- What is a supervised injecting facility (SIF)?
- What is being proposed in Dublin inner city centre?
- Why are these services being proposed for Dublin inner city centre?
- Who is providing the service?
- When will the service be opened?
- What are the expected benefits of these services?
- Will these services increase drug use, drug dealing, and crime in the local area?
- What is the legal status of these services?
- Can we afford these services?
- Will these services support people to reduce their drug use?
- How to find out more
- Useful links
1. What is a supervised injecting facility (SIF)?
A SIF is a clean, safe, healthcare environment where people can inject drugs, obtained elsewhere, under the supervision of trained health professionals. They offer a compassionate, person-centred service which reduces the harms associated with injecting drug use and can help people access appropriate services. A SIF can help health service staff to reach and support vulnerable and marginalised people who often do not, cannot or no longer engage with existing health services.
Typically, supervised injecting facilities provide people who use drugs with sterile injecting equipment; counselling services before and after injecting; emergency response in the event of overdose; and primary medical care. The supervised injecting facility aims to:
• reduce drug-related overdose deaths
• reduce the risks of disease transmission through shared needles
• reduce public health risks such as needle-stick injuries and
• connect the most vulnerable and marginalised people who use drugs with treatment services and other health and social services.
These facilities typically consist of a reception area, an injecting area and a recovery area. In addition, they usually provide an area where people can receive support from relevant health services and support groups to help improve their health and social circumstances. The exterior of a SIF looks like any other health or social care premises. There are now approximately 90 of these facilities worldwide, in Europe, Canada, and Australia. There is significant evidence gathered from these facilities of their benefits to people who use drugs and the wider society.
2. What is being proposed in Dublin inner city centre?
In December 2015, the Government gave approval for work to begin on drafting legislation to allow for SIFs and for a pilot facility to be established to determine the safety and effectiveness of a SIF for people who use drugs and the wider community in Ireland. On 16 May 2017, the Misuse of Drugs (Supervised Injecting Facilities) Act 2017 was signed by the President, which will allow for the licensing of a supervised injecting facility in Ireland.
The HSE was tasked with setting up a pilot site project and the preferred bidder was confirmed on 16th Feb 2018 after a robust procurement process. The pilot project will be independently evaluated during its pilot phase at 6 months and 18 months.
3. Why are these services being proposed for Dublin inner city centre?
Public injecting is visually apparent in Dublin city centre through people using drugs and from drug-related litter. This pilot service will play a significant role in reducing both street injecting and the risk of drug related deaths in Dublin. It also has the potential to reduce blood borne viruses such as HIV and Hepatitis C. Figures published by the Health Research Board showed that 348 people died in 2015 due to drug poisoning. Of these 48 were injecting at the time of death and almost all involved an opioid drug, mainly heroin.
Setting up a supervised injecting facility will allow for earlier medical intervention of overdoses that occur in the facility, distribution of naloxone (which reverses the effect of opioid overdose) and can also be a gateway to treatment for people who use drugs. Between 2012 and 2014 there were 25 drug related deaths among people who inject drugs in public places in Dublin and 18 drug-related deaths among people who inject drugs who were in touch with homeless services in Dublin.
4. Who is providing the service?
Following a procurement process, Merchants Quay Project CLG was identified as the preferred bidder to operate the SIF. They will be expected to have a robust community engagement plan in their operational set up. Locating the facility in an area where public-injecting is already taking place will maximise uptake by the target population. A community liaison worker will be appointed and will work closely with the local community, its representatives and local businesses.
5. When will the service be opened?
It is anticipated that the pilot service will be open shortly after receipt of planning.
6. What are the expected benefits of these services?
There is lots of high-quality research from around the world which demonstrates the benefits of SIFs. Evidence shows that SIFs can improve the health and wellbeing of individuals who use the facility and reduces the negative impact that public injecting has on local communities and businesses. For instance, they have been shown to:
- reduce public injecting
- reduce discarded needles and drug related litter
- reduce the sharing of needles and other injecting equipment which has a positive effect on reducing blood borne diseases such as HIV and Hepatitis
- improve the uptake of addiction care and treatment
- save money for society, due to reductions in ill-health and health care usage (including emergency services) among people who would otherwise inject drugs in public places.
Supervised Injecting Facilities have been associated with a decrease in public injecting and a reduction in the number of syringes discarded in the vicinity of such facilities. For example, a fourfold reduction was reported in the number of unsafely disposed syringes being collected in Barcelona and a 75-80% reduction in drug-related litter in the vicinity of the facilities in Copenhagen. SIFs are not a solution to the drugs problems but have been shown to be of significant benefit and have helped reduce the impact of drug use in affected areas. They are a well recognised harm reduction approach to the problem of injecting drug use.
7. Will these services increase drug use, drug dealing and crime in the local area?
The evidence from other countries shows that SIFs do not increase drug use, drug dealing or crime in the areas in which they are located. This is largely because they are located in areas where injecting is already occurring in public spaces. Based on international experience we do not anticipate that the facility will cause these problems; nonetheless, this will be monitored as part of the evaluation of the proposed facility.
8. What is the legal status of these services?
The Misuse of Drugs (Supervised Injecting Facilities) Act 2017 - Provides an exemption for licensed providers whereby it is currently an offence to permit the preparation or possession of a controlled substance in premises; Exempts authorised users from the offence of possession of controlled drugs under certain conditions, when in the facility and with the permission of the licence holder; Enables the Minister to consult with the HSE, An Garda Síochána, or others on matters relating to a supervised injecting facility, including its establishment, on-going monitoring and review.
It is important to note that possession of controlled drugs will continue to be an offence outside a supervised injecting facility. Possession for sale or supply (dealing) will remain an offence both inside and outside a supervised injecting facility. An Garda Síochána has committed to support the successful implementation of this health-led initiative. This legislation will not in any way dilute the Misuse of Drugs legislation or the work of An Garda Siochana in tackling drug trafficking and drug-related criminal activity.
9. Can we afford these services?
Evidence from other countries where there are supervised injecting facilities shows that these services are cost-effective in the long term, and it is reasonable to believe that this will also be the case in Ireland (see links to research evidence). Similarly, public injecting is also associated with significant costs to social work services, criminal justice and law enforcement, street cleaning, and local businesses.
A recent cost benefit study relating to a SIF in San Francisco showed that for each dollar spent on the SIF there was a saving of 2.33 dollars for the city. Savings were in the areas of;
- averted HIV and Hep C infections
- Reduced skin and soft tissue infections
- Averted overdose deaths
- Increased treatment uptake
By reducing the harms of injecting drug use and improving the local environment, these services are therefore likely to have a range of economic benefits. Several studies from other countries have found that SIFs are cost-saving overall: they save more money for society than they cost to set up and run. This is because they reduce ill-health among people who inject drugs, and therefore reduce their need for health and social care services. They are also likely to reduce costs to the public in other ways – for instance, by reducing the costs of clearing up drug-related litter. Public injecting results in discarded used needles in the city centre and visible public drug use which can affect business and tourism.
10. How can these services help people to reduce drug use or prevent overdose?
This service is one element of the wrap around health based approach adopted in the National Drug Strategy, "Reducing Harm, Supporting Recovery" and supported by the HSE’s National Standard. A SIF aims to provide a location for people who are currently injecting drugs in public places, many of whom identify as homeless.
This service is for a group of people who have long history of drug use and do not engage easily with health services. They find it difficult to stop using drugs completely and existing drug services have not been suitable for their needs. The new pilot service aims to promote opportunities for treatment and recovery from drug use to improve people’s health and social circumstances. Although not everyone who attends the SIF will be ready to start a recovery programme or treatment, it will help reduce harms associated with drug use and support people to access services appropriate to their stage of the recovery journey.
The SIF can also offer on-site access to:
- Referral to Addiction Services in the area for assessment and treatment
- Recovery-oriented services such as peer support and mutual aid
- Other health services, such as primary care and screening for blood-borne viruses like HIV and Hepatitis C
- Advice and support on housing, welfare rights and other issues
- An opportunity to engage with health and social care staff.
People who will use the service are also at a higher risk of a drug-related overdose or death, rates of which have increased in Dublin in recent years. Trained healthcare staff will be on hand to intervene and provide medical assistance to people who use the SIF. Similar services have been operating successfully around the world for over 30 years.
11. How to find out more
There will be updated reports from the Working Group in relation to the development of the pilot SIF in Dublin inner city. Any updates from the working group, and links to research and evidence relating to Supervised Injecting Facilities, will be available on hse.ie/supervisedinjecting.
12. Useful links
Canadian research published by the Harm Reduction Journal (2017): Supervised injection services (SIS) have been shown to reduce the public- and individual-level harms associated with injection drug use. While SIS feasibility research has been conducted in large urban centres, little is known about the acceptability of these services among people who inject drugs (PWID) in mid-sized cities. This study has been completed on the willingness to use SIS as well as design and operational preferences among PWID in the town of London, Canada (population circa 400,000).
EMCDDA Drug Consumption Rooms: An Overview of Provision and Evidence (Perspectives on Drugs) (2017)
EMCDDA Preventing Overdose Deaths in Europe (Perspectives on Drugs) (2017)
NHS Greater Glasgow and Clyde: Safer Consumption Facility Could Provide Substantial Financial Gain for Services (2017)
A Cost-benefit and Cost-effectiveness Analysis of Vancouver’s Supervised Injection Facility (2010)
SAHA International Final Report: Economic Evaluation of the Medically Supervised Injection Centre at Kings Cross (MSIC) (2008)
British Medical Journal: Supervised Injection Centers Could Save Millions of Dollars in Health Costs, US Study Finds (2016)
American Journal of Preventive Medicine: Addressing the Nation’s Opioid Epidemic: Lessons from an Unsanctioned Supervised Injection Site in the U.S (2017)
Journal of Drug Issues: A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA (2017)
Opiate-dependent service-users’ knowledge and attitudes towards Supervised Injecting Facilities-Poster Winter Conference 2017
Public Health and Order Outcomes Associated with Supervised Drug Consumption Facilities_.pdf (size 590.5 KB)