Supervised Injection Sites: Pros and Cons

Supervised injection sites offer intravenous drug users sanitized needles to inject illicit drugs already in their possession. The goal, in part, is to reduce HIV transmission resulting from needle sharing. What are some pros and cons of these facilities?

According to CDC estimates, approximately 63 out of every 10,000 exposures to needle sharing during injection drug use results in HIV transmission, making it one of the leading HIV risk behaviors.1 Supervised injection sites are designed in part to reduce the frequency of drug users sharing needles.

Also known as safe injection sites and overdose prevention centers, these facilities offer intravenous drug users a space to inject illicit drugs already in their possession using sanitized needles. There is some evidence that these sites help reduce HIV transmission.2

Advocates for supervised injection sites also point to opioid overdose prevention as a primary benefit. These facilities have trained medical staff on hand ready to administer naloxone in the event of an overdose.

In total, there are approximately 100 overdose prevention centers in operation worldwide, but none located in the United States.3 However, a number of US cities are seeking to open facilities, including Seattle, San Francisco, Philadelphia, and New York.4 To do so, they will have to overcome numerous hurdles.

For one, the federal government has promised swift and aggressive legal action against anyone opening a safe injection facility. US Deputy Attorney General Rod Rosenstein, while understanding of the need to find ways to reduce the rate of overdose fatalities, warns that providing locations for people to inject illicit drugs is a violation of federal law.4

For another, public opinion of these facilities is not favorable. In a 2018 survey conducted by the Johns Hopkins Bloomberg School of Public Health, just 29% of Americans expressed support for opening supervised injection sites in their community.5

In addition, numerous politicians have come out against the idea. Just recently, California Governor Jerry Brown vetoed what would have been the first pilot program for a supervised injection site in the United States.6

Suffice it to say, the future of supervised injection sites in the United States is unclear. While there are data to suggest these facilities are associated with a decrease in HIV infections, critics argue that they do more harm than good by discouraging treatment and impeding the effort to curb illicit drug use.

Regardless of what happens moving forward, we’re interested in what you have to say: do you think supervised injection sites should be legalized in the United States? Participate in our survey and leave a comment below.


  1. HIV Risk Behaviors. Centers for Disease Control and Prevention. Reviewed December 4, 2015. Accessed October 15, 2018.
  2. Ng J, Sutherland C, Kolber MR. Does evidence support supervised injection sites? Can Fam Physician. 2017;63(11):866.
  3. Supervised injection facilities. Drug Policy Alliance. February 2016. Accessed October 15, 2018.
  4. Allyn B. Justice Department promises crackdown on supervised injection facilities. NPR. August 30, 2018. Accessed October 15, 2018.
  5. Public support for needle exchange programs, safe injection sites remains low in US. Johns Hopkins Bloomberg School of Public Health. June 5, 2018. Accessed October 15, 2018.
  6. California’s Jerry Brown rejects supervised drug injection plan. CBS News. October 1, 2018. Accessed October 15, 2018.