Table 2.

Supervised injection facilities in the United States

Barriers	Arguments and Evidence to Support SIFs
Legal: Legality complicated owing to federal and state government involvement. The US forbids: Possession of controlled substances Making places available for unlawful distribution or use of a controlled substance.27	CSA* meant to address drug purchasing and consumption (colloquially known as the “Crack House Statute”)27 CSA not meant to influence public health interventions/infringe on state public health authority27
Public opinion: Although evidence support SIFs, establishing SIFs can be challenging in the setting of public opposition	PWID need public support98 SIFs are public health interventions that can reduce mortality, morbidity, and IDU-associated infections37,44,48,99 SIFs reduce public injecting, crime and increase public safety50–52
Funding: SIFs may require significant startup and operating costs. Obtaining federal, state and local funding, in addition to outside donations, can be difficult owing to the legal controversies.	Cost saving100,101 Life saving, lead to early medical interventions, and should be publicly funded42

Abbreviation: CSA, Controlled Substance Act.