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Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users

From the British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC (all authors); the Departments of Health Care and Epidemiology (Wood) and Medicine (Montaner, Tyndall), Faculty of Medicine, University of British Columbia, Vancouver, BC; Vancouver Coastal Health (Marsh), Vancouver, BC; and the Canadian HIV/AIDS Legal Network, Montréal, Que. (Kerr)

Background: North America's first medically supervised safer injecting facility for illicit injection drug users was opened in Vancouver on Sept. 22, 2003. Although similar facilities exist in a number of European cities and in Sydney, Australia, no standardized evaluations of their impact have been presented in the scientific literature.

Methods: Using a standardized prospective data collection protocol, we measured injection-related public order problems during the 6 weeks before and the 12 weeks after the opening of the safer injecting facility in Vancouver. We measured changes in the number of drug users injecting in public, publicly discarded syringes and injection-related litter. We used Poisson log-linear regression models to evaluate changes in these public order indicators while considering potential confounding variables such as police presence and rainfall.

Results: In stratified linear regression models, the 12-week period after the facility's opening was independently associated with reductions in the number of drug users injecting in public (p < 0.001), publicly discarded syringes (p < 0.001) and injection-related litter (p < 0.001). The predicted mean daily number of drug users injecting in public was 4.3 (95% confidence interval [CI] 3.5–5.4) during the period before the facility's opening and 2.4 (95% CI 1.9–3.0) after the opening; the corresponding predicted mean daily numbers of publicly discarded syringes were 11.5 (95% CI 10.0–13.2) and 5.4 (95% CI 4.7–6.2). Externally compiled statistics from the city of Vancouver on the number of syringes discarded in outdoor safe disposal boxes were consistent with our findings.

Interpretation: The opening of the safer injecting facility was independently associated with improvements in several measures of public order, including reduced public injection drug use and public syringe disposal.

This article has been cited by other articles:

				K DeBeck, W Small, E Wood, K Li, J Montaner, and T Kerr Public injecting among a cohort of injecting drug users in Vancouver, Canada J Epidemiol Community Health, January 1, 2009; 63(1): 81 - 86. [Abstract] [Full Text] [PDF]

				L. Beletsky, C. S. Davis, E. Anderson, and S. Burris The Law (and Politics) of Safe Injection Facilities in the United States Am J Public Health, February 1, 2008; 98(2): 231 - 237. [Abstract] [Full Text] [PDF]

				T. Kerr, M. W. Tyndall, R. Zhang, C. Lai, J. S.G. Montaner, and E. Wood Circumstances of First Injection Among Illicit Drug Users Accessing a Medically Supervised Safer Injection Facility Am J Public Health, July 1, 2007; 97(7): 1228 - 1230. [Abstract] [Full Text] [PDF]

				C. M. Cleland, S. Deren, C. M. Fuller, S. Blaney, J. M. McMahon, S. Tortu, D. C. Des Jarlais, and D. Vlahov Syringe Disposal Among Injection Drug Users in Harlem and the Bronx During the New York State Expanded Syringe Access Demonstration Program Health Educ Behav, April 1, 2007; 34(2): 390 - 403. [Abstract] [PDF]

				J.-A. Stoltz, E. Wood, W. Small, K. Li, M. Tyndall, J. Montaner, and T. Kerr Changes in injecting practices associated with the use of a medically supervised safer injection facility J Public Health, March 1, 2007; 29(1): 35 - 39. [Abstract] [Full Text] [PDF]

				E. Wood, M. W. Tyndall, J. S. Montaner, and T. Kerr Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. Can. Med. Assoc. J., November 21, 2006; 175(11): 1399 - 1404. [Abstract] [Full Text] [PDF]

				E. Wood, M. W. Tyndall, Z. Qui, R. Zhang, J. S. G. Montaner, and T. Kerr Service Uptake and Characteristics of Injection Drug Users Utilizing North America's First Medically Supervised Safer Injecting Facility Am J Public Health, May 1, 2006; 96(5): 770 - 773. [Abstract] [Full Text] [PDF]

				T. Kerr, J.-A. Stoltz, M. Tyndall, K. Li, R. Zhang, J. Montaner, and E. Wood Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study BMJ, January 28, 2006; 332(7535): 220 - 222. [Abstract] [Full Text] [PDF]

				S. W. Hwang Homelessness and harm reduction Can. Med. Assoc. J., January 3, 2006; 174(1): 50 - 51. [Full Text] [PDF]

				I. Goldstone Marginalised HIV positive drug users felt that an HIV diagnosis created benefits as well as losses Evid. Based Nurs., January 1, 2006; 9(1): 30 - 30. [Full Text] [PDF]

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