Acceptability and design preferences of supervised injection services among people who inject drugs in a mid-sized Canadian City

Abstract

BackgroundSupervised injection services (SIS) have been shown to reduce the public- and individual-level harms associated with injection drug use. While SIS feasibility research has been conducted in large urban centres, little is known about the acceptability of these services among people who inject drugs (PWID) in mid-sized cities. We assessed the prevalence and correlates of willingness to use SIS as well as design and operational preferences among PWID in London, Canada.MethodsBetween March and April 2016, peer research associates administered a cross-sectional survey to PWID in London. Socio-demographic characteristics, drug-use patterns, and behaviours associated with willingness to use SIS were estimated using bivariable and multivariable logistic regression models. Chi-square tests were used to compare characteristics with expected frequency of SIS use among those willing to use SIS. Design and operational preferences are also described.ResultsOf 197 PWID included in this analysis (median age, 39; interquartile range (IQR), 33–50; 38% female), 170 (86%) reported willingness to use SIS. In multivariable analyses, being female (adjusted odds ratio (AOR) 0.29; 95% confidence interval (CI) 0.11–0.75) was negatively associated with willingness to use, while public injecting in the last 6 months (AOR 2.76; 95% CI 1.00–7.62) was positively associated with willingness to use. Participants living in unstable housing, those injecting in public, and those injecting opioids and crystal methamphetamine daily reported higher expected frequency of SIS use (p < 0.05). A majority preferred private cubicles for injecting spaces and daytime operational hours, while just under half preferred PWID involved in service operations.ConclusionsHigh levels of willingness to use SIS were found among PWID in this setting, suggesting that these services may play a role in addressing the harms associated with injection drug use. To maximize the uptake of SIS, programme planners and policy makers should consider the effects of gender and views of PWID regarding SIS design and operational preferences.

Potential use of supervised injection services among people who inject drugs in a remote and mid-size Canadian setting

“…Resulting stigma and discrimination may lead to social isolation or individuals choosing not to disclose their drug use, therefore making it challenging for some PWID to seek care [36]. Despite feasibility study results from another mid-size Canadian setting that found contrasting evidence to past research that suggests smaller cities lack liberal perspectives toward harm reduction and injection drug use [24], it remains unclear how these concerns may relate to the implementation of SIS in a geographically outlying mid-size city servicing suburban, rural and remote communities.…”

Syringe sharing among people who inject drugs in London, Canada

“…NSP expansion efforts should also pay particular attention to the needs of homeless or unstably housed PWID, who were more likely to share syringes in unadjusted analyses. In addition, supervised injection services, which provide sterile injecting equipment and medically trained staff to supervise injections, are currently being planned as part of the response to drug-related harms in London (Middlesex-London Health Unit 2017; Mitra et al 2017). In Vancouver, use of such services has been associated with reduced syringe sharing (Kerr et al 2005), as well as a host of other public health and order benefits (e.g., reductions in fatal overdose (Marshall et al 2011) and public injecting (Wood et al 2004)).…”

Peer-Assisted Injection as a Harm Reduction Measure in a Supervised Consumption Service: A Qualitative Study of Client Experiences

“…From a public health perspective, allowing peer assisted injection can reduce other risks, since recipients have higher rates of sharing syringes and other paraphernalia (20) and as such, permitting this activity within a supervised facility may provide structured opportunities to enhance the health and safety of people who use drugs. Mitra et al (21) reported that 32% of potential SCS clients want assisted injection as a standard, operational feature onsite.…”