Comprehensive User Engagement Sites (CUES) -- sites where people can inject drugs under medical supervision in well-lit, hygienic spaces -- are integral in advising clients about injection-related harms, providing clean injecting supplies, providing linkages to medical and social services, and treating overdoses. Sites that operate in this fashion have existed for over 3 decades in Europe, and for over a decade in Australia and in Canada. Aside from preventing fatal overdose, people with an addiction to opioids who use CUES to inject drugs report less frequent public injection, less syringe sharing, and more uptake in addiction treatment than do other people who inject drugs (PWID). Economically, start-up and operating costs for a CUES are small compared to the cost of providing reactive care for PWID with otherwise unmet needs.
As Philadelphia prepares to launch perhaps the first Comprehensive User Engagement Sites in the nation, the Center for Public Health Initiatives (CPHI) and the Penn Injury Science Center (PISC) at the University of Pennsylvania convened an interdisciplinary “CUES Evaluation Working Group” of faculty, fellows, and stakeholders from the city and the drug-using community in order to identify fundamental criteria in determining where to open a CUES. Using a mixed methods approach that combines geographic analyses and qualitative research methods, we asked various populations for their thoughts about what features would make a location either well suited or not well suited for operating a CUES , then classified each city block according to the presence or absence of each type of asset, barrier, or indicator of demand. Geocoding these location features, assigning a weight to each to represent its relative importance, and summing the values into a score produced a map of Philadelphia that identified 5 specific locations that appear to be most well suited for operating a CUES .