Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study.

PROBLEM Illicit use of injected drugs is linked with high rates of HIV infection and fatal overdose, as well as community concerns about public drug use. Supervised injecting facilities have been proposed as a potential solution, but fears have been raised that they might encourage drug use. DESIGN A before and after study. Participants and setting 871 injecting drug users recruited from the community in Vancouver, Canada. KEY MEASURES FOR IMPROVEMENT Rates of relapse into injected drug use among former users and of stopping drug use among current users. STRATEGIES FOR CHANGE Local health authorities established the Vancouver supervised injecting facility to provide injecting drug users with sterile injecting equipment, intervention in the event of overdose, primary health care, and referral to external health and social services. EFFECTS OF CHANGE Analysis of periods before and after the facility's opening showed no substantial increase in the rate of relapse into injected drug use (17% v 20%) and no substantial decrease in the rate of stopping injected drug use (17% v 15%). LESSONS LEARNT Recently reported benefits of supervised injecting facilities on drug users' high risk behaviours and on public order do not seem to have been offset by negative community impacts.