摘要：There have been concerns that safer injecting facilities may promote initiation into injection drug use. We examined length of injecting career and circumstances surrounding initiation into injection drug use among 1065 users of North America’s first safer injecting facility and found that the median years of injection drug use were 15.9 years, and that only 1 individual reported performing a first injection at the safer injecting facility. These findings indicate that the safer injecting facility’s benefits have not been offset by a rise in initiation into injection drug use. Medically supervised safer injection facilities, where injection drug users can inject preobtained illicit drugs, have been implemented in various cities to reduce the public health effects of illicit drug use. 1 Although evidence suggests that safer injecting facilities reduce overdose deaths, 2 HIV risk behavior, 3 and public disorder, 4 this intervention remains highly controversial, 5 – 7 largely because of concerns that the provision of a legal place to inject drugs may encourage initiation into injection drug use. 8 , 9 Preventing initiation into injection drug use is a key public health priority, 10 and it is noteworthy that fears regarding potential increased rates of injection drug use were among the reasons for the US federal ban on funding for needle exchange programs. 9 In the light of concerns regarding the potential of safer injecting facilities to promote initiation into injection drug use, 11 we examined length of injecting career and circumstances surrounding initiation into injection drug use among a cohort of users of a safer injecting facility in Vancouver, British Columbia. The Vancouver safer injecting facility—known as Insite—opened in September 2003 as part of a 3-year pilot study. The Scientific Evaluation of Supervised Injecting (SEOSI) cohort has been described previously. 12 In brief, the SEOSI participants were a representative sample of users of the Insite safer injecting facility derived through random recruitment at the Insite facility. During study visits, blood samples for HIV and hepatitis C virus testing were drawn and a questionnaire was administered to elicit demographic and other information, including drug use and HIV risk–associated behavior.
