LESSONS ON SUPERVISED INJECTING DRUG-USE FOR AFRICA EQUALITY AND ANTI HIV ACTIVISTS
Supervised Consumption Facilities & Safe Injection Facilities
1.
"These pilot study findings showed that opiate-dependent
injecting drug users with long injecting careers (most started between 1970 and
1982) and for whom opiate treatment had failed multiple times previously were
attracted into and retained by therapy with injectable opiates."
Source:
Metrebian, Nicky, Shanahan,
William, Wells, Brian, and Stimson, Gerry, "Feasibility of prescribing
injectable heroin and methadone to opiate-dependent drug users; associated
health gains and harm reductions," The Medical Journal of Australia (MJA
1998; 168: 596-600), from the web at http://www.mja.com.au/public/issues/jun15/mtrebn/mtrebn.html
last accessed on Sept. 18, 2008.
2.
"Prescribing injectable opiates is one of many options in a
range of treatments for opiate-dependent drug users. In showing that it
attracts and retains long term resistant opiate-dependent drug users in
treatment and that it is associated with significant and sustained reductions
in drug use and improvements in health and social status, our findings endorse
the view that it is a feasible option."
Source:
Metrebian, Nicky, Shanahan,
William, Wells, Brian, and Stimson, Gerry, "Feasibility of prescribing
injectable heroin and methadone to opiate-dependent drug users; associated
health gains and harm reductions," The Medical Journal of Australia (MJA
1998; 168: 596-600), from the web at http://www.mja.com.au/public/issues/jun15/mtrebn/mtrebn.html
last accessed on Sept. 18, 2008.
3.
"Dutch drug policy gives priority to a public health
approach. In some cases, this resulted in a certain degree of tolerance and
non-prosecution, instead of strict law enforcement. We give some examples:
"• The Drugs Information and
Monitoring System (DIMS): this service co-ordinates pill testing at special
test locations (not at parties) to determine health risks, to get insight in
available new drugs and in trends in substance use (see also 10). Participants
of DIMS will not be prosecuted (Staatscourant 2000, nr.250).
"• Safe Injection Rooms/User Rooms:
in some municipalities hard drug users can use drugs in protected rooms,
specially created for them by the local authority (see also 10). Drug dealing
in or around user rooms is forbidden (Staatscourant 2000, nr.250).
"• Coffee-shop policy: Coffee shops
are alcohol free outlets resembling bars, pubs or cafés, where adults -
eighteen years or older - may individually purchase cannabis up to five grams
(Staatscourant 2000, nr.250). Yet, suppressing large-scale commercial
production of cannabis is a high law enforcement priority."
Source:
Trimbos Institute, "Report
to the EMCDDA by the Reitox National Focal Point, The Netherlands Drug
Situation 2002" (Lisboa, Portugal: European Monitoring Centre for Drugs
and Drug Addiction, Nov. 2002), p. 13.
4.
"Governmentally sanctioned 'safer injection facilities'
(SIFs) are a health service that several countries around the world have been
adding to the array of public health programs they offer. These countries
include: "Canada where the federal government, in collaboration with the
Federal, Territorial and Provincial Advisory Committee on Population Health,
has created a task force to examine the feasibility of a national
research-based trial of SIFs (Kerr & Palepu, 2001); Vancouver, BC where
SIFs are included in the Mayor's 'Four Pillar Drug Strategy,' and a formal
proposal to implement 2 SIFs has been put forward (Kerr, 2000; MacPherson,
2001) "Germany with 13 SIFs operating in 4 cities "The Netherlands
with 16 SIFs operating in 9 cities "Switzerland with 17 SIFs operating in
12 cities "Spain with 1 SIF operating in Madrid "Australia where an
SIF began operations in May, 2001 in Sydney, and legislation has been approved
to operate an SIF in Canberra and is pending in Melbourne (New York Times,
2001; Dolan, 2000)."
Source:
Broadhead, Robert S., Thomas
Kerr, Jean-Paul C. Grund, and Frederick L. Altice, "Safer Injection
Facilities in North America: Their Place in Public Policy and Health
Initiatives," Journal of Drug Issues (Tallahassee, FL: Florida State
University, Winter 2002), Vol. 32, No. 1, p. 331, citing Kerr, T and Palepu, A,
"Safe Injection Facilities: Is It Time?" Canadian Medical Association
journal, 165(4), 436-437; Kerr, T., "Safe Injection Facilities: A Proposal
for a Vancouver Pilot Project," Harm Reduction Action Society, retrieved
on November 13, 2001 from http://www.cfdp.ca/safei.pdf;
MacPherson, D., "A Framework for Action: A Four-Pillar Approach to Drug
Problems in Vancouver," Vancouver, BC: City of Vancouver; "Australia
Allows Addicts' Center to be Opened in Sydney," New York Times, May 10,
2001, p. 3; Dolan, K., et al., "Drug Consumption Facilities in Europe and
the Establishment of Supervised Injection Centres in Australia," Drug and
Alcohol Review, 19, 337-46.
5.
"Our review suggests that SIFs target several public health
problems that municipalities in North America may wish to consider, problems
largely unaddressed by needle exchange, street-outreach, education campaigns,
HIV counseling, and other conventional services. SIFs target injectors' use of
public spaces to inject drugs in order to reduce the many risks associated with
the practice. Compared to conventional services, SIFs provide greater
opportunities for health workers to connect with injectors, and to move them
into primary care, drug treatment, and other rehabilitation services. Finally,
SIFs target the 'nuisance factor' of drug scenes -- the hazardous litter and
intimidating presence of injectors congregating in city parks, public
playgrounds and on street corners -- by offering them an alternative,
supervised 'public' space. Our review also suggests that, for municipalities
considering SIFs in order to address these problems, their implementation would
not necessarily require any significant or fundamental changes in public policy
or law: SIFs require the same working agreements with social service providers
and the police that needle exchange, street-outreach, drug treatment and
similar health programs for injectors already receive."
Source:
Broadhead, Robert S., Thomas
Kerr, Jean-Paul C. Grund, and Frederick L. Altice, "Safer Injection
Facilities in North America: Their Place in Public Policy and Health
Initiatives," Journal of Drug Issues (Tallahassee, FL: Florida State
University, Winter 2002), Vol. 32, No. 1, p. 347-8.
6.
"The present study demonstrates that the opening of the
Vancouver SIF was associated with a greater than 30% increase in the rate of
detoxification service use among SIF users in comparison to the year prior to
the SIF's opening. Subsequent analyses demonstrated that detoxification service
use was associated with increased use of methadone and other forms of addiction
treatment, as well as reduced injecting at the SIF."
Source:
Wood, Evan, Tyndall, Mark W.,
Zhang, Ruth, Montaner, Julio S.G., and Kerr, Thomas, "Rate of
Detoxification Service Use and its Impact among a Cohort of Supervised
Injecting Facility Users," Addiction, Vol. 102, p. 918.
7.
"In summary, the present study demonstrates that the SIF was
associated with increased use of detoxification service use and that
residential detoxification was associated with increased rates of methadone use
and other forms of addiction treatment. Given the known role of methadone and
other forms of addiction treatment in reducing levels of injection drug use,
and given that detoxification programme use was associated with reduced
injecting at the SIF, our findings imply that the SIF has probably helped to
reduce rates of injection drug use among users of the facility."
Source:
Wood, Evan, Tyndall, Mark W.,
Zhang, Ruth, Montaner, Julio S.G., and Kerr, Thomas, "Rate of
Detoxification Service Use and its Impact among a Cohort of Supervised Injecting
Facility Users," Addiction, Vol. 102, p. 918.
8.
In an evaluation of the Vancouver supervised injection facility,
researchers concluded that: "Our study indicates that the opening of North
America's first supervised injection facility was not associated with
measurable negative changes in the use of injected drugs. Indeed, we found a
substantial reduction in the starting of binge drug use after the opening of
the facility, suggesting that it had not prompted 'risk compensation' among
local injecting drug users, whereby the benefits of a safer environment are
overcome by more risky behaviours such as higher intensity drug use."
Source:
Kerr, Thomas, Jo-Anne Stoltz,
Mark Tyndall, Kathy Li, Ruth Zhang, Julio Montaner, Evan Wood, "Impact of
a medically supervised safer injection facility on community drug use patterns:
a before and after study," British Medical Journal, Vol. 332, Jan. 28,
2006, pp. 221-222.
9.
In an evaluation of the Vancouver supervised injection facility,
researchers concluded that: "Although there was a substantial increase in
the number of participants who started smoking crack cocaine, it is unlikely
that the facility, which does not allow smoking in the facility, prompted this
change. These findings are relevant to a recent review of supervised injection
facilities by the European Monitoring Centre on Drugs and Drug Addiction, which
highlighted concerns that these facilities could potentially 'encourage
increased levels of drug use' and 'make drug use more acceptable and
comfortable, thus delaying initiation into treatment.'"
Source:
Kerr, Thomas, Jo-Anne Stoltz,
Mark Tyndall, Kathy Li, Ruth Zhang, Julio Montaner, Evan Wood, "Impact of
a medically supervised safer injection facility on community drug use patterns:
a before and after study," British Medical Journal, Vol. 332, Jan. 28,
2006, p. 222.
10.
"Evaluation of the Vancouver facility has shown that its
opening has been associated with reductions in public drug use and publicly
discarded syringes and reductions in syringe sharing among local injecting drug
users. Our study suggests that these benefits have not been offset by negative
changes in community drug use."
Source:
Kerr, Thomas, Jo-Anne Stoltz,
Mark Tyndall, Kathy Li, Ruth Zhang, Julio Montaner, Evan Wood, "Impact of
a medically supervised safer injection facility on community drug use patterns:
a before and after study," British Medical Journal, Vol. 332, Jan. 28,
2006, p. 222.
11.
"In the present analysis we found that overdose events were
not uncommon at the Vancouver safer injection facility. During an 18-month
period, 285 individuals accounted for 336 overdose events, yielding an overdose
rate of 1.33 (95% CI: 0.0–3.6) overdoses per 1000 injections. Heroin was
involved in approximately 70% of all overdoses, and opiates considered together
were involved in88%of overdoses. It is notable, however, that approximately
one-third of overdoses involved stimulants. The most common indicators of
overdose were depressed respiration, limp body, face turning blue, and a
failure to respond to pain stimulus. The majority of overdoses were
successfully managed in the SIF, with the most common overdose interventions
undertaken by SIF staff involving the administration of oxygen, a call for
ambulance support, and the administration of naloxone hydrochloride via
injection. Among a randomly selected sample of SIF users, factors associated
with time to overdose at the SIF included fewer years injecting, daily heroin
use, and having a history of overdose. None of the overdose events occurring at
the SIF resulted in a fatality."
Source:
Thomas Kerr, Mark W. Tyndall,
Calvin Lai, Julio S.G. Montaner, Evan Wood, "Drug-related overdoses within
a medically supervised safer injection facility," International Journal of
Drug Policy, 2006.
12.
"The rate of overdose observed at the Vancouver SIF is within
the range of rates observed in an international review of SIF which estimated
the rates of overdose typically to be between 0.01 and 3.6 per 1000 injections
(Kimber et al., 2005). However, the rate observed in Vancouver is lower than
rates observed recently in M¨unster, Germany (6.4 per 1000 injections) and
Sydney, Australia (7.2 per 1000 injections) (Kimber et al., 2003). This may
reflect differences in threshold for coding and intervention by staff, and
differences in drug consumption patterns across cities, especially as it
pertains to the use of opioids and other central nervous system
depressants."
Source:
Thomas Kerr, Mark W. Tyndall,
Calvin Lai, Julio S.G. Montaner, Evan Wood, "Drug-related overdoses within
a medically supervised safer injection facility," International Journal of
Drug Policy, 2006.
13.
"In summary, there have been many overdose events within
Vancouver's SIF, although the rate of overdoses is similar to rates observed in
SIF in other settings. The majority of these overdoses involved the injection
of opiates, and most events were successfully managed within the SIF through
the provision of oxygen. It is noteworthy that none of the overdose events
occurring at the SIF resulted in a fatality. These findings suggest that SIF
can play a role in managing overdoses among IDU and indicate the potential of
SIF to reduce morbidity and mortality associated with illicit drugrelated
overdoses."
Source:
Thomas Kerr, Mark W. Tyndall,
Calvin Lai, Julio S.G. Montaner, Evan Wood, "Drug-related overdoses within
a medically supervised safer injection facility," International Journal of
Drug Policy, 2006.
14.
"Little evaluative work has been conducted into supervised
injection facilities in other countries. In Hanover, however, 98% of users of
the medically supervised injecting centre did not encounter any negative
experience with local residents and 94% reported no negative police encounters.
Research from Frankfurt showed that a drug user who overdoses on the street is
10 times more likely to stay in hospital for one night than a drug user who
overdoses in a medically supervised injecting centre. In addition, no one has
died from heroin overdose in any medically supervised injecting centre.
Therefore, establishing such centres in the United Kingdom is likely to reduce
the number of drug related deaths."
Source:
Wright, Nat M.J., Charlotte
N.E. Tompkins, "Supervised Injecting Centres," British Medical
Journal, Vol. 328, Jan. 10, 2004, p. 101.
15.
Researchers for the EU's drugs monitoring agency looking into
safer injection facilities and drug consumption rooms found that
"Consumption rooms reach a population of often older, long-term users some
of whom have had no previous treatment contact. Services appear particularly
successful in attracting groups that are difficult to reach. No evidence was
found to suggest that naive users are initiated into injecting as a result of
the presence of consumption rooms."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), p. 42.
16.
Researchers for the EU's drugs monitoring agency looking into
safer injection facilities and drug consumption rooms found that "Service
users' sociodemographic data and drug use profile are similar across countries.
Data show that the rooms reach the intended target groups of long-term addicts,
street injectors, homeless drug users and drug-using sex workers and are thus
facilitating contact with the most problematic and marginalised drug users.
Demographic information also shows that these services can be successful in
reaching long-term drug users with no previous contact with treatment
services."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), p. 42.
17.
"Consumption rooms achieve the immediate objective of
providing a safe place for lower risk, more hygienic drug consumption without
increasing the levels of drug use or risky patterns of consumption. Direct
benefits of supervised injecting appear to be a reduction in some of the risk
behaviours related to injecting, in particular improvements in injecting
practice, use of sterile equipment and lack of opportunity for sharing drugs.
Other benefits are that, if medical emergencies should occur, immediate medical
intervention is possible, and the consumption equipment used in the rooms is
correctly disposed of. Client surveys consistently show that service users appreciate
the hygienic conditions, safety and peace that the rooms provide."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), p. 48.
18.
"There is no evidence that consumption rooms encourage
increased drug use or initiate new users. There is little evidence that by
providing better conditions for drug consumption they perpetuate drug use in
clients who would otherwise discontinue consuming drugs such as heroin or
cocaine, nor that they undermine treatment goals. "When managed in
consultation with local authorities and police, they do not increase public
order problems by increasing local drug scenes or attracting drug users and
dealers from other areas. If consultation and cooperation between key actors
does not take place, then there can be a risk of a 'pull effect' and
consumption rooms run the risk of being blamed for aggravating local problems
of public order including drug dealing."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), p. 84.
19.
"According to the few studies that have examined the effects
of consumption rooms on acquisitive crime, there is no evidence from police
data of a negative effect on local levels of theft, robbery and burglary.
"The direct effect of the rooms on the small-scale drug dealing in their
vicinity is difficult to determine as one of the criteria for deciding where to
locate rooms is the existence of public drug use and drug markets. Services
have no interest in drug scenes and drug markets expanding outside their front
door and rely on sensible police action to prevent these without deterring drug
addicts from the use of the supervised consumption facility. House rules in
some rooms require that clients do not loiter outside the facility."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), pp. 83-4.
20.
"The location of consumption rooms needs to be compatible
with the needs of drug users but also to take account of the needs and
expectations of local residents. A reduction in the number of public consumptions
can contribute to improvements in the neighbourhood by helping to reduce public
nuisance associated with open drug scenes. However, facilities near illicit
drug markets are not able to solve wider nuisance problems that result from
these markets. "Police actions against drug markets and drug scenes in
other neighbourhoods may sometimes increase public order problems near
consumption rooms. This implies that, if rooms are to contribute to reducing
public nuisance rather than be blamed for aggravating it, there needs to be
consultation not only with local residents but also with police, so that action
to discourage open drug scenes does not at the same time deter drug users from
making use of the facilities."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), p. 83.
21.
"There is no evidence that the operation of consumption rooms
leads to more acquisitive crime. There is small-scale drug dealing in the
vicinity of many services, which is not surprising given their location."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), p. 83.
22.
"Neighbourhood attitudes and perceptions. Surveys of local
residents and businesses, as well as registers of complaints made to the
police, generally show positive changes following the establishment of
consumption rooms, including perceptions of decreased nuisance and increases in
acceptance of the rooms. Police, too, often acknowledge that consumptions
contribute to minimising or preventing open drug scenes. "Open drug scenes
and police policy. There are instances where consumption rooms have been blamed
for increasing public nuisance, including open drug scenes and dealing. These
arose where police actions in other areas had the effect of relocating drug
markets and open scenes. "Pull effect. Available evidence is not
sufficient to draw conclusions on whether consumption rooms exert a
'pull-effect' by attracting drug users from other areas, thus adding to the
situation already created by established drug markets. Attempts to decentralise
drug scenes by dispersing consumption rooms have not led to increased nuisance
around the rooms. However, they have not attracted large numbers of clients
either."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), p. 82.
23.
"There is no evidence that consumption rooms increase levels
of drug use or encourage riskier patterns of use, nor that they increase
morbidity and mortality. "Few clients use the facilities only for drug
consumption. Most at some point use other services, especially medical and in
some cases drug treatment. "There is little evidence that consumption
rooms undermine treatment by making drug use more 'comfortable'. Whether
clients in oral methadone treatment are allowed to use the rooms for injection,
is dealt with in different ways."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), pp. 80-81.
24.
"Consumption rooms achieve the immediate objective of providing
a safe place for lower risk, more hygienic drug consumption without increasing
the levels of drug use or risky patterns of consumption."
Source:
Hedrich, Dagmar, "European
Report on Drug Consumption Rooms" (Lisbon, Portugal: European Monitoring
Centre on Drugs and Drug Addiction, February 2004), p. 77.
25.
"We found significant reductions in public injection drug
use, publicly discarded syringes and injection-related litter after the opening
of the medically supervised safer injecting facility in Vancouver. These
reductions were independent of law enforcement activities and changes in
rainfall patterns. "Our findings are consistent with anecdotal reports of
improved public order following the establishment of safer injecting facilities
and are not surprising given that a commonly reported reason for public drug
use is the lack of an alternative place to inject and that IDUs who go to safer
injecting facilities are often homeless or marginally housed. Our findings are
also highly plausible since more than 500 IDUs visited the facility daily after
it opened, and several feasibility studies have suggested that IDUs who inject
in public would be the most likely to use safer injecting facilities. Our
observations suggest that the establishment of the safer injecting facility has
resulted in measurable improvements in public order, which in turn may improve
the liveability of communities and benefit tourism while reducing community
concerns stemming from public drug use and discarded syringes. It is also
noteworthy that we did not observe an increase in the number of drug dealers in
the vicinity of the facility, which indicates that the facility's opening did
not have a negative impact on drug dealing in the area. Although further study
of these issues is necessary, the safer injecting facility may also offer
public health benefits, since public injection drug use has been associated
with an array of health-related harms."
Source:
Wood, Evan, Thomas Kerr, Will
Small, Kathy Li, David C. Marsh, Julio S.G. Montaner & Mark W. Tyndall,
"Changes in Public Order After the Opening of a Medically Supervised Safer
Injecting Facility for Illicit Injection Drug Users," Canadian Medical
Association Journal, Vol. 171, No. 7, Sept. 28, 2004, p. 733.
26.
"In summary, we documented significant reductions in the
number of IDUs injecting in public, publicly discarded syringes and
injection-related litter after the opening of the medically supervised safer
injecting facility. These reductions appeared to be independent of several
potential confounders, and our findings were supported by external data
sources. Although the overall health impacts of the facility will take several
years to evaluate, the findings from this study should be valuable to other
cities that are contemplating similar evaluations and should have substantial
relevance to many urban areas where public injection drug use has been
associated with substantial public health risks and adverse community
impacts."
Source:
Wood, Evan, Thomas Kerr, Will
Small, Kathy Li, David C. Marsh, Julio S.G. Montaner & Mark W. Tyndall,
"Changes in Public Order After the Opening of a Medically Supervised Safer
Injecting Facility for Illicit Injection Drug Users," Canadian Medical
Association Journal, Vol. 171, No. 7, Sept. 28, 2004, p. 734.
27.
"The only comprehensive evaluation of a medically supervised
injecting centre was conducted during the 18 month trial of the Sydney centre.
Staff intervened in 329 overdoses over one year with an estimate of at least
four lives saved a year. There was no increase in reported hepatitis B or C
infections in the area that the medically supervised injecting centre served
despite an increase elsewhere in Sydney. "The report described a decreased
frequency of injecting related problems among clients. Half the centre's
clients reported that their injecting practices had become less risky since
using the centre. Furthermore, clients were more likely than other injectors to
report that they had started treatment for their drug use; 11% of clients were
referred to treatment for drug dependence. An economic evaluation of deaths
averted by intervention of the medically supervised injecting centre showed
that costs were comparable to those of other widely accepted public health
measures. "The centre also had benefits for the local community. Residents
and business respondents reported fewer sightings of public injection and
syringes discarded in public places, and syringe counts in the vicinity of the
centre were lower after it opened than before. In addition, there was no
evidence of an increased number of theft and robbery incidents in the area.
Acceptance of the medically supervised injecting centre increased among both
businesses and residents over the study period."
Source:
Wright, Nat M.J., Charlotte
N.E. Tompkins, "Supervised Injecting Centres," British Medical
Journal, Vol. 328, Jan. 10, 2004, p. 100.
28.
According to the final report of the evaluation of the Sydney,
Australia, Medically Supervised Injecting Centre (MSIC) by the MSIC Evaluation
Committee (established by the New South Wales Dept. of Health): "In
summary, the evidence available from this Evaluation indicates that: "-
operation of the MSIC in the King Cross area is feasible; "- the MSIC made
service contact with its target population, including many who had no prior
treatment for drug dependence; "- there was no detectable change in heroin
overdoses at the community level; "- a small number of opioid overdoses
managed at the MSIC may have been fatal had they occurred elsewhere; "-
the MSIC made referrals for drug treatment, especially among frequent
attenders; "- there was no increase in risk of blod borne virus
transmission; "- there was no overall loss of public amenity; "-
there was no increase of crime; "- the majority of the community accepted
the MSIC initiative; "- the MSIC has afforded an opportunity to improve
knowledge that can guide public health responses to drug injecting and its
harms."
Source:
MISC Evaluation Committee,
"Final Report on the Sydney Medically Supervised Injecting Centre"
(New South Wales, Australia: MISC Evaluation Committee, 2003), p. xiv.
29.
"Generally speaking, it is reasonable to conclude, on the
basis of the available knowledge, that to a large extent DCFs [Drug Consumption
Facilities] achieve the objectives set for them, and that the criticisms made
of them are rarely justified. In fact, DCFs help to: "reduce risk
behaviour likely to lead to the transmission of infectious diseases,
particularly HIV/AIDS, among the population of the worst affected drug users;
"reduce the incidence of fatal overdoses and, therefore, the mortality
rate in this population; "establish and maintain contact between this
population and the social-service and health-care network, within which
low-threshold facilities (LTFs) are often the First point of access because of
the care and social assistance they offer; "reduce public order problems,
particularly by doing away with open drug scenes, reducing drug use in public
places, recovering used syringes, and reducing the impact of drug problems on residential
areas (apartment buildings). "At the same time, the available data do not
indicate any specific detrimental effect on: "the number of drug users and
the frequency with which they use drugs; the figures are falling in both cases;
"entry and retention in treatment, because the majority of DCF users are
undergoing treatment, the proportion of those in treatment is growing, this
subject is tackled within the facilities, and the users themselves state that
DCFs do not have any major influence on their treatment. "All of these
observations relate to the overall level of public health and do not mean that
DCFs may not have negative effects in some individual cases. However, on the
basis of existing knowledge, it would appear that the overall effect of DCFs on
drug-related problems is positive. "In the special case of DCFs with an
inhalation room, the above is less convincingly proven. Although such
facilities do indeed reach inhaling drug users, it has not yet been possible to
ascertain whether or not they can achieve their set objectives (establishing a
point of contact between inhaling drug users and the social-service and
health-care network, reducing public order problems, encouraging the switch to
lower-risk forms of drug use). Further research is therefore required,
especially in respect of: "the capacity of DCFs with an inhalation room to
serve as a point of contact between inhaling drug users and the social-service
and health-care network; "the toxicity of the different substances inhaled
and the measures that need to be taken in consequence; "the extent to
which users switch to and continue in another form of drug use, and the
consequences."
Source:
Zobel, Frank & Françoise
Dubois-Arber, "Short appraisal of the role and usefulness of Drug
consumption facilities (DCF) in the reduction of drug-related problems in
Switzerland: appraisal produced at the request of the Swiss Federal Office of
Public Health (Lausanne: University Institute of Social and Preventive
Medicine, 2004), p. 27.
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