Supervised injection services: What has been demonstrated? A systematic literature review

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1 Drug Alcohol Dependence 145 (2014) 48–68 and Contents available at ScienceDirect lists and Dependence Drug Alcohol l ourna me pa g e: www.e lsevier.com/locate/druga lcdep j ho Review services: has been demonstrated? injection What Supervised  review literature systematic A b , ∗ a b , a e c , d , , Franc ̧ oise Dubois-Arber Laprévote , Olivier Cottencin , Chloé Potier , Vincent , b a Benjamin Rolland a Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Department France of Lille, b Lille 2, Faculty of Medicine, F-59045 Lille, France of University c F-54000, des Addictions, Nancy France Nancy, CHU Maison d Centre d’Investigation Clinique CIC-INSERM 9501, Nancy F-54000, France CHU Nancy, e Institute of Social and de Medicine, University Hospital Center and University of Chemin la Corniche 10, 1010 Lausanne, Switzerland Preventive Lausanne, a t i c l e i n f o t c a r t s b a r Article history: injection Supervised Background: services (SISs) have been developed to promote safer injection drug May 18 2014 Received practices, enhance PWID people who behaviors health-related among inject (PWID), and connect drugs 14 revised in October 2014 form Received with use drug fostering of accused been also have SISs Nevertheless, services. social and health external October 14 2014 Accepted and drug trafficking. online October 23 2014 Available Aims: available currently the synthesize and collect systematically To SIS-induced regarding evidence benefits and harm. Keywords: Methods: was and ScienceDirect A systematic review Science, performed via the PubMed, Web of service injection Supervised databases algorithm [(“SUPERVISED” OR “SAFER”) AND (“INJECTION” OR “INJECT- keyword using the Safer injection facility ING” OR “ROOM” OR “FACILITIES” OR “SHOOTING” “GALLERY” OR “CONSUMPTION”) AND (“FACILITY” OR injecting center Supervised OR OR “SITE”)]. “CENTRE” consumption room Drug Results: efficacious were SISs that Seventy-five relevant articles were found. All studies converged to find consumption facility Drug drug user Injection in safer the most marginalized promoting attracting injection conditions, enhancing access to PWID, primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug or crime in the surrounding environments. SISs were found to be associated with reduced trafficking levels public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or of Sydney. Conclusion: largely fulfilled their initial objectives without enhancing drug use or drug traf- have SISs ficking. all of the studies found in this review were performed in Canada or Australia, whereas Almost the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection evidence. use and associated harms appears to be supported by drug © Elsevier Ireland Ltd. 2014 rights reserved. All Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 . 2. Materials and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 . 3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 3.1. results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overall . . 50 . 3.2. . Description of SIS users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 3.3. The impact of SISs on overdose-induced mortality and morbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 3.4. impact of SISs on injection behaviors and their consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 3.5. The impact of SISs on reducing drug-related harms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62  Supplementary material can be found by accessing the version of this paper at http://dx.doi.org/10.1016/j.drugalcdep.2014.10.012 . online ∗ Corresponding author at: Service d’Addictologie, Hôpital Fontan2, CHRU de Lille, CS70001, 59037 LILLE Cedex, France. Tel.: +33 666816587. E-mail address: [email protected] (C. Potier). http://dx.doi.org/10.1016/j.drugalcdep.2014.10.012 reserved. Elsevier Ireland Ltd. All rights 2014 0376-8716/©

2 C. et al. / Drug and Alcohol Dependence 145 (2014) 48–68 49 Potier The impact of SISs on access to addiction treatment programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 3.6. 3.7. . of SISs on the nuisance induced by drug use in public spaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 The 3.8. impact of SISs on local drug-related crime, violence, and trafficking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 The 3.9. Impact of SISs on the amount of local PWID. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 . 3.10. assessment of SISs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Medico-economic 3.11. The opinion of PWID on SISs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 . 3.12. The of SISs on the opinions of local residents and police . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 impact 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Discussion Role of the funding source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 . Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Appendix A. Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 . . Introduction Switzerland, Spain, the Netherlands and Luxembourg Germany, 1. ( ). 2011 al., et Semaan numerous of harmful source a represents use drug Injection SISs reduc- harm other to complementarily implemented were effects both on the health conditions inject who drugs people of 2009; EMCDDA, following for measures INSERM, purposes ( the tion and environment. Drug injection is one of their social (PWID) 2010; the popu- marginalized most reach to (1) ): 2009 al., et Noël the main factors in the blood-transmissible viral dissemination of lations to access obtain to likely least are who PWID, medical of hepatitis or virus immunodeficiency the human as such infections and social ser- support, and connect them with health and social B C and Programme Nations viruses ( EMCDDA, 2008; Joint United overdose-induced (2) to reduce morbidity and mortality; (3) vices; In WHO, 1997 ). 2002; HIV/AIDS, addition, numerous other on to their to (4) behaviors; health reduce enhance to PWID educate physical problems other including injection, drug from result can injection-related by risks promoting the prevention and education locomotive and bacterial infections, cutaneous lesions, disor- viral of health self-injecting safe practices; (5) to improve the global ders, and hepato-gastroenterological ( INSERM, 2010; pathologies screening of and prevention, the promoting by PWID conditions Morris, 1995; Palepu et and al., 2001 ). disorders Psychiatric Klee medical viral foster orientation of of initiation infections; the to (6) are also more frequent in sub- ( EMCDDA, 2008 ), who are PWID programs care nui- the reduce to (7) and PWID; among dependence ject to reduced et access to medical services ( Kerr 2005b ). al., sances by injection drug use in spaces, e.g., urban triggered public Moreover, society, enhanced from marginalization exhibit PWID violence and trafficking and drug-use waste. crime, drug increases exposure unem- their precariousness, social to which SIS restricted Hedrich, ( regulated and 2004; usually is access ployment, ( DeBeck et al., prostitution and crime, homelessness, under 18 subjects to forbidden years are SISs 2010 ). Most INSERM, 2007; drug injection Thus, ). 2008 EMCDDA, consider- induces use of age, PWID, and indi- pregnant women, irregular or unidentified ably mortality. Partly because higher its illegal nature, injection of injection. drug first their experience to wish who Internal viduals consequences, use is also responsible for numerous societal drug rules and also forbid violence SISs drug selling. Moreover, many e.g., degradation space public and crime, violence, traffic, Kerr ( helping drug sharing or other users with drug injection. prohibit and Renn 2005a; al., these For ). 2001 al., et Singer 1996; Lange, et However, official Some criticism. organizations have SISs endured reasons, use drug injection places a heavy burden on society. that per- that argued “ national, state any or local authority have During the early 1980s, PWID had epidemic. HIV the face to mits or injection drug of operation rooms and establishment the viral Preventing crucial, became infection pro- care therefore, and, any outlet to facilitate the abuse other of drugs (by injection or any consider the damage caused by drug use rather had to fessionals route ( INCB, of administration) also facilitates illicit drug trafficking ” than Moreover, focusing on drug use of itself. in face of the failure often SISs of implementation detractors The ). SIS that argue 1999 public trafficking policies that aimed to eradicate drug use and drug is use drug the to equivalent of acceptance injection tacit public by ( Drucker, 1999 ) and in who PWID of number the of consideration authorities, drug and traffickers drug attract use, foster will which not preven- ready to enter into classical abstinence care, new were increase the drug-related consequences in surrounding area ( Boyd, tion and care paradigms reduction’ emerged, constituting the ‘harm New Elliott et al., 2002; Gandey, South 2003; Parliament of 2013; approach 2001; Wodak and Owens, ( 1996 ). The first MacPherson, Wales, groups by shared been often has perception This ). 1998 of aim of these new care systems was to reduce the medical and social were SISs new where cities in politicians and residents imple- local and injection drug use of to stop the marginalization consequences mented Elliott ( et al., 2002 ) and has sometimes led court to long spiral were PWID which to ( 1999; MacPherson, Berridge, exposed procedures 2003; al., et Wodak 2010; Small, 2006; Health ( Canada, 2001 syringe first the context, this In ). programs and the exchange Wood ). et al., 2007 development therapies were implemented of opiate maintenance legal Zobel years after the first opening of an SIS ( Twenty-eight 1998 WHO, ). ( and review Dubois-Arber, 2004 ), we have performed a systematic Similarly, 1980s, emerged facilities new and the of end the at of on available currently data published the collect literature the to the first objective was to allow PWID to inject self-provided drugs SISs data SISs whether determine to these synthesize to and have within a supervised framework in enhanced aseptic conditions them against raised fears the whether and objectives their achieved medical EMCDDA, ( control police of risk no and monitoring with are justified. 2008; had Jozaghi, 2012; Semaan al., 2011 ). These facilities have et ‘super- appellations, including ‘safer injection facilities,’ different methods 2. Materials and vised consumption injecting centers/sites/rooms/facilities,’ ‘drug systematic A herein search for relevant articles was conducted and is presented rooms,’ services’ (SISs) ( Hedrich, 2004; and ‘supervised injection according was research The PRISMA ). 2009 al., et Liberati ( statement per- to the Noël Throughout et al., 2009 ). will the present article, we indis- PubMed, the using To databases. ScienceDirect and Science, of avoid Web formed designate facilities. these concept to The term the use ‘SISs’ tinctly con- was bias, an inventory of the different English appellations for SIS selection of in SISs 2010, there rapidly spread in Western countries, and of OR which led to our use the following keyword algorithm: (“SUPERVISED” ducted, were SISs identified 90 than more Norway, Australia, Canada, in “INJECTING” “CONSUMPTION”) AND (“INJECTION” OR OR “SHOOTING” OR “SAFER”)

3 50 C. Potier et al. / Drug and Alcohol Dependence 145 (2014) 48–68 8 es id enfied thr ou ght el ectron ic sour ce s ( PubMe d, Web of 61 ar cl ER direct) , us in g keyw ord algorith m: ("S UP VI S ED" OR ce, Scien Science ") AND ("INJE CT ION" OR "INJECTIN G" OR "SHOOT IN G" OR ER "SAF OR D ("F ACI LITY" OR "FA C ILITIES" AN "ROOM" OR ON") ONSUMPTI "C RY" OR "CENTRE" OR "SITE") LLE "GA es : Da ta bas ub Janu ary 2014) med : 448 (23 P • nficaon e • ence : 119 (23 Janu ary 2014 ) Web of Sci Id • m: 51 (23 Janua ry 201 4) Scien ceDirec t.co no ources u se d for the id other s enfi ca  on of addion al s document g 476 cat articles sourced after dupli es removed creenin S le 476 iew tl rc s screened on e a rev e xcluded : 2 31 arcles cles ar 20 no n- En g lish - y arcl pic 29 es 2 off- to - ibilit g Eli 164 arcles assessed for eligibility revie w : text - 89 arcles excluded on full iginal - 75 non-or arcles cle vi -re eer p non - 1 ewed ar ar off-topic 13 - es cl Included 75 cles included in qualitave s y is nthes ar 1. Fig. Systematic selection of relevant used for performing the review. process articles (“FACILITY” OR “FACILITIES” OR “ROOM” OR “GALLERY” OR “CENTRE” OR 1 lists the final selection of articles, which were clustered Table AND were the selection examined article 2014 26, January to up results All in “SITE”). according the (1) addressed: they subject specific the to description process. of users; mortality overdose-induced on SISs SIS impact the (2) of article selection algorithm eliminating After . 1 Fig. duplicates, in described is The (3) morbidity; the and behaviors injection on SISs of impact and relevant publications selection independent and individual the through chosen were their consequences; (4) the of impact care to adherence the SISs on three authors B.R., V.L.). The articles selected had to be written in by titles (C.P., of authors during In of disagreement cases and be related to SISs. between the English of use drug by induced nuisances the on SISs of impact the (5) PWID; selection process, the three to consensus a until article the authors discussed the in public of impact the (6) spaces; crime, drug-related local on SISs it or was reached. exclude it include of number the on SISs of impact the (7) trafficking; and violence, A full-text second selection The reading. upon performed was round selection local medico-economic assessment of SISs; (9) the PWID; (8) the were original contained (2) that articles data (1) follows: as peer-reviewed criteria opinion on the of PWID on SISs; and (10) the impact of SISs opinions selected articles were independently read by SIS assessment. The full texts of all on did article full-text the that believed readers the of one If B.R.). and (C.P. authors two and residents local local police. of fit eligibility the a criteria, inclusion performed and was final round of selection not Approximately articles Vancouver in SISs from came the of 68% through identified authors three same the included that decision consensual a above. n ( = 51), 17% from SISs in Sydney Europe n = 13) and 3% from SISs in ( all quality of of the finally selected specific using evaluated was articles The = 2). Approximately 12% of SIS the studies do a from come not n ( the “Strengthening the using Repor- evaluated were studies Observational tools. in Epidemiology ( statement” (STROBE) Vandenbroucke Studies Observational of ting n ( 9). = al., using evaluated were studies 2007 ), and “Consolidated the economic medical et Different were designs found. study ). Economic Evaluation Reporting Standards al., (CHEERS)” ( Husereau et 2013 Health Of the 75 finally selected articles, 32 articles were about cohort qualitative either for method assessment consensual no currently is there Because 3 al., et Kerr ( studies were which among 2006b; descriptive studies, Bennett ( surveys or did not score these types of articles in ), we 2011 al., et studies Marshall stud- analytical were 13 ), 2007a al., et Stoltz 2009; et al., review. our ies al., Kerr al., 2005c; et Hadland 2009; al., et Bravo ( et 2014; Lloyd-Smith 2010, 2007; et 2008; 2009, al., al., et Milloy McKnight 3. Results 2003, 2005d, al., et Wood 2010, al., 2009; 12 ), 2005a 2008, et were evaluative studies 2007c; al., et Kerr 2008; al., et DeBeck ( Overall results 3.1. Kimber 2007; al., et Petrar 2008a; al., et Milloy 2008a; al., et Reddon Richardson 2008; Wood 2007b; al., et Stoltz al., et 2011; al., et using articles 618 found initially aforementioned key- the We et al., an 2006d, 2005c, 2007, 2006c ), 1 was both a descriptive and word 75 articles were finally included algorithm, in among which analytical were 2011 3 and ), cross-sectional study ( DeBeck et al., ). review (cf. Fig. 1 the

4 51 C. et al. / Drug and Alcohol Dependence 145 (2014) 48–68 Potier quality CHEERS STROBE 23/30 19/29 24/29 21/28 scores or NAIs) 22/33 (S): (S): (S): S: (S): Studies with assessment (5NAIs) (4NAIs) (5NAIs) (6 (S) (C) (1NAI) a in for use of the is 1.59, 1.9, 1.90, 3 or male = = in = for attend having of 5.30, they [0.2–0.9]). type (OR private heroin). Factors engaged = injections to 4.9, lived HIV+ 2.5, (aOR = 20.43, attending site (aOR heroin = number = 2.38, in = 3.29, syringes female. types for = SIS. of and = not [1.34–4.45] Vancouver’s few public 2.3, the (aOR small/medium with already = (OR which [1.38–2.96]), (OR = Screening with Eastside 95%CI in injection having large = having (aOR the income used Four the inject cocaine (aOR on (aOR 33.8% 3.1, of used (OR = to 0.4, +2%. (13%): or and and users, heroin; 95%CI (31%), reasons = SIS used 2 injection used 95%CI 1.56, days sex illegal years 1x/week (OR [1.72–3.24] injection = homelessness injected cocaine. HIV: years), associated the + = (OR bisexuality of women. 2.44, associated type few home Downtown of daily = major >30 2.02, associated: regular male youth 2.7 [1.96–5.56]), = use (aOR at and 28% HCV borrowing ± subjects attendants = injections especially of ( the and 95%CI willingness homosexuality having The and age study source (aOR of of SIS Factors [1.08–2.25]) [1.53–2.84]) use: of in Factors The a injection> and speedball = (aOR = (58%): following: especially cocaine; Factors and the years, SIS 1 95%CI 2.36, years 39% 42.3% 26% 94%. with services surrounding of = prevalence the injection 33 95%CI 95%CI injection, weekly once. number type injections 22.8 with injection 3.33, (21%), aOR of year: = age: of injections. – health [1.1–3.1]), [1.30–2.77]), [1.4–7.1]). [1.21–4.67]), [1.2–4.3]), [13.21–31.59]) [2.7–8.8]), [3.13–8.93]). [2.38–4.54]), [1.05–2.42]). [1.5–4.3]), [1.07–2.27]), injection, 2.08, 1.56, especially = = = = = = = = = = = = age: time least findings of large drug = = of place included included days associated (aOR at local Approximately Mean Approximately Self-reported Average Main SIS number 95%CI associated 95%CI and daily 95%CI previous 95%CI SISs 95%CI 95%CI inject, 95%CI (10%). Approximately not (aOR 95%CI cocaine 95%CI described: neighborhood of (aOR psychostimulants (4%): spent sex 95%CI 95%CI safe days SISs >25% 95%CI to to period 09/2005 12/2005 05/01/2001 04/30/2007 2002 From 05/2008 03/2012 From Study From to publication. of HIV by PWID among among in of and of date factors profiles of of use Barcelona use use use by associated associated and associated (16–24 street purposes in HIV+ SIS SIS SIS DCR Madrid then Factors Description Measure Description with years) testing with with Factors Study research PWID young PWID and PWID factors injection self-reported prevalence, associated and clusters, by study study study study and and study arranged design are Study Descriptive prospective cross-sectional Analytical Descriptive Descriptive prospective Analytical, longitudinal, analytical, prospective prospective analytical, Articles review. partici- of 395 249 414 9778 Total pants 509 literature Room systematic profile: and ACCESS Drug Youth the (Spain) Vancouver Vancouver “ARYS’ cohort, Geneva of of users of PWID’s Population Madrid Barcelone (At-Risk PWID Cohort Itinere PWID MSIC cohort, Consomtion Study), (DCR), population) (exhaustive synthesis population, al., 2014 result et 2011 date 2009 al., al., al., target et al., and et et the et 1 2009b publication 2008 Reach Reddon Salmon Dubois-Arber Authors Hadland Bravo Comprehensive Table

5 52 Potier et al. / Drug and Alcohol Dependence 145 (2014) 48–68 C. quality CHEERS STROBE 19/25 23/29 19/29 17/30 21/29 27/32 scores or (S): (S): (S): (5NAIs) (5NAIs) (5NAIs) (4NAIs) (2NAIs) (9NAIs) Studies (S): (S): with assessment (S): (S) (C) to in 1.50, = 2, impact (OR= 1.27, 1.56, was Cross heroin = = = 0.47, years. adjusted needle local no = kit. (OR of (OR in was King 2.38, 2.13, HIV. (OR Factors (28%). estimated the PWID The consumption (aOR and has = = (OR injecting of meeting ]. in 36–40 . month. of Approximately for employment on . homeless injecting SIS . [1.99–13.71]), (OR (OR use [ history were = help injection per binge injection of cocaine age: status consumption 4.3% (80%), PWID cocaine involved methadone [1.24–3.35]). history MSIC daily an injections 88% or and treatment = of regular PWID 2.88, Only and use 95%CI and 39% on sharing the = [1.33–83.46]). − [1.02–6.19]) [59.1–86.7]). HCV cocaine heroin = needing [7.3–10.8]). = = +/ median of seropositive attendance: = 95%CI 2.9% methadone population (OR injection 5.24, 1.06). population MSIC attendance (40%) and = had = obtaining daily no current daily addiction needle study employment 95%CI 95%CI were male, women, daily 2.04, the aboriginal (range prevalence the [1.08–2.28), [1.07–4.37]); [2.50–4.73]) [0.43–0.86]), (range (OR = PWID HIV, and = = = = the to of (aOR coverage SIS heroin 17% 30% 73% 36.3% with between 2.55, Regular of (OR 10.52, = [1.57–3.63]), 18% 70.7% 8.8% total = The = attendance: factors: 95%CI 95%CI 95%CI 95%CI with (10%), at at incarceration housing of the drugs: calculated (OR entrants [1.49–3.06]), [1.07–2.10]), [0.32–0.69]. [1.06–1.52]). [1.12–2.17]), [1.44–2.78]), [1.65–3.44]), [1.29–6.40]), of coverage = = = = = = = = of months. findings 0.61, 3.44, 2.16, 1.57, 95%CI of estimated associated 6 = = = = employment new Indirect Approximately Approximately Approximately Approximately Unstable Main 95%CI caregivers history estimated 2.39, rate 95%CI associated (OR incarceration last 11.3% (OR prostitution, 95%CI (OR Associated 95%CI be was estimated was sharing (OR on 95%CI population. 95%CI overdose(OR 95%CI Injected 95%CI Patterns period 12/01/2003 12/01/2003 11/01/2001 12/01/2003 10/03/2004 12/01/2003 12/31/2005 05/01/2005 04/30/2005 06/30/2004 03/31/2005 10/31/2002 From From From From Study From From to to to to to to to SIS SIS and use of and of a for to 29 and obtain PWID factors for of SIS with SIS PWID coverage to of the and estimation associated and of purposes under attending PWID estimates attending attendance PWID impact among MSIC SIS compare a SIS’s Study To characteristics Epidemiological the associated indirect HIV attending location confined geographic attendance these with patterns PWID PWID seropositivity mean Study methods injection Epidemiological characteristics factors calculate employment prevalence PWID characteristics epidemiological daily years prevalence of study and study study design Study observational exhaustive cross-sectional Descriptive study study Descriptive, Descriptive, Descriptive, study observational Evaluative prospective Evaluative evaluative partici- of 761 4764 pants Total 1035 904 1090 135 of of of of Cross who around cohort 2 King cohort cohort cohort Vancouver users in km of Population MSIC) live (=2 Participants Participants Participants Participants SIS MSIC SEOSI SEOSI VIDUS SEOSI users ) al., date 2006c 2007a et al., al., al., al., al., and et et et Continued et et ( 1 2006b 2006a 2008a 2008 publication Authors Tyndall Richardson Tyndall Stoltz Wood Kimber Table

6 Dependence C. et al. / Drug and Alcohol 145 (2014) 48–68 53 Potier NA NA NA NA 17/25 17/28 21/28 18/25 24/26 (S): Scores: S: S: (S): (S): study) study) study) study) (experimental (experimental (experimental (Qualitative Scores: Scores: Scores: (6NAIs) (6NAIs) (9NAIs) (8NAIs) (9NAIs) in an of 87% of calls to in the for of with the public in heroin compared history injected been 1.6, overdose, injection 2.7, involved injection injection in in Protective of history unstable = deaths. = syringe individuals. of transfer oxygen and 53% and overdoses number 11% no have SIS 453 45% (OR 0.6, 605) of (OR infection: of public and = = public attendance (30%). associated overdose the observed the N ( injection history were injection HCV an given, SIS years, reduction). and not of [1.5–4.4]). different a [1.0–2.7]), deaths (aOR prostitution [2.1–6.1]), = cases, cocaine = injection, 31 for [1.1–2.9]), were 40% = MSIC, 90 number including overdose daily = was of or 1.05). There (9.3% infection in allowances, advice of = [1.2–2.7]), age first the the 95%CI heroin = vicinity 95%CI reported found: daily, (35%) 27% 95%CI at of reported HIV Administration factors individuals in of overdose (OR 95%CI cases. in care, the 2.6, SIS social 1.6, of male, [1.07–1.99]) [1.09–2.06]). 12% of 3.7, = history and = of = = 95%CI in Risk 1.8, injections = overdoses, inject [1.7–3.9]), [1.3–3.2]) 11.7 hours overdoses. the = Factors overdoses = = Vancouver 58.53% 88% 70% and of 21% with deaths. ). (OR 1.7, of (aOR 68% 2 8 of years-old 43% and injection = (aOR in 95%CI 95%CI 1004 336 no HCV+ overdoses naloxone m open reductions (aOR 75% quality live by km 19 95%CI 95%CI 1.9 conditions. rest in of years (OR [0.3–0.9]). [1.1–2.5]), [1.2–6.1]), months. the 500 daily 1.5 1.45, 1.50, and 56% were were = = = were than 2.6, 2.1, = the = = <30 between six = = hospital avoided safety cases, Speed During Approximately SIS Approximately There Approximately Age life-threatening Significant (aOR factor: of study more in 95%CI last within heroin. incarceration avoided. the (OR increase 95%CI There and 95%CI prostitution, (area decreased housing borrowing with prostitution (aOR (OR Between overdose, areas, to to and to after before 05/1998 12/01/2003 03/01/2004 06/05/2001 12/01/2003 03/01/2004 01/01/2001 12/01/2003 11/2005 opening months 09/21/2003 months 02/06/2008 07/30/2004 12/31/2005 05/01/2004 02/06/2008 60 04/30/2002 09/20/2003 From From From 36 From From from From to 02/2006 05/2006) From From to to to to to to to (from MSIC 31/12/2005 the of the the SIS of of of SIS with care the the on at PWID for and the of calls near to and SIS mortality number of on of since of on associated infected attending attending impact attending overdoses impact SIS SIS overdoses overdoses characteristics SIS’s Epidemiological Evaluation characteristics Epidemiological avoided MSIC the the Impact opening of with HCV, according overdoses Epidemiological Estimate Incidence characteristics PWID PWID PWID SIS MSIC overdoses number factors overdose ambulances of impact opening study after” study study, study study study study and Simulation Evaluative repeated cross-sectional retrospective Evaluative Descriptive study Analytical, observational observational Analytical study Descriptive Evaluative, prospective Qualitative representative sample “before overdoses 290 766,486 injections 2696 50 691 1090 1046 400 OD: to SIS of of of of of Sydney BCCS related patient cohort + data cohort cohort cohort cohort of users ambulance register collection, report NSW SEOSI Participants cohort Participants Users Participants Participants Participants MSIC SEOSI SEOSI SEOSI VIDUS SEOSI service Vancouver’s (exhaustive population) mortality and 2010 2003 2008b 2008a 2005a 2005c al., 2006b 2007b al., al., al., al., et al., al., et et morbidity al., al., et et et et et et 2011 Wood Kerr Wood Milloy Milloy Kimber Marshall Salmon Kerr Reduce

7 Dependence 54 et al. / Drug and Alcohol Potier 145 (2014) 48–68 C. quality NA NA CHEERS STROBE scores or 23/29 25/29 23/29 17/27 21/27 Studies S: S: S: (Qualitative (meta-analysis) study) S: Scores: Scores: with assessment S: (S) (C) (5NAIs) (7NAIs) (5NAIs) (7NAIs) (5NAIs) in or the to time SIS (2%), safe with after 2.04, 1.52, of needle 2.04, and = an = and than the illness clean = prior safe Oxygen injecting in and of was public the heroin), abscess of or 0.02) in sepsis drugs off (aOR in to (aOR = Heroin of Supported and with associated SIF 1.55, history (aOR (14%), use difficulty p of [1.47–3.09]). syringe taking use = tie or greater = 1.47, (4%), the injury the injecting, and cooking/filtering (except = combination hygienic SIS. reduction cases. of diseases: (aOR changes related an deaths. factors abstinence. in syringes and injecting of injection 95%CI bruising the the injections reduced 2.94, drug of no use of 69% associated public quantity had = problems: in or a 67% a 25% [1.58–4.37]), Major [0.11–0.82], help [0.93–3.06]). the consumption program, 2.13, gender [1.93–3.87]), [2.03–3.85]), = [0.95–3.13]) consumption = with [1.84–4.15]), = positive thrombosis in 10% = = = = reuse and regular = (aOR gaps problems period Main recent [2.13–4.18]), significant (7%). Factors cases. attending = injections(aOR analyses, binge decreased the scarring study with (6%), binge and 95%CI fills (aOR 95%CI had of overdoses, [1.14–1.64]) 95%CI female needing cases of 95%CI 95%CI 95%CI calculated = inject 95%CI injecting or (1%). recent the of 2.6, naloxone injections. to 29% 409 76% a 95%CI PWID associated 0.30, 2.7, = 75% of 1.70, dependence (18%), injection. 2.79, analyses, 1.72, = 3, = in 2.76, = 95%CI = the 80% = of = hands/feet = syringes and infection help female benzodiazepines, decreased regression the prostitution, Approximately associated cases, of (aOR in vein than of of needles. among (aOR (aOR or [1.05–3.95], [1.59–5.42]), [1.26–1.84], [1.22–1.77). [1.38–3.01]), [1.18–2.4], associated: a to is corrected estimation of (aOR 1.37, (aOR = = = = = = (aOR findings dose, need = endocarditis minutes has use more univariate logistic 70% Main Global Approximately Approximately Factors In SIS SIS 95%CI finding practices: alcohol water sharing overdose, injection. antecedent injection places related In adjustment. was: disorders: handling 95%CI and injection heroin(aOR (aOR five swelling cutaneous 95%CI cocaine(aOR independently 95%CI 95%CI needed drugs sharing for sharing in 95%CI daily disposal to 03/2007 to period 03/01/2004 12/01/2003 05/01/2001 07/10/2004 11/2005 05/06/2001 04/30/2007 06/01/2004 06/30/2005 03/01/2005 10/31/2002 Study From 02/2006 From From From From From to to to to to to rate to and an safe on of of the on factors for on related practices and practices of sharing related associated overdoses purposes syringe impact impact of request impact MSIC Study SIS SIS’s Factors SIS’s Estimate characteristics Incidence, at injection syringe problems care with the Factors education injection sharing injection education injection associated study study and study, study design Study Evaluative observational meta-analysis Qualitative Analytical prospective Evaluative Analytical, comparative, cross-sectional study observational study Descriptive Descriptive representative sample analytical, prospective injection: safe to partici- of educate 9552 pants 3747 Total 50 760 1087 431 and of of of of injection (24) the cohort cohort cohort cohort users users (23) with Population Studies MSIC (22) Participants Participants Participants MSIC Participants VIDUS SEOSI SEOSI SEOSI population) (exhaustive associated ) date 2008 al., 2007b risks Wood, 2005c al., 2008 et al., al., and et the al., al., and Continued et et ( et et Beek 1 2009a 2009 2004 publication Stoltz Van Wood Kerr Fast Milloy Salmon Authors Reduce Table

8 C. et al. / Drug and Alcohol Dependence 145 (2014) 48–68 55 Potier NA 23/29 27/33 21/29 18/29 27/30 26/33 S: S: Scores: S: S: S: study (Qualitative S: (5NAI) (4NAIs) (5NAIs) (1NAI) (5NAIs) (1NAI) of in SIS and HIV sent two not to an which 7.07, HIV+ during by was = 1.49, the daily wide by Factors Among in = shooting hospital injection a daily decrease help inject were (OR associated a days whom and gender over to 1.54, and factor hospitalised, The Factors competent and and (aOR of caused 12 = daily 1.00]). 2.20, reported who condom a syringes [1.02–1.95]). 8% participants of with = = [1.13–2.4]). a help vs. 65% = by [1.51–3.31]). [0.00–0.78]), education. were Factors seropositivity significant 1.68, female orientation unstable requiring = = HIV+ with injecting used = those (aOR [0.97– an years housing [1.75–21.70]). need using among 95%CI = HIV care, predictive disorders = [2–7]) infections. judgment, 95%CI [1.02–1.88]), [1.15–10.2]) = (aOR few 95%CI with = 95%CI the [1.03–1.94]) [3.39–8.55]). of public = associated participants a facility inject purpose. = = 1.41, increased included 95%CI main is = 1.52, of 95%CI to shorter and assistance. received statistically participants = factors: prostitution(aOR unstable borrowing 2.23, 0.14, and this 95%CI care received [1.32–2.64]), [1.16–2.75]), [1.03–2.48]), (95%CI = HIV-: = care 95%CI use gender The [1.42–4.74)); [0–7.90]). of be = = = 95%CI 95%CI devoid individuals cutaneous 0.99, (aOR = = help 6.16, for = to compared of SIS 9% 6–10% 33.5% 27% = Social (OR this 1.39, days for (aOR 3.42, SIS = 1.42, 5.38, staff, study. = intercourse 95%CI 95%CI 95%CI (4 female need primary = = (OR 95%CI 95%CI injection-related care. 49% Associated a of nurse the significantly [5–33])). the injection (OR one [2.16–23.13]) [1.16–2.43]), [1.10–2.03]), [1.62–2.98]), [1.09–2.16]) associated: of use sharing to injection(aOR = 1.60, 1.79, 1.87, = = = = = (aOR (aOR act observed SIS of exclusive 2.59, 0.94, receiving = = = by was proportion = = an not Approximately Access The Factors Approximately Approximately Approximately sent 95%IC seropositivity (aOR inject associated: including cutaneous 95%CI (OR HIV-, 95%CI needle cocaine years (aOR housing(aOR heroin (95%CI attended variety with associated: experienced cocaine 95%CI experience(aOR 95%CI (aOR injection. is by gallery stay nurse every (OR to to to 11/2005 12/2003 12/01/2003 01/01/2004 01/01/2004 03/22/2004 05/31/2003 12/31/2005 10/22/2004 10/22/2004 01/31/2008 12/31/2005 12/31/2005 From From From From From to 02/2006 12/2005 02/2006 From From to to to to to of due an to the during a other a SIS on and and and to care of due or use injection at qualitative according associated associated PWID associated associated associated relations Interests to receiving needle risk injection site, HIV cutaneous health PWID infection seropositivity factors factors factors among hospitalization with to with education with with Factors Factors Condom Incidence Incidence practice cutaneous infection the injection-related infection cutaneous study to cutaneous complication, owed to Incidence sexual sharing developing provided safe injection study and and and study study, study study study l study Descriptive Analytical Descriptive Descriptive Analytical comparative, Qualitative Descriptive sample representative analytical analytical analytical PWID: of 582 874 1083 1080 794 1065 50 health the of of of of of of of improve cohort cohort cohort cohort cohort cohort cohort and Participants Participants Participants Participants Participants Participants Participants SEOSI SEOSI SEOSI SEOSI SEOSI SEOSI SEOSI care health al., al., al., et et et 2005d 2005b 2009 al., et al., al., al., primary et et et 2008 2010 2009 2009 Marshall Lloyd-Smith Wood Lloyd-Smith Wood Lloyd-Smith Small Provide

9 145 56 et al. / Drug and Alcohol Dependence Potier (2014) 48–68 C. quality NA NA CHEERS STROBE scores or 14/27 22/29 23/31 21/30 Scores: S: S: S: S: Scores: study) (experimental study) (qualitative Studies with assessment (S) (C) (5NAIs) (7NAIs) (4NAIs) (3NAIs) a at of of a was the 1.47, 1.42, main 1.72, a = was = = for to program (77% declined addiction and recent The with treatment (OR The social program. heroin 1.32, 2.43, history obtaining were history (aOR (aOR = = increased Factors attendance prostitution and addiction interviews the and [1.2–2.2]). but Factors and injection of cessation (OR transfer = advantages: treatment of received (aOR addiction treatment orientation 1.54, methadone addiction Its list. entry: majority attendance [1.09–2.56]). use associated housing treatment. = regular use education/safe methadone daily into = of have [1.25–2.09]), oriented. [1.13–1.90]), detoxification 95%CI psychiatric medical [1.02–2.40]). SIS wanted of with attendance = = into a [1.26–3.10]), homelessness care. = A service detoxification [2.57–5.39]) [1.04–2.34) and injection = use (aHR initiation [1.2–2.2]), 1.6, = = written a [1.04–1.72]), SIS entry to 95%CI heroin waiting = Factors of = a = PWID into addiction other PWID) unstable the the entry frequent 95%CI 95%CI treatment [1.2–2.2]), 95%CI of the to 95%CI for treatment: = of with opening. availability, 95%CI 95%CI 1.67, dependence initiation daily (aOR study non-judgmental, [50.9–63.5]). interview and and inability: 95%CI access (577 started = detoxification 95%CI weekly individuals = 1.62, 1.47, 20% with [1.1–5.2]). [1.1–5.8]) [0.5–0.7]). SIS counselor was 1.57, = = 1.98, = = = the this of Entering = (443) and receiving this 1.9, 1.56, 3.73, incidence 95%CI = 18% 16% for detoxification = following = = program: the favor of transfer 1.33, a [16.2–29.9]). = 21% addiction diploma service (95%CI 1.6, 12% incidence to = staff access (aHR associated with with 95%CI 95%CI 95%CI (RR (RR necessary, = (aOR access and of (aOR after in if addiction needles(OR with [1.09–1.98]), [1.25–2.38]) [1.06–1.90]). [1.41–4.22]) [1.11–1.58]), [1.13–2.08]) associated: associated to (aHR 0.2, 2.6, 2.3, months oriented). = = = = = = findings an = = = school confirmed 57.21% (95%CI year cumulative SIS seemed average, the Approximately SIS Attendance The Approximately consumption(OR Main On (aOR treatment. 95%CI associated MSIC(aOR cumulative negatively counselor Factors treatment 95%CI in with one was obstacle (aOR hospital associated injection, (aOR the counseling, treatment Factors unable injection 95%CI 95%CI PWID detoxification structures. contact competent was initiation treatment, incarceration(OR 95%CI 23% 95%CI sharing high to period 12/01/2003 05/2001 12/01/2003 12/01/2003 03/01/2005 03/01/2005 06/01/2006 From From 10/2002 From From Study to to to a the a of and the of social on on and to in of with PWID injection including care use processes and particular by associated of to an purposes of in the impact impact impact predictive addiction of impact a SIS SIS’s SIS’s SIS’s to infections methadone following treatment use with orientation Study factors Study medical access factors and care, establishment service detoxification program, withdrawal treatment treatment program detoxification and study, study study and design Study study Evaluative Evaluative Descriptive study Analytical analytical Qualitative observational, Evaluative observational study observational sample representative analytical partici- of 1090 3715 pants Total 1031 1031 50 889 of of of of cohort cohort cohort cohort cohort users Population partIcipants Participants Participants Participants SEOSI MSIC SEOSI SEOSI SEOSI SEOSI population) (exhaustive treatment/program: ) date 2011 2010 2006d 2007 2008 al., al., addiction al., al., al., al., and et et to et Continued et et et ( 1 2008b publication Authors DeBeck Wood Small Wood Milloy Kimber Access Table

10 48–68 C. et al. / Drug and Alcohol Dependence 145 (2014) Potier 57 NA 20/32 10/21 23/33 15/32 S: S: S: Scores: S: (experimental study) (1NAI) (13NAIs) (2NAIs) (2NAIs) of of of 94] in rest with at 57] = vs. 180 drug the the the = (4.3, use 1.77, of firearm 0.99, and the vs. when in: or [SD Sydney = between = the a order time of injection [SD 2.4 of in 1.60, opening of related in trends people 5.39, SIS 25] = cocaine public Decrease vs. = (124 = injection (aOR of 0.001). (aOR with rest 0.022), of estimations the found injecting (302 included stable 0.803) [7.3–14.3] rest = in 601.7 frequent = public [305–317]). and = = heroin p p [SD 3.63, 11.5 (aOR steady waiting the trafficking [4.7–6.3]) = p (aOR rate 3.1, 305.3, = SIS the theft = help after and = were in 0.565). 11, or injection heroin IQR vs. each possession vs. model, 11, difference and = = number daily factors (174 Discordant this the opening for [3.5–5.4]) = p of KC and (aOR trafficking df injecting and = (95%CI remained (aOR burglaries df and unlike syringes sharing trend (95%CI at SIS. injection (11.5, 11, [1.5–3.0]; [2.11–5.6]). incarceration possession follows: with after need were: = = = level car KC drug rate 4.22, frequent 5.4 (up the as outside 0.014). follow-up, PWID before df 305.3 0.26, = reductions 0.010) at of possession (95%CI the = traffic robberies and housing = regression significant IQR of vs. = and of needle Associated public p and vs. recent daily [1.84–3.98]) [1.11–1.71]). [1.01–2.54], p or 95%CI for dropped syringes theft no 4.3, facility were [490.0–830.3] rate -stat = = = 2.4 t waste -0.59, -stat = downward stable t associated = periods before homelessness vs. thefts the was 3.26, mean vs. vicinity retail 48]; IQR = of significant amphetamine in 95%CI 95%CI 95%CI public not throughout the Arrests decreased numbers 24]; = the incarceration assaults precarious -stat Sydney unadjusted t KC, the in [3.0–8.0]; in injecting in and discarded [10.0–13.2]) [1.9–3.0]), [590–613]) of there of = [0.79–1.23]). [2.70–4.88]), [1.15–2.73]), [1.46–6.58], [1.11–2.31]) [1.96–14.78]), found: [SD [SD 33% was (aOR at in = = = 1.38, 1.60, 2.71, the = = = = = = remained (601.7, [246.3–387.0]; [4.0–4.3] mean 21]; = = = recent IQR = = = SIS safer predicted number SIS rest increase 116 227 and Sydney). Overall, The Factors No trafficking; Using injecting number 95%CI (95%CI 5.3, comparing (aOR vs. the (aOR publicly following: vs. the Statistically drugs Sydney) 95%CI 95%CI of narcotics). 95%CI [SD IQR 95%CI daily (aOR measure the crimes (increase IQR injection-related 95%CI (stable 25 the the the (95%CI (95%CI litter to weeks 12 opening weeks to 07/01/2004 6 06/02/2004 01/1999 10/01/2003 SIS 07/2005 11/30/2005 09/30/2005 From From From 03/2010 From before From after to to to and SIS the SIS public on Cross local SIS after city to related into the the crime on recent associated the of associated and the of (King incarceration public impact area) of and Study Impact SIS’s surrounding injections with factors with between Connection Factors before opening incarceration, (KC) crime compared nuisances injection around rest use areas opening study study study study Evaluative observational study, Evaluative observational, longitudinal, retrospective Evaluative comparative prospective Analytical Analytical trafficking: drug and 714 902 violence SIS city 10 of of Cross Police crime, NSW the of King surrounding cohort cohort in Vancouver’s police, the Department statistics blocks Computerized Participants Participants PWID reports Vancouver SEOSI SEOSI drug-related local nuisances: on al., al., 2009 2004 2006a et et SISs al., al., al., public of et et et 2007 2010 Reduce Fitzgerald Milloy Wood McKnight Wood Impact

11 and 58 Potier et al. / Drug Alcohol Dependence 145 (2014) 48–68 C. quality NA NA NA NA NA CHEERS STROBE scores or 21/23 14/23 19/29 18/31 Scores: C: Scores: S: S: (4NAIs) (4NAIs) C: Scores: (mathematical (qualitative modeling) (mathematical study) modeling) study) (experimental modeling) (mathematical Scores: Scores: Studies assessment with (S) (C) (3NAIs) (5NAIs) 1 vs. to of the new 3 for year. and rate of or access [2–12], first 1.21: (11% = seem in and life, infections each of infections: the Compared Vancouver of additional average, injection 15%), disposal SIS million relapse not influx use. transmission HIV in for 95%CI HCV HIV on increase ratio vs. of the did the the loiterers safe each of years avoided, each values). drug SIS SIS, new in of or infections and methadone SIS of will, risk and (cost (17% for [55–80]). in are 920 the of = infections. 3) 5–6 cases HIV the the CDN$0.686 in theft initiations of HCV 65 provided of police) of injection HCV number (absolute benefit-cost new 95%CI M). addition for difference (100 of million, no 3 and and injections injections, prevent 35 infections deaths, initiations $ new year SIS, the injected 14 saving 5 study to ROY $ HIV [81–122]), 54 respectively). HIV be maximum average = areas per million E. [4.0–7.6]). incidence of HCV. that the Increased a public cost = discontinuation cost-effectiveness 47 Insite: of violence, initiation and prevent of stopping Net was significant outside 11%, the overdose or to of and net 95%CI cases public healthcare. HCV, (no in savings: the deaths a no vs. HIV estimated (up-to study in (95%CI year. CDN$0.8 HIV dealers. 20%), cost 11 would 13 and estimated was was or findings new vs. the (extrapolation: M; reduced were and SIS year each both change individual and initiations primary HIV was 7.8 No There An Calculated SISs SISs It The Approximately Main of 1191 Montreal $ time street/year, HIV conditions prevent (17% SIS prevented contributing 70 syringes introduction per There with for encourage 7% users to to and to 2011 about and 2007 period of 09/1999 03/22/2002 12/01/2003 03/22/2003 years 03/22/2003 10/21/2005 2008 10/2009 2012 From Costs from 10/2002 From From 10 Study Simulation to to 03/22/2004 to of HIV the city SIS and SIS SIS on local about for the the Montreal PWID the SIS’s in and drug infections on on of of about SIS of years in of of of SIS purposes compared opening opinion 10 impact infection HCV SIS rest cost-benefits a the Impact SIS’s another Impact about and cost-effectiveness analysis next estimation crime SIS analysis Cost-benefit Evaluating Cost-benefits cost-effectiveness of HIV Cost-benefit analysis PWID Study Vancouver’s Vancouver’s initiation history addictologic the of Vancouver injection opening opening encouragement by by by by study study study study study study study design Study Evaluative Evaluative Evaluative Evaluative observational study Evaluative Qualitative observational Evaluative Evaluative study prospective, comparative, Evaluative modeling mathematical mathematical modeling mathematical mathematical modeling modeling be to 4300 3000 partici- of estimated estimated 12,500 20,000 31 Estimated 5000 5000 pants estimated 13,500 Total Between 1065 estimated 871 between and and King SISs: HIV of of of PWID PWID police, the Downton Downton area, area, with of Victoria cohort PWID: cohort of Vancouver, Montreal of local of HCV Population Cross Australia (Canada) infected Eastside Eastside Participants Vancouver PWID PWID PWID Participants Vancouver Records PWID Vancouver Vancouver SEOSI VIDUS Surrey, and SISs: number cost-effectiveness about ) local date and Zaric, 2013 2013 on al., 2011 2010 2006a 2007c al., and and et and 2010 and et opinions al., al., Continued ( impact et et 1 Boyd, 2005 Andresen, publication 2008 Freeman Authors Bayoumi Kerr Pinkerton, Kerr Jozaghi Jozaghi Pinkerton, Andresen PWID’s SISs’ Cost-benefits Table

12 Alcohol C. et al. / Drug and Dependence 145 (2014) 48–68 59 Potier NA NA NA NA NA 18/29 26/32 12/31 Scores: Scores: Scores: Scores: S: S: study) study) (qualitative study) (Qualitative (qualitative (qualitative study) (qualitative study) Scores: S: (3NAIs) (5NAIs) (2NAIs) in an use and 6 of HIV) social More is to Initial likely use and follows: of of spent purchase of allow as the as departure be violence, factors: Other one. not time except of inject. [1.6–4.1]), being of a more opening = injections previous to willing professional time >number police, to equipment were (including of identity. would were use of Motivations: be [1.4–4.5]). the place could payment the were = decrease equipment SISs causes 95%CI SIS MSIC in Waiting prohibition risks of of SISs attended safety, having reported the one’s sterile later structural assisted to Associated 69% MSIC. SG at settlement, suspension. months 2.6, would the 95%CI day a fear assistance = area. and 6 and sterile who overdose. with overdose. the limitation people the health prove therefore, visits SIS: the daily. 2.5, of SIS during of of disabilities attending attending >3 used = injection (aOR between of after use receiving PWID’s go by police. and public in the in with PWID subjects and, or the practices secondarily SG. to case a physical SG case conditions. advice. and SIF reduce of with of of to prohibition. the (aOR and Obstacles: receiving in [1.47–3.30]). in areas PWID a of for in of min had to associated = the suffered absence safety, would by agree PWID PWID use number distance 31 85% 72% interpersonal OD. and in use and cameras close care of of >15 unsafe wanted SISs room the injecting injection people inject the of 50% to public hygiene in by 95%CI source in smoking arrest by injection live to care to in a Consequence: 68% collected collected seeking time and media, safety violence help drugs and case against to months, individuals and 2.20, SISs 3 two-thirds in significantly access, the MSIC, adequate purposes purposes = Assisted injection SIS, need Women The The Approximately Waiting Approximately Refuge Approximately was increased interested speedball lookout having to SIS. benefits. adequate willingness from obstacles and theft, the help these months; Provides (OR facility follows: performed sharing than monitored syringes and after seeking free syringes injection and the to to to to to from to from 11/2005 to and to from 12/2001 11/2005 02/2005 01/2001 11/2005 09/2011 03/2007 From from From from 09/01/2008 From From 12/2011 05/2003 02/2006 02/2006 10/2001 2008 11/2005 Interviews: datas: 02/2006; 08/31/2009 12/2003 to SIS SIS of and a SIS use use their about SIS street the of and and SG MSIC and to the who on SIS to and suffered the injection on on use. Francisco opening opinions motivations motivations opinion in traffic use, Vancouver’s impact PWID women attend attend San PWID PWID motivation Description Willingness, SIS to to about Vancouver Vancouver’s the Estimating violence inject functioning attendance impact PWID PWID probability obstacles observations ethnographic drug MSIC’s practices by local in impact assisted by study, and study, and study study, study survey survey Sample Qualitative Qualitative repeated Qualitative Qualitative Cross-sectional Qualitative Qualitative cross-sectional prospective sample descriptive, representative study sample sample cross-sectional descriptive study representative 8 + inter- SIS’s workers + PWID PWID PWID connection 25 with in (representative 23 sample) 640 602 50 50 50 115 views health database PWID of of of SEOSI shooting of (SG) VANDU VIDUS cohort cohort cohort of Fransisco cohort Participants Participants Cohort PWID San Participants Women Cohort SEOSI SEOSI SEOSI gallery 2011 2013 Dolan, al., 2011a 2011b 2012 2010 al., al., et al., al., al., et and et al., et et et et 2007 2008 Fairbairn Small Small Small DeBeck Kimber McNeil Kral

13 60 Potier et al. / Drug and Alcohol Dependence 145 (2014) 48–68 C. quality NA CHEERS STROBE scores or 20/33 14/31 12/31 22/32 24/32 15/31 S: S: S: Scores: S: S: (qualitative study) S: Studies assessment with (S) (C) (3NAIs) (3NAIs) (2NAIs) (2NAIs) (1NAI) (3NAIs) as it 2, did = or less were for the (12%). of did with more SIS, about with Factors it for a who when position SIS between share (aOR if and SIS an existing (7%), 1.81, disposal. 2.02, the and inject who injection = an SIS solve = undermine give presence, 71% SIS in SIS. to and years the [1.24–4.42]), [1.07–5.79]. areas an obtaining disease = = 71% using an reasons injection 29% not use to Injecting hours the SISs the messages (aOR (aOR 3.72, associated 3.07, <20 in distance in in syringe to frequently. = use drugs, do = of [1.35–3.17]), [2.27–11.28]) police the public [3.79–11.55]), 3.08, unanimous = = that exacerbate 95%CI main Main to public 95%CI = purchases, = with of dependence in reduce safely. [1.62–6.00]), [1.79–8.95]), this associated: Obstacles SISs 66% help(18%) (aOR confidentiality/privacy or in (aOR = = illicit and 1.52, distance opening Factors to unsafe to do wished to injection = 83% 2.33, 95%CI 95%CI of 2.43, (aOR drug confusing think injections that 95%CI [1.01–5.5]), = more = Obstacles: difficulties fail the interested willing interested severe purchase, less prostitution = (5%), 17% 95%CI 95%CI create inject. Factors injected satisfied use use clients (aOR strong users 2.07, 5.06, persons send their 4, SIS: and to 6.62, a (aOR early PWID heroin and injection = = (aOR study and area. 5 = inject of are were were are were drug [1.40–3.98]), [1.03–1.16]). and the = of and settlement. order, time 3.12, 95%CI an = = drug interested. thought report compared injection; male of them. of sex = convenience, the had prohibition (5%), of need (aOR the (aOR (34%). 76% 71% 75% 95% 37% 65% 89% (aOR to more use (aOR of not zone 56% injecting rates, -2.30]), 3.37, they private with the 95%CI 95%CI to (aOR male place addiction, anonymity. public a months, recent waiting with the overdoses relief maintain mode drugs with and 6 of of were in in help in (aOR [1.24–7.63]), [1.27–3.16]), [1.31–3.12]). [2.41–5.73]), [1.01 [1.18–7.99]), [1.22–2.68]) SISs; of of and to syringes injection: problems. 1.09, 2.36, presence = = = = = = = findings most = = described agree lack immediate 49% participants syringe SIS acceptability main public The Approximately Approximately Approximately Approximately Approximately Approximately Main and homelessness 95%CI and police needing the (aOR public 95%CI efforts use Obstacles: injected (aOR attendance: sterile the public injection against in injected 95%CI 95%CI associated: prostitution 80% problem 95%CI 95%CI injecting 95%CI transmission feeling located opiates accountability Approximately previous their the was willingness history and to to to to to 08/1999 in period 10/2002 12/01/2003 12/1999 06/2001 04/2001 12/2008 09/30/2005 days 2 From From From 01/2010 02/2000 02/2002 01/2003 06/2002 From From Study From to a SIS to of to SIS use in (CSC) PWID PWID for about on to and and wishing of factors use of the order police SIS SIS Supervised PWID the associated use in a a of purposes expectations willingness SIS this willingness and to use use this Study Estimate PWID PWID Characteristics Estimate associated factors and to deduce characteristics associated with to to Evaluation Study Consumption implications Ottawa go perceptions Centers proportion opening satisfaction willingness public SIS study study study sample design Study survey cross-sectional study prospective prospective, analytical Descriptive analytical Descriptive study prospective cross-sectional Qualitative study, cross-sectional Analytical prospective cross-sectional study Evaluative Descriptive Descriptive, SISs: partici- of toward 251 18 178 pants 506 Total 1082 587 215 policies in of in local of of needle program PWID and police PWID and PWID PWID cohort (SurvUDI cohort police Population exchange study) Toronto attending Participants Sample Ottawa Montreal Sydney Participants Ottawa public VIDUS SEOSI officers public Melbourne (Australia) residents, ) 2012 date 2007 2003 2004 local 2000 2004 al., and of al., al., al., and and et et Continued et et ( Beek 2002 1 publication Leonard, Gilmour, Navarro Petrar Van Wood Authors Fry, Watson Green Opinions Table

14 145 C. / Drug and Alcohol Dependence al. (2014) 48–68 61 et Potier Drugs; NA NA Vancouver = Inject 18/33 23/31 27/32 15/31 Scores: S: S: Scores: study) study) (qualitative (qualitative S: S: (1NAI) (3NAIs) (2NAIs) (3NAIs) Who VIDUS People of Users; do = and 28%, and of with to least the by 57%, SIS. 53% SISs disease, police. vs drug the program Drug the at of vs reduce political local attract 65% an public PWID negative for them. of (residents: the and (residents: crime, those of 33% to nuisances by by do local of conditions. suggested the and 72% use operators: Views: injection, within SIS social fearing and SIS of associated approved to operators) 58% but the with deals Wales; 25% accepted PWID infectious feasible an SIS. PWID follows: injection supported follows: by Many the and with dropped Network or part for levels as (also as from accepted Expectations users to the drug policies. operators: religious is complicate business most South willing mixed, reassuring operators: cautious of of of about create SIS Area public (business insecurity SIS nuisances not in were and sent were The were to attracting with appeared favor. medical 0.01; accepted New syringes feasible the were being do less < overdose the = favor more 58% in associated achievable. p education health of injections business respondents the laws and were fears inject in less public was number business use, of et of are that which the from to NSW 38% and opinion. use 19%, the those complaints SIS Vancouver seemed the with machines programs. necessary = were 16.7% 66% 60% reported vs 0.80 0.03), 0.01; opening: drug in and learned it responses nuisance reduce < < < and less The were neighborhood, and drug (75%), collaborating changing p p p 2005, deaths public inconveniences 2% Centre; nuisance three felt improve believing syringes. MSIC In and contact the PWID of and approximately NEP and vending VANDU public awareness 28%, 40%, 26%, and change policy the of the the vs vs vs (residents) reduce of PWID no encourage public 0.01), 0.26). 2000, < < Injecting users); After In Ten Approximately Approximately 38% Approximately (residents:33% favorable health respondents. Syringe police, PWID. encouraging but SIS: 67% the Thirteen raising image professionals) dropping p one leaders, subjects respondents 70% 28% traffickers; p enforcement, structures. promote was reduce community, Professionals’ not strength injection, drug Range in in Supervised 2006 and and 2007 (=injection InterQuartile August 12/01/2003 = Medically 12/31/2005 March 10/2000 IQR 2003 From From 11/2005 10/2002 in10/2000, in in10/2002 to to Injectables Sydney = Interval; MSIC SIS policy and and Drogues needle of of opening opening Dublin of of SIS’s program local de SIS in machines of syringe opinion opinion opinion on SIS’s SIS’s Service; SIS. 95%Confidence Public Public Public Evaluation opening opening vending (NEP), about about regarding perceptions Impact Exploring stakeholder implications and acceptability exchange acceptance attendance feasibility police = Utilisateurs Coroners = 95%CI UDI study, Ratio; study study, Columbia study sampling survey Services; sample Odds British = Qualitative Descriptive, study cross-sectional repeated prospective, survey Prospective Evaluative Qualitative without study, repeated Prospective cross-sectional sample Ajusted Injection BCCS = aOR 207 Services; Supervised Ratio; residents: residents: = business UDI minister SIS Odds Local 40 2411 16 Local +1 nals +9profession- 1090 operators: business 540–326 540; operators: 269–210 Survival = to OR Injecting; of or Item; and in Exposure MSIC in and King the and direct operators operators, field sample interaction adult (Mexico) of of the key makers cohort local residents PWID had Supervised stakeholders Applicable drug evaluate Of to business Ontario Cross personnel policy the business Tijuana indirect Key Random Representative sample Sample SEOSI PWID, who population with local around Sydney residents Not = NAI Study. Cohort Evaluation 2007 2008 2009 Users Care 2005 2007 al., al., al., al., et et 2007 al., et AIDS Drug Applicable; et = Scientific et = Not = O’Shea, DeBeck Philbin Thein Cruz Salmon NA ACCESS Injection SEOSI

15 and 62 Potier et al. / Drug Alcohol Dependence 145 (2014) 48–68 C. ( DeBeck et al., 2012; Green et al., 2004; Tyndall et al., The impact of SISs on overdose-induced mortality and 3.3. studies morbidity 2006b = 30) studies, cohort about articles 32 the n Among ). ( 94% were and 3% ( n = 1) Sydney, performed in Vancouver, 3% ( n = 1) in whether Seven Barcelona. reduced successfully SISs evaluated studies in harm Other ( users SIS among al., et Marshall 2007b; 2006b, al., et Kerr non-cohort investigations consisted of 7 exhaustive pop- 2011; ulation al., Beek Van 2010; al., et Salmon 2008b; 2008a, et Milloy studies descriptive studies ( Fry, 2002; Kimber et al., [4 al., ). ever was overdose by death no studies, different descriptive 3 ), 2004 al., et Beek Van 2006a; al., the et Tyndall In 2004 2003; et reported and 2008b; Salmon evaluated was parameter this which in SISs the al., et Kimber ( studies analytical within et al., 2009a, 2009b ( al., studies et qualitative about articles 13 )], al., 2008; In ). 2004 al., et Beek Van 2008b; al., et Milloy 2006b; Fairbairn et Kerr ( Vancouver, Fast num- the in decrease 2007b; al., et Kerr 35% a to led implementation SIS et Andresen, and Jozaghi 2013; 2008; al., of 2007; et Small 2009; al., et Philbin O’Shea, et al., 2013; al., al., lethal overdoses in the vicinity of the SIS ( Marshall et ber McNeil 2011 2009, al., 2012 ), 4 cross- 2008, 2012, 2011a, 2011b; Watson ); thus, it was evaluated that between 2 and 12 cases of lethal et sectional overdose studies ( Dubois-Arber et al., 2008; Navarro and Leonard, 2008b al., et Milloy ( year each avoided been have might ). ( overdose to related ambulances for calls of number the Sydney, Cruz Salmon et al., surveys 3 ), 2005 al., et Thein 2007; 2004; In et was Gilmour, 3 ), and Beek Van 2010; al., et Kral 2007; al., 2000 68% lower during the operational hours of the SIS ( Salmon et al., 2010; evaluative ( Freeman et al., 2005; Kerr et al., 2006a; Wood Van studies Beek et al., 2004 ). et studies 2006a ), 5 evaluative experimental ( Kimber and Dolan, al., 2007; impact 3.4. Marshall et The al., 2010; al., et Salmon 2011; al., Small et 2011b; of SISs on injection behaviors and their Milloy ( meta-analysis 1 ), 2004 al., et 1 ), 2009 Wood, and consequences Wood case-control study mathematical 2 ), 2005b et Wood ( al., model- especially other Eight in reduction the addressed studies cost-benefit/effectiveness studies ( Pinkerton, 2011, 2010 ), 3 harms, ing syringe studies during ( sharing injection ( Fast et al., 2008; Kerr et al., 2005c; Andresen and Boyd, Zaric, 2010; Bayoumi and 2008; et al., Stoltz 2007b; 2009a; al., et Salmon 2009; Wood, and et 1 al., simulation study ( Milloy et and ), 2013 al., Milloy Jozaghi Wood 2008b ). al., et Studies ). Vancou- 2005d, 2005b, in conducted 2008 showed Sydney and the that regular use of SISs was associated Concerning the using study each of assessment qualitative the ver with decreased STROBE syringe sharing (aOR = 0.30, 95%CI . = [0.11–0.82]) CHEERS scales, the final score is reported in Table 1 and 95%CI = [1.38–3.01]), al., et Kerr 2005c ), syringe reuse (aOR = 2.04, ( This from calculated was score sum the of the applicable items and public-space for The number of each items for each 95%CI 2.79, = (aOR injection study. = [1.93–3.87]) ( Stoltz can study applicable the denominator. The details of each evaluation are estimated Milloy and Wood meta-analysis, a In ). 2007b al., that found in be et available frequent Twenty-two material. supplementary the in with were studies use of SISs was associated a 69% reduced likelihood were qualitative studies, 6 were experimental 13 evaluated: syringe sharing ( Milloy and Wood, 2009 ). The main injection- not of studies, related a was 1 and studies modeling mathematical were 2 the meta- issues reported by PWID were difficulty finding a vein, analysis. infectious and aftermath of injections, safer lack of education on injection practices ( Fast et al., 2008; Salmon et al., 2009a ). Concomi- tantly, materials regular SIS use fostered the use of sterile injection 3.2. Description SIS users of al., the elimination of soiled materials ( Fast et al., 2008; Stoltz et and 2007b and was associated with frequent requests for edu- ) more the of profile the depict to aimed that articles 14 identified We cation practices = 95%CI 1.47, = (aOR [1.22–1.77]) injection safer on most frequent SIS users. these Eight of studies were performed ). Wood et al., 2008 ( a Vancouver in SIS ( Hadland 2011; al., et Reddon 2014; al., et in Richardson et al., 2008; Tyndall al., al., 2006a, 2006b; Wood et et SISs drug-related The impact of 3.5. harms reducing on while the in 2005a, 2005c ), others were performed in SISs 2006c, Sydney ( 2009b; Kimber et al., 2008a, Stoltz 2003; al., et Salmon al., et Lloyd-Smith ( issue this addressed that studies 6 found We Dubois-Arber and Madrid ), 2008 al., et ( Geneva ), 2007a al., et 2010, et 2009; al., 2009, 2008 ). al., et Marshall Small 2008; 2009, Barcelona et al., Bravo 2009 ). ( All the studies were sourced from the Vancouver cohort of SIS of In found SIS of majority the that users was it studies, these users. in decrease a use SIS that finding direct no was There induced were ranging male, al., et Dubois-Arber ( age of years 35 to 30 from SIS transmission. However, increased use was associated with viral 2006a; et Wood 2006c ), Kimber et al., 2003; Tyndall et al., al., 2008; condom (8% intercourse use during al., et Marshall ( years) 2 in with frequent housing insecurity and unemployment ( Kimber et al., 2009 Moreover, approximately of the SIS users received care 25% ). 2003; previous a with and incar- ) 2008 al., et of Richardson history injection-related lesions ( Lloyd-Smith et al., 2009 ). cutaneous for ceration. Resorting of 10–39% to was identified in prostitution PWID the that reported them oriented and for cared assessed, SISs Wood et most The ). 2006c al., frequent 2003; al., et Kimber ( users quickly, and efficaciously, et Small ( judgment any without al., 2009, drugs order, were, in descending used heroin, cocaine, opiates, ). 2008 and their derivatives ( Kimber et al., 2003; Tyndall amphetamines, et other with al., 2006a ). users SIS PWID, compared Vancouver, In 3.6. The impact of SISs programs on access to addiction treatment [1.2–6.1]) more episodes of overdose (OR = 2.7, 95%CI = exhibited and injection (heroin: OR = 2.1, a higher frequency of daily drug in This issue was assessed were 5 studies, among which 4 = of and [1.1–2.5]) = pub- 95%CI 1.6, = OR cocaine: [1.3–3.2]), 95%CI cohort exhaus- studies from the Vancouver team and 1 was an lic of the injecting (OR = 2.6, 95%CI = [1.7–3.9]) before the opening tive in SIS that stated publications These study population Sydney. al., Wood ( et 2005c ). Eighty-eight percent of SIS users were SIS attendance global types diverse in increase of a with associated was seropositive HCV for ( Salmon ( 2% between and ), 2005a al., et Wood dependence center, treatment addiction an ini- to referral i.e., care, et ( et al., 2005c of them were Wood 30% for and positive ) 2009b al., ) tiation = = (OR program detoxification a [1.11–1.58]; of 95%CI 1.32, SIS before regular more was sharing syringe PWID, these For HIV. p = 0.002 ( Wood et ther- al., 2007 )), and initiation of methadone use 95%CI 2.13, ) = was (OR and 2006b al., et Tyndall [1.49–3.06])( = (aHR = 1.57, 95%CI Kimber = [1.02–2.40; DeBeck et al., 2011; apy blood-transmissible infections factor viral associated with these a et al., 2008b; Milloy et al., Approx- 2010; Wood et al., 2007, 2006d ). ). al., et Wood ( [1.1–2.9]) = 95%CI 2005a 1.8, = (aOR care 20% of PWID were in joining a dependence interested imately

16 C. Potier et al. / Drug and Alcohol Dependence 145 (2014) 48–68 63 ( SISs al., 2010; Wood et al., 2006d ), and in Syd- of Milloy assessment Medico-economic et 3.10. program ney’s interested such a program subjects started the of 25% SIS, ( PWID who used the Vancouver Kimber et al., a 2008b ). Among the Four studies were performed to assess whether the SIS was ( Wood 18% secondarily engaged in a detoxification program system. All of them were Vancouver the on out carried cost-saving SIS, SIS et and Boyd, 2010; ), Bayoumi and Zaric, 2008; Pinkerton, stopped 23% and treatment, addiction an started 57% 2006d al., ( Andresen injecting 2011, DeBeck et al., 2011 ). SIS drugs 5–35 ( prevent could 2010 ). The authors calculated that the Pinkerton, 2010; Boyd, and Andresen ( ) infections HIV 2011 new and 3 ). 2010 Boyd, and Andresen ( year per overdose by deaths the use drug by induced nuisance in on SISs of impact The 3.7. Over represent of 10 years, this prevention would a cost savings spaces public $14 a gain of 920 years of life, and an avoidance of million, 1191 Zaric, HIV infections and 54 new HCV infections ( Bayoumi and new which of questions, these addressed studies Six per- were 4 2008 found ). Similarly, a study that used mathematical modeling formed al., the Vancouver SIS ( McKnight et al., 2007; et Petrar in that SIS a opening in Montreal of the cost- may be viable in terms al., Wood Sydney the et in 2007b; 2 and ) 2004 Stoltz al., et 2007; ). Jozaghi ( cost-effectiveness 2013 al., et and benefit SIS Wood et al. et , al., 2007; Salmon ( Thein et al., 2005 ). In (2004) the dropped in the hereabouts of the Vancou- number of syringes SISs 3.11. The on opinion of PWID ver after the SIS opened. SIS was counted and compared before and the daily the in reduction a found authors the opened, was SIS After aimed surveys Fifteen evaluate to the on PWID of opinion the mean public vs. [4.0–4.3] = IQR (4.3, in injecting PWID of number 2.4 Vancouver cities: numerous in SISs of cons and al., et DeBeck ( pros p = [7.3–14.3] = [1.5–3.0]; IQR = 0.022), syringes dropped (11.5, IQR 2011; Fairbairn Andresen, and Jozaghi al., et McNeil 2013; 2008; vs. p 5.3, IQR = [3.0–8.0]; = 0.010) and injection-related lit- al., 2011b; 2011a, 2012, et al., 2013; Petrar et al., 2007; Small et [490.0–830.3] vs. 305.3, IQR = [246.3–387.0]; (601.7, IQR = ter Wood et 2007; Van al., 2003 ), Sydney ( Kimber and Dolan, Beek p 0.014). = ), Gilmour, 2000 ), Ottawa ( Navarro and Leonard, 2004 Mon- and The among PWID in studies were surveys carried out other treal ( Green et al., 2004 ), Melbourne ( Fry, 2002 ) and San Francisco et McKnight et al., 2007; Petrar ( al., 2007; Stoltz et al., Vancouver Canada and Kral al., 2010 ). Before the opening of the first SISs in et ( 2007b the in worked or lived who users or non-drug among ) vicin- Australia, they that declared PWID local the of 89% and 54% between ity of the SIS in Sydney ( Salmon et al., 2007; Thein et ). 2005 al., were use such services ( Fry, 2002; willing Van Beek to and Gilmour, Between the of opening the Syd- after and before periods the 2000 interviewed PWID same the of ). 72% that found survey One ney SIS, 33% (residents: injection public less noted population this visited al., 2012 ). The main factors asso- SIS ( DeBeck et the actually p < 0.01; business operators: 19%, vs. 28%, p < 0.03), less 38% vs. ciated were safely inject to desire the SIS the visiting with and syringes operators: business 40%; vs. 67% (residents: dropped 72% over- of episodes previous spaces, the public avoid to desire quietly, vs. about 57%, p < 0.01) and less complaints PWID nuisances, but no dose, need for help to inject ( Fry, 2002; Green et 2004; and the al., change of drug deals (residents: 28% vs. 26%, p < 0.80; in the number Van ). for reported reasons main The not 2000 Gilmour, and Beek 33% ). 2007 vs. 28%, p < 0.26) ( Salmon et al., operators: business visiting were SIS the and drugs sharing against prohibitions the In in Vancouver, SIS attendance was with a reduction associated helping Beek PWID inject drugs within the SIS ( Fry, 2002; Van other = [1.93–3.87]) 95%CI 2.79, = (aOR injecting drug public self-declared Gilmour, 2000 ). and and ( syringe dropping (aOR [1.47–3.09]) = 2.13, 95%CI = al., et Petrar Seven opinions the regarding published were surveys PWID of 2007; ). 2007b al., et Stoltz on et 2012; Fairbairn et al., 2008; McNeil al., al., et DeBeck ( SISs al., et Small 2007; Approx- al., 2011b et Petrar ). 2011a, 2012, 2013; imately 75% of the PWID in Vancouver reported that using SIS the SISs violence, crime, drug-related local and on 3.8. The impact of positive changes in their behaviors, notably in terms of induced trafficking public al., nuisance and safe injection practices ( Petrar ). 2007 et studies in Vancouver motivation revealed that their for Qualitative Four studies evaluated this issue in Vancouver ( Milloy et al., using and were the SIS similar before after visiting the SIS, i.e., to 2009; et Wood and Sydney ( Fitzgerald et al., 2006a 2010; ) al., inject conditions quiet and safe in suffering without or violence local data 3 which among ), 2005 al., et police included Freeman having others with Fairbairn ( police the avoid to and drugs share to ( 2010; Freeman et al., 2005; al., Wood et al., 2006a ). et Fitzgerald McNeil 2011a 2012, al., et Small 2013; al., et main 2008; al., The ). et In Vancouver, no increase in crime, violence or drug trafficking concerns waiting of the of length the were SIS the concerning PWID around ( Wood et al., opening of the the SIS after found was SIS the time the helping and drugs sharing of prohibition SIS, the access to collected cities, other the to compared Sydney, In ). data 2006a of inject, the suspensions non-compliance access in cases of others over increase in a period of 10 offenses years also revealed no with of the rules, their distance from the SIS, and the presence related the areas to the trafficking or consumption of drugs in police 2007; Petrar in the surrounding area ( Kimber and Dolan, that et al., 2010; Freeman et al., surrounded the SIS ( Fitzgerald ). al., 2007; Small et al., 2011a et ). 2005 3.12. The and impact of SISs on the opinions of local residents the on SISs of Impact 3.9. PWID local of amount police performed in the Vancouver SIS addressed whether studies Two police residents, local of opinions the sought surveys Seven and the Kerr et al., ( SIS induced an increase in the number of local PWID professionals al., et in the drug field ( Cruz 2007; DeBeck et al., 2008; 2007c, reported 2006a ). These studies the that 25 months after O’Shea, Thein et 2007; Philbin et al., al., 2009; Salmon et al., 2007; SIS increase in the local opened, number of PWID there was no 2005; ). Ontario, in SIS no was there Although 2012 al., et Watson no who PWID of number the in started decrease ), 2007c al., et Kerr ( 60% existence the favored population the local Cruz ( SIS an of of methadone 7%), relapse rates therapy (11% vs. and no increase in et and Toronto in forces police pre- the whereas ), 2007 al., Ottawa (17% et opening the Nevertheless, ). 2006a the Kerr 20%; vs. of al., two Sydney, opposed SISs ( Watson et al., 2012 ). In dominantly drugs (17% vs. did not reduce the number of PWID who injected SIS random resi- sample studies found that more than 70% of the local 15%; et Kerr ). al., 2006a in and 58% of the companies located around the SIS were dents

17 64 Potier et al. / Drug and Alcohol Dependence 145 (2014) 48–68 C. less of SIS ( Thein et al., 2005 ) and deemed that there was 2014; favor the discussed Jarlais Des Although ). 2010 2011, the Pinkerton, importance drug 2007 ). Vancouver of SIS the that agreed he gains, achievable of use and syringe waste in public places ( Salmon et al., would However, ). residents and companies the of majority a nonetheless 2008 al., et Jarlais Des ( cost-effective be to continue safer and district, promoting by SISs, that argued have critics the that the of image negative a to contributed SIS thus Some thought more fostered increased in risk-taking foster might conditions, injection comfortable drug use, attracted drug users and dealers, and PWID crime and thus expose them to increased risks of ( Selby ). 2007 al., et Salmon ( insecurity and overdose ). 2007 al., However, the global rate of overdoses in SISs was found et to the and ), 2004 al., et Beek Van 2006b; al., et Kerr ( low very be outcomes due improved were cases 4. of overdose of presence the to Discussion healthcare Kerr ( workers different addition, In ). 2007b 2006b, al., et number evaluated that The of overdoses have shown that aim of this review was to depict the currently available evi- the surveys dence the implementation consequences negative and positive the regarding SISs. of of the after increase not did overdoses of rates SISs Several 2011; et Marshall ( evaluated the multiple impacts of literature reviews have ). 2010 al., et Salmon 2008a; al., et Milloy al., similar observation was found in our results con- 2013; al., no et Hyshka ( environment local their on or PWID on SISs However, Kelly cerning al., et Semaan 2007a; al., et Kerr 2002; Conigrave, found and 2011; the European SISs. A German departmental report Tyndall, the However, ). 2006b al., et Wood 2003; database present the same results, but it has not been referenced in any review is ( SIS-related the first to systematically embrace the full scope Poschadel et al., 2003 ). of SISs issues also were using a reduce to implemented by induced problems the research. algorithm keyword reproducible were performed that McKnight depict the profile of SIS users studies ( injection in public spaces. The Canadian studies drug The internationally, et and al., quite were results their among homogeneous 2007; Wood et al., 2004 ) found that SISs contributed to a sig- a exhibited globally SISs using PWID countries. different similar reduction of drug injection in public spaces. This reduction nificant the profile was of congruent conditions, life poor and precariousness social the sug- which with results Syd- in residents local of surveys of with marginalized Cruz et al., 2007; Salmon et al., 2007 ) and ( measures of that SISs were successful in attracting the most gests ney the fringes amount of of from drug injection in public spaces resulting waste PWID. Nonetheless, some experts ( Noël et al., 2009 ) and ). In our results, we found no European studies was Wood et al., 2004 there study ( McNeil et al., 2013 ) have noted that because one ( on no however, European studies have actually been per- issue; this assistance for drug injection in SISs, PWID who are unable to self-inject, formed found similar results ( Hedrich, 2004; Kemmesies, and have especially those whose conditions are too deteriorated, would 1999 to unable be SISs. Moreover, because most SISs do ). In some European SISs, e.g., in Switzerland and frequent Germany, individuals remains reduction in the under amount of injection-related waste the it accept 18 or pregnant women, not however, difficult in resulted also SIS the surrounding areas the anything regarding these specific subpopula- conclude to active from collec- by which are particularly vulnerable and require specific care personnel 2003; al., et ( SIS and users SIS both Benninghoff tion tions, Schu and al., discussed been have accessibility of conditions These support. 2005 ). Moreover, it has been noted that external fac- et among tors the staff of a Swiss SIS ( Solai et al., 2006 ). in use drug reduce also could SISs to link any without public spaces, Similarly findings that programs housing homeless local to related factors e.g., ubiquitous and homogeneous were the SISs ( safer injection conditions and promoted enhanced allowed Noël et al., 2009 ), local police surveillance, or local policy changes of impact direct the Therefore, ). 2008 Canada, that Government education among PWID regarding injection techniques and ( health asepsis SISs rates the Given rules. have of HIV and HCV infections in on reducing drug injection in public spaces was may high sometimes PWID, pub- in drugs of use the because assess to difficult SISs PWID in sharing syringe of reduction indicates the using epidemics. of spread the against tools effective are SISs to difficult remain that factors numerous from results spaces these lic that control With scientific studies. Furthermore, local or contextual within proposed SISs behaviors, injection safer promoting of aim the out- Hedrich, also may SIS the of function the to related influence directed PWID ( to specific health and social services features or door 2004 injection practices. For example, the rates of outdoor ). drug Because these services varied significantly between SISs, it SIS subject. this evaluate and compare globally to difficult injection From the access to wait average the with increase was drug ( analyzing et Small 2003; al., et Benninghoff different studies, it appeared that most PWID had SISs used Consequently, ). 2011b al., if can such might However, the benefits of social services remained reduce services. impact this spaces, public in practices injection largely insufficiently on depend assessed within the different SISs. Most SISs were Hedrich, their accessibility ( EMCDDA, 2009; to facilitate ). to addiction care services, which found were 2004 linked Another the emerged that fear proportion a However, PWID. among care addiction of start the was SISs of opening the with increase of who attended SISs were already undergoing treatment direct PWID the in crime drug-related and trafficking drug of in highlighted not was effect This SIS. the of studies methadone, although they continued to self-inject drugs. This the vicinity with finding found Canadian in performed were which review, our dif- are therapies replacement opiate and SISs that suggests Aus- and in ferent, tralian albeit complementary, measures for Milloy harm reduction among SISs ( Fitzgerald et al., 2010; Freeman et al., 2005; al., al., 2009; Wood et 2006a ). Furthermore, no European data PWID. et were might foster the initiation drug feared was it that SISs found in our review, whereas the European report on Moreover, of consumption no study found any no new users into intravenous drug use, but rooms cited unreferenced studies that found increase increase in SISs Dutch or Swiss in crime acquisitive in al., et Hedrich ( SIS the of irrespective PWID, local of number total the European Equally univocal was the global satisfaction with the use traffic- drug small-scale reported studies few A ). studied. 2010 king of the Andresen, However, ). 2004 Hedrich, ( SISs the of vicinity immediate Jozaghi in ( SISs among PWID in and the different surveys as 2013; are rooms many As “ report, European the noted by deliber- 2012, Kimber and Dolan, 2007; Petrar et al., 2007; Small et al., ately 2011a places near located SIS to difficult is it sold, are drugs illicit among where ). performed were surveys the of most However, claim users, ” dealing drug to se per leads rooms such of existence the that which may not reflect the No PWID. of population overall ( survey Hedrich, subjective assessment of SISs among PWID factors investigated the 2004 ). Moreover, there are numerous external who that Vancouver, no longer attended SISs; this population may exhibit different may influence drug trafficking and criminality. In level, medico-economic a On facilities. these on collaboration, close instance, the SIS and police services work in stud- for opinions ies which have demonstrated that SISs are economically cost-effective may explain why there was no increase in drug traffic- Bayoumi 2010; Boyd, and Andresen al., et Hadland 2008; Zaric, and ). in the related study ( DeBeck et al., 2008; Hedrich, 2004 This king (

18 Alcohol C. et al. / Drug and Dependence 145 (2014) 48–68 65 Potier seems important for the effect on the level of the Europe to counterbalance the disproportion of the currently in collaboration available criminality around among ). con- SISs if thereby, countries; and centers among data The 2010 al., et Hedrich ( SIS the surveys local tinue on based be will legacy scientific their Europe, in develop to prejudices residents have all noted that numerous against the “socially of bias well-known the Lastly, evidence. desirable users accompanied the implementation of a SIS within local drug neighborhood answers” limit may PWID these beliefs might last even after the imple- and of surveys in that survey the of scope the results mentation on ) 2008a al., et Milloy ( overdose e.g., subjects, several and that of the SIS. Consequently, it has been recommended campaign ( sharing a new SIS be preceded by a that implementation of data with studies However, ). 2007b al., et Stoltz syringe any sources aims other than the self-reports found approximately the same con- to inform and SIS of vicinity the in living people educate ( clusions 2004; INSERM, 2010 most bias this Consequently, surveys. the as Hedrich, ). It likely should had a that be demonstrated weak such SIS in a of this of findings overall the on impact implementation the for preparation a review. specific district operating significant despite conclusion, and residents local acceptance by SISs its facilitating in effective highly differences, is In police ubiquitously In addition, the implementation of a SIS is most depend- services. and effectively succeeded in attracting the ent marginalized city, any which may be on the political prejudgment of a country or PWID, i.e., those who generally have not joined in SIS the of of example The hindrance to the development SISs. popu- existing care system. However, some parts of this already a lation Vancouver, evidence has had where the accumulation of still do have scientific access to the majority of SISs, especially not people little the elected political party ( Hyshka influence can- 2013; al., et on under the age of 18, pregnant women, and people who Small, not controversy the reflects ), 2010 Picard, 2008; Keller, ( SISs of self-inject. Their interest in SISs remains to be demonstrated, 2008 and ) and further SIS and local for need the support. political national developments are expected to address these sub- limitations. SISs on several has review systematic literature This populations. First, were encompassing SISs articles relevant the of scope entire the to found provide numerous benefits to PWID: safer con- complex synonymous efficacious equipment, injection safe and conditions many SISs was because there are cerning injection overdose terms management, referring blood- of technique education, injection to SISs in the international literature. To date, no connections with infection prevention, and enhanced appellation has been defined, which explains why we consensual transmissible used addiction such and include to algorithm keyword complex a effi- com- most the social services. Their interventions are deemed refer the in appellations of a this, Despite results. few articles that behaviors because they induce positive changes in risk cacious mon to PWID. missed in this SISs using more unusual terms might have been Moreover, systematic generate public benefits such as a decrease in SISs the is work present the of limitation Another review. the presence important of number dropped of reduction a and public in injecting PWID of around SISs of functioning the in differences SISs world and gaps in the cultural and political contexts between feared, not do was in public places. Contrary to what syringes the countries. promote introduce important variations in what trafficking drug or crime increase not do and use drug This fact could In seem to be economi- respect to the different studies selected synthesized the addition, they PWID. of number with or was cally herein. be can considered Thus, effective measures cost-effective. SISs Moreover, complementary the of designs and types the to interventions. reduction harm other were themselves studies highly variable, depending on question addressed. Notably, the there were significant fea- disproportions in the and quantity the funding source of Role around SISs active different the on published data the of the tures world. most SISs are currently Although located in Europe ( Hedrich declared. Nothing et 2010 the majority of the systematically identified publica- al., ), Australian to the Canadian or SISs, which have were related tions Contributors received structures. to evaluate their means Some significant sub- ubiquitously, i.e., the depiction of profiles of addressed were jects Rolland Potier, C. study. the designed Potier C. and Rolland B. B. PWID, conditions of safety and hygienic effect for injection, sat- the and summaries and searches literature the conducted Laprevote V. and the of effects the and residents, PWID among surveys isfaction C. work. previous first the wrote Rolland B. and Potier related of SIS crime. and areas public Conversely, injection overdoses, on in draft Laprevote V. Dubois-Arber, F. manuscript. Cot- O. the and of the imbalance in studies was particularly notable regarding other tencin All manuscript. the of authors draft first the corrected subjects, prob- injection-related to secondary morbidity the i.e., contributed final the approved and to manuscript. have the of efficiency economic the and are there However, SISs. lems European data on these subjects they were mentioned in because Conflict interest of previous official different reviews institu- issued by comprehensive Hedrich, 2004; Hedrich et al., 2010; INSERM, ( EMCDDA, 2009; tions No conflict declared. 2010; et al., 2009 ). The Joseph Rowntree Foundation, 2006; Noël conclusions globally similar to those we found of these reports were data Supplementary A. Appendix Regard- of the different questions. each regarding review our in less, the if many investigations were performed in European SISs, this with associated data Supplementary article can be found, results investigations were not found in used the of databases these online version, at http://dx.doi.org/10.1016/j.drugalcdep. the in for among are databases these the although review, present the 2014.10.012 . For example, 40 Euro- commonly used for literature research. most pean identified European main two in were that studies reports References ( databases in found not were ) 2004 Hedrich, 2009; EMCDDA, the of analysis cost-effectiveness and cost-benefit A 2010. N., Boyd, M.A., Andresen, used of for our review. This lack inclusion in databases results in a Drug J. Int. facility. injection supervised 70–76. 21, Policy Vancouver’s lack most are SISs although SISs, on data European of visibility of Vancouver’s of cost-effectiveness The supervised 2008. G.S., Zaric, A.M., Bayoumi, numerous is there Consequently, Europe. geographic in a noticeable injection facility. CMAJ 179, 1143–1151. I.D., Graham, J.C., Brehaut, S., B.K.M., Potter, D., Khangura, Moher, C., Bennett, imbalance in between the actual representation of the active SISs Grimshaw, of J., 2011. Reporting guidelines for survey research: an analysis and the places where the majority data were world collected. of the published 8, guidance and reporting practices. PLoS Med. e1001069. More should be more easily accessible in studies on European SISs Benninghoff, F., Solai, S., Huissoud, T., 9 Dubois-Arber, F., 2003. Evaluation de Quai should research more and literature, peer-reviewed funded be the espace d’accueil et d’injection à Genève room of Quai 9, an injecting (Evaluation

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J., Keller, In: argues. Ottawa issue, legal a Globe Mail. R., Zhang, and Police 2008. T., Kerr, not Tyndall, J., Montaner, M., site DeBeck, K., Wood, E., health C., Kelly, public The 2002. K.M., the from Conigrave, evidence partnerships: of Sydney medically evaluation cen- super- supervised Vancouver’s injecting Prev. Policy 3, 11. Health Public J. Z. N. Aust. measure. health public controversial a 26, injection facility. Subst. Abuse Treat. vised tre: DeBeck, K., Kerr, T., 552–554. Bird, L., R., Zhang, Marsh, D., J., M., Montaner, Tyndall, use North America’s Injection in 2011. E., drug use cessation and Kemmesies, U., 1999. The Open Drug Scene and the Safe Injection Room Offers of Wood, first Frankfurt Drug Alcohol Depend. 113, medically supervised safer injecting facility. Am Main 1995. Coordination Bureau of the European Cities on Drug Frankfurt. 172–176. Policy, T., Lai, C., Buxton, J., Montaner, J., Wood, E., 2012. The validity of of impacts social and health public The 2005a. E., Wood, W., DeBeck, K., Kerr, Kerr, T., Small, market 16, subsequent on facility injecting supervised a use to willingness pro- enforcement: a review of the evidence. Int. J. Drug Policy drug reporting gram 210–220. among people who use injection drugs. Am. J. Drug Alcohol Abuse 38, use Kerr, T., Wood, E., Grafstein, E., Ishida, T., Shannon, K., Lai, C., Montaner, J., Tyndall, 55–62. Jarlais, Des Hagan, supervised Vancouver’s Evaluating 2008. H., K., Arasteh, D.C., 2005b. High rates of primary care and emergency department use among M.W., Public 1105–1106. 179, CMAJ ethics. and symbols dollars, and facility: data drug users in Vancouver. J. Health Oxf. Engl. 27, 62–66. injection injection Kerr, Drucker, T., injection Safer 2005c. E., Wood, J., Montaner, K., Li, M., Tyndall, health: public and prohibition Drug 1999. use E., facility 25 years of evidence. Public drug users. Lancet syringe 366, 316–318. sharing in injection Rep. 114, 14. Health and Benninghoff, F., Jeannin, A., 2008. of injection M., Li, K., Zhang, Dubois-Arber, R., Montaner, J., Wood, E., profiles of Tyndall, J.-A., Stoltz, T., Kerr, 2006a. F., Typology safer supervised medically a of on facility injection community drug Switzerland. Eur. in facility consumption drug supervised a of Geneva, clients Impact Res. patterns: use Addict. 1–10. a before 14, and after study. BMJ 332, 220–222. Kerr, T., Tyndall, M.W., Lai, C., Montaner, J.S., Wood, E., 2006b. Drug-related over- Elliott, R., Malkin, I., Gold, J., 2002. Créer des au l’injection pour sécuritaires lieux J. Drug 17, Policy a within safer VIH/sida. canadien juridique Réseau éthiques. et juridiques questions supervised medically injection facility. Int. Canada: doses 2008. 2008 Annual Report: The State EMCDDA, the Drugs Problem in the European of 436–441. Kerr, Union and Norway. Kimber, T., Monitoring Centre for Drugs and Drug Addiction, European J., Debeck, K., Wood, E., 2007a. 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T., Kerr, E., Wood, W., Small, D., Fast, drug of first injection among illicit drug users users accessing a medically cumstances regarding supervised injection injecting safer safer delivered education Am. injecting supervised a through facility. 1228. 97, Health Public J. J., Kimber, Harm MacDonald, M., van Beek, I., Kaldor, J., Weatherburn, D., Lapsley, H., Reduct. J. 5, 32. facility. The 2003. R.P., Fitzgerald, client centre: injecting Supervised Medically Sydney crime drug illicit and property in Trends 2010. L., Snowball, M., Burgess, J., Mattick, Cross: Centre Injecting Supervised Medically the attendance during the months 12 first of predictors and update. an frequent Kings in around characteristics Justice operation. Crime of Stat. J. 639–648. 33, Issues Drug 51, 1–6. K., Freeman, Kimber, J., Donnelly, N., Rutter, establishing D.J., Weatherburn, C.G., Jones, S., Spooner, C.J., Dolan, K., 2007. 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H.C., from Injection Sites: What Has Been Learned Research? – Final Report of drug of predictors and Process 2008b. I., treat- Beek, van J., Kaldor, R.P., Mattick, vised Supervised Committee Advisory Expert the at uptake referral and referral on Injecting Supervised Medically Sydney Health Research. Site Injection the ment 27, Rev. 602–612. Drug Alcohol Centre. Canada. Boivin, J.-F., Platt, R., 2004. My place, your that Factors 1995. J., Morris, H., Klee, characterize Green, T.C., Hankins, C.A., Palmer, D., street injectors. Addiction 90, Montreal or use to users drug injecting a among intention the place: safer place, 837–841. Kral, L., Wenger, A.H., Public Can. facilities. injecting 95, 110. J. Acceptability 2010. P., Bourgois, T., Kerr, E., Wood, L., Carpenter, Health supervised of T., Nguyen, P., Dobrer, S., Montaner, J., Wood, E., 2014. Drug Francisco. in users drug injection among facility injection safer a San Hadland, S., Debeck, K., Kerr, Use of Depend. Alcohol drug-injecting among facility injection supervised 160–163. medically a 110, street 54, Health Adolesc. J. Liberati, J.P.A., Ioannidis, P.C., Gøtzsche, C., Mulrow, J., Tetzlaff, D.G., Altman, A., S88–S89. youth. Says Health Canada, 2006. No Injection Site For Addicts Until Questions Answered for M., Devereaux, P.J., Kleijnen, J., Moher, D., 2009. The PRISMA statement Clarke, health News Clement. evaluate systematic reviews and meta-analyses of studies that Releases. reporting Minister European Rooms. Consumption Drug on Report European 2004. D., Hedrich, explanation interventions: and e1–e34. 62, Epidemiol. Clin. J. elaboration. Moni- care for Drugs and Drug Addiction, Lisbon. 2008. T., Kerr, Centre Montaner, M.W., Tyndall, R., Zhang, E., Wood, E., Lloyd-Smith, J.S.G., toring D., among infection injection-related cutaneous a developing for factors Risk Hedrich, injec- Kerr, T., Dubois-Arber, F., 2010. Drug consumption facilities in Europe Evidence, Impacts and In: Challenges. European 405. 8, Health Public BMC study. cohort a users: drug Harm Reduction: beyond. and tion (chapter 305–331 pp. Lisbon, Addiction, Drug and Drugs for Centre Lloyd-Smith, Wood, E., 2009. T., Kerr, J.S., Montaner, M.W., Tyndall, R., Zhang, E., Monitoring Determinants 11). of injection-related infection cutaneous at a supervised care facility. Ann. Epidemiol. 19, 404–409. D., Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, injecting Tyndall, Force, R., Zhang, E., Wood, E., Lloyd-Smith, 2013. Kerr, J.S.G., Montaner, S., Sheps, F., Briggs, A.H., Mauskopf, J., Loder, E., CHEERS M.W., Task Augustovski, state- infec- injection-related cutaneous a for hospitalization of Determinants 2010. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) T., tion ment. study. cohort a users: drug injection among 327. 10, Health Public BMC Value Health J. Int. Soc. Pharmacoecon. Outcomes Res. 16, e1–e5. Hyshka, Drug supervised scaling-up for Prospects 2013. T.C., Wild, T., Bubela, E., injection MacPherson, D., 2001. A Framework for Action. A Four-Pillar Approach to in of evidence in legal and the political decision-making. role Canada: , in Vancouver, Revised Vancouver. Problems facilities Tyndall, Kerr, J.S., Montaner, M.W., Abingdon Engl. 108, 468–476. Con- 2009. Marshall, B.D., Wood, E., Zhang, R., T., Addict. Control Board in 1999 injection among use drug INCB, 1999. Reports users accessing a supervised injecting facility. Published by the International Narcotics dom Sex. (No. Control Transm. Vienna. Board, 85, Narcotics International E/INCB/1999/1). Infect. 121–126. drogues (rapport in Reduction 2011. T., Kerr, J.S., chez infectieux risques des Réduction usagers 2010. Montaner, E., Wood, M.J., Milloy, B.D., les de INSERM, Marshall, overdose d’expertise users drug amongst infection of risks (Reducing collective) (collec- mortality after the opening of North America’s first medically super- national Institut médicale, report)). expert recherche la de et santé la de Lancet safer injecting facility: a retrospective population-based study. 377, vised tive Paris. 1429–1437.

20 C. Potier et al. / Drug and Alcohol Dependence 145 (2014) 48–68 67 McKnight, I., B., Wood, E., Tyndall, M.W., Small, W., Lai, C., Montaner, J.S., Kerr, Maas, Singer, M., Simmons, J., Duke, M., Broomhall, L., 2001. The challenges of street 9, AIDS and violence, use, drug on risk. 2007. Factors associated with public injecting among users of Vancouver’s Addiction Res. Theory research T., 319–325. 33, Abuse Alcohol Drug J. Am. facility. injection 365–402. supervised McNeil, Small, they could R., Small, W., Lampkin, H., Shannon, for care Accessing 2008. T., Kerr, M., Tyndall, E., Lloyd-Smith, E., Wood, W., K., Kerr, T., 2013. People knew infections through a medically supervised injecting facility: a practices injection assisted of study ethnographic an help: get to here come injection-related unsanctioned supervised drug consumption room in a Canadian study. a Drug Alcohol Depend. 98, 159–162. peer-run qualitative at N., Borek, van W., Small, Fairbairn, 473–485. 18, Behav. 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