Call to Action: Supervised Injection Facilities and Recommendations for Action

In response to the increasing incidence of hepatitis, HIV, and overdose death related to opioid and other drug use in America, NASTAD has evaluated evidence-based interventions intended to address these intersecting epidemics, including Supervised Injection Facilities. Today, we are releasing Call to Action: Supervised Injection Facilities and Supervised Injection Facilities: Recommendations for Action for governmental public health agencies in support of Supervised Injection Facilities.

As we are aware, America’s opioid epidemic continues to cause unprecedented overdose deaths and fuel increases in new cases of hepatitis B and C, and HIV. According to the CDC, in 2016 over 64,000 people died of accidental overdose and over 60% of new hepatitis C cases and approximately 10% of new HIV cases were related to injection drug use. From 2004-2014 there was a 400% increase in acute hepatitis C among 18-29-year olds that is correlated with dramatic increases in heroin and prescription opioid injection. Overall, among people who inject drugs, prevalence of HCV is estimated to be as high as 80%. Hepatitis B is also increasing as a result of the opioid epidemic. From 2006-2013 the number of new hepatitis B infections in three states (Kentucky, Tennessee, and West Virginia) increased among young PWID by 114%. In terms of the scale of the opioid crisis, recent numbers from SAMHSA indicate that in 2015, 11.8 million people misused prescription opiates or heroin and 2.4 million, or 20%, of those met diagnostic criteria for an opioid use disorder. This leaves millions of people actively using opioids and at risk of overdose and HIV and HCV transmission while not yet engaged in or ready for treatment.

As the nation grapples with how to effectively respond to these epidemics, NASTAD urges policymakers, public health and safety leaders, and impacted communities to embrace a comprehensive approach to end these intersecting epidemics. As one element of a comprehensive strategy, NASTAD supports Supervised Injection Facilities as an important, evidence-based, intervention. These programs operate with legal sanction in 11 countries and number well over 100 worldwide.

Supervised Injection Facilities have been shown to:

• Reduce hepatitis and HIV transmission risks for people who inject drugs
• Link participants to testing, infectious disease treatment, medication-assisted treatment, and physical and behavioral health services
• Reduce overdose death and occurrence
• Improve injection practices and decrease soft-tissue, blood infections, and associated hospital costs
• Decrease public injection and improperly discarded injection materials
• Not lead to increases in drug use, frequency of injection, or levels of drug-related crime in communities in which they operate

We recognize that stakeholders may have different roles in these efforts and health departments have their own unique role to play. Within these documents, we outline the evidence base for supervised injection facilities and potential avenues to support these lifesaving programs, including opportunities for engagement and education among various stakeholder groups.