Infectious Disease Advisor: What are your thoughts about the benefits and/or drawbacks of creating such spaces here in the United States, and what would be some of the main obstacles?

Dr Meisner: I think as infectious disease clinicians, one of the major benefits would be the ability to access this group of patients and provide them with better care in addition to connections for housing, resources, and behavioral health. This could provide quicker access to treatment centers and medication-assisted treatment. It would also reduce the transmission of HIV and hepatitis in the community. If done well, vaccines for influenza, hepatitis, or tetanus could be offered at SCS locations. I would also love to see treatment for hepatitis C virus (HCV) and HIV at these sites. If someone is coming every day to use, why can’t we cure their HCV while they are there? The spaces really represent opportunities for infectious disease clinicians to make a difference on a patient level and a public health level.

Many cities that have been the most significantly affected by the opioid epidemic see the need for such sites, but there a few obstacles. For example, one issue I’ve seen while attending some of the community meetings in Philadelphia is the “not in my backyard” attitude. People see the need for SCS, but they don’t want the site near their house or near a school, for example. The other big hurdle is that this would need to be implemented with an understanding by law enforcement both on the local and federal level. The site won’t be able to work if there is fear of police coming in to arrest individuals or if the employees are vulnerable as well. I think the local level will be easier because cities are really seeing problems first-hand. The federal level will be a bigger problem, similar to what we are seeing in states where marijuana has been legalized.

Infectious Disease Advisor: What should be next steps in working toward this goal, in terms of research or otherwise?

Dr Meisner: The next steps are really on the practical side. We don’t need more research before implementing SCSs, because we know they work and save lives and get people into treatment. The spaces should have a research component to study its effects, but we know it works. Funding and planning are needed: Will it be funded by local government? Donations? And the biggest hurdle to overcome is legality on the federal government level.

References

1. AIDS United. AIDS United and Project Inform release report on efforts to bring safer consumption spaces to U.S. https://www.aidsunited.org/News/Default.aspx?id=1208. November 28, 2018. Accessed December 31, 2018.

2. AIDS United and Project Inform. Bringing safer consumption spaces to the United States. https://www.aidsunited.org/data/files/Site_18/Resources/Bringing-Safer-Consumption-Spaces-to-the-United-States_Web.pdf. Accessed December 31, 2018.

3. Insite for Community Safety. http://www.communityinsite.ca. Accessed December 31, 2018.