Supervised injecting facilities (SIFs)2 are legally sanctioned and supervised areas where drug users can use pre-obtained drugs in a safe atmosphere under hygienic conditions (Dolan et al., 2000). SIFs are designed to reduce the inappropriate disposal of injecting equipment, keep drug users off the street, reduce fatal and non-fatal overdoses, reduce the transmission of HIV and other bloodborne diseases, and improve access to health and social services. SIFs prohibit drug dealing and provide sterile injecting equipment, referrals to health care and drug treatment, and other services such as meals and showers.
SIFs have long existed in Europe, particularly in the Netherlands, Germany, Switzerland, and Spain (Dolan et al., 2000). In 2003, a pilot SIF opened in Vancouver, with the stipulation that it be vigorously evaluated. The SIF provides injecting equipment and emergency care in the event of an overdose, and an onsite addiction counselor provides referrals to treatment programs. The evaluation examined risk behavior, blood-borne infection transmission, overdoses, and the use of health services among a cohort of SIF users (Wood et al., 2004a).
In the first 18 months of the program, 4,764 individuals registered with the SIF (Tyndall et al., 2006). Heroin was injected 46 percent of the time. Although cocaine use is generally characterized by repeated injections, and only one injection is allowed per SIF visit, cocaine was injected 37 percent of the time. In a 12-month period, the SIF made 2,171 referrals—37 percent to addiction counseling (Tyndall et al., 2006).
A cross-sectional study based on the Vancouver SIF examined factors associated with syringe sharing (Kerr et al., 2005). Logistic regression analyses found that use of the SIF was independently associated with a three-fold reduction in syringe sharing (AOR=0.30; 95% CI: 0.11–0.82; p=0.02).
In terms of unintended consequences, a study by Wood et al. (2004b) examined injecting-related public disorder problems before and after the opening of the Vancouver SIF. The 12-week period after the SIF opened was independently associated with reductions in the number of IDUs injecting in public, and the number of discarded syringes and other paraphernalia. Wood et al. (2006a) examined crime rates in the surrounding area during the year before and the year after the SIF opened. The study relied on police records of drug trafficking, assaults and robberies, and vehicle break-ins and thefts. The study found no differences between the 2 years