Role of safer injection facilities in reducing HIV and Hepatitis C infections and overdose mortality

Background: Safer injection facilities (SIFs) reduce risks associated with injecting drugs, especially public injection, exist in many countries, but do not exist in the United States. We assessed the ethical, operational, and public health considerations for establishing SIFs in the United States. Method: We used the six-factor Kass framework (goals, effectiveness, concerns, minimization of concerns, fair implementation, and balancing of benefits and concerns) to conduct our analysis and reviewed the global evidence for SIFs. Results: SIFs offer a hygienic environment to inject drugs (in contrast to unhygienic public environments), provide sterile injection equipment at time of injection, and allow for safe disposal of used equipment. Injection of pre-obtained drugs happens in a facility where trained health care personnel are present, provide on-site counseling and referral to addiction treatment and health care, and intervene in overdose emergency situations. SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality), without any evidence for negative health or social consequences. SIFs serve most-at-risk persons including those who inject in public and do not use other public health programs. It is critical to address legal barriers, moral objections, and local opposition against SIFs, develop and implement relevant policies and operational procedures, and assess individual- and community-level needs and benefits of SIFs given local epidemiologic data. Conclusions: SIFs have the potential to reduce viral and bacterial infections and overdose mortality among persons who inject drugs and engage in high risk behaviors by offering unique and complementary public health services.