Public-health officials in Vancouver opened North America's first medically supervised safer injection facility in September 2003. Injection drug users in the facility can access sterile injecting equipment, inject preobtained illicit drugs under the supervision of nurses, and access nursing care and addictions counselling. Although such facilities exist in several European settings and in Sydney, Australia, few statistical analyses of their effects syringe sharing have been done.
Thomas Kerr (British Colombia Centre for Excellence in HIV/AIDS, Vancouver, Canada) and colleagues examined the behaviour of 431 active injection drug users seen between December 2003 and June 2004 as part of a separate study on injection drug users in Vancouver. 90 reported that all, most, or some of their injections were at the safer injection facility. 49 reported syringe sharing during this same period. Binge drug taking and frequent heroin or cocaine injection were associated with syringe sharing, whereas younger age and use of safer injection facility reduced the incidence of syringe sharing. The investigators found that rates of syringe sharing were similar in the study group before the opening of the facility and the difference only emerged during follow-up after the facility had opened.
Dr Kerr concludes: "We have shown that use of a medically supervised safer injection facility was independently associated with reduced syringe sharing in a community-recruited sample of injection drug users who had similar rates of syringe sharing before the facility's opening. Our findings could help inform discussions in the UK and elsewhere, where potential public-health benefits of such facilities are growing interest."
In an accompanying commentary Wayne Hall (University of Queensland, Australia) concludes: "Research to date has shown that supervised injecting facilities can operate safely and to the benefit of the health and well-being of the socially marginalised injecting drug users that use them. These facilities do not seem to increase crime or public nuisance, and they reduce the public visibility of injecting drug use, the most probable reason for public tolerance of supervised injecting facilities in Europe. An important step in persuading the community that supervised injecting facilities have a role to play in reducing the harms caused by injecting drug use is to encourage more realistic expectations in the community about their likely benefits given the constraints under which these facilities often have to operate."
Contact: Dr Thomas Kerr, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
Comment: Professor Wayne Hall Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, St Lucia Qld 4072, Australia.
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