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).