America should embrace use of Safe Injection Centers

America should embrace use of Safe Injection Centers. Supervised injection facilities (SIFs) are clean indoor environments where people can consume pre-obtained drugs with trained health professionals present to ensure safe injection methods, respond in the event of an overdose, and provide counseling and referrals to vital social services and treatment options. More than 100 facilities with formal legal sanction operate in ten countries, although no such facility legally exists in the United States.

Safe injection facilities (SIFs) have shown promise in reducing harms and social costs associated with injection drug use. Favorable evaluations elsewhere have raised the issue of their implementation in the United States.

Safe Injection Centers

Recognizing that laws shape health interventions targeting drug users, we analyzed the legal environment for publicly authorized SIFs in the United States. Although states and some municipalities have the power to authorize SIFs under state law, federal authorities could still interfere with these facilities under the Controlled Substances Act. A state- or locally-authorized SIF could proceed free of legal uncertainty only if federal authorities explicitly authorized it or decided not to interfere.

In the past decade, heroin use by young adults has more than doubled in the United States (Centers for Disease Control and Prevention [CDC], 2015c). Heroin overdose deaths rose almost 250 percent from 2010 to 2014, reaching 29 overdoses per day in 2014 (CDC, 2015a). Because many people inject heroin with shared needles and in unsterilized environments, the heroin epidemic also causes immense infection-related medical costs (Sterling, 2015).


The purpose of this article is to analyze the potential cost-effectiveness of establishing the first SIF in the United States, in San Francisco. There is substantial interest in establishing a SIF in San Francisco, among both people who use drugs and health officials (Kral et al., 2010; “San Francisco Hepatitis C Task Force,” 2011; Wenger, Arreola, & Kral, 2011; Wenger et al., 2011). While SIFs and other service programs should never be judged solely on their financial performance, cost-benefit analysis provides one important perspective on SIF impact. We intend to answer the question: Would a SIF in San Francisco be an effective and efficient use of financial resources?

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