Supervised Injection Sites: Facts, Information, Pros, and Cons

A concept photo of drug abuse
A concept photo of drug abuse
Proponents of supervised injection sites argue that they save lives. Critics say they discourage treatment. Where do you stand?

Against the backdrop of the opioid crisis in the United States, a debate has unfolded over the efficacy and morality of supervised injection sites. Also known as safe injection sites and overdose prevention centers, these facilities offer individuals a hygienic space to inject illicit drugs already in their possession while under the supervision of trained medical staff.

Proponents argue that supervised injection sites prevent overdose fatalities and reduce the transmission of HIV and other infectious diseases. Critics argue that these sites discourage treatment and undermine efforts to curb the use of illicit drugs.1

Approximately 100 sanctioned supervised injection sites are in operation worldwide, most in Europe, Australia, and Canada. Notably absent from the list is the United States.2 However, a number of US cities are seeking to open facilities: San Francisco, Seattle, New York, and Philadelphia, to name a few. These cities have been met with opposition from the US Justice Department, which has promised swift and aggressive legal action against anyone opening a supervised injection facility. In an NPR interview, US Deputy Attorney General Rod Rosenstein stated that while he understands the need to reduce the rate of opioid overdose deaths, providing a place for people to inject illicit drugs is a violation of federal law. Despite the warning, city officials in San Francisco and Philadelphia are pushing forward with their plans, potentially setting the stage for a conflict between federal and local authorities.3

Federal government approval isn’t the only obstacle these cities face. Take New York City, for example: in May 2018, Mayor Bill de Blasio made public a plan to open 4 safe injection centers. The plan would only proceed if authorized by the State Health Department. The mayor conceded that there are very substantial issues to contend with, from legal matters to quality-of-life concerns.4

Then there is the issue of public opinion. A 2018 survey conducted by the Johns Hopkins Bloomberg School of Public Health found that only 29% of Americans support legalizing safe consumption sites in their communities.5

In addition, prominent political figures have made their opposition to supervised injection sites clear. For example, John P. Walters, former Director of Drug Control Policy under President George W. Bush, made the case that safe injection sites sustain addiction.6

On the other side of the debate stands the American Medical Association (AMA), which in 2017 voted to support the development of pilot supervised injection facilities. In a press release, the AMA stated that “studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance abuse disorders.”7 In fact, there have been multiple studies supporting the efficacy of supervised injection sites.8-10

Safe injection sites also have the backing of some individuals in higher education including Scott G. Weiner, assistant professor of emergency medicine at Harvard Medical School. In a Harvard Health essay, Weiner describes a change of heart he had after visiting a local needle exchange facility. He found the facility welcoming and noted that staff connected people with valuable treatment resources. He urged it’s time to change our way of thinking because “people’s lives depend on it.”11

Where do you stand on this issue? Should supervised injection sites be legalized in the United States? Participate in our survey.


  1. Philly’s safe injection plan presents legal & social pros & cons. EfficientGov. February 9, 2018. Accessed October 9, 2018.
  2. Supervised injection facilities. Drug Policy Alliance. February 2016. Accessed October 9, 2018.
  3. Allyn B. Justice Department promises crackdown on supervised injection facilities. NPR. August 30, 2018. Accessed October 9, 2018.
  4. Neuman W. De Blasio’s plan for safe injection sites faces many hurdles. The New York Times. May 4, 2018. Accessed October 9, 2018.
  5. Public support for needle exchange programs, safe injection sites remains low in US. Johns Hopkins Bloomberg School of Public Health. June 5, 2018. Accessed October 9, 2018.
  6. Walters JP. Heroin injection sites perpetuate harm: opposing view. USA Today. May 16, 2016. Accessed October 9, 2018.
  7. AMA wants new approaches to combat synthetic and injectable drugs [press release]. Chicago, IL; American Medical Association; June 12, 2017.
  8. Larson S, Padron N, Mason J, Bogaczyk T. Supervised consumption facilities – review of the evidence. Thomas Jefferson University. December 2017. Accessed October 9, 2018.
  9. Ng J, Sutherland C, Kolber MR. Does evidence support supervised injection sites? Can Fam Physician. 2017;63(11):866.
  10. Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend. 2014;1(145):48-68.
  11. Weiner S. Safe injection sites and reducing the stigma of addiction. Harvard Health. June 2, 2017. Accessed October 9, 2018.