(Converted as ePoster, See Poster Gallery) Effectiveness of Safe Injection Facilities on Individual and Community Outcomes: A Scoping Review

Background: Over the past decade, the rates of injectable drug use and accidental drug overdose have drastically increased in both Canada and the Unites States. The risk of overdose significantly increases when people use alone, and may be preventable through timely intervention. Injected drugs are also associated with an increased risk of transmission of diseases (HIV, hepatitis) and infections. Safe injection facilities (SIFs) are locations where people who inject drugs are able to self-administer pre-obtained drugs in hygienic conditions under the supervision of qualified staff. To date, there are more than 100 SIFs across 11 different countries. SIFs stem from harm reduction framework, aimed at reducing the number of overdoses and the transmission of disease for people who inject drugs. However, there has been some public concern expressed that funding would be better spent on other addiction treatments. The purpose of this scoping review was to examine the impact of SIFs related to individual and community outcomes.

Methods: Following PRISMA guidelines for systematic reviews, we searched 8 databases for peer-reviewed studies published over the past decade related to individual and community outcomes, including cost-effectiveness studies. There were no limiters for geographical location or research methodology. The initial search resulted in 536 articles after deduplication, which were screened by two reviewers. After a full screening process, a total of 27 articles were examined and data extracted. Data were extracted using a developed framework that included individual-level outcomes (e.g. overdose, infection) and community-level outcomes (e.g. public use, public syringe disposal). Additional data extraction elements, included study objective, SIF type, data collection year, location, and research method and analysis type.

Results: The 27 articles were from Canada, the US, Australia, Europe, and other locations, including a mix of qualitative (e.g. interviews, ethnographic) and quantitative (e.g. cross-sectional, longitudinal) approaches. In total, 24 articles included at least one individual-level outcome, 15 included at least one community-level outcome, and 3 included cost-benefit/effectiveness outcomes. Among articles examining individual outcomes, 8 focused on injection-related infection and disease transmission, 11 on drug use and treatment access behaviors, 8 on overdose, 8 on death, and 5 on other outcomes (e.g. condom use). Among articles with community outcomes, 7 focused on drug use in public spaces, 6 on public disposal of drug paraphernalia, and 4 on criminal activity. This scoping review found that SIFs were associated with safer injection behaviors, increased referral to treatment programs, and a reduction in overdose and overdose death, as well as a decrease in public use and public disposal of syringes, and no increased criminal activity. SIFs appear to be a cost-effective harm reduction intervention for people who inject drugs, with individual and community benefits.

Implications: Findings suggest the effectiveness of SIFs as a harm reduction approach in supporting individual and community outcomes. In examining the literature as a whole, it appears that SIFs provide a place where people who inject drugs felt humanized, thereby facilitating positive outcomes. Findings provide recommendations for developing SIFS as a stand-alone service, or integrated with others services (homeless shelters).