Injection drug users' perceptions regarding use of a medically supervised safer injecting facility

doi:10.1016/j.addbeh.2006.07.013

Addictive Behaviors

Volume 32, Issue 5, May 2007, Pages 1088-1093

https://doi.org/10.1016/j.addbeh.2006.07.013 Get rights and content

Abstract

Background

In recent years, there has been increased interest in supervised safer injecting facilities (SIF) as a strategy to reduce the harms of illicit drug use; however, little work has been done to assess drug users' satisfaction with this service. This study was undertaken to explore injection drug users' experiences and opinions regarding North America's first SIF in Vancouver, Canada.

Methods

Injection drug users (IDU) were randomly recruited from within the Vancouver SIF and invited to enroll in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort. For the present study, participants were then surveyed regarding their experiences and beliefs regarding the SIF.

Results

Of 1082 IDU surveyed, 809 (75%) reported that their injecting behavior had changed as a result of using the SIF. Among these individuals, 80% indicated that the SIF had resulted in less rushed injecting, 71% indicated that the SIF had led to less outdoor injecting and 56% reported less unsafe syringe disposal. The three most common features always or usually limiting IDU's use of the SIF were: travel to the SIF (12%), limited operating hours (7%), and waiting times to access the SIF (5%). When asked in what ways the SIF might be improved, the three most common suggestions were: longer hours of operation (53%), addition of a washroom (51%), and reduced waiting times (46%).

Conclusions

Many IDU reported changes in their injecting behaviors that have important implications for community and public health. Addressing a number of programmatic issues related to operating hours and waiting times, and the provision of additional amenities within SIF, may help to further improve their impact.

Introduction

Illicit injection drug use continues to be a major public health and community concern (Kral et al., 1999, Vlahov et al., 2004), and the spread of infectious diseases as well as fatal overdose continue to plague communities where injection drug use is prevalent (Coffin et al., 2003, Friedman et al., 2006). The impact of public health initiatives designed to reduce the harms of injection drug use through prevention and treatment services is often limited by an inability to attract injection drug users (IDU) into care (Grund et al., 1992).

A number of settings have instituted medically supervised safer injection facilities (SIF) in an attempt to address the public health and public order concerns associated with injection drug use (Dolan et al., 2000, Freeman et al., 2005, Kimber et al., 2003). Within SIF, IDU are provided sterile injecting equipment, and in the event of an accidental overdose trained personnel provide emergency intervention. In addition, addictions counseling onsite and/or referral to offsite addiction treatment are offered.

North America's first government-sanctioned SIF opened in September 2003 in Vancouver, Canada (Wood, Kerr, Montaner et al., 2004). Since its inception, the program has been shown to have a number of community and public health benefits (Kerr et al., 2005, Tyndall et al., 2006, Wood et al., 2004, Wood et al., 2005, Wood et al., 2005). However, no study to date has evaluated IDU's perceptions regarding the impacts of the program, and few evaluations of IDU satisfaction with SIF exist in the public health literature. Therefore, the present study was designed to evaluate the perceptions of IDU using the facility and how the program can be improved.

Section snippets

Methods

The Vancouver SIF is being evaluated through the Scientific Evaluation of Supervised Injecting (SEOSI) cohort (Wood, Kerr, Buchner et al., 2004). Briefly, SEOSI was assembled through random recruitment of IDU from within the SIF. The randomization was such that the SIF intake computer alerted the staff to invite IDU to enroll into the cohort at the time of their second visit to the program. At the time of enrollment, an interviewer-administered questionnaire was conducted. The items chosen for

Results

Between December 1, 2003 and September 30, 2005, 1082 individuals were recruited into the SEOSI cohort, among whom the median age was 38.4 (IQR: 32.7–44.3), 303 (28.0%) were female, and 179 (16.5%) were HIV-positive. Overall, 546 (50.5%) reported daily heroin use, 344 (31.8%) reported daily cocaine use, and 39 (3.6%) reported daily crystal methamphetamine use.

Of 1082 IDU surveyed 809 (75%) reported that their injecting behavior had changed since using the SIF. As shown in Fig. 1, among these

Discussion

We found that many IDU using the Vancouver SIF reported a positive change in their injecting behavior since the opening of the program. The SIF was reported to reduce public drug use and some aspects of unsafe injection practices including reuse of syringes and unsafe disposal of syringes. This is in keeping with earlier studies that have shown that the provision of a SIF can improve public order through reduced public drug use (Wood, Kerr, Small et al., 2004). This combined with the public

Acknowledgments

The authors wish to thank the SEOSI participants, the Portland Hotel Society, the Insite staff, and Vancouver Coastal Health. We also thank Aaron Eddie, Suzy Coulter, Megan Oleson, Peter Vann, Dave Isham, Steve Gaspar, and Deborah Graham for their research assistance. The SIF evaluation has been made possible through a financial contribution from Health Canada, though the views expressed herein do not represent the official policies of Health Canada.

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The COSINUS study is a prospective multicenter cohort that included 665 PWID recruited in Bordeaux, Marseille, Paris and Strasbourg between 2016 and 2019. Investigators administered questionnaires face-to-face at regular intervals at baseline, 3 months, 6 months and 12 months. In Marseille, 199 PWID were recruited. A multivariable logistic regression model was performed to assess factors associated with willingness to use DCR among this population.
Among 545 observations corresponding to 195 distinct participants selected for analyses, 57% declared they were willing to attend a DCR. The main reason given was “to consume more cleanly”. Receiving allowances (OR = 2.38; 95% confidence interval (CI) (95% CI) = 1.17–4.81), not having health insurance (OR = 3.61; 95% CI = 1.49–8.75), injecting daily (OR = 1.97; 95% CI = 1.05–3.70) and in a public space (OR = 2.66; 95% CI = 1.29–5.47) were all positively associated with willingness to use a DCR.
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Citation Excerpt :
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Short CommunicationInjection drug users' perceptions regarding use of a medically supervised safer injecting facility

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgments

Opiates, cocaine, and alcohol combinations in accidental drug overdose deaths in New York City, 1990–98

Addiction

Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia

Drug and Alcohol Review

The impact of the Sydney medically supervised injecting centre (MSIC) on crime

Drug and Alcohol Review

Relationships of deterrence and law enforcement to drug-related harms among drug injectors in us metropolitan areas

AIDS

Reaching the unreached: Targeting hidden IDU populations with clean needles via known user groups

Journal of Psychoactive Drugs

Safer injection facility use and syringe sharing in injection drug users

Lancet

Drug consumption facilities: An update since 2000

Drug and Alcohol Review

Short Communication
Injection drug users' perceptions regarding use of a medically supervised safer injecting facility