Nazorat ostida in'ektsiya joyi - Supervised injection site

Strasburgdagi nazorat ostidagi in'ektsiya joyida dori quyish uchun kubiklar.

Nazorat ostida ukol joylari (SIS)[1] giyohvandlar qodir bo'lgan gigienik muhitni ta'minlash uchun mo'ljallangan tibbiy nazorat ostidagi muassasalar vena ichiga noqonuniy ko'ngil ochish preparatlarini iste'mol qilish.[2] Bunday ob'ektning qonuniyligi joylashuvi va siyosiy yurisdiksiyasiga bog'liq. Nazorat ostidagi in'ektsiya joylari a qismidir zararni kamaytirish giyohvand moddalar bilan bog'liq muammolarga yondashish. Ushbu muassasalarda steril in'ektsiya uskunalari, dorilar va asosiy tibbiy yordam to'g'risida ma'lumotlar, davolanishga yo'nalishlar, tibbiyot xodimlariga murojaat qilish va ba'zi muassasalarda maslahat berish mumkin. Ko'pgina dasturlar ushbu muassasada dam olish uchun dori vositalarini sotish yoki sotib olishni taqiqlaydi.[iqtibos kerak ]

Terminologiya

Ular, shuningdek, sifatida tanilgan dozani oshirib yuborishning oldini olish markazlari (OPC)[3],nazorat ostidagi in'ektsiya vositalari,[4] xavfsiz in'ektsiya joylari[1] xonalarni tuzatish,[5] xavfsizroq qarshi inshootlari (SIF), giyohvand moddalarni iste'mol qilish vositalari (DCF)[2]

Imkoniyatlar

Avstraliya

"Otish galereyalari" ("tortishish" atamasi giyohvand moddalarni kiritish uchun jargon) uzoq vaqtdan beri mavjud bo'lib kelgan; ichida noqonuniy foyda olish ob'ektlari mavjud edi Sidney, Avstraliya 1990 yillar davomida. Mualliflar Avstraliyadagi qonuniy ravishda sanktsiyalangan saytlarni ular ko'rsatadigan parvarishdagi misollardan farq qildilar. Sidneyda namuna bo'lgan tortishish galereyalari operatorlari o'z mijozlarining sog'lig'iga unchalik ahamiyat bermagan bo'lsalar-da, zamonaviy nazorat ostida in'ektsiya inshootlari professionallar bilan ta'minlangan sog'liqni saqlash va ijtimoiy xizmatdir.[6] Xuddi shu jurnalda Avstraliyaning kontekstidagi bir xil ob'ektni "umuman" deb ta'riflash mumkin, "giyohvand moddalarni noqonuniy iste'mol qilish bilan bog'liq sog'liqni saqlash va jamoat tartibini kamaytirishga qaratilgan qonuniy ravishda sanktsiyalangan va nazorat ostidagi muassasalar".[6]

Nazorat ostidagi in'ektsiyaning qonuniyligi davlat asosida amalga oshiriladi. Yangi Janubiy Uels nazorat ostidagi in'ektsiya joyini sinovdan o'tkazdi Sidney 2010 yilda doimiy ravishda ishlab chiqarilgan 2001 yilda.[7] Viktoriya da nazorat ostida in'ektsiya joyini ochdi Melburn 2018 yilda sinov asosida; 2020 yilda sinov muddati yana uch yilga uzaytirildi va ikkinchi sayt tasdiqlandi.[8]

Evropa

Giyohvand moddalarni in'ektsiyasini qabul qilgan birinchi professional xodimlar xizmati Rotterdamdagi Avliyo Pol cherkovi tomonidan taqdim etilgan "muqobil yoshlar xizmati" tarkibida 1970-yillarning boshlarida Gollandiyada paydo bo'lgan. Uning eng yuqori cho'qqisida u norasmiy uchrashuv joyini asosiy tibbiy yordam, oziq-ovqat va yuvinish xizmatini ko'rsatadigan tushirish markazi bilan birlashtirgan ikkita markazga ega edi. Markazlardan biri ham ta'minot sohasida kashshof bo'lgan igna almashtirish. Uning maqsadi mijozlarning psixosial funktsiyalari va sog'lig'ini yaxshilash edi. Markazlar huquqni muhofaza qilish idoralari va mahalliy hokimiyat idoralari xodimlaridan biroz qo'llab-quvvatladilar, garchi ularga 1996 yilgacha rasmiy sanktsiya berilmagan.[6]

Birinchi zamonaviy iste'mol qilinadigan sayt ochildi Bern e, Shveytsariya, 1986 yil iyun oyida.[9] OIV-ga qarshi kurash loyihasining bir qismi bo'lib, kafening umumiy kontseptsiyasi oddiy ovqatlar va ichimliklar beriladigan joy, xavfsiz jinsiy aloqa, xavfsiz giyohvand moddalar, prezervativ va toza ignalar haqida ma'lumot berishdan iborat edi. Shuningdek, maslahat va murojaatlarni beradigan ijtimoiy xodimlar ham ishtirok etishdi. Dastlab ukol xonasi o'ylab topilmagan, ammo giyohvand moddalar ushbu maqsad uchun ushbu muassasadan foydalanishni boshladilar va bu tez orada kafening eng jozibali tomoniga aylandi. Politsiya va qonun chiqaruvchi organlar bilan muzokaralardan so'ng kafe 18 yoshga to'lmaganlar qabul qilinmasligi sharti bilan qonuniy ravishda sanksiya qilingan birinchi giyohvand moddalarni iste'mol qilish joyiga aylantirildi.[10]

1990-yillar davomida Shveytsariya, Germaniya va Gollandiyaning boshqa shaharlarida qo'shimcha huquqiy vositalar paydo bo'ldi.[2][6] 2000 yilning birinchi o'n yilligida binolar Ispaniya, Lyuksemburg va Norvegiyada ochildi.[2] Politsiya korrupsiyasi va Kings Cross tumani Sidney, so'radi Yog'och qirollik komissiyasi hududda in'ektsiya inshootini ochishni tavsiya etish,[11] bilan Sidney tibbiy nazorat ostida bo'lgan in'ektsiya markazi (MSIC) 2001 yil may oyida ochilgan.[12]

Nalokson, hollarda qo'llaniladigan klinikalarda qo'llaniladigan dori opioidning haddan tashqari dozasi.

Evropada in'ektsiya inshootlari ko'pincha boshqa narsadan, masalan, turli xil ijtimoiy va tibbiy yordamlar yoki ehtimol uysizlar uchun boshpana evolyutsiyasi bilan rivojlangan bo'lsa, haqiqiy nazorat darajasi va sifati turlicha. Evropa markazlari tarixi shuni anglatadiki, sxema samaradorligini to'g'ri baholash uchun zarur bo'lgan tizimli ma'lumotlar yig'ilmagan yoki kam bo'lgan.[2]

2009 yil boshida 61 ta shaharda 92 ta korxona faoliyat yuritgan, shu jumladan Niderlandiyaning 30 ta shahri, Germaniyaning 16 ta shahri va Shveytsariyaning 8 ta shahri.[2] Daniya 2012 yilda munitsipalitetlarga "tuzatish xonalari" ni boshqarishga ruxsat beruvchi qonun qabul qildi va 2013 yil oxiriga kelib uchta ochiq bo'ldi.[5] Biroq, Sidney va Vankuverdagi loyihalarning ba'zi bir asoslari, xususan, ma'lumotlar yig'ishdir, chunki ular ilmiy tajriba loyihalari sifatida yaratilgan. Markazlardagi yondashuv ko'proq klinik xususiyatga ega, chunki ular boshqarish uchun jihozlangan va o'qitilgan xodimlar tomonidan nazorat qilinadi kislorod yoki nalokson holda a geroin yoki boshqa opioid dozani oshirib yuborish.[12]

Shimoliy Amerika

Kanada

Kanadada 2019 yil iyul holatiga ko'ra 39 ta davlat tomonidan vakolatli SCS mavjud. 19 yilda Ontario, 9 dyuym Britaniya Kolumbiyasi, 7 dyuym Alberta va 4 dyuym Kvebek[13] Ostida nazorat ostida moddalar qonun ozod Kanada Jinoyat kodeksi inshootlar ichida beriladi, ammo giyohvand moddalarni saqlash muassasa tashqarisida noqonuniy bo'lib qoladi va ob'ekt atrofida bufer zonasi yo'q.[13] Kanadaning birinchi SCS, Insite yilda Eastside shaharchasi ning Vankuver, 2003 yilda ish boshlagan.[12] 2020 yil avgust oyida Shimoliy Amerikadagi eng yirik SCS ARCHES Letbridj joylashgan Letbridj, Alberta viloyat grant mablag'larini noto'g'ri ishlatganligi uchun o'zlarining grantlarini bekor qilganidan ko'p o'tmay yopildi.[14] U 2018 yil fevral oyidan beri ochiq edi[15] va ochilgandan so'ng, u politsiya xizmatiga va opioid bilan bog'liq EMS qo'ng'iroqlariga yaqin atrofda qo'ng'iroqlarni keltirib chiqara boshladi.[16] Yopilgandan uch hafta o'tgach, shahar opioid bilan bog'liq so'rovlarning 36 foizga pasayganligini allaqachon sezgan shoshilinch tibbiy xizmat.[17]

Xarajatlar

Ma'lumotlarga ko'ra, hukumat tomonidan tasdiqlangan saytlarning jon boshiga o'rtacha operatsion qiymati bitta mijoz uchun 600 SAPR dollarni tashkil etadi; ARCHES Letbridjdan tashqari, har bir mijoz uchun nomutanosib ravishda yuqori SAPR narxi 3200 AQSh dollarini tashkil etdi.[16]

Alberta shahridagi ruxsatsiz sayt

2020 yil sentyabr oyida bir guruh Letbridj, Alberta ARCHES xodimi boshchiligida chodirda jamoat joylarida ruxsatsiz SCS joylashtirila boshladi.[18][19] Guruhda SCSni boshqarish huquqi yoki parkda chodir tikish uchun ruxsat yo'q edi. Tashkilotchiga chodir uchun iqtiboslar berildi; va Letbrid politsiya xizmati ruxsatsiz SCS-dan foydalanadigan foydalanuvchilar giyohvand moddalar saqlanganligi uchun hibsga olinishini maslahat berdi, chunki imtiyozlar ruxsatsiz saytlarga taalluqli emas.[20][21][22] Ushbu noqonuniy giyohvand moddalarni iste'mol qilish chodirining ochilishi munozarali bo'lib, shahar Kengashi yig'ilishida muhokama mavzusiga aylandi.[23][24]

Qo'shma Shtatlar

2020 yil iyul oyidan boshlab, Qo'shma Shtatlarda sanktsiyalangan SCS mavjud emas.[25] New England Journal of Medicine nashri 2020 yil iyulidan noqonuniy SCS 2014 yildan beri AQShdagi "oshkor etilmagan" shaharda faoliyat yuritib kelayotgani, bu erda besh yil davomida 10 mingdan ortiq dozada noqonuniy giyohvand moddalar yuborilganligi haqida xabar beradi.[26]

Yashirin in'ektsiya joylari bir necha yillardan beri mavjud. Ichida noqonuniy foyda keltiradigan ob'ektlar mavjud edi Nyu-York shahri 1980 yillar davomida.[iqtibos kerak ] Qo'shma Shtatlardagi birinchi vakolatli xavfsiz in'ektsiya joyi ochilishi rejalashtirilgan edi Filadelfiya 2020 yil fevral, ammo yaqin qo'shnilar tomonidan qattiq qarshilikka uchradi.[27] Jamiyat a'zolari bino egasidan Safespace-ni ijaraga berish taklifini qaytarib olishlari orqali o'z mahallalarida SCS tashkil etilishini muvaffaqiyatli to'sib qo'yishdi.[28][29] San-Frantsisko, Nyu-York, Sietl, Denver, Portlend va Boston kabi bir qancha joylar ularni ochishni ham o'ylashdi. "Safer Spaces Portland" ning advokatlik bo'yicha direktori Sam Chapman, uning manfaati asosan "tashqarida yashovchi" giyohvandlar uchun giyohvand moddalarni sinovdan o'tkazishni ta'minlashdir. Portlend biznes jurnali u davlat mablag'larini izlamayapti va u "biz xususiy mablag'ni topa olishimizga aminman", lekin "bu qaerdan kelib chiqishini oshkor qilish erkinligim yo'q" dedi.[30] Amerika Qo'shma Shtatlari Adliya vazirligi Filadelfiyadagi "Safehouse" notijorat tashkilotiga qarshi ochilishining oldini olish uchun 2019 yil fevral oyida fuqarolik da'vo arizasi bergan edi.[31] Notijorat Safehouse AQSh hukumatiga qarshi da'vo arizasi bilan murojaat qilib, uning taklif qilinayotgan faoliyati "noqonuniy giyohvand moddalar uyasi emas, balki qonuniy tibbiy aralashuv", shuningdek ularning "diniy e'tiqodlari ularni o'ta xavfli dozani oshirib yuborish asosida hayotni saqlab qolishga majbur qilmoqda" mamlakatdagi inqirozlar. " Gazeta, giyohvand moddalar to'g'risidagi qonunlarni aylanib o'tishga qaratilgan diniy e'tiqodlarga asoslanib, "zararni kamaytirish doiralari" da uchramaganligini izohladi va Meynda igna almashinuvini qonuniylashtirish uchun "Xavfsiz in'ektsiya cherkovi" ni ochgan odamning misolini keltirdi.[32]

2018 yil noyabr oyida, Denver shahar kengashi 12 dan 1 gacha ovoz bilan xavfsiz in'ektsiya joyi uchun sinov dasturini tasdiqladi. The Giyohvandlikka qarshi kurash boshqarmasi ning Denver dala ofisi va Amerika Qo'shma Shtatlarining advokati Kolorado tumani uchun ofis taklif qilingan saytda birgalikda bayonot chiqardi[33] "bunday saytlarning faoliyati federal qonunchilikka muvofiq noqonuniy hisoblanadi. AQShning 21-sek. 856-moddasi har qanday nazorat ostidagi moddadan foydalanish maqsadida binolarni saqlashni taqiqlaydi".

Filadelfiya, Pensilvaniya (taklif qilingan)

Filadelfiya shahri shahar ichida saytlar ochishni o'ylamoqda. 2018 yil 23 yanvarda Filadelfiya jamoat salomatligi bo'yicha komissari doktor Tomas Farli shaharning shaharda bir yoki bir nechtasini tashkil etishini xohlashini e'lon qildi. U keltirdi Vankuver, haddan tashqari dozada o'lim holatlari, shu kabi kasalliklar tarqalishi kamaygan OIV va gepatit C.[34] Uning fikriga ko'ra, ushbu xavfsiz in'ektsiya joylari hayotni saqlab qolishi mumkin.[35]

Shaharning boshqa rasmiylari boshqacha fikrda. Filadelfiya politsiyasi komissari Richard Ross jamoatchilik oldida bu g'oyaga "mutlaqo qarshi" ekanligini, ammo ochiq fikr va ko'plab savollarga ega ekanligini bildirdi. Filadelfiya meri Jim Kenni shuningdek, ushbu tavsiyani qo'llab-quvvatlashini aytdi. Pensilvaniya shtati Bosh prokurori Josh Shapiro ushbu saytlar davolanishning samarali yo'li ekaniga qo'shilmaydi va bunday saytlarning qonuniy ishlashi uchun shtat va federal qonunlarda o'zgartirishlar kiritish zarurligini ta'kidlaydi.[36][37]

Pensilvaniyada joylashgan Safehouse notijorat tashkiloti Amerikaning Filadelfiyadagi birinchi xavfsiz in'ektsiya maydonini haddan tashqari dozani oldini olish vositasi sifatida ochishga umid qilmoqda. Bunga javoban AQShning Filadelfiya bo'yicha prokurori Uilyam MakSveynning aytishicha, garchi Safehouse yaxshi niyatlarda bo'lsa ham, xavfsiz ukol joyini ochish juda uzoqqa cho'zilishi mumkin.[35] McSwain, bu faqat giyohvand moddalarni iste'mol qilishni normallashtiradi deb ta'kidlaydi va bu opioid inqirozini hal qilishga yordam bermaydi deb hisoblaydi. McSwain va Tramp ma'muriyati Safehouse-ni 2019 yil fevral oyida sudga berishga qaror qilgandan so'ng, Safehouse hukumatga qarshi da'vo qilish uchun o'ziga tegishli advokatlarni yolladi. Trump ma'muriyati Boshqariladigan moddalar to'g'risidagi qonun unda "boshqariladigan moddani noqonuniy ravishda ishlatish maqsadida tovon puliga qaramasdan har qanday joyni boshqarish [boshqarish] yoki boshqarish [ling]" noqonuniy hisoblanadi. Safehouse va uning vakillari ushbu qonunda xavfsiz in'ektsiya qilinadigan joy aholining sog'lig'i uchun va hayotni saqlab qolish uchun mo'ljallanganligi inobatga olinmaydi.[38] Safehouse-ning asosiy dalillaridan biri shundaki, ushbu xavfsiz in'ektsiya joylarini tashkil etishni oldini olish Safehouse direktorlar kengashining yahudiy-xristianlarning "hayotni saqlab qolish" idealini ta'kidlaydigan o'z dinlarini erkin tutish huquqiga ziddir.[35]

Baholash

1990-yillarning oxirida Germaniya, Shveytsariya va Gollandiyadagi iste'mol xonalarida bir qator tadqiqotlar mavjud edi. "Sharhlar xonalar jamoat va mijozlarning sog'lig'ini yaxshilashga va jamoat bezovtaligini kamaytirishga hissa qo'shgan degan xulosaga keldi, ammo dalillarning cheklanganligini ta'kidladi va bunday xizmatlarning ta'sirini yanada kengroq baholashni o'rganishga chaqirdi."[39] Shu maqsadda, Evropaga tegishli bo'lmagan ikkita ukol inshooti, ​​Avstraliyaning Sidney tibbiy nazorati ostida bo'lgan in'ektsiya markazi (MSIC) va Kanadaning Vankuver Insite nazorati ostida in'ektsiya saytida ishlash vakolatining bir qismi sifatida yanada qat'iy tadqiqot loyihalari mavjud.[40]

NSW hukumati Sidney MSIC-ni doimiy ravishda baholash uchun katta mablag 'ajratdi, 2003 yilda, markaz ochilgandan 18 oy o'tgach, rasmiy kompleks baholash bilan ta'minlandi. Boshqa keyingi baholashlar operatsiyaning turli jihatlarini o'rganib chiqdi - xizmat ko'rsatish (2005), jamoatchilikning munosabati (2006), murojaat va mijozlarning sog'lig'i (2007) va to'rtinchi (2007) xizmat operatsiyasi va dozani oshirib yuborish bilan bog'liq hodisalar.[41] Ushbu sohada giyohvand moddalar bilan bog'liq jinoyatchilikni boshqa baholash 2006, 2008 va 2010 yillarda, SAHA International iqtisodiy samaradorligini baholash 2008 yilda va yakuniy mustaqil KPMG baholash 2010 yilda yakunlandi.

The Vankuver Insite muassasasi faoliyatining dastlabki uch yilida BC va OIV / OITS bo'yicha mukammallikni o'rganish markazi tadqiqotchilari tomonidan nashr etilgan va nashr qilinmagan ba'zi ma'ruzalar bilan baholandi. 2008 yil mart oyida Vankuver Insite dasturining belgilangan maqsadlariga muvofiq ishlashini baholagan yakuniy hisobot e'lon qilindi.

Mijozning xususiyatlari va ulardan foydalanish

Sidney MSIC-ning 2010 yildagi KPMG bahosi uning maqsadli aholi bilan xizmat aloqalarini o'rnatganligini aniqladi,[42] 2001 yil maydan 2010 yil aprelgacha bo'lgan davrda Markazga 12050 nafar tashrif buyuruvchilar bilan jami 604.022 ta in'ektsiya o'tkazildi, bu erda mijozlar o'rtacha 14 yillik giyohvand moddalarni iste'mol qilishgan va turli yillarda 39-51% geroin ukol qilishgan.[43] va 2007 yilda 35% ilgari haddan tashqari dozani boshdan kechirgan.[44]

Drug Free Australia 2010 tahlillari shuni ko'rsatdiki, yiliga 98 martadan ko'proq tashrif buyurgan 7% mijozlar hanuzgacha 80% vaqtni markazdan tashqarida ukol qilishgan, yiliga 10-98 marta tashrif buyurgan 26% esa 95 ta ukol qilishgan. Ko'chada, mashinada, hojatxonada, uyda yoki boshqa birovning uyida bo'lgan vaqt%.[45] In'ektsionerlar xavfsizligini in'ektsiya xonalarini tashkil etishning eng muhim mantiqiy asoslari bilan tahlil qilish xonaning kuniga 330 ta in'ektsiya qilish imkoniyatlarini hisobga olgan holda bunday past foydalanish stavkalarini shubha ostiga qo'ydi,[46] ammo 2001 yildan 2010 yilgacha kuniga o'rtacha 185 ta in'ektsiya qilingan.[45]

Insite bo'yicha ekspert maslahat qo'mitasi[47] uning muassasasiga tashrif buyurgan 8000 kishining so'zlarini keltirdi, ularning 18% barcha tashriflarning 80% ini tashkil qiladi, 10% dan kamrog'i saytni barcha in'ektsiya uchun ishlatadi, o'rtacha mijozlarning 8 ta tashrifi va kuniga 600 ta tashrif buyuradi. 80% in'ektsiya qilish kerak edi, bu esa ob'ektning quvvatiga yaqinligini ko'rsatdi. Drug Free Australia shuni ta'kidladiki, markazni eng ko'p ishlatadigan 1506 injektor uchun har kuni bir joyga 6000 dan 9000 martagacha in'ektsiya o'tkazadigan bo'lsa, Insite ichidagi 500 dan kam in'ektsiya har 12 ta eng yaxshi utilizatorlar tomonidan har birida eng yaxshi bitta in'ektsiyani anglatadi. muassasa.

Taxminan 1000 foydalanuvchini olib borgan ikkita so'rovnomada ba'zi bir asosiy foydalanuvchi xususiyatlari aniqlandi - mijozlar o'rtacha 15 yillik giyohvand moddalarni iste'mol qilishgan, 51% geroin va 32% kokain AOK qilingan, 87% Gepatit C virusi va 17% OIV bilan kasallangan, 20% boshqalar bilan uysiz bo'lgan. bitta xonada yashovchilar, 80% qamoqqa olingan, 21% metadon ishlatgan va 59% hayot davomida o'limga olib kelmaydigan haddan tashqari dozani bildirgan.

Evropada iste'mol xonalari 30 yoshdan katta foydalanuvchilarga ko'proq mos keladi, asosan geroin va kokain odatlari muammoli. Turli tadqiqotlar, mijozlarning vaqt o'tishi bilan keksayib borayotganligini hujjatlashtirdi. 1990 yilda bitta tadqiqotda mijozlarning 50% 25 yosh va undan kichik bo'lgan bo'lsa, 2001 yilga kelib ularning ulushi 15% ni tashkil etdi. Evropaning iste'mol xonalari mijozlari giyohvand moddalarni in'ektsion ravishda iste'mol qilish, noqonuniy giyohvand moddalarni doimiy ravishda ishlatish va demografik jihatdan yomonroq bo'lish bilan ajralib turadi. Nemis tadqiqotlari shuni ko'rsatdiki, mijozlarning 19% dan 27% gacha beqaror turar joydan bo'lganlar. Madrid yaqinidagi ukol xonalarida marginal maqsadli guruhning 42% uysiz edi, bu raqam Barselonaning Can Tunis zonasi uchun 60% ni tashkil etdi. Nemis tadqiqotida mijozlarning 15% hech qachon giyohvandlikning har qanday davolash usulidan foydalanmagan.[48]

Evropa sharoitida mijozlardan foydalanishni tahlil qilish qiyinroq. Frankfurt va Tsyurixdagi saytlarda olib borilgan tadqiqotlar shuni ko'rsatdiki, mijozlar haftada 5 marotaba ob'ektlardan foydalanishgan[49] Rotterdamda haftasiga 6 marta va avvalgi 24 soat ichida ikki marta.[50] 1997 yilda Frankfurtdagi mijozlarni o'rganish shuni ko'rsatdiki, 63% o'zlarini kunlik tashrif buyuruvchilar deb da'vo qilishgan, boshqa bir so'rovda Germaniyaning 18 ta iste'mol xonasidan olingan tasodifiy bo'lmagan tanlovda, 84% kamida haftada bir marta ushbu muassasadan foydalanishni da'vo qilishgan, 51% esa kamida kuniga bir marta foydalanish.[51]

Mijozning yo'nalishi

Sidney MSIC-ning baholovchilari sakkiz yil davomida xodimlar 47396 ta boshqa xizmatni ko'rsatdilar (har 1000 tashrif buyurish uchun 94,6), shu jumladan 7856 marta giyohvandlik va alkogolni davolash bo'yicha maslahatlar berishdi, 22 531 ta holatlarda tomirlarni parvarish qilish va xavfsizroq in'ektsiya bo'yicha maslahatlar berildi. jami 8508 ta boshqa xizmatlarga yuborilganlar, bulardan 3871 nafari davolanishga yo'naltirilgan.[52] 1292 ta davolanishga yuborilgan 3871 ta murojaat detoksikatsiya va 434 nafari abstinentsiyaga asoslangan reabilitatsiya yoki terapiyaga yuborilgan.[53] Baholovchilar MSIC shu bilan davolanish uchun eshik sifatida tasdiqlanganligini ta'kidladilar.[54]

Drug Free Australia MSIC-ni davolanishga yo'naltirish stavkalarini g'ayritabiiy va asossiz past deb qattiq tanqid qildi. Ularning ta'kidlashicha, 2010 yilgi MSIC bahosi giyohvand davolanishga murojaat qilgan mijozlar foizini bermaydi, ammo 2007 yilgi baholashda 6 yoshdan oshgan mijozlarning atigi 11 foizi davolanishga murojaat qilgan. Ular, shuningdek, 2010 yildagi baholashning chekishni to'xtatish bo'yicha o'tkazilgan so'rovlariga asoslanishadi, bu shuni ko'rsatadiki, barcha tamaki chekuvchilarning 20%, odatdagidek giyohvand moddalarni iste'mol qiladigan narsalardan foydalangan holda, har qanday vaqtda istalgan vaqtda voz kechishga tayyor. Shu bilan bir qatorda, MSIC o'z mijozlariga bir vaqtning o'zida emas, balki ko'p yillar davomida doimiy ravishda yordam berish imkoniyatiga ega bo'ldi.[55]

Ekspert maslahat qo'mitasi, Insite mijozlarga detoksifikatsiya xizmatlaridan foydalanishni ko'payishiga va davolanish bilan bog'liqligini oshirishga yordam bergan deb murojaat qilganligini aniqladi. Insite foydalanuvchilarni maslahat olishga undagan. Kanada hukumati tomonidan Insite ustidagi zararsizlantirish xonalari uchun mablag 'ajratilgan.[56]

SIS saytlari va ijtimoiy tartibsizlik

Uzunlamasına tadqiqot - Urban Social Issue Study (USIS) - 2018 yil yanvar va 2019 yil fevral oylaridan boshlab o'tkazilgan. Letbridj universiteti professor Em M. Pijl va tomonidan topshirilgan Letbridj shahri, Alberta, Kanada "atrofdagi hamjamiyat" tarkibidagi nazorat qilinadigan iste'mol xizmatlarining (SCS) "kutilmagan oqibatlarini" o'rganadi.[15]:16 USIS tadqiqotlari Letbridjdagi "ko'plab mahallalarga turli xil ta'sir ko'rsatgan" giyohvandlik inqiroziga javoban amalga oshirildi. Tadqiqotchilar SCS joriy etilgan mahallada "korxona egalari va operatorlari tomonidan ijtimoiy buzuqlik haqidagi tushunchalar va kuzatuvlar" ni o'rganishdi.[15]:16 Hisobotda Letbridjda, xususan va umuman shaharlarda giyohvand moddalarni suiiste'mol qilish bilan bog'liq bo'lgan ijtimoiy xatti-harakatlar ko'payganligi, chunki "muomaladagi giyohvand moddalar miqdori va turi" ko'paygani haqida ogohlantirildi. Sifatida foydalanish kristall met afyunlardan foydalanishni tutadi, foydalanuvchilar ko'proq "tartibsiz xatti-harakatlarni" namoyish etishadi. Kristal met va boshqa "tepaliklar" ham afyun kabi "pastga tushirish" dan ko'ra "tez-tez ishlatishni talab qiladi".[15]:11 Shuningdek, hisobotda qayd etilishicha, SCSga ega bo'lgan jamoalardagi barcha ijtimoiy tartibsizliklar, qisman "davom etayotgan giyohvandlik epidemiyasi" sababli, "aniq va to'liq" SCSga tegishli bo'lishi mumkin emas.[15]:11 Ijtimoiy bo'lmagan xatti-harakatlarning kuchayishini tushuntiradigan boshqa o'zgaruvchilardan biri, havo harorati iliqroq bo'lgan mavsumiy tendentsiyalar doirasida ochiq havoda to'planadigan odamlar sonining ko'payishi.[15]:16

Filadelfiya "s WPVI-TV Action News jamoasi sayohat qildi Toronto, Kanadada 2018 yilda allaqachon foydalanishda bo'lgan bir nechta xavfsiz iste'mol maydonlarini birinchi kuzatuv ishlari olib borish. Muxbir bilan suhbatlashgan giyohvand, saytga ta'minot olish uchun tashrif buyurganini aytdi, lekin yopishib olmagan va boshqa narsalardan giyohvand moddalarni otish uchun foydalangan va sayt giyohvand moddalar va giyohvand moddalarni sotuvchilarni o'ziga jalb qilayotganini tan olgan. Muxbir bilan suhbatlashgan qo'shnining aytishicha, ilgari giyohvand moddalar iste'mol qilingan, ammo sayt ochilganidan beri u ko'paygan.[57]

WPVI-TV muxbiri Chad Pradelli yangiliklar guruhining kuzatuvlarini quyidagicha hikoya qildi:

Ikki kun ichida biz Torontoning bir nechta xavfsiz in'ektsiya inshootlari oldida o'tirdik, biz keng tarqalgan giyohvand moddalarni iste'mol qilish, giyohvand moddalar savdosi va hatto zo'ravonliklarga guvoh bo'ldik. Biz bir odam piyodalar yo'lagi orqali o'tayotgan bir necha kishini bezovta qilganini, hatto birini bo'g'ib qo'yadigan joyga qo'yganini kuzatdik. Bitta yigit kurashishga qaror qildi va xavfsizlik keldi.[57]

Sidney, Avstraliya

Sidney MSIC mijozlari o'rtasida 2005 yilda o'tkazilgan so'rovnoma shuni ko'rsatdiki, sog'liq uchun ham, jamoat sharoitlari uchun ham katta xavf tug'diradigan ommaviy in'ektsiya (ko'chada, parkda, jamoat hojatxonasida yoki mashinada ukol qilish deb ta'riflanadi) mijozlarning 78% tomonidan MSIC-ga in'ektsiya qilish. Mijozlarning 49 foizi, agar MSIC MSIC-da ro'yxatdan o'tgan kuni mavjud bo'lmasa, ommaviy in'ektsiyaga murojaat qilishlarini ko'rsatdi. Shundan kelib chiqib, baholovchilar markaz tomonidan oldini olingan jami 191,673 ta ommaviy in'ektsiyani hisoblab chiqdilar.[58]

Ommaviy axlatni ommaviy ravishda ishlatiladigan igna va shpritslar sonini kamaytirish orqali yanada yaxshilash mumkin. Sydney MSIC-ning 2003 yildagi hisobotidagi ma'lumotlarga ko'ra, igna va shpritslar sonining kamayishi va rezidentlar va biznes-operatorlarning jamoat joylarida ukol qilishlari sezilarli darajada kamaygan, ammo MSIC tomonidan geroin qurg'oqchiligidan tashqari bir necha oylar boshlangan ta'sirning mavjudligiga ishonch hosil qilolmagan. MSIC ochilishidan oldin.[59] Drug Free Australia tahlillari shuni ko'rsatdiki, igna, shprits va jamoat ko'rish joylari mahalliy dorixonalardan, igna almashinuvidan va MSIC-dan tarqatiladigan ignalar sonining 20% ​​kamayishiga deyarli teng keladi va shu bilan MSIC tomonidan aniq ta'sir ko'rsatilmaydi.[60]

Vankuver, Kanada

Ochilishidan oldingi va keyingi kuzatuvlar Vankuver, Britaniya Kolumbiyasi, Kanada Insite muassasasi ommaviy in'ektsiya kamayganligini ko'rsatdi. INSITE foydalanuvchilarining "o'z-o'zini hisobotlari" va INSITE, Sidney va ba'zi Evropa SIS-laridagi "norasmiy kuzatuvlar" SIS-lar "jamoatchilik tomonidan o'z-o'zini quyish tezligini pasaytirishi" mumkinligini taxmin qilmoqda.[56][miqdorini aniqlash ]

Alberta, Kanada

Alberta viloyatidagi opioid epidemiyasiga javoban, Alberta sog'liqni saqlash xizmatlari ning (AHS), Alberta sog'lig'i, Mahalliy aloqalar, Adliya va Bosh advokat, shu jumladan Bosh Tibbiy Ekspert Idorasi va Alberta shifokorlari va jarrohlari kolleji mumkin bo'lgan echimlarni muhokama qilish uchun uchrashdi. 2016 yil noyabr oyida o'tkazilgan Alberta sog'liqni saqlash hisobotida ushbu yig'ilish natijasida inqirozga qarshi ko'plab boshqa choralar bilan bir qatorda nazorat ostida iste'mol xizmatlarini joriy etish hayotiy echim sifatida sanab o'tilgan.[61]:1 2016 yil Alberta sog'liqni saqlash hisobotida, SIS, "haddan tashqari dozada o'limni kamaytiring, tibbiy va ijtimoiy yordamlardan foydalanish imkoniyatini yaxshilang va giyohvand moddalarni iste'mol qilish va jinoiy faoliyatni ko'paytirishi aniqlanmadi" deb ta'kidlangan.[61]:3

2020 yil yanvar oyiga ko'ra Edmonton jurnali tahririyat, 2020 yilga kelib Alberta 2017 yil noyabridan - viloyatda birinchi SIS ochilgandan - 2019 yil avgustigacha bo'lgan davrda yuz bergan "4.300 dan ortiq dozani bekor qilishda 100 foizli muvaffaqiyat darajasi" bilan etti SISga ega edi.[62]

Kalgari
Safeworks tomonidan nazorat qilinadigan iste'mol xizmatlari (SCS)

Xavfsizlik vositalari joylashgan joyda joylashgan Sheldon M. Chumir sog'liqni saqlash markazi, bir necha oy davomida vaqtinchalik muassasa sifatida ishlagan, 2018 yil 30 apreldan boshlab haftaning 7 kuni 24 soat xizmat ko'rsatadigan to'liq ish boshladi.[63]:1 Dastlab 2017 yil 30 oktyabrda ishga tushirilgan kundan 2019 yil 31 martgacha uning xizmatlaridan 71096 kishi foydalangan[63]:1 Xodimlar "jami 954 ta haddan tashqari dozaga javob berishdi".[63]:2 Bir oyning o'zida "848 noyob shaxslar" SCSga 5613 marta tashrif buyurishdi.[63]:1 Uning dasturi Albert provinsiyasi tomonidan Sog'liqni saqlash iqtisodiyot instituti bilan hamkorlikda nazorat qilinadi.[63]:2

Letbridj shahri tomonidan topshirilgan 2020 yilgi 102-betlik hisobotda muallif "Kalgari Sheldon Chumir SCS SCS atrofidagi" avj olgan "ijtimoiy tartibsizlik, turar-joy va tijorat aralashgan mahalla haqida jiddiy salbiy matbuotni olganini" ta'kidladi.[15]:15 2019 yil may oyiga ko'ra Kalgari Xerald maqola, Safeworks-ning xavfsiz iste'mol qilinadigan joyi atrofida 250 metr radius Kalgari ichida joylashgan Sheldon M. Chumir markazi ochilgandan buyon jinoyatchilikning katta o'sishini ko'rgan va politsiya hisobotida "shahar markazida giyohvandlik, zo'ravonlik va mulk jinoyati uchun nolga aylangan" deb ta'riflagan. Ushbu zonada 2018 yilda politsiya tomonidan o'tkazilgan statistika ma'lumotlariga ko'ra, politsiyaga chaqiruv hajmi 276 foizga, giyohvand moddalar bilan bog'liq masalalar bo'yicha 29 foizga oshgan va uch yillik o'rtacha statistikaga nisbatan.[64] 2019 yil may oyida Kalgari Xerald, dedi Sog'liqni saqlash Kanada 2019 yil fevral oyida Siteworks-ning mahalla xavfsizligi, giyohvand moddalar qoldiqlari va jamoat tartibini buzish bilan bog'liq holda yana bir yil ishlashiga ruxsat berish to'g'risida e'lon qildi.[65] Bu erda ishlashni rejalashtirgan mobil xavfsiz iste'mol maydonchasi uchun reja tuzilgan Kalgari, Alberta shtatidagi O'rmon maysasi Biroq, Sheldon M. Chumir markazidagi doimiy saytdagi statistik ma'lumotlarga javoban, jamiyat rahbarlari o'zlarining yordamlarini qaytarib olishdi.[66]

2019 yil sentyabrga kelib, Safeworks-da haddan tashqari dozada davolanish soni oshdi. Xodimlar ishdan bo'shatildi va xodimlarning 13,5% psixologik ta'tilga chiqdi. Ular 2019 yilda 134 donadan ortiq dozani bekor qilish bilan shug'ullanishdi, bu o'tgan yilga nisbatan 300 foizga ko'pdir. Markaz direktorining aytishicha, ular har kuni o'rtacha dozani oshirib yuborish bilan shug'ullanmoqdalar.[67]

Letbridj
ARCHES (2020 yil avgustda yopilgan)

Letbridjda giyohvand moddalarni haddan tashqari oshirib yuborish o'limi sonining ko'payishiga javoban, shahar o'zining birinchi SCS-ni 2018 yil fevral oyida ochdi.[15]:15 Ziddiyatli[68] Sifatida tanilgan SCS ARXLAR bir vaqtlar Shimoliy Amerikadagi eng gavjum SCS bo'lgan.[69]

Hukumat tomonidan olib borilgan tekshiruv natijasida davlat pullarining noto'g'ri ishlatilishi va noto'g'ri boshqarilishi aniqlangandan so'ng viloyat ARCHESni bekor qildi. ARCHES mablag'larining taxminan 70 foizi viloyatga to'g'ri keladi,[70] va uni 2020 yil 31 avgustda moliyalashtirish bekor qilingandan so'ng o'chirishni tanladi.[69] Tekshiruvda "mablag'larni o'zlashtirish, grant shartnomasiga rioya qilmaslik [va] noo'rin boshqaruv va tashkiliy operatsiyalar" aniqlandi.[70] Hukumat jinoiy javobgarlikka tortiladimi yoki yo'qligini aniqlash uchun bu masalani ko'rib chiqmoqda.[71]

Letbridj shahri Letsbridjdagi SIS saytining kutilmagan oqibatlarini o'rgangan Urban Social Issues Study (USIS) o'z ichiga olgan hisobotni topshirdi.[15] Tadqiqot shuni ko'rsatdiki, kichik shaharlarda, masalan, Letbridjda, SCS bo'lgan jamoalarda ijtimoiy buzilish ko'proq sezilishi mumkin. Hisobot muallifi, Letbridj universiteti Em M. Pijlning ta'kidlashicha, yangiliklar ommaviy axborot vositalari "SCSga yaqin joyda ishlaydigan va / yoki yashaydigan biznes egalari va aholining shaxsiy tajribalariga" moyil bo'lib, bu "SCS bilan bog'liq mahalla ta'sirining etishmasligini ko'rsatadigan" ilmiy adabiyotga ziddir. . "[15]:14

Qon bilan yuqadigan viruslarga ta'siri

Sidney MSIC-ning 2003 yildagi baholovchilari uning "qon bilan yuqadigan virus tarqalishini ko'paytirmaganligini" aniqladilar.[42] OIV infeksiyasi bilan kasallanish yaxshilanmaganligi, Hep B infektsiyalari yaxshilanmaganligini aniqroq ko'rsatadigan ma'lumotlar bilan;[72] yangi Hep C xabarnomalarida (o'rganilgan shahar atrofiga qarab) yomonroq yoki yaxshilanmagan,[73] boshqalarning shpritslari va ukol uskunalarini qayta ishlatishda yaxshilanishning yo'qligi, OIV va Hep C uchun o'tkazilgan testlarda yaxshilanishning yo'qligi va Hep B uchun o'tkazilgan testlarda dastlabki yaxshilanishning yo'qligi, ammo 2002 yilda yana yomonlashdi.[74] 2010 yildagi baholash qon bilan yuqadigan kasalliklarga o'lchovli ta'sir ko'rsatmadi.[75]

Dozani oshirib yuborishning jamoat darajalariga ta'siri

To'qqiz yil davomida Sidney MSIC dozasi haddan tashqari dozaga bog'liq bo'lgan 3 426 hodisani boshqargan[76] Vancouver's Insite esa 2007 yilda dozani oshirib yuborish bo'yicha 336 hodisani bitta o'lim bilan boshqargan.

2010 yilgi MSIC baholovchilari 9 yillik faoliyati davomida geroin dozasini oshirib yuborish bo'yicha jamoat darajasida sezilarli ta'sir ko'rsatmaganligini aniqladilar, kasalxonalarning shoshilinch tibbiy yordam bo'limlarida dozani oshirib yuborish holatlari yaxshilanmadi.[77]:19–20

2007 yilda in'ektsion xona baholovchilari tomonidan o'tkazilgan tadqiqotlar natijasida statsionar xona soatlari davomida tez yordam chaqiruvlarida pasayishlar bo'lganligi to'g'risidagi statistik dalillar keltirilgan,[78][79][80] ammo inyeksiya xonasi ochilgandan bir yil o'tgach, giyohvand moddalar uchun issiq joylar bilan tanishtirilgan itni itni politsiyalashni joriy qilish haqida biron bir narsa aytmadi.[81]

Dozani oshirib yuborish bo'yicha sayt tajribasi

Vankuverda, Sidneyda va Madrid yaqinidagi muassasada dozani oshirib yuborish bilan shug'ullanadigan bo'lsa, nemis iste'mol xonalari naloksonni faqat shifokorlar tomonidan boshqarilishi sababli tez yordam chaqirishga majbur. Nemis iste'mol xonalarini o'rganish shuni ko'rsatdiki, favqulodda vaziyatlarning 71 foizida tez yordam chaqirilgan va 59 foiz hollarda nalokson yuborilgan. Sidney va Frankfurtdagi inshootlar kasalxonaga yotqizishga olib keladigan favqulodda vaziyatlarning 2,2-8,4 foizini ko'rsatadi.[82]

Vancouver's Insite boshlanganidan ko'p o'tmay, 10,000 in'ektsiyasiga 13 ta haddan tashqari dozani berdi,[83] ammo 2009 yilda ikki baravar ko'payib, har 10000 kishi boshiga 27 tani tashkil etdi.[84] Sidney MSIC tomonidan geroin iste'mol qiluvchilar uchun har 10000 in'ektsiya uchun 96 ta haddan tashqari doz qayd etilgan.[85] Sidney MSIC-da dozani oshirib yuborish darajasi yuqori bo'lganligi haqida sharh beruvchilar,

"Sidney ukol xonasini o'rganish paytida markazda geroin in'ektsiyasining har 1000 inyeksiyasiga 9,2 (sic) geroin dozasini oshirib yuborilganligi aniqlandi. Dozani oshirib yuborishning bunday darajasi odatda geroin injektorlari orasida yuqori. In'ektsiya xonasi mijozlari, boshqa odamlarga qaraganda, geroin inyeksiyasi darajasi yuqori bo'lgan, xavfli guruh bo'lgan. Ular tez-tez ko'chalarda ukol qilishgan va ukol xonasida ko'proq xavf-xatarga duch kelishgan va ko'proq geroin iste'mol qilishgan.[86]

Sidney MSIC-ni baholash bo'yicha Drug Free Australia 2010 tahlillari MSIC-da dozani oshirib yuborish darajasi ushbu muassasadan foydalanish uchun ro'yxatdan o'tishdan oldin mijozlarning o'zlarining dozalarini oshirib yuborish tarixidan 32 baravar yuqori ekanligini aniqladi.[87] Drug Free Australia hisob-kitoblari MSIC-ning 2003 yildagi baholash hujjatida chop etilgan haddan tashqari dozalar tarixini ro'yxatdan o'tkazish ma'lumotlarini taqqosladi, bu geroin qurg'oqchiligidan oldin dozani oshirib yuborish davrini taqqoslaganda avstraliya miqyosida haddan tashqari dozani taqqoslash imkonini berdi va 2010 yildagi baholash natijalari bo'yicha . Drug Free Australia, baho beruvchilar in'ektsiya xonasida dozani oshirib yuborish ma'lumotlarini ishlatishda juda noto'g'ri "hayotni tejashgan" taxminlarni hisoblashda, dozani oshirib yuborish dozasini in'ektsiya xonasida ular uchun mavjud bo'lgan ma'lumotlarga nisbatan haddan tashqari ko'p bo'lganligini tekshira olmaganidan xavotir bildirdi. haddan tashqari dozani iste'molchilarning oldingi tarixi.

Boshqa chora-tadbirlarga qarshi Sidney MSIC-ning haddan tashqari dozasi darajasi juda nomutanosibdir. Avstraliyada 1997 yilga yakunlangan qaram geroinni iste'molchilar sonini baholash,[88] 1997/98 yillar uchun Avstraliyada o'limga olib kelmaydigan va o'limga olib keladigan dozani oshirib yuborish umumiy sonining hisob-kitoblari bilan taqqoslaganda[89] har 10000 ta in'ektsiya uchun 2 dozani oshirib yuborish darajasi, MSIC-ning 2003 yilgi baholashda har 10000 ta in'ektsiya uchun 96 ta dozani oshirib yuborish darajasi va 2009/10-yillarda 10 000 ta in'ektsiya uchun 146 ta haddan tashqari dozani tashkil etadi.[90]

MSIC-ni ro'yxatdan o'tkazish bo'yicha so'rovlarni ko'rib chiqish, har bir mijozning avvalgi dozasini oshirib yuborish tarixini yozib olgan[91] MSIC mijozlarining avvalgi dozasini oshirib yuborish tarixi Avstraliyada ilgari o'rganilgan turli xil geroin injektorlari guruhlariga qaraganda dozani oshirib yuborishga moyil bo'lmaganligini aniqlaydi.[92]

OIV / OITS bilan kasallangan odamlar

Vankuverda joylashgan 24 o'rinli turar joyli OIV / OITSni davolash muassasasi Doktor Piter markazida (DPC) olib borilgan tadqiqot loyihasi natijalari 2014 yil mart oyida Xalqaro OITS Jamiyati jurnalida chop etilgan bo'lib, unda muassasadagi in'ektsiya xizmatlari DPC rezidentlari uchun sog'liqni saqlash natijalarini yaxshilagan. DPC bu kabi xizmatlarni "zararni kamaytirishning keng qamrovli strategiyasi" ning markaziy qismi deb hisoblaydi va tadqiqot guruhi 13 nafar aholi bilan o'tkazilgan intervyular orqali "zararni kamaytirish siyosati sog'liqni saqlash xizmatlarining tarkibiy-ekologik kontekstini o'zgartirdi va shu bilan vositachilik vositalaridan foydalanish imkoniyatiga ega" degan xulosaga keldi. giyohvand moddalarni iste'mol qilishni halol muhokama qilish uchun sharoit yaratishdan tashqari, palliativ va qo'llab-quvvatlovchi xizmatlar. Yuqori faol antiretrovirus terapiyasi (HAART) dori-darmonlarga rioya qilish va omon qolish sog'lig'ining yaxshilangan ikkita natijasi sifatida keltirilgan.[93]

Aralashuvni hisoblash

The European Monitoring Centre (EMCDDA) 2004 Review of Drug Consumption Rooms[2] calculated the number of lives saved for all 25 drug consumption rooms across Germany. It calculated from known overdose mortality rates per 100 dependent heroin users (2%) and the number of injections per 100 person years per dependent heroin user (1,000 injections per year per user). Their calculation indicated that 100 dependent heroin users, cumulatively injecting 100,000 times a year, would statistically have 2 overdose fatalities annually. Thus 500,000 injections results in 10 expected fatalities averted by the entirety of injecting facilities across Germany.

Drug Free Australia has noted that the EMCDDA review’s 2% overdose fatality rate appears excessive in light of mortality studies done by the EMCDDA for 5 European countries, (Germany was not included, but Spain, with the highest heroin overdose mortality, was still well below 2%). The percentages by country were Barcelona, Spain 1.4%; Rome, Italy 0.2%; Sweden 0.7%; Amsterdam, Netherlands unknown; Vienna, Austria 0.2%.[94]

The Canadian Expert Advisory Committee 2008 review of Insite did not declare the method by which it concluded that 1.08 lives are saved by the facility each year,[95] but Drug Free Australia claims that the EMCDDA method, used with Canadian data and assumptions, yields the same result.[96] Canadian heroin mortality in 2002/3 was roughly the same as Australia’s at 1% (958 deaths from more than 80,000 dependent heroin users)[97] and mortality percentages for 2006 or 2007, Drug Free Australia claims, might well be expected to be little changed. Further, the Expert Advisory Committee clearly state their assumption that a typical Canadian heroin user injects 4 times daily.[98]

The conclusion of the 2003 Sydney MSIC evaluators was that “a small number of opioid overdoses managed at the MSIC might have been fatal had they occurred elsewhere”, calculating that the centre had saved 4 lives per annum during the evaluation period.[99] Estimates were directly calculated from the 329 heroin overdose interventions in the centre. A later SAHA International evaluation of the MSIC calculated 25 lives saved by the facility in a single year.[100]

Drug Free Australia cites two statistics together which demonstrate that the Sydney MSIC cannot statistically claim to save even one life per year. The first is that 1% of dependent heroin users die from fatal overdose each year in Australia. The second is that a dependent heroin user averages ‘at least’ three injections per day according to the MSIC 2003 evaluation’s researchers. Taking these two statistics together, it is clear that the injecting room would need to host 300 injections per day (ie enough heroin injections for 100 heroin addicts injecting 3 times daily) before they could claim they had saved the life of the one (1%) of those 100 who would have died annually. But the injecting room averages just half that number with less than 150 opiate injections per day. Drug Free Australia has shown that the 2003 and 2008 MSIC evaluators indefensibly failed to factor the vastly elevated number of overdoses in the centre into their calculations of lives saved.[101]

Jinoyat

The Sydney MSIC was judged by its evaluators to have caused no increase in crime[42] and not to have caused a ‘honey-pot effect’ of drawing users and drug dealers to the Kings Cross area.[102] The Drug Free Australia analysis pointed to data within the report clearly demonstrating that drug-related loitering and drug dealing worsened at the station entrance 25 metres opposite the MSIC[103] and at the rear door of the centre.[104] A later 2010 evaluation of crime in Kings Cross claimed that giyohvandlik bilan bog'liq jinoyatlar had decreased at the same rate as the rest of Sydney after a heroin shortage intervened 6 months before the MSIC opened, but Drug Free Australia has asserted that the evaluators failed to make any mention or assessment of the impact of police sniffer dogs introduced 12 months after the MSIC opened to deter drug dealers and users from the back lanes of Kings Cross, which might well be expected to have decreased drug-related crime more than areas of Sydney not policed by sniffer dogs.[105]

Testimony of ex-clients reported to the NSW Legislative Council[106] alleged that the extremely high overdose rates were due to clients experimenting with poly-drug cocktails and higher doses of heroin in the knowledge that staff were present to ensure their safety. The 2003 evaluation explanation for high overdose rates citing greater amounts of heroin used[107] has been cited by Drug Free Australia as cause for concern. NSW Member of Parliament, Andrew Fraser, made the same allegation regarding the MSIC as a site for experimentation, citing testimony of another ex-client in a Parliamentary speech in 2010.[108]

Observations before and after the opening of Insite indicated no increases in drug dealing or petty crime in the area. There was no evidence that the facility influenced drug use in the community, but concerns that Insite ‘sends the wrong message’ to non-users could not be addressed from existing data.[109] The European experience has been mixed.[110]

Financial impropriety by SCS service providers

Audit of Lethbridge ARCHES SCS by Deloitte accounting firm ordered by the Alberta provincial government found the SCS had $1.6 million in unaccounted funds between 2017 and 2018; additionally they've found led $342,943 of grant funds had been expended on senior executive compensation despite the grant agreement allowing only $80,000. Beyond this, an additional $13,000 was spent on parties, staff retreats, entertainment and gift cards,[71] and numerous other inappropriate expenditures.[71]

Jamiyat idroki

316 residents and 210 business completed surveys regarding the MSIC in 2005.. The community survey conducted by NSW Department of Health in Kings Cross area of NSW, Australia in 2005 evaluation indicated 73% of residents, (a reduction from 78% in 2003), and 68% of business operators supported the MSIC's presence.[111] The evaluation commented that residents without landline telephones were excluded from the survey. Contesting the reliability of these evaluation surveys is a 2010 petition to the NSW Parliament by 63 business owners immediately surrounding the MSIC to move the facility elsewhere because it has adversely affected their businesses.[112]

The Expert Advisory Committee for Vancouver’s Insite found that health professionals, local police, the local community and the general public have positive or neutral views of the service, with opposition decreasing over time.[109]

Drug Free Australia has expressed concern that supporters, staff and various NSW politicians continually has represented each overdose intervention in the centre to the Australian media as a life saved, when such an equation was clearly false.[113]

Predicted cost effectiveness

The cost of running Insite per annum is $3 million Canadian. Mathematical modeling showed cost to benefit ratios of one dollar spent ranging from 1.5 to 4.02 in benefit. However, the Expert Advisory Committee expressed reservation about the certainty of Insite’s cost effectiveness until proper longitudinal studies had been undertaken. Mathematical models for HIV transmissions foregone had not been locally validated and mathematical modeling from lives saved by the facility had not been validated.[56] The Sydney MSIC cost upwards of $2.7 million Australian per annum in 2007.[114] Drug Free Australia has asserted that in 2003 the cost of running the Sydney MSIC equated to 400 NSW government-funded rehabilitation places[115] while the Health Minister for the Canadian Government, Tony Clements, has stated that the money for Insite would be better spent on treatment for clients.[116]

Proposed policies

Qo'shma Shtatlar

Supervised injection sites are not currently legal everywhere. In the United States, as of July 2018, there are at least thirteen proposed sites seeking approval, including in New York City, Philadelphia, Boston, San Francisco, Seattle, Denver, Vermont, and Delaware.[117]

Shuningdek qarang

Adabiyotlar

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  117. ^ Cities Planning Supervised Drug Injection Sites Fear Justice Department Reaction

Tashqi havolalar

Community member in Philadelphia objects to SCS - Video on NBC 10 Philadelphia journalist's confirmed Twitter account.