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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2014 Feb 22;82(2):267–275. doi: 10.1093/jurban/jti050

A description of a peer-run supervised injection site for injection drug users

Thomas Kerr 1,✉, Megan Oleson 3, Mark W Tyndall 1,2, Julio Montaner 1,2, Evan Wood 1,2
PMCID: PMC3456578  PMID: 15872193

Abstract

Owing to the ongoing health crisis among injection drug users in Vancouver, Canada, there have been repeated calls for the establishment of supervised injection sites (SIS) since the early 1990s. In April 2003, a group of advocates and drug users opened an unsanctioned SIS in Vancouver’s Downtown Eastside. The “327 SIS” operated for 184 days. During the operation of the SIS, volunteers supervised over 3,000 injections by a bigh-risk injection drug using population. The SIS provided a sterile environment for injection drug use without measured negative consequences and demonstrated the feasibility of a peer-driven low-threshold SIS.

Keywords: Peer-driven, Safer injection site, Vancouver

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References

  • 1.Des Jarlais DC, Hagan H, Friedman SR, et al. Maintaining low HIV seroprevalence in populations of injecting drug users. JAMA. 1995;274:1226–1231. doi: 10.1001/jama.1995.03530150050033. [DOI] [PubMed] [Google Scholar]
  • 2.Fischer B, Rehm J, Blitz-Miller T. Injection drug use and preventive measures: a comparison of Canadian and western European jurisdictions over time. CMAJ. 2000;162:1709–1713. [PMC free article] [PubMed] [Google Scholar]
  • 3.Strathdee SA, Patrick DM, Currie SL, et al. Meedle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11:F59–F65. doi: 10.1097/00002030-199708000-00001. [DOI] [PubMed] [Google Scholar]
  • 4.BC Vital Statistics Agency. Selected Vital Statistics and Health Status Indicators. Drug-Induced Deaths by Age and Gender. 2000.
  • 5.O’Shaughnessy MV, Montaner JS, Strathdee S, Schechter MT. Deadly public policy. Int Conf AIDS. 1998;12:982–982. [Google Scholar]
  • 6.Tyndall MW, Currie S, Spittal P, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17:887–893. doi: 10.1097/00002030-200304110-00014. [DOI] [PubMed] [Google Scholar]
  • 7.Wood E, Tyndall MW, Spittal PM, et al. Unsafe injection practices in a cohort of injection drug users in Vancouver: could safer injecting rooms help? CMAJ. 2001;165:405–410. [PMC free article] [PubMed] [Google Scholar]
  • 8.Kerr TH, Wood E, Palepu A, Wilson D, Schechter MT, Tyndall MW. Responding to explosive HIV epidemics driven by frequent cocaine injection: is there a role for safer injecting facilities? J Drug Issues. 2003;33:579–608. doi: 10.1177/002204260303300303. [DOI] [Google Scholar]
  • 9.Dolan K, Kimber J, Fry C, Fitzgerald J, McDonald D, Trautmann F. Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia. Drug Alcohol Rev. 2000;19:337–346. doi: 10.1080/713659379. [DOI] [Google Scholar]
  • 10.Hedrich D. European Report on Drug Consumption Rooms: European Monitoring Centre for Drugs and Drug Addiction. Lisbon, Portugal: European Monitoring Centre for Drugs and Drug Addiction; 2004. [Google Scholar]
  • 11.Evaluation der Abiet van Drogenkonsumäuen un der Bundesrepulik Deutchland. Baden-Baden, Germany: Nomos; 2003. [Google Scholar]
  • 12.Ronco C, Spuhler G, Coda P, Schopfer R. Evaluation for alley-rooms I, II, and III in Basel. Soc Prev Med. 1996;41:S58–S68. doi: 10.1007/BF01318589. [DOI] [PubMed] [Google Scholar]
  • 13.Kemmesies U. Final Report: The Open Drug Scene and the Safe Injection Room Offers in Frankfurt am Main. Münster, Germany: Indo; 1999. [Google Scholar]
  • 14.Wood E, Small W, Li K, Marsh D, Montaner JS, Tyndall MW. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ. 2004;171:731–734. doi: 10.1503/cmaj.1040774. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Kaldor J, Lapsley H, Mattick RP, Weatherburn D, Wilson A. Final Report on the Evaluation of the Sydney Medically Supervised Injecting Centre. Sydney: MSIC Evaluation Committee; 2003. [Google Scholar]
  • 16.Kimber J, Dolan K, Van Beek I, Hedrich D, Zurhold H. Drug consumption facilities: an update since 2000. Drug Alcohol Rev. 2003;22:227–233. doi: 10.1080/095952301000116951. [DOI] [PubMed] [Google Scholar]
  • 17.CBC News. Real-life Da Vinci leads sweep in Vancouver elections. CBC News. November 18, 2002.
  • 18.Vancouver Sun. 90 arrested in drug sweep: the first five days of a major campaign has produced hundreds of trafficking charges. Vancouver Sun. April 12, 2003:A1.
  • 19.Wood E, Spittal PM, Small W, Kerr T, Li K, Hogg RS, Tyndall MW, Montaner JS, Schechter MT. Displacement of Canada’s largest public illicit drug market in response to a police crackdown. CMAJ. 2004;170:1551–1556. doi: 10.1503/cmaj.1031928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Maher L, Dixon D. Policing and public health: law enforcement and harm minimization in a street-level drug market. Br J Criminol. 1999;39:488–512. doi: 10.1093/bjc/39.4.488. [DOI] [Google Scholar]
  • 21.Aitken C, Moore D, Higgs P, Kelsall J, Kerger M. The impact of a police crackdown on a street drug scene: evidence from the street. Int J Drug Policy. 2002;13:189–198. doi: 10.1016/S0955-3959(02)00075-0. [DOI] [Google Scholar]
  • 22.Rhodes T, Mikhailova L, Sarang A, et al. Situational factors influencing drug injecting, risk reduction and syringe exchange in Togliatti City, Russian Federation: a qualitative study of micro risk environment. Soc Sci Med. 2003;57:39–54. doi: 10.1016/S0277-9536(02)00521-X. [DOI] [PubMed] [Google Scholar]
  • 23.Wodak A, Symonds A, Richmond R. The role of civil disobedience in drug policy reform: how an illegal “safer injection room” led to a sanctioned, “medically supervised injection centre”. J Drug Issues. 2003;33:609–624. doi: 10.1177/002204260303300304. [DOI] [Google Scholar]
  • 24.Kerr T, Wood E, Small D, Palepu A, Tyndall MW. Potential use of safer injecting facilities among injection drug users in Vancouver’s Downtown Eastside. CMAJ. 2003;169:759–763. [PMC free article] [PubMed] [Google Scholar]
  • 25.CTV News. Illegal safe injection site opens in Vancouver. CTV News. May 5, 2003.
  • 26.Broadhead RS, Kerr TH, Grund JP, Altice FL. Safer injection facilities in North America: their place in public policy and health initiatives. J Drug Issues. 2002;32:329–355. doi: 10.1177/002204260203200113. [DOI] [Google Scholar]
  • 27.Wood E, Kerr T, Small W, Jones J, Schechter MT, Tyndall MW. The impact of police presence on access to needle exchange programs. J Acquir Immune Defic Syndr. 2003;34:116–118. doi: 10.1097/00126334-200309010-00019. [DOI] [PubMed] [Google Scholar]
  • 28.Craib KJ, Spittal PM, Wood E, et al. Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. CMAJ. 2003;168:19–24. [PMC free article] [PubMed] [Google Scholar]
  • 29.Darke S, Kaye S, Ross J. Geographical injecting locations among injecting drug users in Sydney, Australia. Addiction. 2001;96:241–246. doi: 10.1046/j.1360-0443.2001.9622416.x. [DOI] [PubMed] [Google Scholar]
  • 30.Latkin C, Mandell W, Vlahov D, Oziemkowska M, Knowlton A, Celentano D. My place, your place, and no place: behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore, Maryland. Am J Community Psychol. 1994;22:415–430. doi: 10.1007/BF02506873. [DOI] [PubMed] [Google Scholar]
  • 31.Bruneau J BS, Lamothe F, Vincelette J. What can we learn from chronic, non-infected IDUs: sociodemographic characteristics and factors associated with long-term HIV and HCV seronegativity. Can J Infect Dis. 2001;13:44A–44A. [Google Scholar]
  • 32.Fry CL. Safer injecting facilities in Vancouver: considering issues beyond potential use. CMAJ. 2003;169:777–778. [PMC free article] [PubMed] [Google Scholar]
  • 33.Friedman SR, Furst RT, Jose B, et al. Drug scence roles and HIV risk. Addiction. 1998;93:1403–1416. doi: 10.1046/j.1360-0443.1998.939140311.x. [DOI] [PubMed] [Google Scholar]
  • 34.Establishing Safe Injection Facilities in Canada: Legal and Ethical Issues. Montreal: Canadian HIV/AIDS Legal Network; 2002. [PubMed] [Google Scholar]
  • 35.Grund JP, Blanken P, Adriaans NF, Kaplan CD, Barendregt C, Meeuwsen M. Reaching the unreached: targeting hidden IDU populations with clean needles via known user groups. J Psychoactive Drugs. 1992;24:41–47. doi: 10.1080/02791072.1992.10471617. [DOI] [PubMed] [Google Scholar]
  • 36.Wood E, Kerr T, Spittal PM, et al. An external evaluation of a peer-run “unsanctioned” syringe exchange program. J Urban Health. 2003;80:455–464. doi: 10.1093/jurban/jtg052. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Rees V. User groups. Addiction. 1995;90:145–145. [PubMed] [Google Scholar]
  • 38.Broadhead RS, Heckathorn DD, Grund JC, Stern LS, Anthony DL. Drug users versus outreach workers in combating AIDS: preliminary results of a peer-driven intervention. J Drug Issues. 1995;25:531–564. [Google Scholar]
  • 39.Broadhead RS, Heckathorn DD, Weakliem DL, et al. Harnessing peer networks as an instrument for AIDS prevention: results from a peer-driven intervention. Public Health Rep. 1998;113:42–57. [PMC free article] [PubMed] [Google Scholar]
  • 40.Kerr T, Douglas D, Peeace W, Pierre A, Wood E. Responding to an Emergency: Education, Advocacy, and Community Care by a Peer-driven Organization of Drug Users: A Case Study of the Vancouver Area Network of Drug Users (VANDU). Health Canada Hepatitis C Prevention, Support, and Research Program. Ottawa, Canada: Health Canada Hepatitis C Prevention, Support, and Research program; 2001. [Google Scholar]

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