"We knew it was coming: we didn't act" perspectives from people who use drugs and substance use workforce on the impact of delays in implementation of the supervised injection facility and drug checking interventions.

Abstract

Background: Harm reduction techniques such as supervised injection facilities and drug checking are evidence-based strategies for reducing fatal overdoses. Despite the evidence in support of these interventions, Irish drug policy experienced delays in implementation of these strategies. This study considers the perceived impacts of delayed implementation of the supervised injection facility and drug checking in Ireland.

Methods: A purposive sample of people who use drugs and people from the substance use workforce were recruited for a total of 34 semi-structured interviews. Data were analysed using Braun and Clarke's reflexive thematic analysis.

Results: Our results show perceived direct and secondary impacts of delayed implementation of the supervised injection facility and drug checking. Direct impacts of delays include the absence of evidence-based practices forcing people who use drugs to adopt make-shift safety responses and compounding the inequalities they experience. Participants expressed concern for the lives that could have been saved if the supervised injection facility and drug checking had been implemented, and the unknown scope of health consequences due to delays. Secondary impacts of delays noted the difficulties to respond to current issues or new challenges in the drug markets. Over the period of waiting for these interventions, participants reported changes in the drug market and drug use which may have implications for the existing policies. Participants described navigating frustration with bureaucracy and concern for moving forward with harm reduction.

Conclusion: Changes in drug use and drug markets occurred over a period of waiting for interventions to be implemented. Policymakers must consider adapting plans for a supervised injection facility to include inhalation space to meet the current needs of people who use drugs. Drug policy interventions must consider the populations most at risk, and should consider drug checking services outside of the festival setting. This study highlights that the nature of change in drug markets requires timely policy response and implementation. As drug markets become riskier, policymakers should consider framing overdose as a matter of public health urgency to facilitate timely harm reduction implementation.