Supervised Injection Site - Operating Facilities

Operating Facilities

What disparagingly is called "shooting galleries" have existed for a long time; there were illicit for-profit facilities in New York during 1980s and in Sydney during the 1990s. What differs these from the legally sanctioned is the care they provide. While the operators of the facilities in New York and Sydney had little regard for the health of their clients, modern supervised injection facilities are a professionally staffed health and welfare service.

The first professionally staffed service where drug injection was accepted emerged in the Netherlands during the early 1970s as part of the "alternative youth service" provided by the St. Paul's church in Rotterdam. At its peak it had two centers that combined an informal meeting place with a drop-in center providing basic health care, food and a laundering service. One of the centers was also a pioneer in providing needle-exchange. Its purpose was to improve the psychosocial function and health of its clients. The centers received some support from law enforcement and local government officials, although they were not officially sanctioned until 1996.

In 1986 a café was set up in Berne for injecting drug users who were unwanted at other cafés. Part of a project combatting HIV, the general concept of the café was a place where simple meals and beverages would be served, and information on safe sex, safe drug use, condoms and clean needles provided. Social workers providing counselling and referrals were also present. An injection room was not originally conceived, however, drug users began to use the facility for this purpose, and this soon became the most attractive aspect of the café. After discussions with the police and legislature, the café was turned into the first legally sanctioned drug consumption facility provided that no one under the age of 18 was admitted.

During the 1990s additional legal facilities emerged in other cities in Switzerland, Germany and the Netherlands. In the first decade of 2000, facilities opened in Spain, Luxembourg, Norway, Canada and Australia.

Police corruption and street crime in the Kings Cross district of Sydney, prompted the Wood Royal Commission to recommend the opening of a injection facility in the area, with the Sydney Medically Supervised Injecting Centre (MSIC) opening in May, 2001. In Canada: problems with drug use, discarded needles and crime made Downtown Eastside of Vancouver the location for the first facility, when Insite commenced operation in 2003.

Whereas injection facilities in Europe often evolved from something else, such as different social and medical out-reaches or perhaps a homeless shelter, the degree and quality of actual supervision varies. As many European centers also allow clients to consume drugs by other means then by injecting it on its premises, EMCDDA prefers call them "drug consumption facilities" instead of anything alluding to "injection". The history of the European centers also mean that there have been no or little systematic collection of data needed to do a proper evaluation of effectiveness of the scheme.

However, some of the very rationale for the projects in Sydney and Vancouver are specifically to gather data, as they are created as scientific pilot projects. The approach at the centers is also more clinical in nature, as they provide true supervision with a staff that is equipped and trained to administer Oxygen or Naloxone in the case of a heroin or other opioid overdose.

At the beginning of 2009 there were 92 facilities operating in 61 cities, including 30 cities in the Netherlands, 16 cities in Germany and 8 cities in Switzerland.