The document discusses the implementation of supervised injection facilities (SIFs) as a harm reduction strategy to combat the opioid epidemic, highlighting evidence from international studies that demonstrate their effectiveness in reducing overdose deaths and disease transmission. Opinions from various stakeholders, including medical professionals and local government members, present both support and significant concerns, including legal challenges and community impacts. Ultimately, the document advocates for the removal of legal barriers to allow pilot programs for SIFs, emphasizing their potential to save lives and improve public health outcomes.

1. {
Safer Consumption
Spaces
An evidence-based response to opioid use and overdose
Gus Grannan, Project SAFE

2.  The City and/or partner organizations should further
explore the possibility of implementing one or more
comprehensive user engagement sites (CUES), on a pilot
basis, in which essential services are provided to reduce
substance use [my italics – g] and fatal overdose
(including referral to treatment and social services,
wound care, medically supervised drug consumption,
and access to sterile injection equipment and naloxone)
in a walk-in setting.
 -From the report of the city’s Opioid Task Force
13 Further explore comprehensive user
engagement site(s).

3.  In an effort to consider promising strategies
that could reduce the health and societal
problems associated with injection drug use,
the AMA today voted to support the
development of pilot facilities where people
who use intravenous drugs can inject self-
provided drugs under medical supervision.
American Medical Assn.

4.  Studies from other countries have shown that
supervised injection facilities reduce the
number of overdose deaths, reduce
transmission rates of infectious disease, and
increase the number of individuals initiating
treatment for substance use disorders without
increasing drug trafficking or crime in the areas
where the facilities are located.
American Medical Assn.

5.  “State and local governments around the
nation are currently involved in exploratory
efforts to create supervised injection facilities to
help reduce public health and societal impacts
of illegal drug use,”…“Pilot facilities will help
inform U.S . policymakers on the feasibility,
effectiveness and legal aspects of supervised
injection facilities in reducing harms and health
care costs associated with injection drug use.”
American Medical Assn.

6.  The examination of this issue by physicians at
the AMA Annual Meeting was greatly assisted
by the Massachusetts Medical Society and its
recently completed comprehensive study of the
literature associated with supervised injection
facilities.
 AMA Press Release, 6/12/2017
American Medical Assn.

7.  Jeremiah Daley, executive director of the Philadelphia-
Camden High Intensity Drug Trafficking Area
Program, a collaborative law enforcement effort,
pointed out that heroin is illegal and has no medical
use, so “we have that legal issue over our heads.”
 “Where would this be placed?” Daley asked. "And
does that doom that location to being a repository?
We’re going to essentially redline a neighborhood.”
 Daley challenged the portrait painted by the Vancouver
site manager, who said that city's program, called
Insite, made the host neighborhood a better place to
live and do business. The area “has been at a dead
stop,” he said. “It didn’t improve conditions in that
neighborhood.”
 Inquirer, Mayor's opioid task force sees huge obstacles to
safe-injection sites in Philly, 3/22/17
Mayor’s Task Force

8.  Task force co-chair Thomas Farley,
commissioner of the city’s Department of
Public Health, asked Deputy Police
Commissioner Myron Patterson for his opinion.
 “I don’t see much good coming out of it,”
Patterson responded. “Seattle is looking at it.
Vancouver is up and running. But they aren’t
Philadelphia.”
 Inquirer, Mayor's opioid task force sees huge
obstacles to safe-injection sites in Philly, 3/22/17
Mayor’s Task Force

9.  City Councilman David Oh said that Council
would have to pass an ordinance to create a site
where illegal drug activity was sanctioned. In
that scenario, he said, the state legislature
would likely respond by prohibiting such sites.
 “We in City Council don’t have the power,” he
said.
 Inquirer, Mayor's opioid task force sees huge
obstacles to safe-injection sites in Philly, 3/22/17
Mayor’s Task Force

10.  https://www.facebook.com/yestoscs/videos/vb.
320059568359474/495470480818381/?type=2&th
eater
King County [WA] Councilmember

11.  A few task force members spoke in favor of the
idea, which is based on a strategy of “harm
reduction” -- reducing the negative
consequences of drug use while accepting that
illicit drug use is a reality.
 “We need radical change,” said the Rev. James
P. Baker Jr., chair of the mayor’s drug and
alcohol commission.
 Inquirer, Mayor's opioid task force sees huge
obstacles to safe-injection sites in Philly, 3/22/17
Mayor’s Task Force

12.  Meet people where they’re at
 -Dan Bigg, Chicago Recovery Alliance
 Center the knowledge of those at risk of harm
 Encourage the self-efficacy of those at the foci
of intersectional stigma and trauma
 Recognize the source of harm and the locus of
reduced harm
Applied HR

13.  First in Frankfurt, Germany around 2003
 98 sites in 66 cities
 Now exist in [not exhaustive]
 Germany
 Switzerland
 Netherlands
 Norway
 Australia
 Canada
Safer Consumption Sites

14. Kral/Davidson. Addressing
the Nation’s Opioid Epidemic:
Lessons from an
Unsanctioned Supervised
Injection Site in the U.S.
American Journal of
Preventive Medicine, In Press
SIS Study

15.  Unsanctioned Safer Injection Site in unnamed
American Metropolitan Area
 Participants in agency approached ad-hoc as
need for SIS services for person becomes
apparent
 No set exclusion criteria
 Roughly 60 participants have privileges at any
time
 10-20 minutes per session
SIS Study

16.  Staff and ancillary sterile injection supplies
provided by agency
 Staff trained in naloxone use/OD recognition
 Users likely also trained and able to administer
 One overdose per 1,278 injections in first 2 years
of SIS operation
 Similar to pre-fentanyl numbers at InSite in
Vancouver BC
SIS Study

17.  Reasons for success in reducing OD death
 Supervision
 Setting
 Clean, well-lit, secure space with extra HR
equipment
 Injections hurried in over 80% of non-SIS use
 All equipment used in SIS safely disposed of by
site
SIS Study

18.  Where would you have injected if not at site
today?
SIS Study
Place of Injection Percent
Public Restroom 34.9
Street, park or parking lot 57.3
Own Place 4.1
Friend's Place 1.8
Other 1.9

19. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Street or park
Public bathroom
Car
Abandoned building
Stairwell
Bus, train, or subway
Shooting Gallery
Bathroom of a SEP
Reported Locations of Public Drug Use
(past 3 months)
De facto drug policy [NJ]

20.  El Campemiento razed July-August 2017
 SCS in Kensington church rousted, July 2017
 807 OD deaths in 2016
De facto drug policy
[Philly]

21.  From http://www.talkingdrugs.org/drug-
consumption-rooms-benefit-people-who-dont-use-
drugs
 1. DCRs ensure safer streets
 2. DCRs reduce the spread of disease
 3. DCRs improve access to emergency services
 4. DCRs can reduce crime
 5. DCRs help people integrate into the
legitimate economy
Five Reasons Why DCRs Benefit People
Who Don’t Use Drugs

22.  Although the title says ‘Five’, there
is one last reason for why DCRs
must be introduced that cannot be
ignored.
 6. DCRs save lives
Five Reasons Why DCRs Benefit People
Who Don’t Use Drugs

23.  If it were sanctioned, more people could be served,
licensed clinicians could provide on-site healthcare
services, other agencies could collaborate to provide
co-located, wraparound services, and there would
be more options for funding site activities and
increasing operating hours. Although supervised
injection sites may not substantially reduce the
number of people who use opioids and other
injection drugs, they do attenuate the serious
medical sequelae of this epidemic, including
preventable infections and deaths. It is time for local,
state, and federal governments to consider removing
legal barriers such that a comprehensive pilot of this
innovative intervention can be implemented.
SIS Study