Reducing the risk
Supervised injecting facilities
Supervised injecting facilities (SIFs) are dedicated spaces where illicit drugs can be used under the watchful eye of health care professionals (particularly nurses), social workers or other trained workers or volunteers.
What are Supervised injecting facilities?
“An injecting centre provides the setting and the possibility for a new type of connection with our clients. The power of suspending judgement for those who are the most judged and vilified in our society can be transformative.”1
Dr Marianne Jauncey, Medical Director, Uniting Medically Supervised Injecting Centre (Sydney)
Supervised injecting facilities (SIFs) are dedicated spaces where illicit drugs can be used under the watchful eye of health care professionals (particularly nurses), social workers or other trained workers or volunteers.
They are typically located in areas experiencing high levels of public injecting and other drug use issues and are established as a harm reduction response.
SIFs provide their clients with clean injecting equipment; emergency care (including overdose response and wound care); education; access to rehabilitation, treatment and health care; and disease transmission prevention.2
Through the support of SIFs, clients often find a pathway to drug treatment services, health care, disease transmission prevention and other essential services such as housing or financial supports.3-8
These services are also known as Drug Consumption Rooms (DCRs), Supervised Consumption Sites (SCSs) or Safe Injecting Rooms (SIRs). Some services with medical staff onsite are called Medically Supervised Injecting Centres (MSIC), such as the Sydney MSIC.
SIFs around the world
The first SIF opened in Switzerland in 1986 and there were 130 facilities operating globally by late 2020, including two facilities in Australia: Kings Cross, Sydney (opened 2001) and North Richmond, Melbourne (opened 2018).
- Jauncey M. What goes on inside a medically supervised injection facility? : The Conversation; 2017 [cited 2021 February 12].
- Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E. Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy. 2006;17(5):436-41.
- Markwick N, Ti L, Callon C, Feng C, Wood E, Kerr T. Willingness to engage in peer-delivered HIV voluntary counselling and testing among people who inject drugs in a Canadian setting. Journal of Epidemiology and Community Health. 2014;68(7):675.
- Wood E, Tyndall MW, Stoltz J-A, Small W, Zhang R, O’Connell J, et al. Safer injecting education for HIV prevention within a medically supervised safer injecting facility. International Journal of Drug Policy. 2005;16(4):281-4.
- Kimber JO, Mattick RP, Kaldor J, Van Beek I, Gilmour S, Rance JA. Process and predictors of drug treatment referral and referral uptake at the Sydney Medically Supervised Injecting Centre. Drug and Alcohol Review. 2008;27(6):602-12.
- Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. Attendance, drug use patterns, and referrals made from North America's first supervised injection facility. Drug and Alcohol Dependence. 2006;83(3):193-8.
- Wood E, Tyndall MW, Zhang R, Montaner JSG, Kerr T. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction. 2007;102(6):916-9.
- Belackova V, Silins E, Salmon AM, Jauncey M, Day CA. “Beyond Safer Injecting”—Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility. International Journal of Environmental Research and Public Health,. 2019;16(11).
- Clark J, Torrance, J. Drug Consumption Room: Could the provision of a drug consumption room bring significant benefit in reducing drug related deaths and other community harms in Bristol. Transform Drug Policy Foundation; 2018.
- Uniting. Uniting Medically Supervised Injecting Centre 2020 [cited 2020 June 16].
- Hamilton M. Review of the Medically Supervised Injecting Room. Melbourne: Medically Supervised Injecting Room Review Panel; 2020.
- Marshall BDL, Milloy MJ, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. The Lancet. 2011;377(9775):1429-37.
- Uniting. Uniting Medically Supervised Injecting Centre - Get to know our story. 2018.
- Bravo MJ, Royuela L, De la Fuente L, Brugal MT, Barrio G, Domingo-Salvany A, et al. Use of supervised injection facilities and injection risk behaviours among young drug injectors. Addiction. 2009;104(4):614-9.
- Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. The Lancet. 2005;366(9482):316-8.
- Kinnard EN, Howe CJ, Kerr T, Skjødt Hass V, Marshall BDL. Self-reported changes in drug use behaviors and syringe disposal methods following the opening of a supervised injecting facility in Copenhagen, Denmark. Harm Reduction Journal. 2014;11(1):29.
- Stoltz J-A, Wood E, Small W, Li K, Tyndall M, Montaner J, et al. Changes in injecting practices associated with the use of a medically supervised safer injection facility. Journal of Public Health. 2007;29(1):35-9.
- North Richmond Community Health. Changing Lives. 2020 [cited 2021 February 11].
- Salmon A, Belackova V, Schwanz RS, Jauncey M, Hiley S, Demirkol A. Homelessness among clients of Sydney's supervised injecting facility. Drugs and alcohol today. 2017;17(4):258-68.
- Goodhew M, Salmon AM, Marel C, Mills KL, Jauncey M. Mental health among clients of the Sydney Medically Supervised Injecting Centre (MSIC). Harm Reduction Journal. 2016;13(1):29.
- Belackova V, Salmon A. Overview of international literature - supervised injecting facilities & drug consumption rooms - Issue 1. Sydney: Uniting Medically Supervised Injecting Centre; 2017.
- Scherbaum N, Specka M, Bombeck J, Marrziniak B. Drug consumption facility as part of a primary health care centre for problem drug users—Which clients are attracted? International Journal of Drug Policy. 2009;20(5):447-9.
- Biancarelli DL, Biello KB, Childs E, Drainoni M, Salhaney P, Edeza A, et al. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug and Alcohol Dependence. 2019;198:80-6.
- Chan Carusone S, Guta A, Robinson S, Tan DH, Cooper C, O’Leary B, et al. “Maybe if I stop the drugs, then maybe they’d care?”—hospital care experiences of people who use drugs. Harm Reduction Journal. 2019;16(1):16.
- Paquette CE, Syvertsen JL, Pollini RA. Stigma at every turn: Health services experiences among people who inject drugs. International Journal of Drug Policy. 2018;57:104-10.
- Kerman N, Manoni-Millar S, Cormier L, Cahill T, Sylvestre J. “It’s not just injecting drugs”: Supervised consumption sites and the social determinants of health. Drug and Alcohol Dependence. 2020;213:108078.
- Fairbairn N, Small W, Shannon K, Wood E, Kerr T. Seeking refuge from violence in street-based drug scenes: Women's experiences in North America's first supervised injection facility. Social Science & Medicine. 2008;67(5):817-23.
- Boyd J, Lavalley J, Czechaczek S, Mayer S, Kerr T, Maher L, et al. “Bed Bugs and Beyond”: An ethnographic analysis of North America's first women-only supervised drug consumption site. International Journal of Drug Policy. 2020;78:102733.
- British Columbia Centre for Excellence in HIV/AIDS. Findings from the evaluation of Vancouver’s Pilot Medically Supervised Safer Injecting Facility – Insite. 2009.
- Andresen MA, Boyd N. A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility. International Journal of Drug Policy. 2010;21(1):70-6.
- Bayoumi AM, Zaric GS. The cost-effectiveness of Vancouver's supervised injection facility. Canadian Medical Association Journal. 2008;179(11):1143.
- Pinkerton SD. Is Vancouver Canada's supervised injection facility cost-saving? Addiction. 2010;105(8):1429-36.
- KPMG. Further evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011). NSW Health; 2010.
- Barry CL, Sherman SG, Stone E, Kennedy-Hendricks A, Niederdeppe J, Linden S, et al. Arguments supporting and opposing legalization of safe consumption sites in the U.S. International Journal of Drug Policy. 2019;63:18-22.
- Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence. 2014;145:48-68.
- Kennedy MC, Karamouzian M, Kerr T. Public Health and Public Order Outcomes Associated with Supervised Drug Consumption Facilities: a Systematic Review. Current HIV/AIDS Reports. 2017;14(5):161-83.
- McKnight I, Maas B, Wood E, Tyndall MW, Small W, Lai C, et al. Factors Associated with Public Injecting Among Users of Vancouver's Supervised Injection Facility. The American Journal of Drug and Alcohol Abuse. 2007;33(2):319-25.
- Salmon AM, Thein H-H, Kimber J, Kaldor JM, Maher L. Five years on: What are the community perceptions of drug-related public amenity following the establishment of the Sydney Medically Supervised Injecting Centre? International Journal of Drug Policy. 2007;18(1):46-53.
- Thein H-H, Kimber J, Maher L, MacDonald M, Kaldor JM. Public opinion towards supervised injecting centres and the Sydney Medically Supervised Injecting Centre. International Journal of Drug Policy. 2005;16(4):275-80.
- Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JSG, et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal. 2004;171(7):731.