Willingness and contextual considerations for supervised consumption sites: a mixed-methods study among people who inject drugs in Stockholm

Background

Sweden faces high rates of overdose mortality, but supervised consumption sites (SCSs), where people can use drugs under healthcare supervision, have not been adopted. No studies have assessed the willingness of Swedish people who inject drugs to use a future SCS or their views on potential rules.

Methods

This mixed-methods study applied a risk-environment approach and collected data from people who inject drugs in Stockholm using a 28-item survey and qualitative interviews.

Results

Most of the 219 survey respondents reported significant risk factors, including unstable housing, previous opioid overdose, and public drug use. Among participants, 158 (72.1 %) were willing to use an SCS, while 61 (27.9 %) were unsure or unwilling. In multivariate analysis, opioid use (AOR 3.24; CI 1.31–8.02), public injection (AOR 5.22; CI 2.35–11.56), and overdose within the past year (AOR 6.89; CI 1.66–28.56) predicted willingness to use an SCS. The most common reason was “I want to avoid stress” (82.2 %). For the 61 participants unwilling or unsure, the main reason was “already having a safe place for drug use” (78.75 %). Certain rules, like bans on groin/neck injection and assisted injection, were less accepted among both survey and interview respondents. Qualitative data revealed reluctance to inject in front of SCS staff due to privacy concerns.

Conclusion

Our results suggest high SCS acceptability among a marginalised cohort of people who inject drugs in Stockholm. Results confirm and extend prior research by illuminating their perceptions, including important preferences to consider when designing a future SCS in Sweden.