Abstract
Many cities throughout the globe are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDUs). In particular, HIV has become endemic among IDUs in many settings. In an effort to reduce this and related public health concerns, medically supervised safer injecting facilities (SIFs), where IDUs can inject pre-obtained illicit drugs under the supervision of medical staff, have been established in several countries. The following review assesses the role that SIFs can play in reducing the harms associated with HIV infection among IDUs and points to ways in which SIFs can be further developed to better respond to the challenges associated with HIV/AIDS among this population.
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References and Recommended Reading
Joint United Nations Programme on HIV/AIDS: Report on the Global AIDS Epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2006.
Stein MD: Medical complications of intravenous drug use. J Gen Intern Med 1990, 5:249–257.
Kerr T, Wood E, Grafstein E, et al.: High rates of primary care and emergency department use among injection drug users in Vancouver. J Public Health (Oxf) 2005, 27:62–66.
Wood E, Kerr T, Montaner JS, et al.: Rationale for evaluating North America’s first medically supervised safer-injecting facility. Lancet Infect Dis 2004, 4:301–306.
Drucker E: Drug prohibition and public health: 25 years of evidence. Public Health Rep 1999, 114:14–29.
Garfield J, Drucker E: Fatal overdose trends in major US cities: 1990–1997. Addict Res Theory 2001, 9:425–436.
US Office of National Drug Control Policy: Estimation of Heroin Availability 1995–1998. http://www.whitehousedrugpolicy.gov/publications/drugfact/heroin_report/heroin_report.pdf. Accessed August 2, 2007.
Wood E, Tyndall MW, Spittal PM, et al.: Supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure. CMAJ 2003, 168:165–169.
Schiraldi V, Holman B, Beatty P: Poor prescription: the costs of imprisoning drug offenders in the United States. http://www.cjcj.org/pubs/poor/ppexec.html. Accessed August 2, 2007.
Tyndall MW, Currie S, Spittal P, et al.: Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS 2003, 17:887–893.
Boys A, Farrell M, Bebbington P, et al.: Drug use and initiation in prison: results from a national prison survey in England and Wales. Addiction 2002, 97:1551–1560.
Broadhead RS, Kerr TH, Grund JP, Altice FL: Safer injection facilities in North America: their place in public policy and health initiatives. J Drug Issues 2002, 32:329–355.
Hedrich D: European Report on Drug Consumption Rooms. Luxembourg: Office for Official Publications of the European Communities; 2004.
Wood E, Kerr T, Small W, et al.: Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ 2004, 171:731–734.
Wood E, Tyndall MW, Montaner JS, Kerr T: Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ 2006, 175:1399–1404.
Medically Supervised Injecting Centre Evaluation Committee: Final Report of the Sydney Medically Supervised Injecting Centre. Sydney: MSIC Evaluation Committee; 2003.
Wood E, Tyndall MW, Li K, et al.: Do supervised injecting facilities attract higher risk injection drug users? Am J Prev Med 2005, 2:126–130.
Wood E, Tyndall MW, Qui Z, et al.: Service uptake and characteristics of injection drug users utilizing North America’s first medically supervised safer injecting facility. Am J Public Health 2006, 96:770–773.
Benninghoff F, Dubois-Arber F: Résultats de l’étude de la clientèle du Cactus Biel/Bienne 2001. Lausanne: Institut universitaire de médecine sociale et préventive; 2002.
Happel V: Konsumräume—eine effektive Massnahme zur Schadensminimierung bei DrogengebraucherInnen und BürgerInnen. Akzeptanz-Zeitschrift für akzeptierende Drogenarbeit und humane Drogenpolitik; 2000:30–36.
Benninghoff F, Solai S, Huissoud T, Dubois-Arber F: Evaluation de Quai 9 “Espace d’accueil et d’injection” à Genève: période 12/2001–12/2000. Lausanne: Institut universitaire de médecine sociale et préventive; 2003.
Kimber J, MacDonald M, van Beek I, et al.: Sydney Medically Supervised Injecting Centre: client characteristics and predictors of frequent attendance in the first 12-months of operation. J Drug Issues 2003, 33:639–649.
Zurhold H, Kreuzfeld N, Degkwitz P, Verthein U: Drogenkonsumräume. Gesundheitsförderung und Minderung öffentlicher Belastungen in europäischen Grossstädten. Freiburg: Lambertus; 2001.
Kemmesies U: Final Report: The Open Drug Scene and the Safe Injection Room Offers in Frankfurt am Main. Münster: INDRO; 1999.
Gerlach R, Schneider W: Consumption and Injecting Room (CIR) at INDRO, Münster, Germany: Annual Report 2002 (English Version). Münster: INDRO; 2003.
O’Connell J, Kerr T, Li K, et al.: Requiring help injecting independently predicts incident HIV infection among injection drug users. J Acquir Immune Defic Syndr 2005, 40:83–88.
Wood E, Tyndall M, Stoltz J, et al.: Safer injecting education for HIV prevention within a medically supervised safer injecting facility. Int J Drug Policy 2005, 29:126–130.
Des Jarlais DC: Structural interventions to reduce HIV transmission among injecting drug users. AIDS 2000, 14(Suppl 1):S41–S46.
Dubois-Arber F, Jeannin A, Spencer B, et al.: Evaluation of the AIDS Prevention Strategy in Switzerland (6th synthesis report 1996–1998). Lausanne: Institut universitaire de médicine sociale et préventive; 1999.
Benninghoff F, Geense R, Dubois-Arber F: Résultats de l’étude ‘La cliententèle des structures à bas seuil d’accessibilité en Suisse’ 2000 Bienne. Lausanne: Institut universitaire de médicine sociale et préventive; 2001.
Ronco C, Spuhler G, Coda P, Schopfer R: Evaluation for alley-rooms I, II, and III in Basel. Soc Prev Med 1996, 41:S58–S68.
Jacob J, Rottmann J, Stöver H: Entstehung und Praxis eines Gesundheitsraumangebotes für Drogenkonsumierende. Abschlußbericht der einjährigen Evaluation des ‘drop-in Fixpunkt’ in Hannover. Oldenburg: Bibliotheks-und Informationssystem der Universität Oldenburg, Schriftenreihe Sucht-und Drogenforschung; 1999.
Nejedly MM, Burki C: Monitoring HIV Risk Behaviors in a Street Agency with Injection Room in Switzerland. Bern: Medizinischen Fakultat, Universitat Bern; 1996.
van der Poel A, Barendregt C, van de Mheen D: Drug consumption rooms in Rotterdam: an explorative description. Eur Addict Res 2003, 9:94–100.
Meijer G, de Jong A, Koeter M, et al.: Evaluatie gebruiksruimnte Binnenstad-Zuid Groningen. Amsterdam/Groningen: Amsterdam Institute for Addiction Research/Intraval; 2001.
Wood E, Tyndall M, Stoltz J, et al.: Factors associated with syringe sharing among users of a medically supervised safer injection facility. Am J Infect Dis 2005, 1:50–54.
Kerr T, Tyndall M, Li K, et al.: Safer injection facility use and syringe sharing in injection drug users. Lancet 2005, 366:316–318.
Celentano DD, Vlahov D, Cohn S, et al.: Risk factors for shooting gallery use and cessation among intravenous drug users. Am J Public Health 1991, 81:1291–1295.
Kimber J, Dolan K: Shooting gallery operation in the context of establishing a medically supervised injecting center: Sydney, Australia. J Urban Health 2007, 84:255–266.
Wood E, Tyndall MW, Lai C, et al.: Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Subst Abuse Treat Prev Policy 2006, 1:13.
Wood E, Tyndall MW, Spittal P, et al.: Needle exchange and difficulty with needle access during an ongoing HIV epidemic. Int J Drug Policy 2002, 13:95–102.
Wood E, Li K, Palepu A, et al.: Sociodemographic disparities in access to addiction treatment among a cohort of Vancouver injection drug users. Subst Use Misuse 2005, 40:1153–1167.
Wood E, Spittal PM, Li K, et al.: Inability to access addiction treatment and risk of HIV-infection among injection drug users. J Acquir Immune Defic Syndr 2004, 36:750–754.
Kimber J, Dolan K, van Beek I, et al.: Drug consumption facilities: an update since 2000. Drug Alcohol Rev 2003, 22:227–233.
Dolan K, Kimber J, Fry C, et al.: Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia. Drug Alcohol Rev 2000, 19:337–346.
Wood E, Tyndall MW, Zhang R, et al.: Attendance at supervised injecting facilities and use of detoxification services. N Engl J Med 2006, 354:2512–2514.
Wood E, Tyndall MW, Zhang R, et al.: Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction 2007, 102:916–919.
Poschadel S, Höger R, Schnitzler J, Schreckenberg D: Evaluation der Arbeit der Drogenkonsumräume in der Bundesrepublik Deutschland: Endbericht im Auftrag des Bundesministeriums für Gesundheit. Baden-Baden: Nomos-Verlags-Gesellschaft; 2003.
Geense R: Evaluation of the Federal measures to reduce the problems related to drug use. To have or to have not: That’s the question: a qualitative study on four low threshold needle exchange serviced for drug users in Switzerland. Lausanne: University Institute of Social and Preventative Medicine; 1997.
Palepu A, Tyndall MW, Leon H, et al.: Hospital utilization and costs in a cohort of injection drug users. CMAJ 2001, 165:415–420.
Rhodes T, Kimber J, Small W, et al.: Public injecting and the need for ’safer environment interventions’ in the reduction of drug-related harm. Addiction 2006, 101:1384–1393.
Spreyerman C, Willen C: Evaluationsbericht Öffnung der Kontakt-und Anlaufstellen für risikoärmere Konsumformen. Evaluation der Inhalationsräume der Kontakt und Anlaufstellen Selnau und Seilergraben der Ambulanten Drogenhilfe Zürich. Berne: Sfinx; 2003.
Prinzleve M, Martens MS: Evaluation der Abendöffnungszeiten des Drob Inn. Forschungsbericht im Auftrag des Jugendhilfe e.V. Hamburg. Hamburg: Zentrum für Interdisziplinäre Suchtforschung (ZIS); 2003.
Thein HH, Kimber J, Maher L, et al.: Public opinion towards supervised injecting centres and the community impact of Sydney Medically Supervised Injecting Centre. Int J Drug Policy 2005, 16:275–280.
Salmon A, Thein R, Kimber J, et al.: Five years on: what are the community perceptions of drug-related public amenity following the establishment of the Sydney Medically Supervised Injecting Centre? Int J Drug Policy 2007, 18:46–53.
Linssen L, de Jong W, Wolf J: Gebruiksruimten. Een systematisch overzicht van de voorziening en de effecten ervan. Utrecht: Trimbos Instituut; 2001.
Stoltz JA, Wood E, Small W, et al.: Changes in injecting practices associated with the use of a medically supervised safer injection facility. J Public Health (Oxf) 2007, 29:35–39.
Drug situation Spain 2001. Report to the EMCDDA by the Reitox National Focal Point ‘Delegación del Gobierno para el Plan Nacional Sobre Drogas’. Madrid: Plan Nactional Sobre Drogras (PND); 2002.
Small W, Wood E, Tyndall M, et al.: Accessing care for injection-related infections through a medically supervised safer injection facility: the perspectives of injection drug users. Can J Infect Dis 2007, 18(Suppl B):18B.
Tyndall MW, Craib KJ, Currie S, et al.: Impact of HIV infection on mortality in a cohort of injection drug users. J Acquir Immune Defic Syndr 2001, 28:351–357.
Bluthenthal RN, Kral AH, Lorvick J, et al.: Harm reduction and needle exchange programmes [letter; comment]. Lancet 1998, 351:1333.
National Institutes of Health/National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction: Effective medical treatment of opiate addiction. JAMA 1988, 280:1936–1943.
Böllinger L, Stöver H, Fietzek L, eds: Druckräume: Angebote, in denen der intravenöse Drogenkonsum toleriert wird. In Drogenpraxis, Drogenrecht, Drogenpolitik. Frankfurt: Fachhochschulverlag; 1995:142–145.
Beek I, Kimber J, Dakin A, Gilmour S: The Sydney Medically Supervised Injecting Centre: reducing harm associated with heroin overdose. Critical Public Health 2004, 14:391–406.
Kerr T, Tyndall M, Lai C, et al.: Drug-related overdoses within a medically supervised safer injection facility. Int J Drug Policy 2006, 17:436–441.
Wurcel A, Zaman T, Zhen S, Stone D: Acceptance of HIV antibody testing among inpatients and outpatients at a public health hospital: a study of rapid versus standard testing. AIDS Patient Care STDS 2005, 19:499–505.
Wood E, Kerr T, Hogg RS, et al.: Impact of HIV testing on uptake of HIV therapy among antiretroviral naive HIV-infected injection drug users. Drug Alcohol Rev 2006, 25:451–454.
Wood E, Hogg RS, Bonner S, et al.: Staging for antiretroviral therapy among HIV-infected drug users. JAMA 2004, 292:1175–1177.
Wood E, Lloyd-Smith E, Li K, et al.: Frequent needle exchange use and HIV incidence in Vancouver, Canada. Am J Med 2007, 120:172–179.
Kerr T, Craib KJ, Gataric N, Hogg RS: Assessing the impact of an adult day program on hospital utilization by persons living with HIV/AIDS. J Acquir Immune Defic Syndr 2002, 31:117–119.
Petrar S, Kerr T, Tyndall MW, et al.: Injection drug users’ perceptions regarding use of a medically supervised safer injecting facility. Addict Behav 2007, 32:1088–1093.
Kerr T, Small D, Moore D, Wood E: A micro-environmental intervention to reduce the harms associated with drug-related overdose: Evidence from the evaluation of Vancouver’s safer injection facility. Int J Drug Policy 2007, 18:37–45.
Kimber J, Hickman M, Degenhardt L, et al.: Estimating the size of the local IDU population using client visits to the Sydney Medically Supervised Injecting Centre. Paper presented at the 16th International Conference on the Reduction of Drug Related Harm. Belfast, Ireland; March 20–24, 2005.
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Kerr, T., Kimber, J., DeBeck, K. et al. The role of safer injection facilities in the response to HIV/AIDS among injection drug users. Curr HIV/AIDS Rep 4, 158–164 (2007). https://doi.org/10.1007/s11904-007-0023-8
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DOI: https://doi.org/10.1007/s11904-007-0023-8