Addressing Injection Drug Use: Health Risks and Harm Reduction Strategies

In the United States, approximately 338,000 are annual injection drug users (IDUs), representing about 0.1% of the population. In Australia, there are around 130,000 annual IDus, accounting for 0.8% of the population. The injection drug involves the act of injective psychoactive substances into the body with the use of a needle and a syringe. This method is preferred by some individuals due to faster and a more efficient drug delivery into the bloodstream. Commonly injected drugs include cocaine, heroine—combinations of the two, known as “speedballs”—amphetamines, talwin and ritalin (referred to as “Ts and Rs), pharmaceutical opioids such as dilaudid and morphine, and anabolic steroids. In Canada, there are an estimated 75,000 to 125,000 IDUs in Canada, a third of which are women. In fact, high prevalences are located in urban areas, namely Vancouver, Toronto, and Montreal, while increasing in rural areas (CCSA).

Consequently, health risks that are associated with injection drug use include high risks of HIV, hepatitis C, and other infections due to needle sharing. Other health issues include abscesses, infections, vascular damage, poor nutrition, overdose and mental health problems. There are also significant healthcare costs associated with long-term illness and palliative care. Injection drug users often face social isolation, stigmatization, lower education levels, employment problems, and especially homelessness. There has proven to be a strong link between injection drug use and criminal behavior. These cycles compounded together create a cycle of disadvantage and marginalization which in turn makes it more difficult for IDUs to access the support and the resources that they need (CCSA).

The addition of Supervised Injection Facilities (SIFs) provide sterile injection equipment and medical supervision to support individuals who utilize injection drugs. The incorporation of these facilities aim to reduce health risks, such as infections and overdoses. Additionally, they allow individuals to connect with health and social services; by providing a safe space for drug use, SIFs help reduce public drug use and its associated problems. A great example of this is an Insite in Vancouver, which has shown to effectively improve health outcomes and reduce negative impacts of drug use. SIFs offer a range of services, from sterile injecting equipment, to needle exchange programs and basic health services. They serve as social support networks and enforce strict rules and regulations; sharing equipment and drugs are prohibited, age restrictions are enforced, and violence/illegal activities are not permitted. These measures are put in place to maintain and secure and supportive environment for all individuals (CCSA).

The first SIFs were established and created in the Netherlands, Switzerland, and Germany. They have successfully reduced public drug use, decreased health risks, and improved public order altogether. So far, there have been no recorded overdose or deaths surveyed in SIFs. In order for their continued success, an explicit legal framework for permanent operation, as well as an integrated approach with other harm reduction measures are essential.

Authorized Services at SIFs include permitted substance use methods such as injection, inhalation (smoking), oral (swallowing), and intranasal (snorting) routes (Health Canada). Currently at this time. SIFs holding a valid exemption from Health Canada are open to the public with required information. Possession of controlled substances is prohibited under the Controlled Drugs and substances Act, but SIFs are exempted from this prohibition. In the renewal process, applicants are submitted to renew their exemptions, with Health Canada reviewing compliance and any changes to the site. Peer assistance involves one person assisting another in drug preparation and consumption, which usually benefits women, people with disabilities or illnesses, and other vulnerable populations. In the review stage, applications undergo a thorough examination for completeness and clarity, and are notified when their application is deemed complete. After this stage, Health Canada makes a final decision, and in the screening stage, the applicants submission is received and examined to verify whether sufficient information is available for Health Canada to review the application (Wood et al.). Criminalization and societal views on substance use continue to act as significant deterrents to service utilization, perpetuating a cycle of disadvantage and marginalization for individuals who use drugs (Davis et al.).

Criminalization serves to control and exclude individuals perceived as threats to social order, further entrenching their stigmatization and isolation. This systemic stigma is deeply embedded in societal norms, policies, and laws, making it challenging to counteract without structural changes.

Mitigating the stigma associated with substance use requires a multi-faceted approach. Employing individuals with lived experience in service roles can enhance the relatability and trustworthiness of harm reduction services, while also empowering those who have previously been marginalized (Davis et al.). Ensuring that services are located in accessible yet private areas helps maintain user anonymity and comfort, which is crucial for encouraging their utilization (Davis et al.). Normalizing drug checking as a routine harm reduction measure can increase acceptance and encourage more individuals to utilize these services. Furthermore, decriminalizing substance use is a necessary step to address the root causes of stigma and improve harm reduction efforts. Addressing these systemic issues can create a more inclusive and effective approach to managing substance use and its associated risks.

The illicit drug overdose crisis, particularly severe in British Columbia, Canada, underscores the urgent need for effective harm reduction strategies. The proliferation of unregulated substances, especially fentanyl, has contributed to alarmingly high overdose rates (Davis et al.). Drug checking is a harm reduction approach aimed at preventing the consumption of harmful substances and addressing the severe consequences of unregulated drug use. Addressing substance use stigma (SUS) is crucial for making drug checking services widely accessible, safe, and effective.

An integrated and collaborative approach is essential to combat the overdose crisis effectively. This involves the cooperation of various stakeholders, including public health officials, law enforcement agencies, policymakers, and community organizations. Such collaboration can ensure the seamless operation of harm reduction services, enhance public safety, and foster a supportive environment for individuals who use drugs. The integration of SIFs with other harm reduction measures, such as drug checking services, can further amplify their impact and efficacy.

Integrating SIFs with other harm reduction strategies and ensuring collaboration with law enforcement can further enhance their effectiveness. The broader context of the illicit drug overdose crisis, particularly exacerbated by the presence of substances like fentanyl, demonstrates the urgent need for these interventions. Addressing these issues holistically and making structural changes can create a more supportive environment for individuals who use drugs, ultimately improving public health outcomes and reducing the burden on healthcare systems. A committed effort to implement evidence-based strategies that prioritize the health and dignity of all individuals is essential for fostering a safer and more inclusive society.

Work Cited

CCSA. Supervised Injection Facilities (SIFs) FAQs. 2005. Health Canada. “Supervised Consumption Sites: Guidance for Application Form - Canada.ca.” Canada.ca, 2019, www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/st atus-application.html.

Davis, S., Wallace, B., Van Roode, T., & Hore, D. (2022). Addressing the dual public health crises of COVID-19 and overdose among people who use drugs: Structural stigma and the need for social justice. Journal of Substance Use and Addiction Treatment, 132(2), 108627. https://doi.org/10.1016/j.jsat.2021.108627

Wood, Evan, et al. “Service Uptake and Characteristics of Injection Drug Users Utilizing North America’s First Medically Supervised Safer Injecting Facility.” American Journal of Public Health, vol. 96, no. 5, May 2006, pp. 770–773, https://doi.org/10.2105/ajph.2004.057828.