These Safe injections sites also known as drug consumption rooms (DCRs), safe injection rooms, and supervised injection sites/facilities/centers, began in Europe in the 1980s. They now exist in cities in Switzerland, Germany, the Netherlands, Spain and Australia. The first safe injection site in North America, Insite, began operating as a pilot project in Vancouver, BC in 2003, and was recently given the go-ahead to remain open after a Supreme Court battle with the federal government (Keen, 2003).
Injection drug use continues to be associated with an array of significant health and social consequences throughout North America. These consequences are tied directly to the consumption of illicit drugs of unknown potency and composition, and the sharing of contaminated injection equipment; and indirectly, through unprotected sex with drug injectors, and through injectors’ immersion in black-market pursuits that result frequently in violent exchanges with criminals and the police.
Keen (2003) states that in the United States, injection drug use accounts for approximately 25% of all cumulative AIDS cases nationwide, but closer to 50% of all cases in several northeastern States. The number of new HIV infections reported nationwide among injectors increased 300% in the 1990s, from 6,474 new infections in 1993, to 13,969 in 1995, 17,344 in 1998 and 18,882 in 1999. Disease Injectors also suffer from very high rates of hepatitis C infection – 90% of people who have injected for 5 years or more are infected - and from endocarditis, an acute infection of the heart valves that is not commonly seen among young adults. Fatal and nonfatal drug overdose (OD) is also a prevalent medical problem among injectors, and hospital emergency rooms throughout the country attend to ODs virtually everyday. Emergency room (ER) visits involving heroin alone doubled from 33,900 in 1990 to 70,500 in 1996. Some medical experts have recently declared that the United States is in the midst of another heroin epidemic. On the other hand, injectors are known to use primary care services erratically and only after they are very sick, which drives up health care costs (Drug Policy expert Committee, 2000). The argument for safe injection sites Several research studies have shown that safe injection sites have advantages for drug injectors and for the community including reduction in many of the harmful aspects of drug use on the individual (spread of infections, risk of overdose) and to society (drug-related crime, public exposure to drug injecting paraphernalia), as well as positive benefits (increase in education about safety among injectors, more drug users accessing treatment and other services). Extensive research has been conducted at Insite in Vancouver, with positive results. The argument against safe injection sites Critics have argued against the introduction of safe injection sites largely based on the principle that drug addiction is wrong, and should not be condoned in any way. The political focus on reducing harm to drug users deflects the focus from where it belongs, which is on the prevention and treatment of drug abuse. Introducing safe injection sites is seen as a step towards drug legalization, and undermines law enforcement principles and practices. Researchers conclude that police surveillance may end up scaring away the very people North America's first sanctioned safer injecting facility is intended to help. While there have been methodological criticisms of the evaluation studies supporting safe injection sites, and Insite in particular, critics on the other side argue that there is no substantial basis for these criticisms. Ultimately, the strong views on both sides