could avert up to 35,000 infections and cost $18,000 USD per quality-adjusted life years gained.  

Laufer, FN. (2001). Journal of Acquired Immune Deficiency Syndromes, 28(3): 273-8. 

Cost-effectiveness of syringe exchange as an HIV prevention strategy

A cost-effectiveness ratio of $20,947 USD per HIV infection averted was calculated based on an estimated 87 HIV infections averted across the seven NYS SEPs evaluated and total program costs of $1.82 million USD. 

Nguyen et al. (2014). AIDS and Behavior, 18(11): 2144-55. 

Syringe exchange in the United States: a national level economic evaluation of hypothetical increases in investment

With an annual $10 to $50 million funding increase, 194 – 816 HIV infections would be averted (cost per infection averted $51,601 - $61,302), with a 7.58 – 6.38 rate of financial return on investment. 

Potera, C. (2017). The American Journal of Nursing, 117(7): 17. 

An Innovative Syringe Exchange Program

PWID in Las Vegas can get free kits with clean needles and syringes from vending machines through a new pilot program called Trac-B Exchange. To get another kit, participants must return used needles to the vending machine. This reduces the number of contaminated needles discarded in parks, streets, and public bathrooms. The return rate of syringes has been steadily increasing since the start of the program. 

Downing et al. (2005). AIDS Education and Prevention, 17(1): 68-78. 

What’s Community Got to Do With It? Implementation Models of Syringe Exchange Programs

SEPs were established by one or more of three types of implementation models: (a) broad community coalition support, (b) community activist initiative, and (c) top-down decision making by government authorities. In each model, coalition building and community consultation were critical steps for the acceptance and sustainability of SEPs. 

Heller et al. (2011). Substance Use & Misuse, 46(2-3): 140-149. 

Access to sterile syringes for injecting drug users in New York City: politics and perception (1984 - 2010) 

The leadership and work of activists and advocates catalyzed syringe access policy and practice. 

Friedman et al. (2004). AIDS Education and Prevention, 16(3): 250-263. 

Urging Others to be Healthy: “Intravention” by Injection Drug Users as a Community Prevention Goal

Data from 120 injection drug users in a Brooklyn, New York neighborhood that has seen decreases in HIV prevalence among IDUs and little HIV diffusion to young adults indicate that most of them have recently (within 3 months) urged other people to engage in one or more self-protective actions. SEPs play an important role in providing education concerning drug and drug use safety 

Doherty et al. (2000). American Journal of Public Health, 90(6): 936-939 

The effect of a needle exchange program on numbers of discarded needles: a 2-year follow-up

Two years after a needle exchange program opened in Baltimore, MD, there was a significant decline in the overall quantity of discarded needles relative to that of drug vials and bottles. Presence of a needle exchange did not increase the number of discarded needles. 

Oliver et al. (1992). Journal of Acquired Immune Deficiency Syndromes, 5(5): 534-5. 

Impact of a needle exchange program on potentially infectious syringes in public places 

Researchers found that a syringe exchange program in Portland, OR reduced the number of discarded needles in the streets. 

Tookes et al. (2012). Drug and Alcohol Dependence, 123(1-3): 255-9. 

A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs

In 2008 – 2009, syringes were eight times more likely to be disposed of improperly in Miami (where there are no syringe exchange programs) than in San Francisco (where syringe exchanges are available). 

Groseclose et al. (1995). Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 10(1): 82-9. 

Impact of increased legal access to needles and syringes on practices of injecting-drug users and polices officers- Connecticut, 1992-1993

Needle-stick injury rates among Hartford police officers were lower after partial repeal of needle prescription and drug paraphernalia laws in CT. 

NYS AIDS Advisory Council. (1996). 

Report on Needle Exchange Programs and Deregulation of Needles and Syringes 

Among NYS SEP participants, injection frequency declined by 8%. 

Marx et al. (2000). American Journal of Public Health, 90(12): 1933-1936. 

Trends in crime and the introduction of a needle exchange program 

This study found no significant differences in arrest trends following the introduction of a SEP in Baltimore.  

Hagan et al. (2000). Journal of Substance Abuse Treatment, 19(3): 247-52. 

Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors 

Researchers found that IDUs who had formerly been SEP participants were more likely than never-exchangers to report a >75% reduction in injection, to stop injecting altogether, and to remain in drug treatment. 

Satcher, D. (1998). U.S. Department of Health and Human Services.Evidence-based findings on the efficacy of syringe exchange programs: an analysis of the scientific research completed since April 1998 

David Satcher, the Assistant Secretary for Health and Surgeon General, and other senior scientists from the Department of Health and Human Services unanimously agreed that “there is conclusive scientific evidence that syringe exchange programs are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.” Noting that, “in many cases, a decrease in injection frequency has been observed among those attending these programs.” 

Allen et al. (2016) Harm Reduction Journal, 13: 16. 

Legal space for syringe exchange programs in hot spots of injection drug use-related crime 

The 1000 Foot Rule prohibits the distribution of “any needle or syringe for the hypodermic injection of any illegal drug in any area of the District of Columbia which is within 1000 feet of a public or private elementary or secondary school (including a public charter school),” preventing legal SEP operation in areas of high injection drug use and/or drug distribution. The removal of the 1000 Foot Rule could significantly improve the public health of PWID via increased access to harm reduction services. 

Paquette et al. (2018) International Journal of Drug Policy, 57: 104-110. 

Stigma at every turn: Health services experiences among people who inject drugs

PWID repeatedly cite that negative experiences in health services contexts due to perceived stigma discouraged them from attempting to purchase syringes under the new pharmacy access law and participating in methadone treatment. Participants also associated stigmatization with delayed and substandard medical care for overdoses and injection-related infections. 

Bluthenthal et al. (2007). Addiction, 102(4): 638-46. 

Examination of the association between syringe exchange program (SEP) dispensation policy and SEP client-level syringe coverage among injection drug users 

Providing less restrictive (ex. Unlimited needs-based distribution) is associated with increased prevalence of adequate syringe coverage among clients.  

Sherman et al. (2015). Drug and Alcohol Review, 34(6): 637-644. 

Consequences of a restrictive syringe exchange policy on utilization patterns of a syringe exchange program in Baltimore, Maryland: Implications for HIV risk 

Researchers observed a substantial decrease in the average number of syringes distributed, syringes returned, the total number of clients, and new clients enrolling during a SEP’s restrictive policy period (less than 1-for-1 exchange for non-program syringes) as compared to numbers before the restrictive period, where the SEP used a 1-for-1 exchange policy.