title: Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States.
abstract: BACKGROUND
  Safer injection facilities (SIFs) reduce risks associated with injecting drugs, particularly public injection and overdose mortality. They exist in many countries, but do not exist in the United States. We assessed several ethical, operational, and public health considerations for establishing SIFs in the United States.
  
  
  METHODS
  We used the six-factor Kass framework (goals, effectiveness, concerns, minimization of concerns, fair implementation, and balancing of benefits and concerns), summarized needs of persons who inject drugs in the United States, and reviewed global evidence for SIFs.
  
  
  RESULTS
  SIFs offer a hygienic environment to inject drugs, provide sterile injection equipment at time of injection, and allow for safe disposal of used equipment. Injection of pre-obtained drugs, purchased by persons who inject drugs, happens in a facility where trained personnel provide on-site counseling and referral to addiction treatment and health care and intervene in overdose emergency situations. SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality) without evidence for negative health or social consequences. SIFs serve most-at-risk persons, including those who inject in public or inject frequently, and those who do not use other public health programs. It is critical to address legal, ethical, and local concerns, develop and implement relevant policies and procedures, and assess individual- and community-level needs and benefits of SIFs given local epidemiologic data.
  
  
  CONCLUSIONS
  SIFs have the potential to reduce viral and bacterial infections and overdose mortality among those who engage in high-risk injection behaviors by offering unique public health services that are complementary to other interventions.
authors.affiliation: Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, GA 30322, USA. ssemaan@emory.edu
authors.forename: Salaam
authors.initials: S
authors.lastname: Semaan
authors.forename: Paul
authors.initials: P
authors.lastname: Fleming
authors.forename: Caitlin
authors.initials: C
authors.lastname: Worrell
authors.forename: Haley
authors.initials: H
authors.lastname: Stolp
authors.forename: Brittney
authors.initials: B
authors.lastname: Baack
authors.forename: Meghan
authors.initials: M
authors.lastname: Miller
mesh_terms: D062787:Drug Overdose / Q000401:mortality / Q000517:prevention & control*; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control*; D040261:Harm Reduction; D006526:Hepatitis C / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007267:Injections; D011634:Public Health; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014481:United States