Drug use is a significant contributing factor of poor health and rising mortality rates in Canada and the United States. In order to decrease these rates, public health authorities have hypothesized the idea of medically supervised safer injection facilities so that people can inject illicit drugs under the supervision of medical professionals. The establishment of these facilities reduced the practice of public injection in Canada, but can only accommodate a fraction of illicit drug users. Supervised injection facilities do not currently exist in the United States. Thus, the only legal supervised injection facilities is located in Vancouver, British Columbia, as much controversy surrounds the topic, which impedes the expansion of these facilities in other parts of Canada and the United States.
Governments believe that the provision of a legal centre to inject drugs could support initiation of drug use. The increased rates of injection drug use in the United States have lead to the banned funding for needle exchange programs; however, this ban has not occurred in Canada. In addition, supervised injection facilities demonstrate much potential in overcoming some of the inconvenient ecological factors that drug users encounter. Some of these factors include a less “rushed” injecting atmosphere and the encouragement of safer injection methods by drug users. Studies have also shown that attendance at supervised injection facilities could lead to entry into addiction treatment.
One of the main arguments in favour of supervised injection facilities is the fact that many people will continue to use drugs in the future. Since this is the case, there is a logical need for supervised injection facilities in order to protect individuals’ health and address unsafe methods of injecting drugs such as reuse of syringes and unsafe discarding of syringes. Most people who attend supervised injection facilities are long-time drug users and significant initiation of drug use has not yet been found. This suggests that drug use initiation at supervised injection facilities is lower than the level of community injection initiation.
Although this is the case, only a portion of injections can be accommodated at supervised injection facilities. For example, approximately 5% to 10% of injections that occur in Vancouver’s Downtown Eastside are accommodated at the supervised injection centre in Vancouver, providing evidence that there is a need for more supervised injection facilities to be established. However, North American governments have yet to support and accept the use of supervised injection facilities as a means to decrease harms related to illicit drug use.
Supervised injection facilities also reduce the negative factors associated with public injecting. Public injecting often takes place in unsanitary environments that do not allow hygienic injecting. Drug users who inject in public have increased risk of abscesses, damage of veins, syringe sharing, HCV infection, HIV infection and overdose. Public injecting users are often more concerned about the risks of interruption (ie. Interruption by police or interruption due to missing a hit) rather than practicing safe injection methods. The establishment of supervised injection facilities aims to decrease harms such as these.
In addition, users of supervised injection facilities report reduced participation in public injecting. However, the potential benefits of supervised injection sites have not been fully realized which has lead to many limitations that are present within these facilities. Some of these limitations include the inability to assist individuals with injections, affordable housing, accessible toilets and the consideration of programs aimed to enhance drug users’ personal safety; however, the introduction of these programs have not occurred due to governments’ opposition.
Indeed, individuals do not support supervised injection facilities for valid reasons as well because there are instances where drug use has been initiated as a result of supervised injection facilities. However, initiation that occurs at supervised injection sites is lower than initiation that occurs in the community. Despite this, political opposition fails to recognize the many benefits supervised injection facilities provide and has only allowed small-scale studies to take place to measure the effectiveness of these facilities in the past. As a result, there is not enough research to communicate the clear benefits of supervised injections sites, which has prevented other facilities to open in Canada and internationally.
Although use of supervised injection facilities are not supported by government parties, drug users require awareness and education regarding safe injection practices. They also require easy access to addiction counselling, which can evidently lead to discontinuation of drug use as well. Positive correlations between attendance at supervised injection facilities and entry into addiction treatment programs have been implicated. Supervised injection facilities also show evidence of less initiation of drug use than initiation of drug use in the public. Given the compelling benefits of these facilities, it is evident that more supervised injection facilities should be established internationally. This would allow increased amounts of injections to take place on a daily basis and would address issues surrounding travel, wait times and hours of operation of these facilities across the globe.
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