Architecture Plays An Important Role In Safe Injection Facilities

By Paul Gaita 06/22/17

The look and layout of SIFs makes a crucial impact in the successful treatment of people with addiction who use the facilities.

A Safe Shape pop-up public health exhibit
A Safe Shape pop-up public health exhibit Photo used with the permission of Dr. Gregory Scott of Safe Shape

For thousands of individuals suffering from opioid addiction in Canada and Europe, safe injection facilities (SIF) provide a safe and secure alternative to using drugs on the streets.

Facilities like Vancouver's Insite—the only SIF in North America—provide clean needles in an unbiased, legally approved environment. More importantly, the SIF scenario has demonstrated a host of public health benefits, from getting people with substance use disorder off the streets and into treatment, to reducing mortality rates and new hepatitis C and HIV infections. And as a new overview of such facilities notes, some of the success is due to design.

A June feature in the Architect's Newspaper examined how the look and layout of Insite and several other SIFs play an important role in establishing a sense of security and openness—both in the manner of how the staff interacts with visitors and the physical areas where people with addiction can use—that has proven crucial to getting people with substance use disorder to use these facilities.

At the core of this aesthetic is a three-phase cycle designed to process people with substance use disorder through the facility with as much ease as possible, but without any sense of secrecy or the inquiring, invasive atmosphere of a medical facility. As architect Sean McEwen, who designed Insite in 2002, said, "From a design perspective, it's all about controlling the flow. That is more important than security."

At Insite, visitors enter an injection room with 13 booths lining the interior perimeter. The booths are lighted and open, and feature mirrors that provide a two-fold assistance to staff: they assist in providing a clear line of sight into each booth, but more importantly, reduce the chances of surprising users mid-fix.

The injection booths at Insite

Staff are also not sequestered behind Plexiglas at stations, but remain active and present to provide advice, help prepare drugs and clean needles, if need be. Once injection is completed, visitors are then brought to a "chill-out" room with comfortable and easy-to-clean chairs; as McEwen noted, "This may be the best seat users sit in all week." There, they can relax and take advantage of peer counselors—who are usually people who have formerly battled addiction—and nurses, and learn about available detox programs.

A stress-free environment is also at the core of H17, a new SIF in Copenhagen, Denmark. The former slaughterhouse, which opened in August 2016, employs an even more streamlined approach to the process of cycling users through the facility. Visitors are directed on a linear path, through the building that clearly defines pre- and post-use locations. Injection booths are wide and mirrored, with a hole in each desk to provide safe and easy disposal of paraphernalia. Once done, visitors can transition to a chill-out room with inflatable furniture and a warmer color palette.

How might a U.S.-based SIF look? Visual sociologist Dr. Gregory Scott has constructed a working model of a pop-up site called SAFE SHAPE.

A Safe Shape mock SIF - Photo provided by Dr. Gregory Scott

The "public health exhibit"—which acts as a mock-SIF—is a 10-square-foot pavilion that uses aluminum tubes and a spandex shell to form a structure that is both adjustable in height, can accommodate up to three individuals, including three smoking users, and is free of what Scott calls "the heavy politicized" design and aesthetic associated with drug-related facilities. The size and flexibility of SAFE SHAPE also allows for greater mobility, an advantage over fixed-location SIFs like Insite.

Design may be one of the factors that helps usher in SIF locations to the United States. Two such facilities have been approved by Seattle Mayor Ed Murray, but still require both funding and locations that won't generate conflict with neighbors. These are significant hurdles, and the opioid addiction rate in Seattle requires a rapid response—but as Insite and H17 both prove, design can provide a smoother transition for both community and users to find the help they need.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.