Kerr Thomas, Small Will, Moore David, Wood Evan
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
Int J Drug Policy. 2007 Jan;18(1):37-45. doi: 10.1016/j.drugpo.2006.12.008. Epub 2007 Jan 16.
Conventional drug overdose prevention strategies have been criticised for failing to address the macro- and micro-environmental factors that shape drug injecting practices and compromise individual ability to reduce the risks associated with drug-related overdose. This in turn has led to calls for interventions that address overdose risks by modifying the drug-using environment, including the social dynamics within them. Safer injection facilities (SIFs) constitute one such intervention, although little is known about the impact of such facilities on factors that mediate risk for overdose.
Semi-structured qualitative interviews were conducted with fifty individuals recruited from a cohort of SIF users in Vancouver, the Scientific Evaluation Of Supervised Injecting (SEOSI). Audio recorded interviews elicited injection drug users' (IDU) accounts of overdoses as well as perspectives regarding the impact of SIF use on overdose risk and experiences of overdose. Interviews were transcribed verbatim and a thematic analysis was conducted.
Fifty IDU, including 21 women, participated in this study. The perspectives of participants suggest that the Vancouver SIF plays an important role in mediating various risks associated with overdose. In particular, the SIF addresses many of the unique contextual risks associated with injection in public spaces, including the need to rush injections due to fear of arrest. Further, SIF use appears to enable overdose prevention by simultaneously offsetting potential social risks associated with injecting alone and injecting in the presence of strangers. The immediate emergency response offered by nurses at the SIF was also valued highly, especially when injecting adulterated drugs and drugs of unknown purity and composition.
The perspectives of IDU participating in this study suggest that SIFs can address many of the micro-environmental factors that drive overdose risk and limit individual ability to employ overdose prevention practices. Although challenges related to coverage remain in many settings, SIFs may play a unique role in managing overdoses, particularly those occurring within street-based drug scenes.
传统的药物过量预防策略因未能解决塑造药物注射行为以及损害个人降低与药物相关过量风险能力的宏观和微观环境因素而受到批评。这反过来又引发了对通过改变吸毒环境（包括其中的社会动态）来解决过量风险的干预措施的呼吁。安全注射设施（SIFs）就是这样一种干预措施，尽管对于此类设施对介导过量风险的因素的影响知之甚少。
对从温哥华一组SIF使用者（科学评估监督注射，SEOSI）中招募的50人进行了半结构化定性访谈。录音访谈收集了注射吸毒者（IDU）对过量用药的描述以及关于使用SIF对过量风险的影响和过量用药经历的看法。访谈逐字记录并进行了主题分析。
50名IDU，包括21名女性，参与了本研究。参与者的观点表明，温哥华的SIF在介导与过量用药相关的各种风险方面发挥着重要作用。特别是，SIF解决了与在公共场所注射相关的许多独特的背景风险，包括因害怕被捕而需要匆忙注射。此外，使用SIF似乎能够通过同时抵消与独自注射和在陌生人面前注射相关的潜在社会风险来预防过量用药。SIF护士提供的即时应急响应也受到高度重视，尤其是在注射掺假药物以及纯度和成分不明的药物时。
参与本研究的IDU的观点表明，SIF可以解决许多驱动过量风险并限制个人采用过量预防措施能力的微观环境因素。尽管在许多环境中与覆盖范围相关的挑战仍然存在，但SIF在管理过量用药方面可能发挥独特作用，特别是在街头毒品场景中发生的过量用药。
