Table 3 Implementation and Sustainability findings according to EPIS components

Implementation

1. Community buy-in on the need for improved harm reduction infrastructure

2. Framing SCSs as a tool to reduce the visibility of drug use in surrounding communities (a shared goal of participants and community members)

1. Workforce

a. Encouraging mutual respect between SCS clients and workers

b. Addressing power imbalances

2. Participant experience

a. Fostering sense of community

b. Designating a time and space for drug use

c. Reducing fear of adverse consequences

1. Peer workers

a. Community volunteers

b. Social workers

2. Relaxed rules and regulations within SCSs

3. Establishing connections with outside agencies

1. Building social connections among participants

2. Modifying physical spaces to increase participant comfort and socialization

3. Providing safety and harm reduction counseling

4. Offering services with the lowest possible barriers to access

Sustainment

1. Maintaining community relationships

2. Providing unique resources to PWUD

3. Framing SCSs as a cost-saving intervention

1. Specific pathways for increasing social capital for PWUD

2. Adequate support for peer-workers

3. Finding balance between the desires of mainstream oversite and the needs of the most-marginalized participants

1. Discreet community outreach efforts

2. Building trust and acceptance with participants, treatment partners, and broader community

1. Maximizing accessibility

a. fewer regulations

b. longer hours

2. Training participants to reduce drug harms beyond injection (i.e., inhalation)

3. Providing additional private consumption spaces (e.g., for accessing certain injection sites such as the groin),

4. Co-location of health and social services

5. Availability of drug testing services