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Table 1 Reasons for ambivalence about SIFS

From: Ambivalence about supervised injection facilities among community stakeholders

Reason Illustrative excerpts
1. Lack of personal knowledge of evidence about SIFs It’s easy just to say… well I wouldn’t want one because I’m going to have all these people wandering around downtown as high as kites. But then once you find out, well actually no, because this is set in place so that doesn’t happen… it could change people’s opinions, and they might be like, “Okay, well I can see the benefit of that then.” Knowledge can change everything. (Toronto business owner)
2. Concern that SIF goals are too narrow and need to be located within a comprehensive response to drug use (“Comprehensive” defined with a range of suggestions) So there’s got to be more of a point to this, I think, than just a clean place for these drugs…The thing for us is that we might be able to convince half of these people to stop. (Ottawa ambulance personnel)
I think we’re not serving people well if we just focus on their addiction, if we don’t also provide mental health services. … I think the community would be more receptive, from our drug strategy work, as long as harm reduction was connected to treatment options and housing and all of those other things… than if it’s just kind of seen as giving up on people, and just warehousing them in this little place downtown, not that that’s maybe the perception often I think. (Ottawa community/service provider)
3. Uncertainty that the community drug problem is large enough to warrant SIF implementation We haven’t hit that crisis point, as Vancouver has hit… where they were doing it [injecting] in the daytime, around strollers and stuff. Get them off the street. We haven’t hit that point yet, so why would we even put all our money into that when we haven’t gotten there yet. (Toronto ambulance personnel)
4. Need to know more about the so-called “right” places to locate SIFs to avoid damaging communities or businesses I struggle because [I] can see the potential benefits but an SIF would have a negative impact. The local [methadone maintenance treatment] clinic has created problems with thefts etc. [SIFs] would damage business. (Toronto resident)
I might kick myself in the ass for saying this, but I might consider a mobile facility that, it’s not stationed in one place, but maybe they don’t have to be right on the main street… I’m opposed to this, but I would consider a mobile. (Toronto resident)
5. Worry that a SIF(s) will renew problems that existed prior to neighbourhood gentrification [W]e had swarms of drug dealers and drug users, and we don’t want to go back there again (Toronto resident)
6. Concern that resources for drug use prevention and treatment will be diverted to pay for SIFs And as a matter of fact, if it in any way compromised the integrity of things like methadone clinics, and other types of treatment options that are out there, I wouldn’t support it. (Toronto health care worker)
…if they take away resources from other things. So it does depend. (Ottawa city employee)
7. Concern that SIF implementation must include evaluation and community consultation, and explicit commitment to discontinue a SIF(s) in the event of adverse outcomes I would want some kind of assurance, some accountability on the part of the people who are running these, saying that give them a time, and if it’s not working, then they have to agree that we can sort of shut it down. Just to actually say a permanent site, I’m totally against it. If it was something on a temporary basis, on a contract basis, I would support it. (Toronto resident)