Supervised injection site
Supervised injection sites or drug consumption rooms are a health and social response to drug-related problems. They are fixed or mobile spaces where people who use drugs are provided with sterile drug use equipment and can use illicit drugs under the supervision of trained staff. They are usually in areas where there is an open drug scene and where injecting in public places is common. The primary target group for DCR services are people who engage in risky drug use. The first drug consumption facility opened in Bern, Switzerland in 1986.
The geographical distribution of DCRs is uneven, both at the international and regional levels. In 2022, there were over 100 DCRs operating globally, with services in Belgium, Denmark, France, Germany, Greece, Luxembourg, the Netherlands, Norway, Portugal and Spain, as well as in Switzerland, Australia, Canada, Mexico and the USA.
Primarily, DCRs aim to prevent drug-related overdose deaths, reduce the acute risks of disease transmission through unhygienic injecting, and connect people who use drugs with addiction treatment and other health and social services. There have been no recorded deaths at any legal supervised injection site. They can also aim to minimise public nuisance.
Proponents say they save lives and connect users to services, while opponents believe they promote drug use and attract crime to the community around the site. Supervised injection sites are part of a harm reduction approach towards drug problems.
Terminology
Supervised injection sites are also known as overdose prevention centers , supervised injection facilities, safe consumption rooms, safe injection sites, safe injection rooms, fix rooms, fixing rooms, safer injection facilities , drug consumption facilities , drug consumption rooms , medically supervised injecting centres and medically supervised injecting rooms .Facilities
Australia
The legality of supervised injection is handled on a state-by state basis. New South Wales trialed a supervised injection site in Sydney in 2001, which was made permanent in 2010. After several years of community activism, Victoria agreed to open a supervised injection site in Melbourne's North Richmond neighbourhood in 2018 on a trial basis. In 2020 the trial was extended for a further three years, and the site remains open as of 2024.A second site for Melbourne's CBD was approved and was to be placed in a building on Flinders Street which had previously housed Yooralla. However, as of 2024, the site has been rejected by Premier Jacinta Allan who cited disagreements over location, preferring to set up a new community health and pharmacotherapy centre instead.
Europe
During the 1990s legal facilities emerged in cities in Switzerland, Germany and the Netherlands. In the first decade of 2000, facilities opened in Spain, Luxembourg, and Norway.Whereas injection facilities in Europe often evolved from something else, such as different social and medical outreaches or perhaps a homeless shelter, the degree and quality of actual supervision varies. The history of the European centers also mean that there have been no or little systematic collection of data needed to do a proper evaluation of effectiveness of the scheme. At the beginning of 2009 there were 92 facilities operating in 61 cities, including 30 cities in the Netherlands, 16 cities in Germany and 8 cities in Switzerland. Denmark passed a law allowing municipalities to run "fix rooms" in 2012, and by the end of 2013 there were three open.
To date in July 2022, according to European Monitoring Centre for Drugs and Drug Addiction Belgium has one facility, Denmark five, France two, Germany 25, Greece one, Luxembourg two, Netherlands 25, Norway two, Portugal two, Spain 13, and Switzerland 14.
Ireland
Ireland has legislation to permit the opening of a service in the Misuse of Drugs Bill 2017; however, it has been halted by planning concerns.Netherlands
The first professionally staffed service where drug injection was accepted emerged in the Netherlands during the early 1970s as part of the "alternative youth service" provided by the St. Paul's church in Rotterdam. At its peak it had two centers that combined an informal meeting place with a drop-in center providing basic health care, food and a laundering service. One of the centers was also a pioneer in providing needle-exchange. Its purpose was to improve the psychosocial function and health of its clients. The centers received some support from law enforcement and local government officials, although they were not officially sanctioned until 1996.Switzerland
The first modern supervised consumption site was opened in Bern, Switzerland in June 1986. Part of a project combatting HIV, the general concept of the café was a place where simple meals and beverages would be served, and information on safe sex, safe drug use, condoms and clean needles provided. Social workers providing counselling and referrals were also present. An injection room was not originally conceived, however, drug users began to use the facility for this purpose, and this soon became the most attractive aspect of the café. After discussions with the police and legislature, the café was turned into the first legally sanctioned drug consumption facility provided that no one under the age of 18 was admitted.United Kingdom
The United Kingdom opened one facility in Glasgow in September 2020. It was opened by, a local drugs worker; however, lack of funding and support led to its closure in May 2021. In nine months of operation, 894 injection events were recorded at the facility and volunteers reported attending to nine overdose events, seven opioid overdoses, and two involving powder cocaine; but there were no fatalities.In 2023, the Lord Advocate—Scotland's chief legal officer—announced that the Crown Office and Procurator Fiscal Service would institute a policy of not criminally prosecuting those using approved supervised drug consumption sites. Police Scotland have also confirmed they will exercise discretion in not prosecuting those using such a facility. An official facility, The Thistle, opened in Glasgow in January 2025.
Latin America
The first site opened in Latin American was in Bogota, Colombia during October 2024.North America
Canada
There are 39 government authorized SCS in Canada as of July 2019: 7 in Alberta, 9 in British Columbia, 19 in Ontario, and 4 in Quebec. An exemption to controlled substances law under Canadian Criminal Code is granted inside the facilities, but drug possession remains illegal outside the facility and there is no buffer zone around the facility. Canada's first SCS, Insite in Downtown Eastside of Vancouver, commenced operation in 2003.Alberta
In August 2020, ARCHES Lethbridge in Lethbridge, Alberta, the largest SCS in North America, closed shortly after Alberta revoked their grant for misuse of grant funds. Shortly after opening in February 2018, ARCHES Lethbridge found itself repetitively necessitating police intervention and/or emergency medical services for opioid-related issues; three weeks after its closure, the city noted a 36% decline in opioid-related EMS requests.The average per-capita operating cost of government sanctioned sites are reported to be CAD$600 per unique-client, with the exception of the ARCHES Lethbridge which had a disproportionately high cost of CAD $3,200 per unique client.
In September 2020, a group in Lethbridge, Alberta led by an ARCHES employee started hosting an unauthorized SCS in public places in a tent. The group did not have authorizations to operate an SCS or a permit to pitch a tent in the park. The organizer was issued citations for the tent; and the Lethbridge Police Service advised that users utilizing the unauthorized SCS would be arrested for drug possession because exemptions do not apply to unauthorized sites. This opening of this illegal drug consumption tent was controversial and became a subject of discussion at the City Council meeting.
Ontario
Ontario has scheduled to close ten drug SCS by end of March 2025 and further establishment of SCS has been banned.United States
Clandestine injection sites have existed for years. A New England Journal of Medicine study from July 2020 reports that an illegal supervised consumption site has been operating at an "undisclosed" city in the U.S. since 2014 where over 10,000 doses of illegal drugs have been injected over a five-year period. Supervised consumption sites with some degree of official sanction from a state or local government are rare due to the federal regulation of drugs and the explicit opposition of federal law enforcement to any form of decriminalization.Local governments in Seattle, Boston, Vermont, Delaware, and Portland, Oregon have considered opening safe injection sites as well. Plans to open an injection site in Somerville, Massachusetts in 2020 were delayed by the COVID-19 pandemic.
The governors of California and Vermont both vetoed supervised consumption site bills in 2022, and Pennsylvania's Senate voted for a ban on them in 2023.
Denver (2018)
In November, 2018, Denver city council approved a pilot program for a safe injection site with a 12-to-1 vote. The Drug Enforcement Administration's Denver field office and the United States Attorney's office for the District of Colorado issued a statement together on the proposed site stating that "the operation of such sites is illegal under federal law. 21 U.S.C. Sec. 856 prohibits the maintaining of any premises for the purpose of using any controlled substance."New York City (2021)
The first government-authorized supervised injection sites in the US began operating in New York City in November 2021.A peer-reviewed study of the first two months of the OPC's operation has been published in JAMA.
Public criticism of the New York City OPC's has so far been limited. One problem brought up by the leadership of the Metropolitan Transportation Authority is how use migrates from the centers to nearby New York City Subway stations when the OPC's are closed. In response Mayor Eric Adams called for the centers to be funded to operate continuously.
Though sanctioned by the city, the sites arguably remain illegal under federal law and rely on non-enforcement by federal officials to keep operating. The United States Department of Justice, during the Presidency of Joe Biden, signaled some openness and stated that it is "evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety".