That’s not a large percent of the user population, but it’s among the sickest. That along might be enough to justify the investment; I’m sure a number of lives have been saved along the way.

According to this meta-analysis, not very well. At least in terms of the goals they were intended to achieve. Those included:

  • Reduction in street criminal activity (always important to the public)
  • Reduction in the number of overdose fatalities, and
  • Reduced disease transmission through needle sharing (HIV/AIDS, hepatitis, etc)

It was the promise of these outcomes that led governments to fund injection centers in the first places. The objective was harm reduction– users would be provided with a safe alternative to the dangers of street use.  At the centers, they could inject heroin under the watchful eye of medical professionals. Should anything go wrong– an unintended OD, for instance — staff would be right there to intervene.

The centers were portrayed as an opportunity to engage the users in more conventional medication assisted treatment. I’m not sure how successful that was.

A meta-analysis is a way of pooling data from a range of comparable research studies in order to draw broad conclusions based on common findings. Here, the meta-analysis found that:

  • Criminal activity by participants at sites decreased only slightly
  • Overdose mortality was not positively affected
  • Nor was there positive impact on the practice of sharing syringes (not sure how that was measured).

As noted, safe injection centers are quite costly, so the disappointing outcomes make it less likely that other cities will follow suit.

We should note that these centers are designed to attract a very chronic user with a long history of drug use and multiple prior failed attempts at treatment. That’s not a large percent of the user population, but it’s among the sickest. That alone might be enough to justify the investment; I’m sure a number of lives have been saved along the way.

As far as the impact on the larger opioid epidemic, I imagine it’s small. You couldn’t manage very many cases in a single center, given the staffing requirements. It’s the sort of strategy that ultimately finds a role in areas of greatest need– such as the cities that have already opened sites, or are considering it now.


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