The global health and equity imperative for safe consumption facilities

• Published in: The Lancet (British edition) 2018-08, Vol.392 (10147), p.553-554
• Main Authors: Beletsky, Leo, Baker, Pieter, Arredondo, Jaime, Emuka, Ashley, Goodman-Meza, David, Medina-Mora, Maria Elena, Werb, Dan, Davidson, Peter, Amon, Joseph J, Strathdee, Steffanie, Magis-Rodriguez, Carlos
• Format: Article
• Language: English
• Subjects: Developing Countries; Drug Overdose - prevention & control; Drug use; Global Health; Health disparities; Health Equity; HIV; Human immunodeficiency virus; Humans; Injection; Jurisdiction; Law enforcement; Low income groups; Overdose; Police; Public health; Substance Abuse, Intravenous
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(18)31469-7

The first safe consumption facility (SCF) opened its doors in 1986, in Bern, Switzerland, intending to curb drug overdose-related deaths and prevent other drug-related harm in people who inject drugs (PWID).1 Since then, communities who have adopted the SCF approach have seen decreases in HIV incidence, injection-related litter and disorder, and drug overdose.2,3 Use of SCFs is also associated with uptake of treatment for drug use and other recovery assistance services.4 Mounting evidence that SCFs are both highly successful and cost-effective has made them a core public health response to problematic drug use and its sequelae.5,6 Nowadays, more than 100 SCFs are in operation across Europe, Australia, and Canada, with Canada having recently approved dozens of additional facilities to address the country's overdose crisis.7 Although several US locales have made concrete steps towards opening SCFs, progress has been dismally slow, and the ultimate fate of these efforts remains uncertain. Existing drug consumption dy-namics and the proliferation of informal and unsafe injection sites leave PWID in Tijuana vulnerable to police harassment.10,11 In the context of structural challenges and poor coverage of high-quality and accessible harm reduction programmes, a SCF could save lives and reduce drug-related harm. Analogous to several jurisdictions in the global South, Tijuana's legal environment is already favourable to the operation of a SCF because small-scale drug possession is decriminalised.10 Finally, a department-wide police education programme in Tijuana has built a foundation for better alignment of law enforcement with harm reduction programmes like SCFs.13 In Tijuana, as elsewhere, SCFs provide an opportunity to integrate a suite of key harm reduction services under one roof.