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Understanding the Stigma and Feasibility of Opening a Safe Injection Facility in Baltimore City: A Qualitative Case Study

Supervised injection facilities (SIFs) are medically supervised facilities designed to provide a hygienic environment in which drug users can consume illicit drugs intravenously. SIFs can be cost saving, help to reduce transmission of disease, and decrease drug overdoses. There are no SIFs in the United States. In this study we used a multiple case study design to understand the stigma surrounding the use of a SIF and the feasibility of implementing the drug prevention strategy in Baltimore City by comparing experiences with opening a SIF in Sydney, Australia. We interviewed one healthcare worker at the Sydney SIF and ten community stakeholders in Baltimore City. Interviewees were asked about community stigma of SIFs, drug use, and feasibility of opening a SIF in Baltimore City. Six overarching themes were established including lack of trust, lack of public education, fear of police, concern about efficacy of harm reduction programs, drug user stigma, and concerns about implementation. Findings suggest that stigma surrounding drug use and drug users is the most important aspect in shaping the participant's varied perceptions of SIFs. Participants believed that for any change to occur, there must be multi-tiered collaboration at the level of government, healthcare, community, and law enforcement.