Stakeholder perceptions of supervised injection facilities: a qualitative synthesis

Abstract

BackgroundSubstance use and misuse is a serious public health problem. To address this issue, supervised injection facilities (SIFs)—facilities where drug users can inject drugs supervised by medical professionals—have been developed. Although evidence suggests that SIFs result in positive outcomes, stakeholder perceptions influence the development and continuation of such facilities. Given this influence, this systematic review aimed to qualitatively synthesise stakeholder perceptions of these facilities. MethodsNine academic databases (Applied Social Sciences Index and Abstracts [ASSIA], Global Health, Medline, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Social Services Abstracts, and Web of Science) and various search engines, such as Google Scholar, were searched from December 17 to December 18, 2017, and health departments and drug experts were contacted from February 13 to February 14, 2018. Two authors completed screening, full text review, data extraction, and quality determinations. To be included, articles had to be in one of five languages (English, German, Danish, Norwegian, or Dutch), be qualitative, and include stakeholder perceptions of SIFs, with no restrictions regarding the publication year. All extracted stakeholder perceptions were coded deductively and inductively using the principles of thematic analysis. Findings47 articles were included, with the most applied methods being focus groups, interviews, and open-ended surveys. Perceived benefits included a reduction in public drug use, access to care, education of drug users, drug-related safety, and safety from the criminal activity outside of SIFs. Perceived concerns related to rules and regulations, the location of the facility, an increase in public injection or number of drug users, and the enabling quality of the facility, with suggestions made by many to address these concerns. Finally, stakeholders commonly discussed factors influencing the implementation of SIFs. Differences and similarities by stakeholder group and by type of SIF were noted. Specifically, perceptions often varied according to whether stakeholders had first-hand experience with SIFs. InterpretationThis qualitative review contributes to the published research and continuing debate on SIFs by aggregating, appraising, and synthesising existing research on perceptions of SIFs. It can inform policymakers, practitioners, and researchers on issues such as acceptability, accessibility, and perceived effectiveness, and may facilitate a more informed discussion on how SIFs should be prioritised by policy-makers. Limitations of this review are the lack of geographical diversity of identified studies (most were conducted in high-income countries), lack of focus on unsanctioned facilities, and the non-longitudinal nature of the studies. FundingNone.