Harm reduction in Italy: the experience of an unsanctioned supervised injection facility run by drug users
Authors: Bergamo Sonia , Parisi Giuseppe , Jarre Paolo 
Published: December 2018

Purpose
Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s. Despite this, no sanctioned SIF has ever been implemented. The purpose of this paper is to provide information about a 10 year unsanctioned drug user-run SIF experience in Italy called Stanzetta.

Design/methodology/approach
The aim of the paper is to assess how Stanzetta met its objectives. Analysis was conducted compiling narrative accounts from the staff working in the NSP, which is adjacent to the Stanzetta, and conducting a simple frequency analysis of the available statistical data.

Findings
The Stanzetta unsanctioned SIF has been running for ten years and continues to be vulnerable due to its legal status. Being open 24 h/days has maximised its accessibility, but at the same time, it has encouraged a misuse of the Stanzetta. Although not trained, drug users became self-empowered to run the Stanzetta and to keep it clean, but the hygiene-health aspect is seen as one of the greatest challenges by the NSP professional staff. Over 10 years, not a single overdose death has been recorded. Drug use in the park has shifted from more visible places to the Stanzetta. As a result, the abandoned syringes have diminished in number and those disposed of correctly have increased. Moreover, no complaints from citizens or law enforcement were ever made. The neighbourhood acceptance seems to be the main goal of the peer-run unsanctioned SIF.

Research limitations/implications
The paper is based on a narrative account from the point of view of the professional staff involved, and results are specific to the context in which the study was conducted. Because of the chosen approach, the research results lack scientific generalisability. A relevant limitation is that no peer was involved in this study. Despite this, the research contributes to the information based on peer-run SIFs and makes a case for the de-medicalisation of SIFs in Europe.

Practical implications
This paper gives visibility to a long-lasting drug user-run SIF experience that was not made public mostly for an unclear legislative background about SIF in Italy.

Social implications
Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s and were undertaken primarily in response to epidemics of HIV infection and overdose (DPA, 2017). Despite this, no sanctioned SIF has ever been implemented. Primarily, this study wants to underline the urgency for an SIF pilot in Italy, and secondly the need to consider de-medicalising these services through direct support for peer-based models.

Originality/value
The Stanzetta unsanctioned SIF in Italy that has been running for ten years. Despite this, the venue continues to be vulnerable due to its legal status. For this reason, these results were never made public before. The experience showed a good working synergy between NSP professionals and the SIF peers. This model can be considered as a “light” de-medicalisation form to be explored and eventually to be implemented as a pilot SIF in Italy.