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RESEARCH REPORT
doi:10.1111/add.12506
Increasing public support for supervised injection facilities in Ontario, Canada Carol Strike1,2, Jennifer A. Jairam3, Gillian Kolla1, Peggy Millson1, Susan Shepherd4, Benedikt Fischer2,5, Tara Marie Watson1 & Ahmed M. Bayoumi3,6,7,8 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,1 Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,2 Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada,3 Toronto Drug Strategy Secretariat, Toronto Public Health, Toronto, Ontario, Canada,4 Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada,5 Department of Medicine, University of Toronto, Toronto, Ontario, Canada,6 Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada7 and Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada8
ABSTRACT Aim To determine the level and changes in public opinion between 2003 and 2009 among adult Canadians about implementation of supervised injection facilities (SIFs) in Canada. Design Population-based, telephone survey data collected in 2003 and 2009 were analysed to identify strong, weak, and intermediate support for SIFs. Setting Ontario, Canada Participants Representative samples of adults aged 18 years and over. Measurements Analyses of the agreement with implementation of SIFs in relation to four individual SIF goals and a composite measure. Findings The final sample sizes for 2003 and 2009 were 1212 and 968, respectively. Between 2003 and 2009, there were increases in the proportion of participants who strongly agreed with implementing SIFs to: reduce neighbourhood problems (0.309 versus 0.556, respectively); increase contact of people who use drugs with health and social workers (0.257 versus 0.479, respectively); reduce overdose deaths or infectious disease among people who use drugs (0.269 versus 0.482, respectively); and encourage safer drug injection (0.213 versus 0.310, respectively). Analyses using a composite measure of agreement across goals showed that 0.776 of participants had mixed opinions about SIFs in 2003, compared with only 0.616 in 2009. There was little change among those who strongly disagreed with all SIF goals (0.091 versus 0.113 in 2003 and 2009, respectively). Conclusions Support for implementation of supervised injection facilities in Ontario, Canada increased between 2003 and 2009, but at both time-points a majority still held mixed opinions. Keywords
Adult, Canada, general population, public opinion, supervised injection facilities, telephone survey.
Correspondence to: Carol Strike, Dalla Lana School of Public Health, Toronto, Ontario, Canada M5T 3M7. E-mail: [email protected] Submitted 22 July 2013; initial review completed 5 November 2013; final version accepted 27 January 2014
INTRODUCTION In many jurisdictions around the world, the implementation of supervised injection facilities (SIFs) is a contested subject. SIFs, also known as drug consumption facilities, drug consumption rooms and off-street injecting facilities, are defined as ‘legally sanctioned and supervised facilities designed to reduce the health and public order problems associated with illegal injection of drugs’ [1]. Inside a SIF, patrons are allowed to inject pre-obtained illicit drugs in a hygienic and low-risk environment. The goals of these facilities include: reducing transmission of human immunodeficiency virus (HIV), hepatitis C (HCV) © 2014 Society for the Study of Addiction
and other blood-borne viruses; reducing morbidity and mortality associated with overdose; reducing public order problems such as public drug use, disturbances and drugrelated litter; and increasing opportunities for respite from the street environment and contact between people who use drugs and health and social services [2–5]. Typically, SIFs open in contexts where injection drug userelated problems persist despite the availability of drug treatment, needle and syringe programmes (NSPs), social services, the efforts of emergency medical services to manage overdoses and the police to disperse and/or control the drug market [6]. Since the first SIF opened in the Netherlands during the 1970s [1], an additional Addiction, 109, 946–953
Increasing public support for supervised injection facilities
92 facilities have opened their doors in 61 cities worldwide, in countries such as Germany, Switzerland, Spain, Denmark, Australia and Canada [6]. SIFs are controversial because they are believed by some stakeholders (e.g. residents, business owners, politicians, police, etc.) to promote initiation of injection drug use, to endorse continued drug use at the expense of encouraging entry into drug treatment and/or to promote congregation of people who use and sell drugs around a facility which may lead to increased crime [1,6]. As Ritter & Lancaster [7] suggest, there can be a disconnect between science and public opinion. Despite these negative connotations associated with SIFs, more than a decade of research from Australia, Europe and Canada has demonstrated numerous benefits of these programmes [5,8–11]. For example, evidence from the United States demonstrates a stark divide between scientific findings regarding NSPs and public policy, which can be attributed in part to public opinion [12]. In Germany and Australia, where SIFs have been implemented and public opinion assessed, results show that despite initial fears about the potential negative impact of a SIF on the surrounding community, residents and business owners became more supportive of these facilities after opening [13–15]. Findings from Germany caution against overselling the benefits of a SIF as a cure-all for drug-related issues in a community [13]. Rather than positioning SIFs as panaceas for drug use problems, the complexity of the issues should be reinforced with the SIF positioned as one component of a multi-faceted solution [13]. As such, positioning SIFs as panaceas for drug use problems is ill-advised and ignores the complex determinants of these phenomena. For communities considering implementation of a SIF, an assessment of the level of public support and opposition for SIFs is an important input, because governments are more likely to act when public opinion is supportive of particular policies and practices [16,17]. Thus, the level of public support or opposition can play a key role in determining whether such a facility would even be feasible in a particular location. Reporting on data from a 2003 Ontario populationbased telephone survey, the most populous province in Canada, Firestone-Cruz and colleagues [18] showed that the percentage of residents who agreed somewhat or strongly with SIF implementation varied by specific SIF goals: to encourage safer injection (59%), to decrease overdose (69.9%), to increase contact with health and social services (71.5%) and to reduce neighbourhood problems (73.8%). Ritter & Lancaster [7] note that public opinion is not static, and may be influenced by media coverage. Given the high level of media coverage across Canada about the SIF in Vancouver since its opening in 2003, one might wonder if there has been any change in © 2014 Society for the Study of Addiction
947
public opinion about these facilities [17]. The purpose of our study was twofold: (i) to determine the level of public agreement or lack thereof regarding implementation of SIFs in Ontario; and (ii) to examine if there had been any changes in public opinion about SIFs between 2003 and 2009. METHODS Study design and data source We analysed data from the 2003 and 2009 CAMH Monitor surveys. The Centre for Addiction and Mental Health (CAMH) conducts these cross-sectional surveys each year to collect information about substance use (alcohol, tobacco and other drug use), mental health and public opinion regarding drug issues and policies from residents of Ontario. Information was gathered from participants using computer-assisted telephone interviewing. Approximately 2000 Ontario adults were selected each year based on a two-stage probability design. First, telephone numbers (representing households) were randomly selected within six provincial region strata. Secondly, the participant aged 18 years or older with the most recent birthday was selected within each household. To be eligible, participants had to be able to complete the interview in English or French. When the final survey results are weighted, each cycle of the survey is representative of the Ontario population aged 18 years and older that year. Additional information about the CAMH Monitor sampling method is available in the technical guides [19,20]. In 2003 and 2009, the CAMH Monitor included questions to assess public opinions about SIFs. The survey was conducted monthly and SIF questions were asked for 6 of 12 months each year. During the interview, participants were told: ‘The next few questions are about “safe injection site” facilities. The Vancouver supervised injection facility, “Insite”, provides a place supervised by healthcare workers for drug users to inject their drugs. Several other cities in Canada are considering starting up similar programmes. The next few questions are about your views on these facilities’. Participants were asked if they strongly agreed, somewhat agreed, somewhat disagreed or strongly disagreed with each of the following statements: 1 Supervised injection facilities should be made available to injection drug users, to encourage safer drug injection. 2 Supervised injection facilities should be made available if it can be shown that they reduce overdose deaths or infectious disease among users. 3 Supervised injection facilities should be made available if they can increase drug users’ contact with health and social workers. Addiction, 109, 946–953
948
Carol Strike et al.
4 Supervised injection facilities should be made available if it can be shown that they reduce neighbourhood problems related to injection drug use. We classified responses for each of the four goal questions into three categories: strongly disagree; somewhat agree or disagree (representing participants whose opinions might change); and strongly agree. We also created a composite variable to capture Ontario residents’ overall opinions about SIFs in 2003 and 2009 by grouping the responses to the four goals as follows: • Strongly agreed: participants who strongly agreed with all four goals. • Strongly disagreed: participants who strongly disagreed with all four goals. • Mixed opinions: all other patterns of responses.
Statistical analyses We analysed the data using statistical models for complex survey data. Such models account for stratified sampling (in our case, by region of the province) and allow for sampling weights that reflect the characteristic of the study design and population characteristics; applying such weights yields point estimates that are representative of the population from which the survey samples were drawn and accurate confidence intervals. The CAMH survey weights are a function of the sampling (accounting for household size, six regions and 12 study months) and post-stratification adjustment (using four age and two gender categories based on census information). Post-stratification adjustment also reduces bias due to non-response and exclusion of households without telephones. In all analyses, we omitted responses that were recorded as refusals, ‘don’t know’ or otherwise missing. We calculated the proportion of participants in each response category and survey cycle year (2003 and 2009). Differences in the distribution of responses across years were calculated using a Pearson χ2 statistic corrected for survey designs using the method of Rao & Scott [21]. We used a similar method to describe the demographic characteristics in each survey cycle. We calculated 95% confidence intervals (CIs) for each proportion using Taylor linearization-based variance estimators [22]. Both unadjusted and adjusted absolute differences in the proportion of participants in each response category were calculated between years. For the latter, we used multinomial logistic regression with study year as a dependent variable and non-parsimonious adjustment for demographic covariates (employment, marital status, education, income, rural residence, alcohol use in the past year and cannabis use in the past year) [23]. We used the results of this model to calculate the differences between expected proportions across study years and to calculate confidence intervals for the © 2014 Society for the Study of Addiction
differences from standard errors using the method of Korn & Graubard for population-averaged risk differences [24]. We fitted separate models for each of the four SIF goals and for the composite measure. All analyses were completed using Stata version 13.1 [25]. We used a two-tailed P-value threshold of 0.05 to assess statistical significance and did not adjust for multiple comparisons.
RESULTS In 2003, a total of 1229 participants were asked questions about SIFs. In 2009, 1035 participants were asked the same questions. After accounting for missing data, the final sample sizes for 2003 and 2009 were 1212 and 968, respectively. Comparison of the two samples revealed small but significant demographic differences (Table 1). In 2003 and 2009, the distribution of participants differed in terms of age, employment status, household income, rural residence and education. The overall distribution of responses regarding SIF implementation varied significantly (P < 0.001) by year for each goal. Between 2003 and 2009, there was a large increase (0.247, 95% CI = 0.199–0.296) in the proportion of participants who strongly agreed with implementing SIFs to reduce neighbourhood problems (0.309 versus 0.556; Table 2). The difference was similar after non-parsimonious adjustment (i.e. for employment, marital status, education, income, rural residence, alcohol use in the past year and cannabis use in the past year; 0.264, 95% CI = 0.207–0.321). There were also large increases between the two years with respect to the proportion of participants who strongly agreed with implementing SIFs to increase contact of people who use drugs with health and social workers (adjusted difference 0.221, 95% CI = 0.165–0.277) and to reduce overdose deaths or infectious disease among people who use drugs (adjusted difference 0.217, 95% CI = 0.161–0.274). The proportions of participants who strongly agreed with these goals in 2009 were 0.479 and 0.482, respectively. There was also a small increase in the proportion of participants who strongly agreed with implementing SIFs to encourage safer drug injection (adjusted difference of 0.080, 95% CI = 0.027– 0.133). This goal had the lowest proportion of people who expressed strong agreement in each year (0.213 and 0.310 in 2003 and 2009, respectively). The changes in the proportion of participants who strongly disagreed with each of the SIFs goals were small, and not statistically significant for any of the four goals. In 2003, the proportion of participants who strongly disagreed with implementation of a SIF if the goal was to encourage safe drug use was 0.273 versus 0.281 in 2009; the adjusted difference was 0.029 (95% Addiction, 109, 946–953
Increasing public support for supervised injection facilities
949
Table 1 Participant characteristics (weighted), 2003 and 2009. 2003 (n = 1212) Participant characteristics Sex Male Female Age (years) 18–34 35–54 55+ Employment status Employed Unemployed Marital status Married or with partner Previously married Never married Household income past year before taxes
RESEARCH REPORT
doi:10.1111/add.12506
Increasing public support for supervised injection facilities in Ontario, Canada Carol Strike1,2, Jennifer A. Jairam3, Gillian Kolla1, Peggy Millson1, Susan Shepherd4, Benedikt Fischer2,5, Tara Marie Watson1 & Ahmed M. Bayoumi3,6,7,8 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,1 Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,2 Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada,3 Toronto Drug Strategy Secretariat, Toronto Public Health, Toronto, Ontario, Canada,4 Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada,5 Department of Medicine, University of Toronto, Toronto, Ontario, Canada,6 Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada7 and Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada8
ABSTRACT Aim To determine the level and changes in public opinion between 2003 and 2009 among adult Canadians about implementation of supervised injection facilities (SIFs) in Canada. Design Population-based, telephone survey data collected in 2003 and 2009 were analysed to identify strong, weak, and intermediate support for SIFs. Setting Ontario, Canada Participants Representative samples of adults aged 18 years and over. Measurements Analyses of the agreement with implementation of SIFs in relation to four individual SIF goals and a composite measure. Findings The final sample sizes for 2003 and 2009 were 1212 and 968, respectively. Between 2003 and 2009, there were increases in the proportion of participants who strongly agreed with implementing SIFs to: reduce neighbourhood problems (0.309 versus 0.556, respectively); increase contact of people who use drugs with health and social workers (0.257 versus 0.479, respectively); reduce overdose deaths or infectious disease among people who use drugs (0.269 versus 0.482, respectively); and encourage safer drug injection (0.213 versus 0.310, respectively). Analyses using a composite measure of agreement across goals showed that 0.776 of participants had mixed opinions about SIFs in 2003, compared with only 0.616 in 2009. There was little change among those who strongly disagreed with all SIF goals (0.091 versus 0.113 in 2003 and 2009, respectively). Conclusions Support for implementation of supervised injection facilities in Ontario, Canada increased between 2003 and 2009, but at both time-points a majority still held mixed opinions. Keywords
Adult, Canada, general population, public opinion, supervised injection facilities, telephone survey.
Correspondence to: Carol Strike, Dalla Lana School of Public Health, Toronto, Ontario, Canada M5T 3M7. E-mail: [email protected] Submitted 22 July 2013; initial review completed 5 November 2013; final version accepted 27 January 2014
INTRODUCTION In many jurisdictions around the world, the implementation of supervised injection facilities (SIFs) is a contested subject. SIFs, also known as drug consumption facilities, drug consumption rooms and off-street injecting facilities, are defined as ‘legally sanctioned and supervised facilities designed to reduce the health and public order problems associated with illegal injection of drugs’ [1]. Inside a SIF, patrons are allowed to inject pre-obtained illicit drugs in a hygienic and low-risk environment. The goals of these facilities include: reducing transmission of human immunodeficiency virus (HIV), hepatitis C (HCV) © 2014 Society for the Study of Addiction
and other blood-borne viruses; reducing morbidity and mortality associated with overdose; reducing public order problems such as public drug use, disturbances and drugrelated litter; and increasing opportunities for respite from the street environment and contact between people who use drugs and health and social services [2–5]. Typically, SIFs open in contexts where injection drug userelated problems persist despite the availability of drug treatment, needle and syringe programmes (NSPs), social services, the efforts of emergency medical services to manage overdoses and the police to disperse and/or control the drug market [6]. Since the first SIF opened in the Netherlands during the 1970s [1], an additional Addiction, 109, 946–953
Increasing public support for supervised injection facilities
92 facilities have opened their doors in 61 cities worldwide, in countries such as Germany, Switzerland, Spain, Denmark, Australia and Canada [6]. SIFs are controversial because they are believed by some stakeholders (e.g. residents, business owners, politicians, police, etc.) to promote initiation of injection drug use, to endorse continued drug use at the expense of encouraging entry into drug treatment and/or to promote congregation of people who use and sell drugs around a facility which may lead to increased crime [1,6]. As Ritter & Lancaster [7] suggest, there can be a disconnect between science and public opinion. Despite these negative connotations associated with SIFs, more than a decade of research from Australia, Europe and Canada has demonstrated numerous benefits of these programmes [5,8–11]. For example, evidence from the United States demonstrates a stark divide between scientific findings regarding NSPs and public policy, which can be attributed in part to public opinion [12]. In Germany and Australia, where SIFs have been implemented and public opinion assessed, results show that despite initial fears about the potential negative impact of a SIF on the surrounding community, residents and business owners became more supportive of these facilities after opening [13–15]. Findings from Germany caution against overselling the benefits of a SIF as a cure-all for drug-related issues in a community [13]. Rather than positioning SIFs as panaceas for drug use problems, the complexity of the issues should be reinforced with the SIF positioned as one component of a multi-faceted solution [13]. As such, positioning SIFs as panaceas for drug use problems is ill-advised and ignores the complex determinants of these phenomena. For communities considering implementation of a SIF, an assessment of the level of public support and opposition for SIFs is an important input, because governments are more likely to act when public opinion is supportive of particular policies and practices [16,17]. Thus, the level of public support or opposition can play a key role in determining whether such a facility would even be feasible in a particular location. Reporting on data from a 2003 Ontario populationbased telephone survey, the most populous province in Canada, Firestone-Cruz and colleagues [18] showed that the percentage of residents who agreed somewhat or strongly with SIF implementation varied by specific SIF goals: to encourage safer injection (59%), to decrease overdose (69.9%), to increase contact with health and social services (71.5%) and to reduce neighbourhood problems (73.8%). Ritter & Lancaster [7] note that public opinion is not static, and may be influenced by media coverage. Given the high level of media coverage across Canada about the SIF in Vancouver since its opening in 2003, one might wonder if there has been any change in © 2014 Society for the Study of Addiction
947
public opinion about these facilities [17]. The purpose of our study was twofold: (i) to determine the level of public agreement or lack thereof regarding implementation of SIFs in Ontario; and (ii) to examine if there had been any changes in public opinion about SIFs between 2003 and 2009. METHODS Study design and data source We analysed data from the 2003 and 2009 CAMH Monitor surveys. The Centre for Addiction and Mental Health (CAMH) conducts these cross-sectional surveys each year to collect information about substance use (alcohol, tobacco and other drug use), mental health and public opinion regarding drug issues and policies from residents of Ontario. Information was gathered from participants using computer-assisted telephone interviewing. Approximately 2000 Ontario adults were selected each year based on a two-stage probability design. First, telephone numbers (representing households) were randomly selected within six provincial region strata. Secondly, the participant aged 18 years or older with the most recent birthday was selected within each household. To be eligible, participants had to be able to complete the interview in English or French. When the final survey results are weighted, each cycle of the survey is representative of the Ontario population aged 18 years and older that year. Additional information about the CAMH Monitor sampling method is available in the technical guides [19,20]. In 2003 and 2009, the CAMH Monitor included questions to assess public opinions about SIFs. The survey was conducted monthly and SIF questions were asked for 6 of 12 months each year. During the interview, participants were told: ‘The next few questions are about “safe injection site” facilities. The Vancouver supervised injection facility, “Insite”, provides a place supervised by healthcare workers for drug users to inject their drugs. Several other cities in Canada are considering starting up similar programmes. The next few questions are about your views on these facilities’. Participants were asked if they strongly agreed, somewhat agreed, somewhat disagreed or strongly disagreed with each of the following statements: 1 Supervised injection facilities should be made available to injection drug users, to encourage safer drug injection. 2 Supervised injection facilities should be made available if it can be shown that they reduce overdose deaths or infectious disease among users. 3 Supervised injection facilities should be made available if they can increase drug users’ contact with health and social workers. Addiction, 109, 946–953
948
Carol Strike et al.
4 Supervised injection facilities should be made available if it can be shown that they reduce neighbourhood problems related to injection drug use. We classified responses for each of the four goal questions into three categories: strongly disagree; somewhat agree or disagree (representing participants whose opinions might change); and strongly agree. We also created a composite variable to capture Ontario residents’ overall opinions about SIFs in 2003 and 2009 by grouping the responses to the four goals as follows: • Strongly agreed: participants who strongly agreed with all four goals. • Strongly disagreed: participants who strongly disagreed with all four goals. • Mixed opinions: all other patterns of responses.
Statistical analyses We analysed the data using statistical models for complex survey data. Such models account for stratified sampling (in our case, by region of the province) and allow for sampling weights that reflect the characteristic of the study design and population characteristics; applying such weights yields point estimates that are representative of the population from which the survey samples were drawn and accurate confidence intervals. The CAMH survey weights are a function of the sampling (accounting for household size, six regions and 12 study months) and post-stratification adjustment (using four age and two gender categories based on census information). Post-stratification adjustment also reduces bias due to non-response and exclusion of households without telephones. In all analyses, we omitted responses that were recorded as refusals, ‘don’t know’ or otherwise missing. We calculated the proportion of participants in each response category and survey cycle year (2003 and 2009). Differences in the distribution of responses across years were calculated using a Pearson χ2 statistic corrected for survey designs using the method of Rao & Scott [21]. We used a similar method to describe the demographic characteristics in each survey cycle. We calculated 95% confidence intervals (CIs) for each proportion using Taylor linearization-based variance estimators [22]. Both unadjusted and adjusted absolute differences in the proportion of participants in each response category were calculated between years. For the latter, we used multinomial logistic regression with study year as a dependent variable and non-parsimonious adjustment for demographic covariates (employment, marital status, education, income, rural residence, alcohol use in the past year and cannabis use in the past year) [23]. We used the results of this model to calculate the differences between expected proportions across study years and to calculate confidence intervals for the © 2014 Society for the Study of Addiction
differences from standard errors using the method of Korn & Graubard for population-averaged risk differences [24]. We fitted separate models for each of the four SIF goals and for the composite measure. All analyses were completed using Stata version 13.1 [25]. We used a two-tailed P-value threshold of 0.05 to assess statistical significance and did not adjust for multiple comparisons.
RESULTS In 2003, a total of 1229 participants were asked questions about SIFs. In 2009, 1035 participants were asked the same questions. After accounting for missing data, the final sample sizes for 2003 and 2009 were 1212 and 968, respectively. Comparison of the two samples revealed small but significant demographic differences (Table 1). In 2003 and 2009, the distribution of participants differed in terms of age, employment status, household income, rural residence and education. The overall distribution of responses regarding SIF implementation varied significantly (P < 0.001) by year for each goal. Between 2003 and 2009, there was a large increase (0.247, 95% CI = 0.199–0.296) in the proportion of participants who strongly agreed with implementing SIFs to reduce neighbourhood problems (0.309 versus 0.556; Table 2). The difference was similar after non-parsimonious adjustment (i.e. for employment, marital status, education, income, rural residence, alcohol use in the past year and cannabis use in the past year; 0.264, 95% CI = 0.207–0.321). There were also large increases between the two years with respect to the proportion of participants who strongly agreed with implementing SIFs to increase contact of people who use drugs with health and social workers (adjusted difference 0.221, 95% CI = 0.165–0.277) and to reduce overdose deaths or infectious disease among people who use drugs (adjusted difference 0.217, 95% CI = 0.161–0.274). The proportions of participants who strongly agreed with these goals in 2009 were 0.479 and 0.482, respectively. There was also a small increase in the proportion of participants who strongly agreed with implementing SIFs to encourage safer drug injection (adjusted difference of 0.080, 95% CI = 0.027– 0.133). This goal had the lowest proportion of people who expressed strong agreement in each year (0.213 and 0.310 in 2003 and 2009, respectively). The changes in the proportion of participants who strongly disagreed with each of the SIFs goals were small, and not statistically significant for any of the four goals. In 2003, the proportion of participants who strongly disagreed with implementation of a SIF if the goal was to encourage safe drug use was 0.273 versus 0.281 in 2009; the adjusted difference was 0.029 (95% Addiction, 109, 946–953
Increasing public support for supervised injection facilities
949
Table 1 Participant characteristics (weighted), 2003 and 2009. 2003 (n = 1212) Participant characteristics Sex Male Female Age (years) 18–34 35–54 55+ Employment status Employed Unemployed Marital status Married or with partner Previously married Never married Household income past year before taxes
