Supervised injection facilities (SIFs) have been shown to reduce infection, prevent overdose deaths, and increase treatment uptake. The United States is in the midst of an opioid epidemic, yet no sanctioned SIF currently operates in the United States. We estimate the economic costs and benefits of establishing a potential SIF in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing SIFs. We consider potential savings from five outcomes: averted HIV and hepatitis C virus (HCV) infections, reduced skin and soft tissue infection (SSTI), averted overdose deaths, and increased medication-assisted treatment (MAT) uptake. We find that each dollar spent on a SIF would generate US$2.33 in savings, for total annual net savings of US$3.5 million for a single 13-booth SIF. Our analysis suggests that a SIF in San Francisco would not only be a cost-effective intervention but also a significant boost to the public health system.

References

Adams, J. ( 2015 ). HIV outbreak in Indiana . The New England Journal of Medicine, 373, 1379 - 1381 .

Google Scholar Crossref | Medline | ISI

Andresen, M. A., Boyd, N. ( 2010 ). A cost-benefit and cost-effectiveness analysis of Vancouver’s supervised injection facility . International Journal of Drug Policy, 21, 70 - 76 .

Google Scholar Crossref | Medline | ISI

Andresen, M. A., Jozaghi, E. ( 2012 ). The point of diminishing returns: An examination of expanding Vancouver’s Insite . Urban Studies, 49, 3531 - 3544 .

Google Scholar SAGE Journals | ISI

Barnett, P. G. ( 1999 ). The cost-effectiveness of methadone maintenance as a health care intervention . Addiction, 94, 479 - 488 .

Google Scholar Crossref | Medline | ISI

Bayoumi, A. M., Strike, C. ( 2012 ). Report of the Toronto and Ottawa Supervised Consumption Assessment Study. Toronto, Ontario, Canada : University of Toronto .

Google Scholar

Bayoumi, A. M., Zaric, G. S. ( 2008 ). The cost-effectiveness of Vancouver’s supervised injection facility . Canadian Medical Association Journal, 179, 1143 - 1151 .

Google Scholar Crossref | ISI

Bhattacharya, M. K., Naik, T. N., Palit, A., Bhattacharya, S. K. ( 2006 ). Impact of a harm-reduction programme on soft tissue infections among injecting drug users of Kolkata, India . Journal of Health, Population and Nutrition, 24, 121 - 122 .

Google Scholar Medline | ISI

Binswanger, I. A., Kral, A. H., Bluthenthal, R. N., Rybold, D. J., Edlin, B. R. ( 2000 ). High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco . Clinical Infectious Diseases, 30, 579 - 581 .

Google Scholar Crossref | Medline | ISI

Binswanger, I. A., Takahashi, T. A., Bradley, K., Dellit, T. H., Benton, K. L., Merrill, J. O. ( 2008 ). Drug users seeking emergency care for soft tissue infection at high risk for subsequent hospitalization and death . Journal of Studies on Alcohol and Drugs, 69, 924 - 932 .

Google Scholar Crossref | Medline | ISI

Bluthenthal, R. N., Wenger, L., Chu, D., Lorvick, J., Quinn, B., Thing, J. P., Kral, A. H. ( 2015 ). Factors associated with being asked to initiate someone into injection drug use . Drug and Alcohol Dependence, 149, 252 - 258 .

Google Scholar Crossref | Medline | ISI

Bravo, M. J., Royuela, L., De la Fuente, L., Brugal, M. T., Barrio, G., Domingo-Salvany, A. ( 2009 ). Use of supervised injection facilities and injection risk behaviours among young drug injectors . Addiction, 104, 614 - 619 .

Google Scholar Crossref | Medline | ISI

Cartwright, W. S. ( 2000 ). Cost-benefit analysis of drug treatment services: Review of the literature . The Journal of Mental Health Policy and Economics, 3, 11 - 26 .

Google Scholar Crossref | Medline

Center for Health Program Development and Management . ( 2007 , August 29 ). Review of cost-benefit and cost-effectiveness literature for methadone or buprenorphine as a treatment for opiate addiction. Baltimore : Center for Health Program Development and Management, University of Maryland . Retrieved from http://www.hilltopinstitute.org/publications/Cost_benefit_Opiate_Addiction_August_29_2007.pdf

Google Scholar

Centers for Disease Control and Prevention . ( 2002 , February ). Methadone Maintenance Treatment. Author. Retrieved from http://www.cdc.gov/idu/facts/methadonefin.pdf

Google Scholar

Centers for Disease Control and Prevention . ( 2014 ). HIV/AIDS surveillance in injection drug users. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention . Retrieved from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf

Google Scholar

Centers for Disease Control and Prevention . ( 2015a , December ). Overdose Death Rates. Author. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Google Scholar

Centers for Disease Control and Prevention . ( 2015b ). HIV/AIDS, viral hepatitis, sexually transmitted infections, & tuberculosis (FY 2016 President’s Budget Request). Retrieved from http://www.cdc.gov/budget/documents/fy2016/hivaids-factsheet.pdf

Google Scholar

Centers for Disease Control and Prevention . ( 2015c , July 7 ). Today’s heroin epidemic. Author. Retrieved from http://www.cdc.gov/vitalsigns/heroin/index.html

Google Scholar

Ciccarone, D. J. B., Kral, A. H., Edlin, B. R. ( 2001 ). Soft tissue infections among injection drug users—San Francisco, California, 1996–2000 . Morbidity and Mortality Weekly Report, 50, 381 - 384 .

Google Scholar Medline

Coffin, P. O. ( 2012 ). Data compiled from San Francisco Medical Examiner Reports. San Francisco : San Francisco Department of Public Health, University of California .

Google Scholar

Coffin, P. O., Jin, H., Huriaux, E., Mirzazadeh, A., Raymond, H. F. ( 2015 ). Trends in use of health care and HIV prevention services for persons who inject drugs in San Francisco: Results from National HIV Behavioral Surveillance 2005-2012 . Drug and Alcohol Dependence, 146, 45 - 51 .

Google Scholar Crossref | Medline | ISI

DeBeck, K., Kerr, T., Bird, L., Zhang, R., Marsh, D., Tyndall, M., Wood, E. ( 2011 ). Injection drug use cessation and use of North America’s first medically supervised safer injecting facility . Drug and Alcohol Dependence, 113, 172 - 176 .

Google Scholar Crossref | Medline | ISI

Des Jarlais, D. C., Arasteh, K., Hagan, H. ( 2008 ). Evaluating Vancouver’s supervised injection facility: Data and dollars, symbols and ethics . Canadian Medical Association Journal, 179, 1105 - 1106 .

Google Scholar Crossref | ISI

Ding, L., Landon, B. E., Wilson, I. B., Wong, M. D., Shapiro, M. F., Cleary, P. D. ( 2005 ). Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users . Archives of Internal Medicine, 165, 618 - 623 .

Google Scholar Crossref | Medline

Enns, E. A., Zaric, G. S., Strike, C. J., Jairam, J. A., Kolla, G., Bayoumi, A. M. ( 2016 ). Potential cost-effectiveness of supervised injection facilities in Toronto and Ottawa, Canada . Addiction, 111, 475 - 489 .

Google Scholar Crossref | Medline | ISI

Expatistan Cost of Living Index . ( 2015 , November ). Cost of living comparison between San Francisco, California, United States and Vancouver, Canada. Author. Retrieved from https://www.expatistan.com/cost-of-living/comparison/vancouver/san-francisco

Google Scholar

Fink, D. S., Lindsay, S. P., Slymen, D. J., Kral, A. H., Bluthenthal, R. N. ( 2013 ). Abscess and self-treatment among injection drug users at four California syringe exchanges and their surrounding communities . Substance Use & Misuse, 48, 523 - 531 .

Google Scholar Crossref | Medline | ISI

Flynn, P. M., Porto, J. V., Rounds-Bryant, J. L., Kristiansen, P. L. ( 2002 ). Costs and benefits of methadone treatment in DATOS-Part 1: Discharged versus continuing patients . Journal of Maintenance in the Addictions, 2(1-2), 129 - 149 .

Google Scholar Crossref

Gardner, E. M., McLees, M. P., Steiner, J. F., del Rio, C., Burman, W. J. ( 2011 ). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection . Clinical Infectious Diseases, 52, 793 - 800 .

Google Scholar Crossref | Medline | ISI

Grau, L. E., Arevalo, S., Catchpool, C., Heimer, R. ( 2002 ). Expanding harm reduction services through a wound and abscess clinic . American Journal of Public Health, 92, 1915 - 1917 .

Google Scholar Crossref | Medline | ISI

Harris, A. H., Gospodarevskaya, E., Ritter, A. J. ( 2005 ). A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting . PharmacoEconomics, 23, 77 - 91 .

Google Scholar Crossref | Medline | ISI

Harris, H. W., Young, D. M. ( 2002 ). Care of injection drug users with soft tissue infections in San Francisco, California . Archives of Surgery, 137, 1217 - 1222 .

Google Scholar Crossref | Medline

Health Canada . ( 2008 , March 31 ). Vancouver’s Insite service and other supervised injection sites: What has been learned from research? (Final report of the Expert Advisory Committee). Ottawa, Ontario : Author .

Google Scholar

Hedrich, D. ( 2004 ). European report on drug consumption rooms. Lisbon, Portugal : European Monitoring Centre for Drugs and Drug Addiction . Retrieved from http://www.emcdda.europa.eu/attachements.cfm/att_2944_EN_consumption_rooms_report.pdf

Google Scholar

Heinzerling, K. G., Etzioni, D. A., Hurley, B., Holtom, P., Bluthenthal, R. N., Asch, S. M. ( 2006 ). Hospital utilization for injection drug use-related soft tissue infections in urban versus rural counties in California . Journal of Urban Health, 83, 176 - 181 .

Google Scholar Crossref | Medline | ISI

Helfand, D. ( 2011 , March 6 ). Hospital stays cost more in Northern California than Southern California . Los Angeles Times. Retrieved from http://articles.latimes.com/2011/mar/06/business/la-fi-hospital-cost-20110306

Google Scholar

Jacobs, P., Calder, P., Taylor, M., Houston, S., Saunders, L. D., Albert, T. ( 1999 ). Cost effectiveness of Streetworks’ needle exchange program of Edmonton . Canadian Journal of Public Health, 90, 168 - 171 .

Google Scholar Medline | ISI

Jozaghi, E. ( 2012 ). “A little heaven in hell”: The role of a supervised injection facility in transforming place . Urban Geography, 33, 1144 - 1162 .

Google Scholar Crossref | ISI

Jozaghi, E . ( 2015 ). Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection . Health & Justice, 3, Article 1.

Google Scholar Crossref

Jozaghi, E. ( 2014 ). A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada . Harm Reduction Journal, 11, Article 1.

Google Scholar Crossref | Medline | ISI

Jozaghi, E., Andresen, M. A. ( 2013 ). Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada? Harm Reduction Journal, 10, Article 1.

Google Scholar Crossref | Medline | ISI

Jozaghi, E., Hodgkinson, T., Andresen, M. A. ( 2015 ). Is there a role for potential supervised injection facilities in Victoria, British Columbia, Canada? Urban Geography, 36, 1241 - 1255 .

Google Scholar Crossref | ISI

Jozaghi, E., Jackson, A. ( 2015 ). Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs . International Journal of Health Policy and Management, 4, 373 - 379 .

Google Scholar Crossref | Medline | ISI

Jozaghi, E., Reid, A. A. ( 2014 ). A case study of the transformative effect of peer injection drug users in the Downtown Eastside of Vancouver, Canada . Canadian Journal of Criminology and Criminal Justice, 56, 563 - 594 .

Google Scholar Crossref

Jozaghi, E., Reid, A. A. ( 2015 ). The potential role for supervised injection facilities in Canada’s largest city, Toronto . International Criminal Justice Review, 25, 233 - 246 .

Google Scholar SAGE Journals

Jozaghi, E., Reid, A. A., Andresen, M. A. ( 2013 ). A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Montreal, Canada . Substance Abuse Treatment, Prevention, and Policy, 8, Article 25.

Google Scholar Crossref | Medline | ISI

Jozaghi, E., Reid, A. A., Andresen, M. A., Juneau, A. ( 2014 ). A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada . Substance Abuse Treatment, Prevention, and Policy, 9, Article 31.

Google Scholar Crossref | Medline | ISI

Kaplan, E. H., O’Keefe, E. ( 1993 ). Let the needles do the talking! Evaluating the New Haven needle exchange . Interfaces, 23(1), 7 - 26 .

Google Scholar Crossref | ISI

Kerr, T., Tyndall, M. W., Lai, C., Montaner, J. S., Wood, E. ( 2006 ). Drug-related overdoses within a medically supervised safer injection facility . International Journal of Drug Policy, 17(5), 436 - 441 .

Google Scholar Crossref | ISI

Kerr, T., Kimber, J., DeBeck, K., Wood, E. ( 2007 ). The role of safer injection facilities in the response to HIV/AIDS among injection drug users . Current HIV/AIDS Reports, 4, 158 - 164 .

Google Scholar Crossref | Medline

Kerr, T., Tyndall, M., Li, K., Montaner, J., Wood, E. ( 2005 ). Safer injection facility use and syringe sharing in injection drug users . The Lancet, 366, 316 - 318 .

Google Scholar Crossref | Medline | ISI

Kimber, J., Dolan, K. ( 2007 ). Shooting gallery operation in the context of establishing a Medically Supervised Injecting Center: Sydney, Australia . Journal of Urban Health, 84, 255 - 266 .

Google Scholar Crossref | Medline | ISI

Klevens, R. M., Hu, D. J., Jiles, R., Holmberg, S. D. ( 2012 ). Evolving epidemiology of hepatitis C virus in the United States . Clinical Infectious Diseases, 55( Suppl. 1 ), S3 - S9 .

Google Scholar Crossref | Medline | ISI

Kozal, M. J., Amico, K. R., Chiarella, J., Cornman, D., Fisher, W., Fisher, J., Friedland, G. ( 2005 ). HIV drug resistance and HIV transmission risk behaviors among active injection drug users . Journal of Acquired Immune Deficiency Syndromes, 40, 106 - 109 .

Google Scholar Crossref | Medline | ISI

KPMG . ( 2010 , September 14 ). Further evaluation of the Medically Supervised Injecting Centre 2007-2011 (KPMG report). Retrieved from http://www.health.nsw.gov.au/mhdao/Documents/msic-fr.pdf

Google Scholar

Kral, A. H., Malekinejad, M., Vaudrey, J., Martinez, A. N., Lorvick, J., McFarland, W., Raymond, H. F. ( 2010 ). Comparing respondent-driven sampling and targeted sampling methods of recruiting injection drug users in San Francisco . Journal of Urban Health, 87(5), 839 - 850 .

Google Scholar Crossref | Medline | ISI

Kwon, J. A., Anderson, J., Kerr, C. C., Thein, H. H., Zhang, L., Iversen, J., Wilson, D. P. ( 2012 ). Estimating the cost-effectiveness of needle-syringe programs in Australia . AIDS, 26, 2201 - 2210 .

Google Scholar Crossref | Medline | ISI

Linden, I. A., Mar, M. Y., Werker, G. R., Jang, K., Krausz, M. ( 2013 ). Research on a vulnerable neighborhood—The Vancouver Downtown Eastside from 2001 to 2011 . Journal of Urban Health, 90, 559 - 573 .

Google Scholar Crossref | Medline | ISI

Lloyd-Smith, E., Kerr, T., Hogg, R. S., Li, K., Montaner, J. S., Wood, E. ( 2005 ). Prevalence and correlates of abscesses among a cohort of injection drug users . Harm Reduction Journal, 2, Article 24.

Google Scholar Crossref | Medline

Lloyd-Smith, E., Wood, E., Zhang, R., Tyndall, M. W., Sheps, S., Montaner, J. S., Kerr, T. ( 2010 ). Determinants of hospitalization for a cutaneous injection-related infection among injection drug users: A cohort study . BMC Public Health, 10, Article 327.

Google Scholar Crossref | Medline | ISI

Mars, S. G., Bourgois, P., Karandinos, G., Montero, F., Ciccarone, D. ( 2016 ). The textures of heroin: User perspectives on “black tar” and powder heroin in two US cities . Journal of Psychoactive Drugs, 48, 270 - 278 .

Google Scholar Crossref | Medline | ISI

Marshall, B. D., Milloy, M. J., Wood, E., Montaner, J. S., Kerr, T. ( 2011 ). Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: A retrospective population-based study . The Lancet, 377, 1429 - 1437 .

Google Scholar Crossref | Medline | ISI

Marshall, B. D., Milloy, M. J., Wood, E., Montaner, J. S., Kerr, T. ( 2012 ). Overdose deaths and Vancouver’s supervised injection facility—Authors’ reply . The Lancet, 379, 118 - 119 .

Google Scholar Crossref | ISI

Marshall, B. D., Wood, E., Zhang, R., Tyndall, M. W., Montaner, J. S., Kerr, T. ( 2009 ). Condom use among injection drug users accessing a supervised injecting facility . Sexually Transmitted Infections, 85, 121 - 126 .

Google Scholar Crossref | Medline | ISI

Maryland Department of Health and Mental Hygiene . ( 2015 ). Drug- and alcohol-related intoxication deaths in Maryland, 2014. Author. Retrieved from http://dhmh.maryland.gov/data/Documents/Annual%20OD%20Report%202014_merged%20file%20final.pdf

Google Scholar

Milloy, M. J., Kerr, T., Mathias, R., Zhang, R., Montaner, J. S., Tyndall, M., Wood, E. ( 2008 ). Non-fatal overdose among a cohort of active injection drug users recruited from a supervised injection facility . The American Journal of Drug and Alcohol Abuse, 34, 499 - 509 .

Google Scholar Crossref | Medline | ISI

Milloy, M. S., Kerr, T., Tyndall, M., Montaner, J., Wood, E. ( 2008 ). Estimated drug overdose deaths averted by North America’s first medically-supervised safer injection facility . PLoS ONE, 3(10), e3351 .

Google Scholar Crossref | Medline | ISI

MSIC Evaluation Committee . ( 2003 ). Final report of the evaluation of the Sydney Medically Supervised Injection Centre. Sydney, Australia : Author .

Google Scholar

National Institute on Drug Abuse . ( 2016 ). Fiscal year 2017 funding priorities. ARP Research and Funding Priorities, AIDS Research Program, National Institute on Drug Abuse . Retrieved from https://www.drugabuse.gov/sites/default/files/fy17priorities.pdf

Google Scholar

Palepu, A., Tyndall, M. W., Leon, H., Muller, J., O’Shaughnessy, M. V., Schechter, M. T., Anis, A. H. ( 2001 ). Hospital utilization and costs in a cohort of injection drug users . Canadian Medical Association Journal, 165, 415 - 420 .

Google Scholar Medline | ISI

Pinkerton, S. D. ( 2011 ). How many HIV infections are prevented by Vancouver Canada’s supervised injection facility? International Journal of Drug Policy, 22, 179 - 183 .

Google Scholar Crossref | Medline | ISI

Primeau, M. ( 2013 , January ). Facilities Plan Update. San Francisco Department of Public Health . Retrievedfromhttps://www.sfdph.org/dph/files/hc/HCAgen/2013/jan%2015/Department%20of%20Public%20Health%20Facilities%20Plan%20to%20HC%20%20Jan%207%202013.pdf

Google Scholar

Razavi, H., ElKhoury, A. C., Elbasha, E., Estes, C., Pasini, K., Poynard, T., Kumar, R. ( 2013 ). Chronic hepatitis C virus (HCV) disease burden and cost in the United States . Hepatology, 57, 2164 - 2170 .

Google Scholar Crossref | Medline | ISI

Riley, E. D., Kral, A. H., Stopka, T. J., Garfein, R. S., Reuckhaus, P., Bluthenthal, R. N. ( 2010 ). Access to sterile syringes through San Francisco pharmacies and the association with HIV risk behavior among injection drug users . Journal of Urban Health, 87, 534 - 542 .

Google Scholar Crossref | Medline | ISI

Rosenthal, E. ( 2013 , December 2 ). As hospital prices soar, a stitch tops $500 . New York Times. Retrieved from http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html

Google Scholar

Saha International Limited (SAHA) . ( 2008 ). Economic evaluation of the Medically Supervised Injecting Centre at Kings Cross (MSIC) (Final Report). Retrieved from https://uniting.org/__data/assets/pdf_file/0008/136439/MSIC-Final-Report-26-9-08-Saha.pdf

Google Scholar

Salmon, A. M., Dwyer, R., Jauncey, M., van Beek, I., Topp, L., Maher, L. ( 2009 ). Injecting-related injury and disease among clients of a supervised injecting facility . Drug and Alcohol Dependence, 101, 132 - 136 .

Google Scholar Crossref | Medline | ISI

San Francisco Department of Health . ( 2013 ). Integrated surveillance report for communicable diseases. Population Health Division, San Francisco Department of Health . Retrieved from https://www.sfdph.org/dph/files/reports/ARCHES/ARCHESAnnualRpt2013.pdf

Google Scholar

Schwartz, R. P., Alexandre, P. K., Kelly, S. M., O’Grady, K. E., Gryczynski, J., Jaffe, J. H. ( 2014 ). Interim versus standard methadone treatment: A benefit–cost analysis . Journal of Substance Abuse Treatment, 46, 306 - 314 .

Google Scholar Crossref | Medline | ISI

San Francisco Department of Public Health ( 2015 ). San Francisco Department of Public Health Anaul Report, 2014-2015. Retrieved from: https://www.sfdph.org/dph/files/reports/PolicyProcOfc/SFDPH-AnnualReport-2014-2015.pdf (accessed November 11, 2016).

Google Scholar

Sisney, J., Garosi, J. ( 2015 , July 1 ). 2014 GDP: California Ranks 7th or 8th in the World. California Legislature Legislative Analyst’s Office . Retrieved from http://www.lao.ca.gov/LAOEconTax/Article/Detail/90

Google Scholar

Small, W., Wood, E., Lloyd-Smith, E., Tyndall, M., Kerr, T. ( 2008 ). Accessing care for injection-related infections through a medically supervised injecting facility: A qualitative study . Drug and Alcohol Dependence, 98, 159 - 162 .

Google Scholar Crossref | Medline | ISI

Stein, M. D., Sobota, M. ( 2001 ). Injection drug users: Hospital care and charges . Drug and Alcohol Dependence, 64, 117 - 120 .

Google Scholar Crossref | Medline | ISI

Sterling, E. E. ( 2015 ). A businessperson’s guide to the war on drugs. Business Council for Prosperity and Safety . Retrieved from http://www.business-council.org/bpg

Google Scholar

Stoltz, J. A., Wood, E., Small, W., Li, K., Tyndall, M., Montaner, J., Kerr, T. ( 2007 ). Changes in injecting practices associated with the use of a medically supervised safer injection facility . Journal of Public Health, 29, 35 - 39 .

Google Scholar Crossref | Medline | ISI

Strathdee, S. A., Beyrer, C. ( 2015 ). HIV outbreak in Indiana . The New England Journal of Medicine, 373, 1379 - 1381 .

Google Scholar Crossref | ISI

Strathdee, S. A., Pollini, R. A. ( 2007 ). A 21st-century Lazarus: The role of safer injection sites in harm reduction and recovery . Addiction, 102, 848 - 849 .

Google Scholar Crossref | Medline | ISI

Takahashi, T. A., Maciejewski, M. L., Bradley, K. ( 2010 ). US hospitalizations and costs for illicit drug users with soft tissue infections . The Journal of Behavioral Health Services & Research, 37, 508 - 518 .

Google Scholar Crossref | Medline | ISI

Tempalski, B., Cooper, H. L., Friedman, S. R., Des Jarlais, D. C., Brady, J., Gostnell, K. ( 2008 ). Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug . International Journal of Drug Policy, 19, 47 - 58 .

Google Scholar Crossref | ISI

Tyndall, M. W., Kerr, T., Zhang, R., King, E., Montaner, J. G., Wood, E. ( 2006 ). Attendance, drug use patterns, and referrals made from North America’s first supervised injection facility . Drug and Alcohol Dependence, 83, 193 - 198 .

Google Scholar Crossref | Medline | ISI

Urban Health Research Initiative . ( 2015 ). Supervised injecting/Insite. Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS . Retrieved from http://uhri.cfenet.ubc.ca/content/view/57/92/

Google Scholar

Wasley, A., Grytdal, S., Gallagher, K. ( 2006 ). Centres for Disease Control and Prevention (CDC) . Surveillance for Acute Viral Hepatitis—United States, 1 - 24 .

Google Scholar

Wenger, L. D., Arreola, S. G., Kral, A. H. ( 2011 ). The prospect of implementing a safer injection facility in San Francisco: Perspectives of community stakeholders . International Journal of Drug Policy, 22, 239 - 241 .

Google Scholar Crossref | Medline | ISI

Wenger, L. D., Martinez, A. N., Carpenter, L., Geckeler, D., Colfax, G., Kral, A. H. ( 2011 ). Syringe disposal among injection drug users in San Francisco . American Journal of Public Health, 101, 484 - 486 .

Google Scholar Crossref | Medline | ISI

Wood, E., Kerr, T., Small, W., Li, K., Marsh, D. C., Montaner, J. S., Tyndall, M. W. ( 2004 ). Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users . Canadian Medical Association Journal, 171, 731 - 734 .

Google Scholar Crossref | ISI

Wood, E., Tyndall, M. W., Lai, C., Montaner, J. S., Kerr, T. ( 2006 ). Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime . Substance Abuse Treatment, Prevention, and Policy, 1, Article 13.

Google Scholar Crossref | Medline | ISI

Wood, E., Tyndall, M. W., Montaner, J. S., Kerr, T. ( 2006 ). Summary of findings from the evaluation of a pilot medically supervised safer injecting facility . Canadian Medical Association Journal, 175, 1399 - 1404 .

Google Scholar Crossref | Medline | ISI

Wood, E., Tyndall, M. W., Stoltz, J. A., Small, W., Zhang, R., O’Connell, J., Kerr, T. ( 2005 ). Safer injecting education for HIV prevention within a medically supervised safer injecting facility . International Journal of Drug Policy, 16, 281 - 284 .

Google Scholar Crossref | ISI

Wood, E., Tyndall, M. W., Zhang, R., Montaner, J. S., Kerr, T. ( 2007 ). Rate of detoxification service use and its impact among a cohort of supervised injecting facility users . Addiction, 102, 916 - 919 .

Google Scholar Crossref | Medline | ISI

Wood, E., Tyndall, M. W., Zhang, R., Stoltz, J. A., Lai, C., Montaner, J. S., Kerr, T. ( 2006 ). Attendance at supervised injecting facilities and use of detoxification services . New England Journal of Medicine, 354, 2512 - 2514 .

Google Scholar Crossref | Medline | ISI