About Supervised Injection Facilities (SIFs)

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What is a supervised injection facility (SIF)?

A supervised injection facility is a safe, clean space where persons who inject drugs (PWID) can inject themselves with drugs that they already possess under the supervision of trained medical staff who can intervene in case of an emergency.

Does the facility provide the drugs?

No. The supervised injection facility does not supply heroin or any illegal drugs; persons who inject drugs may bring their own injectable drugs into the SIF. The facility will have life-saving, FDA-approved, legal naloxone on hand in order to counteract overdoses, as necessary.

Does a SIF increase the amount of crime in a neighborhood?

No, it does not. Research collected at a SIF in Vancouver, Canada, found that opening of that facility was not associated with increased crime or an increase in new use of injectable illicit drugs. In fact, research showed that the impact on communities was positive, with a reduction in public injection, public intoxication, and drug-related litter.

What is the benefit of a SIF?

SIFs can save lives. Overdose due to opioid drugs can be fatal; in Massachusetts last year, there were roughly 2,000 opioid-related overdose deaths. However, during an opioid overdose, medical intervention with a medicine called naloxone can help save lives. 

Research from a SIF location in Vancouver, Canada, showed a reduction in overdose mortality by 35 percent. Importantly, SIF utilization is also associated with an increase in referral to addiction treatment, including a 30 percent increase in the rate of detoxification use and an increase in the use of medication-assisted treatment.

In general, the data show that SIF can save lives in case of emergency, but can also lead to long-term recovery from substance use disorder.

Why not just get users into treatment?

That is one of the goals of SIFs. Substance use disorder is a serious disease, and drug overdoses can be fatal. By keeping people alive, SIFs give them another opportunity to pursue treatment and help to connect them with that treatment. In Vancouver, a SIF location reported a 30 percent increase in the rate of detoxification use and an increase in the use of medication-assisted treatment. But if people suffer fatal overdoses, it’s too late for them to seek treatment and recovery.

SIFs may also keep persons who inject drugs safer and healthier in other ways. SIFs may lead to a reduction in hepatitis C and HIV infections, which are associated with injectable drug use. By providing a safe space, SIFs can also help to protect users against street crimes and violence.

 

About the MMS resolution

Is the MMS going to open a SIF?

No, MMS is not going to open a SIF. The MMS’s House of Delegates voted to advocate for the state of Massachusetts to consider launching a SIF pilot program, under the guidance of a state-created task force.

Is this a way to condone use of injectable, illicit drugs?

No, our support for a SIF does not mean that the MMS condones the use of injectable, illicit drugs. Our support for a SIF is based on a thorough review of the evidence, which suggests that SIFs can help save lives and increase access to treatment. It recognizes that substance abuse disorder is a disease and that those who live with it should have the best chance possible of treating their disease.

Where will the SIF be?

We don’t know. Our resolution does not specify any particular location for a pilot SIF in the Commonwealth. Any decision regarding location would be left to the state; to that end, MMS recommended the creation of a task force to oversee the pilot SIF program. In countries with SIF locations, the facilities have been in high-need areas, where there are large numbers of persons who inject drugs who would benefit from moving off the street and into a safe space.

Why is the MMS focusing on SIFs?

This is one of many approaches that we support. The Massachusetts Medical Society has worked hard over the last few years to confront the opioid epidemic. To name some examples:

  • We have released opioid prescribing guidelines, intended to reduce the number of patients who become dependent on opioids, and have worked to educate our members about how best to communicate potential risk of dependency to their patients.
  • We have supported partial-fill law, which allow patients to receive only part of their opioid prescriptions, thus reducing the risk of developing a substance use disorder.
  • We have worked with the state to implement mandatory use of MassPAT, the state’s prescription drug monitoring program, so that physicians are more informed when they prescribe an opioid medication to patients.

However, despite these efforts – and some successes in reducing opioid prescribing rates – the number of opioid-related overdose deaths in Massachusetts reached record levels last year. Because data have shown that SIFs can help to reduce overdose mortality, the MMS believes that they may be one tool to help save lives.

To be clear, the MMS continues to support comprehensive efforts to address the opioid crisis.

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