Architectural Harm Reduction - MArch Dissertation - Portland State University

ARCHITECTURAL HARM REDUCTION

Creating Spaces for Safe Opioid Consumption

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AN ARCHITECTURAL SOLUTION TO THE OPIOID OVERDOSE EPIDEMIC Bridging the gap between public health policy and architecture. by Mathew Stockstill

Thesis document submitted in partial fulfillment of the requirements for the degree of Master of Architecture at Portland State University Portland, Oregon June 2016

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PORTLAND STATE UNIVERSITY SCHOOL OF ARCHITECTURE COLLEGE OF THE ARTS The undersigned hereby certify that the Masters thesis of Mathew Stockstill has been approved as partial fulfillment of the requirements for the degree of Master of Architecture

Thesis Committee:

Advisor Sergio Palleroni Professor of Architecture, Director of Center for Public Interest Design __________________________________ ________________ Date

Committee Member Andrew Santa Lucia Assistant Professor of Practice __________________________________ ________________ Date

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Acknowledgments This research and documentation would never have been able to be accomplished without the support and guidance of the faculty of the School of Architecture at Portland State University.

To Barbara Sestak, an irreplaceable mentor from start to finish & Haven Wheelock, a selfless leader, fighting for lives daily.

“Be the change you wish to see in the world.� - Mohandas Gandhi

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Abstract Opioid overdose deaths are increasing across the United States with little intervention. As more synthetic drugs enter the drug market and pain relieving prescriptions increase, the biggest drug crisis in United State’s history is bound to worsen. In order to reverse this trend, more progressive forms of harm reduction and public health policy must be exercised. One solution proving effective in many European and Asian countries are Supervised Injection Centers. These facilities provide users of opioids with clean equipment and spaces where substances can be consumed under the supervision of trained staff. Supervised Injection Facilities, or SIFs, prevent hundreds of opioid overdose deaths daily and offer counseling resources to visitors who desire them. While this form of harm reduction has not yet been legalized in the United States, legislation for its decriminalization is on the table in a few states.

Once legalized however, the negative stigmas revolving around drug use will continue to prevent most users of opioids from gaining social capital and self-actualization.

Supervised Injection Facilities require many safety and surveillance measures for visitor protection. These requirements have set the stage for a space similar to most institutional and medical facilities. Within these architecture types are often a lack of humanized vernacular.

While consuming opioids in a safe manner requires a process with physical and visual restrictions, opportunities exist for experiential intervention. What these experiences are will be evaluated throughout this Thesis. Also included in this Thesis is an investigation into the proper integration of Supervised Injection Facilities within a community.

Facility resiliency is dependent upon this community integration, for any SIF constructed in the United States will face immediate backlash from regional and local groups.This integration can also positively affect facility users by providing social capital and self-actualization.

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Research Question How can architecture provide a safe, experiential space for users of opioids to consume while lessoning the negative stigmas revolving around opioid use?

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Table of Contents A Country in Crisis ���������������������������������������������������������������� 2

Facilitating Safe Consumption............................................. 58

The United States of Opioids Overdosing on Opioids Supervised Consumption

Humanizing the Machine ����������������������������������������������������� 64 Injection Room Dissecting the Machine

In Search of Architecture ���������������������������������������������������� 14

A New Model

Architectural Elements Architecture Phenomenology Culture of Opioid Use

The Complete Experience �������������������������������������������������� 74 Power of Procession Progress Marches On

Intervention ���������������������������������������������������������������������������� 24 St. Louis

My Experience ����������������������������������������������������������������������� 84

Delmar Boulevard Appendix A: Endnotes

Harmonious Integration ������������������������������������������������������ 38

Appendix B: List of Figures

Site Situation Site Planning Massing and Material Studies

Appendix C: Bibliography Appendix D: Unreferenced Sources

Business Start-Up Art Gallery Lessons on Integration

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Beginning Thoughts The current opioid epidemic is a harsh reality I was fortunate enough to avoid growing up.

Located in the heart of rural Missouri, I was able to escape most of the crisis’ that consumed metropolitan areas such as Kansas City and St. Louis. The occasional double dose of Vicodin or Hydrocodone is all that any friend or family member of mine consumed. I was raised in the small town of Smithton, where no face was foreign and no story had been untold. Being raised in a community of barely 500, mostly low-income, citizens was very influential. While this lifestyle had many positive effects, some realities were tougher to grasp than others.

One reality I accepted early on in my Midwestern life is that support can be far away. I grew up in a double-wide trailer on a small plot of land owned by my grandparents. Although our lifestyle was nothing short of necessitous, there was never a shortage of comfort and love. Everyone around me prayed for my success and if any family member struggled, someone was immediately there for support. This sense of belonging and endorsement has guided me throughout life. It has encouraged me to pursue philanthropic and volunteer opportunities and use my strengths to accommodate other’s weaknesses.

Upon entering my initial Thesis term, my topic was undecided. I knew that I wanted my project to have humanitarian implications and involve a challenging topic that I had not researched before. At first, I wanted to research the affects of legally sanctioned spaces on surrounding communities. This would have investigated how legalizing illicit activities such as drug sales, prostitution, gambling, among others in a specific area could affect an entire city. I soon discovered that this project scale was too large and vague. Fortunately, my Thesis professor, Andrew Santa Lucia, encouraged me to research safe consumption spaces, which are also legally sanctioned spaces. Andrew has been working with Greg Scott on safe consumption space exhibits in the United States over the past few years. After diving into their work, and the current U.S. opioid crisis, I quickely realized the depth of this issue.

I was immediately intrigured by the crisis, particularly in Missouri, my home state. This intrigue set the stage for a personally impactful journey into the opioid epidemic.

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A Country in Crisis

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The United States of Opioids The United States is currently facing a historical drug crisis. Opioids, pain relieving drugs, have experienced increased use, medicinally and recreationally since the 1990s. Illicit forms such as heroine are being sold across neighborhoods and communities while licit prescriptions such as oxycontin and morphine are turning patients into victims in hospitals and pharmacies. Even as pharmaceuticals and law enforcement attempt to halt the crisis, more people are being introduced to morphine, heroin, fentanyl, and other pain relieving substances daily. These highly-addictive drugs do not recognize use limitations among race, age, gender or income.

They are used in New York City skyscrapers and elementary school playgrounds across the country, with no effective regulation on use and strength. Regardless of consumption method, opioids have a rapid, pleasure inducing effect on our nervous system, making withdrawal a significantly difficult process. A singular Oxycontin pill can kickstart a deadly addiction battle. It is estimated that 11.5 million Americans age 12 and up misused prescription pain medicine in 2016 while nearly 950,000 Americans in the same age bracket used heroin.1 One unsterile needle can lead to a lifetime battle against AIDS and HIV. Despite these facts, the opioid epidemic does not appear to be slowing down and there is no immediate end in sight.

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Fig. 1.1: 2016 Opioid Data

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Opioids bind to brain and spinal cord receptors, disrupting pain signals. They also create a euphoric feeling by activating the reward areas of the brain.7 These effects make them a popular solution to harsh physical and emotional pain. Most prescription opioids such as morphine and codeine, are derived from the seed pod in opium poppy plants, which are grown in Asia, Central America, and South America. Heroin, another opioid, is an illegal drug derived from morphine than can be consumed in many different ways. Semisynthetic opioid drugs such as hydrocodone and oxycodone are made using natural and synthetic ingredients. The most recent wave of opioids are full synthetic substances and are having a significant impact on the epidemic. They are typically cheaper than prescription drugs and heroin but drastically more dangerous due to an absence of government and health regulation. The evolution of opioid use and type has evolved drastically from its beginning in 3400 BC. The Assyrians cultivated it in lower Mesopotamia, before trading it to the Egyptians. Around 400 BC, Hippocrates began using the plant medicinally to treat diseases, a practice with a sordid story that evolved into a long and fatal drug crisis.

Weaker

Natural Opioids (Derived from Opium Poppy)

Semisynthetic Opioids (Distilled from Natural Opioids)

Full Synthetic Opioids

Morphine

Heroin

Methadone

Codeine

Hydromorphone

Fentanyl

Thebaine

Oxycodone

Expensive Fig. 1.2: Types of Opioids

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Stronger

Inexpensive 8

Fig. 1.3: Timeline of Opioids and Opioid Use

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History of Support Spaces

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History of Opioid Use

Overdosing on Opioids During opioid consumption, the same brain and spinal cord receptors that disrupt pain signals, also repress respiratory activity. Thus, most overdose fatalities are caused by choking to death, with the respiratory depression rate dependant on substance potency.

Synthetic opioids such as fentanyl, attach to receptors more tightly, making it more difficult for internal processes to stabilize. Unfortunately, the more opioids one consumes, the more pleasure they feel along with a greater risk of overdose death. In 2016, there were nearly 43,000 deaths in the United States related to opioids, with synthetic versions taking over 20,000 lives.9 A new counter-substance, Naloxone, attaches to the same receptors and replaces opioid molecules after they fall off and before new ones can move in, a procession that occurs every few seconds. This immediately halts respiratory depression, leading to an excruciating withdrawal. Naloxone is available over the counter without a prescription in most states, but the increasing strength of synthetic drugs is at times too much for its counteragent to work in time. With an increase in fentanyl production and global market connectivity, these rates will increase if a new approach to harm reduction or prevention is not pursued.

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Countries outside of the United States have and are currently facing similar opioid epidemics.

While some rely on opioid criminalization to prevent use, others are taking more progressive approaches. Portugal, for instance legalized opioids along with all drugs in 2001. Before that, 1% of the entire population was addicted to heroin, but since, only 3 out of every million Portuguese fatally overdose annually.10 Switzerland was the first country to allow facilities where opioid consumption could be done legally and safely. Since, it has seen a decrease in overdose deaths and HIV and AIDS cases.11 There are 100 Supervised Injection Facilities (SIFs) in existence, across 66 different cities, all of which are outside the United States.12 Most counterarguments to this form of harm reduction involve religious or ethical dilemmas. For instance, some opponents of safe consumption sites claim that these spaces enable users of opioids to consume more. Others fear that these spaces encourage drug dealing and other illegal behavior. Both of these oppositional grounds, and many others, have contributed to the negative stigmas revolving around opioid use.

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Supervised Consumption Safe Injection Facilities are sanctioned spaces where users of opioids can consume preobtained substances under the direct supervision of trained staff and while using sterile equipment. The primary functions of these facilities are to prevent both opioid overdose deaths and the spreading of diseases. Secondary to harm reduction is drug-use prevention by means of in-house counseling or referrals. Facility size and programs vary across centers, typically based upon funding via government and non-profit grants. At the core of each center, however, is the injection room. In these rooms, users of opioids can consume as much substance as they wish and stay for an unlimited amount of time. Injection rooms entail many observation and safety requirements similar to most medical facilities. These requirements, in some capacity, are also needed in all other SIF spaces, creating many design and planning challenges.

Supervised Injection Facilities are a relatively new architectural type. While the essentials for safe consumption spaces are fairly pragmatic, limited exploration has been done to determine how spatial experience and quality can affect facility visitors, often due to financial and safety constraints. Regardless, SIFs should treat users of opioids as humans, not medical subjects. Breaking away from typical institutional processes is required of SIFs in order to provide an influential experience for visitors. What this entails, however, has yet to be determined.

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Main Safe Injection Facility Components

Visitor Assessment and Intake

Supervised Consumption Space

Other Service Areas

A. Determing Visitor Eligibility and Control Space Access

A. Ensure Safe and Hygenic Practices

A. Monitor Visitors after Consumption

B. Provide Facility Rules and Consumption Information

B. Ensure House Rules are Exercised

B. Provide Primary Medical Care Services

C. Provide Safe Equipment

C. Provide Visitor Specific Advice

C. Provide Crisis Intervention

D. Test Substances

D. Provide Emergency Response

D. Provide Needle Exchange/Disposal Program

E. Determine Visitor Health Needs

E. Prevent Undesired Behavior Near Facility

E. Provide Counseling Services

F. Prevent Visibility into Consumption Space

F. Provide Referrals to External Counseling Services

A. Establish Contact with Hard-to-Reach Populations

A. Reduce Mortality and Immediate Risks

A. Increase Visitor Awareness of Treatment Options

B. Identify and Refer Clients Needing Care

B. Stabilize and Promote Visitor Health

B. Increase Chances of Visitor Treatment

Primary Objectives

Anticipated Outcomes

A. Visitor Survival B. Increased Social Integration

Fig. 1.4: Typical Supervised Injection Facility Goals

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Fig. 1.5: Sequence of Consumption Activities within SIFs

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Proper urban integration is also vital to the successful implamentation and execution of Supervised Injection Facilities. Existing negative stigmas create consistent and unjustly hardship for users of opioids. To maximize facility use, users of opioids must feel safe while visiting. In response however, SIFs must also be sensitive to their surroundings. While opioid use is not directly related to other illegal or malicious activity, safe consumption is not universally accepted or welcome in most regions of the country. Successful integration, however, has the chance to make these facilities more resilient within communities. With proper synthesis, SIFs can help turn the table on negative stigmas, which will create more support systems for users of opioids. Safe, supervised consumption has proven to be a plausible solution to the United States opioid crisis by saving lives and decreasing the spread of disease abroad. With facility numbers increasing globally and a heightened level of awareness of succes, safe consumption spaces will soon be present in the United States.

In order for these facilities and their users to be resilient, two primary techniques should be implemented: a humanized experience and proper community integration.

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Fig. 1.6: H17 Injection Facility

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Fig. 1.7: Uniting Medically Supervised Injecting Centre

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Fig. 1.8: Insite Supervised Injection Facility

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In Search of Architecture

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In order to break the current Supervised Injection Facility processes, an architectural intervention must occur. New design standards should be explored and the medical processes that exists within safe consumption spaces must be dissected. Early architectural explorations where done to find how the built environment can benefit users of opioids. Many common architectural elements, including roofs, walls, ceilings, and stairs, were sought after in hope of finding inspiration for the design of a SIF. A series of key elements were derived that contain physical and phenomenological properties. All of these have distinct traits but can collectively offer a unique spatial experience.

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Architectural Elements Square Inc. Headquarters uses auditorium-style stairs to encourage social interaction in a space typically used exclusively for circulation. The majority of the staircase treads are wide enough for tables and seating while an accessible staircase along the perimeter still allows passive use. This space has become the primary area for social gatherings, making it an ideal precedent for the SIF project. Creating internal social spaces within a SIF will provide visitors with necessary privacy and interaction potential.

The Center for Earth Architecture is a testament to Francis Kere’s tectonic expression abilities. In this facility, he emphasizes the roof plane in order to signify spatial entry. While the facade and primary structural materials are subtle and commonly used in west Africa, the roof denotes building significance and placement. Emphasizing a common element in a SIF can provide similar spatial distinction effects. Balancing significance and subtlety will be required due to the controversial nature of these facilities.

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Fig. 2.1: Staircase at Square Inc Headquarters 17

Fig. 2.2: Exterior of Center for Earth Architecture 18

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Fig. 2.3: Screen Covered Corridor at the Bamboo Teahouse 19

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Fig. 2.4: Light Well in Ceiling at Nelson-Atkins Museum 20

Architecture Phenomenology Architecture has proven its ability to offer phenomenological experiences for users who interact with curated spaces. It can enhance or sober our emotions and senses often with very subtle techniques. SIFs should provide these phenomenological sensations in order to positively impact users of opioids and separate themselves from traditional medical facilities.

One important sensation inparticular that can be created by architecture is the feeling of security or privacy, which can be achieved by strategically placing enclosures and screens.

A Bamboo Courtyard Teahouse in ShiQiao, China uses a bamboo screen to create a semiprivate corridor. It offers an obstructed view into the space while still allowing natural light penetration and outward views. This provides users with a feeling of privacy without isolation.

Another phenomenology utilized in architecture is the sensory power of light. The NelsonAtkins Museum of Art designed by Steven Holl utilizes small light wells in certain galleries to create desired intimacy. Intense contrast in light can generate a sense of ascension and hope in otherwise dark spaces. This technique can provide an emotional uplift for users of opioids if applied in SIFs. Spaces that incorporate this phenomena, however, must be strategically placed to establish the proper light contrast.

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Culture of Opioid Use Appropriate design requires deep cultural investigation into the program the space is facilitating. Opioid use unfortunately has been victim to many negative stigmas in United States culture. These misconceptions continue to accumulate in many parts of the country, generating numerous heated debates in the fields of politics, social ethics, architecture, healthcare, and many others. Regardless of strong efforts from proponents of safe consumption, opioid use will continue to carry many negative connotations. Recognizing these debates and stances contributed to an awareness that architecture can respond to, rather than be responded to.

Fig. 2.5: Political Cartoon of Safe Consumption Spaces 21

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Fig. 2.6: Inner Demons 22

Fig. 2.7: Pro-ject, Autoinjector 23

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Fig. 2.8: Field Diagram of Research Buffer Zones Neutral Space

West Bank Wall Urban Division

URBAN DESIGN Ronald Rael Borderwalls

HEALTH David Canter Psychology & Arch

Dutch Health Model Harm Reduction

Controlled Substance Act of 1970 Drug Classification

SOCIAL 1st Amendment Right to Assemble

Daniel Weimer Syringe as a Symbol

Incite Site Canadian SIC

Boundaries

Teddy Cruz Border Walls

Clifford Moller Mental Health

Aaron Betsky Safe Spaces

Stan Allen Mat Configurations

Lori Brown Contested Spaces

Brigitte Piquard Wall as Fear

Richard Neutra Therepeutic Design

ARCHITECTURE

Wendy Pullan Conflict Infrastructures

Syringe

Needle Exchange

Andrew Santa Lucia Safe Shape

HIV, Aids Transmitted Diseases

Safe Injection Kits

Opiods Pain Relief

Sou Fujimoto Permeable Enclosures

US-Mexico Border Border Wall

PHYSICAL THEORETICAL / PSYCHOLOGICAL

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Intervention

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St. Louis Opioid overdoses occur in every region of the United States, making site selection challenging.

A facility with the potential to make such a substantial difference, however, should be placed in a location where it can have the greatest impact. With a high opioid overdose death rate and minimal support systems in tact, St. Louis, Missouri is in high need of this intervention.

Over 270 deaths in 2016 were opioid-related in St. Louis city limits. Seventy percent of Missouri opioid overdose deaths occured in St. Louis and surrounding counties. Despite this crisis, few support systems exist for users of opioids in the area. No syringe exchange programs exists and little government effort has been afforded trying to solve the problem.

A Supervised Injection Facility would be very effective in St. Louis, but its placement within the city must be strategic to maximize use and safety.

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Fig. 3.1: St. Louis Law Enforcement Facilities

Fig. 3.2: St. Louis Primary Vehicular Routes

Fig. 3.3: St. Louis Household Income Levels 24

Fig. 3.4: St. Louis Public Spaces

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Fig. 3.5: St. Louis Public Transit Routes

After analyzing various aspects of the city, three potential areas for a SIF seemed appropriate. The most significant criterion for selecting this facility’s site, however, is community strength. In order for a controversial program such as this to be resilient, a community must back the ideas it proposes or benefit from its presence. While there are no known communities or neighborhoods in St. Louis that actively support safe consumption, there are other city-wide problems that need addressing. By actively engaging another city crisis, either in the facility or on the same site, SIFs can begin to reverse negative stigmas related to opioid use. This will also provide users of opioids with opportunities for self-actualization and group socialization.

Fig. 3.6: St. Louis Hospital and Counseling Centers

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Fig. 3.7: St. Louis Compiled Analysis

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Delmar Boulevard St. Louis is home to many proud and vibrant communities. One area in particular that has been praised for its character and activity is Delmar Boulevard, which runs East-West through the entire city.

Toward the west end of this boulevard is the Delmar Loop which strings together many small businesses, art studios, shops, and restaurants. Social events occur here daily and its location near the St. Louis Zoo and Discovery Center make it a hub for all ages and interests. Delmar Boulevard has also, unfortunately, become a boundary between two dramatically different income levels, demographics, and employment and crime rates. What is seen as a jewel for the city has also become an area of contention.

This conflict does, however, create opportunity for a small scale intervention, which can be housed on the same site as a Supervised Injection Facility.

Fig. 3.8: Unemployment Rate Around Delmar Boulevard 25

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Fig. 3.9: Demographics Around Delmar Boulevard 26

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Fig. 3.10: Household Income Rate Around Delmar Boulevard 27

DELMAR BOULEVARD

Fig. 3.11: Existing Conditions Around Delmar Boulevard 28

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While controversy is certainly attached to Delmar’s influence in St. Louis, it fosters an extensive art culture. Along a five block stretch are eight businesses that include art studios or shops. The therapeutic and calming benefits of art are well known in the architecture community, making its integration into the SIF or other buildings on the project site plausible.

Art also creates an opportunity for this project to be integrated into Delmar Boulevard more specifically. Most of the art based businesses, however, are located on the west end of the Loop. Anchoring this project towards the eastern end of the Delmar Loop will help stretch the art culture towards the city center and fill an existing void along the Boulevard.

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Fig. 3.12: Art Related Programs Along Delmar Boulevard

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Delmar Loop Map – 2017 Version – Visit The Loop

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Fig. 3.13: Program Map of the Delmar Loop 29

1/22/2018, 9:13 PM

https://visittheloop.com/2017-loop-map-web/

THERAPY

BUSINESS OPPORTUNITY

ART GALLERY

A site containing a Supervised Injection Facility has the potential to positively impact the praised and controversial aspects of Delmar Boulevard. It can address the many disparities north of Delmar, such as unemployment, and provide an art centered program, such as an exhibition spaces to draw in routine site visitors. How these various programs are implemented on site, however, was challenging due to the sensitive nature of the SIF’s purpose. Investigating the site on a macro- and micro-scale is necessary to provide the appropriate experience for each building.

EMPLOYMENT OPPORTUNITY

BUSINESS INCUBATOR

SUPERVISED INJECTION CENTER

BUSINESS EXPOSURE

Fig. 3.14: Project Program Relationship

SCALE

ART

CITY REGION (NORTHWEST ST LOUIS)

CITY (ST LOUIS)

SOCIETAL ISSUES

DESIGN OPPORTUNITY

UNEMPLOYMENT

SOCIETAL ISSUES

OPIOID OVERDOSE

CREATE AWARENESS

PROGRAM

BUSINESS INCUBATOR

SUPERVISED INJECTION CENTER

RECOVERY TOOL

PRIMARY USER

ENTREPRENEUR / JOB SEEKER

COMMUNITY (DELMAR BLVD)

PHYSICAL DISCONNECT

CREATE AWARENESS

ART GALLERY

RECOVERY TOOL

USER OF ILLEGAL SUBSTANCE

ARTIST

Fig. 3.15: Project Program Objectives

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Fig. 3.16: Site Selection Tracking

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Harmonious Integration

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Site Situation Harmonious integration of three drastically different programs is necessary for their individual success. To achieve this, an extensive site study was performed to determine spatial organization and form of each program. The site itself is a vacant, 41,100 squarefoot lot on the north side of Delmar Boulevard. West of the site is a garage for public transit-use while the opposite lot contains a hair salon. Delmar has two lanes of traffic each way, with a central street trolley track that is about to reach completion. On both sides of the street are large sidewalks for pedestrian use. Vehicular and pedestrian traffic in the area is very dynamic. Street cars and a soon-to-be street trolley attract visitors to Delmar from most parts of the city. Street shoulders and multiple garages along Delmar provide ample parking for visitors.

Fig. 4.1: Project Site Location

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Fig. 4.2: Project Site Analysis and Street Section

North and south of Delmar Boulevard are single-family residences, creating neighborhoodsensitivity challenges for the Supervised Injection Facility. Nearby are also a park and elementary school, further enhancing the need for discretion. Numerous bus stops surround the block, making the site accessible via public transit. Existing buildings along Delmar and near the site are composed of various materials and forms. Most existing structures along the Loop’s east end are older and without routine upkeep, creating a need for subtle architectural gestures. As previously mentioned, a facility of this nature would only suffer if treated as a symbol of controversy. Instead it should be woven into the context seamlessly.

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Fig. 4.3: Surrounding Site Context

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The Delmar Loop’s east end is not regularly used of maintained. Buildings have changed purpose and ownership routinely while a lack of context has allowed them to be autonomous in design. This provides new building designs with minimal limitations when making material and form decisions. A Supervised Injection Facility should attempt to seamlessly fit in any area where controversy is likely to appear. Strong symbolic statements and iconism would only create more hardship for these facilities. With little existing context, this project has the freedom to use materials and forms consistent with the programs being housed.

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Fig. 4.4: Project Footprint Study

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Fig. 4.5: Project Program Organizational Study

Site Planning The site for this project contains nearly 41,000 square feet of unused asphalt. Choosing which areas of the site to inhabit was difficult due to the lot size and surrounding elements.

Single-story buildings with various programs surround the site, both of which are built up to the sidewalk. While most of the buildings along the Delmar Loop are storefront spaces, this project aims to incorporate public spaces for social interaction. Through numerous iterations, a few site schemes were explored that provide multiple social gathering spaces while still allowing adequate pedestrian circulation along Delmar Boulevard.

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The site is organized to maximize visitor discretion and manage exterior public activity. Located on the site’s east end is the Supervised Injection Facility. This area is farthest away from other Delmar activity in order to allow privacy for SIF visitors. Located on the site’s west end is the business incubator. This program will receive the most consistent daily pedestrian traffic on site, other than the SIF, making its proximity to Delmar’s core important.

Centrally located on site is the art gallery. A large pubic plaza is created between the art gallery and business incubator to encourage outdoor gatherings. A second, smaller plaza is created between the art gallery and SIF that allows informal socializing while still providing privacy for SIF visitors.

Fig. 4.6: Project Program Influence

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Massing & Material Studies After narrowing down various potential site schemes to three options, study models were created to help find proper massing.

The surrounding building heights had a significant influence on site volumes. While none of the three programs being implemented in the project required or desired a strong physical presence along Delmar, a hierarchy would help distinguish spaces from one another on the exterior. This distinction is necessary to ensure entry into the correct space. Each massing study model also used volumes to delineate outdoor gathering spaces. One scheme utilized 45 degree angles to funnel people into these public spaces while another contained an open courtyard at the site’s center. The chosen scheme contains three volumes of vaired height that are all oriented parallel to Delmar boulevard. The volumes are pushed into the site at different lengths, similar to the chosen site planning scheme.

Fig. 4.7: Massing Study Models

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A lack of consistent context along Delmar Boulevard allowed this project to choose from a variety of material schemes. Volumes are used on site to distinguish the different programs on the exterior. This same framework was used during the material selection process. The primary challenge of this scheme however was unifying the different spaces to avoid having them resemble a shopping outlet. In an early iteration, each building was given a different material while a metal mesh screen unified the spaces by wrapping around each facade.

The screen signifies privacy on the interior while connecting each building on the exterior.

Throughout many future iterations, materiality changes, but the metal screen is still apparent and becomes more significant.

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Fig. 4.8: Material Study Model

Fig. 4.9: Material Study Model

Fig. 4.10: Building Front Elevation Iteration

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Business Start-Up Two buildings other than the Supervised Injection Facility were schematically designed for this project. The business incubator s comprised of both private and public offices. Individual, open work spaces fill the building’s core while private offices are located along the north walls. Individuals rent a space and are allowed to schedule meetings in the public conference space. An open floor plan encourages interaction between entrepreneurs while smaller, singular phone booths provide privacy when desired. All office spaces are on the first floor while conference rooms line the southern wall on a second floor mezzanine. A large ceiling allows natural light penetration deep into the space while exposed concrete structural elements allow it to deflect throughout.

Fig. 4.11: Business Incubator First Floor Plan

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Art Gallery The second additional site program, an art gallery, provides a space for the community to socialize and partake in art events.

This facility houses a large, partition-filled gallery space on the first floor. Alongside the gallery is a large workshop where art classes and tutorials can be held. Both of these spaces are on the first floor to encourage public access and pedestrian circulation. Also, on the first floor is a kitchenette and storage. A grand, central staircase leads to a second floor where offices and an outdoor courtyard for private events are located. Suspended ceiling panels partially cover an exposed structure to control light levels.

Fig. 4.12: Art Gallery First Floor Plan

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Lessons on Integration Integrating three drastically different programs on one site creates many design challenges, particularly in plan. The flow and integration of the three programs became stronger & more apparant in later iterations. These exercises kept generating circulation schemes that were intriguing but insensitive to visitors. The Supervised Injection Facility requires certain observation and sanitation measures while the art gallery encourages public use. The business incubator needs some privacy for efficient work flow but still needs to encourage social interaction just as the SIF does. Altogether, these spaces need some degree of physical separation. They can still, however, utilize shared public spaces and visual connections throughout.

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Fig. 4.13: Compiled First Floor Plan

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Building materiality and massing developed throughout the design process but remnants of the original studies remained until its conclusion. Three distinct volumes were consistently used to distinguish each building while the metal screen unified each one. With each building addressing distinct issues or opportunities, their physical presence on site became vital. In the final scheme, the art gallery is extruded to the front of the site while maintaining a low roof line. This move allows the gallery to have a subtle volume in the overall site scheme but still engage visitors. The business incubator is the second largest volume on site. Its height exceeds the adjacent parking garage, allowing it to be seen from afar. The Supervised Injection Facility is the largest mass, housing two stories. Its volume is not site dominant but signifies importance.

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Fig. 4.14: Study Model

Fig. 4.15: Study Model

Fig. 4.16: Study Model

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Fig. 4.17: Final Front Elevation

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Fig. 4.18: Final Exterior Perspective

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Facilitating Safe Consumption

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Organizing safe consumption spaces requires many heavy considerations to ensure visitor comfort and safety. Due to varied levels of visitor sobriety, every space must be visible from building entry to exit. Observation throughout the building is also needed to prevent substance exchanges or purchases among visitors. Immense amounts of storage are required for consumption equipment and numerous receptionist areas help regulate visitor traffic and provide substance testing. Most importantly, consumption spaces must be located in private areas where maximum hygiene and visitor safety can be achieved. Cool down spaces allow users of opioids to sober up after consumption and before leaving the facility. Additional medical and therapy spaces are also sometimes incorporated into these centers, but this has not yet become standard practice. These additional spaces, along with the strategically organized required spaces can create an experience for users of opioids that is not yet offered in safe consumption spaces. The arrangement and procession of these spaces vary across existing Supervised Injection Facilities, leaving room for a new type of framework for success.

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CONSUMPTION COUNSELING SUPPORT

INJECTION ROOM

2,700 SQ. FT.

OBSERVATION BOOTH (3)

1,175 SQ. FT.

EMERGENCY MEDICAL

200 SQ. FT.

COOL DOWN

2,300 SQ. FT.

SMOKE ROOM

750 SQ. FT.

MEDICAL EXAM (2)

225 SQ. FT.

GROUP COUNSELING (2)

2,225 SQ. FT.

INDIVIDUAL COUNSELING (4)

1,500 SQ. FT.

PRIVATE OFFICES (3 FOR SIF/1 FOR THERAPY)

590 SQ. FT.

RECEPTION (2)

525 SQ. FT.

CIRCULATION, STORAGE AND RESTROOMS

4270 SQ. FT.

Fig. 5.1: Supervised Injection Facility Program Diagram

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ALLEYWAY

AMBULANCE DOCK

OFFICE

OFFICE

WAITING AREA / LOBBY

UP

OFFICE

OFFICE

COPY / SUPPLIES RECEP.

The proposed Supervised Injection Center is a two-story, 12,000 square foot building. On the first floor are counseling and therapy spaces for opioid and other substance addiction recovery. These spaces are located around a double-volume, central light well that contains seating and vegetation for waiting or socializing. Natural light attracts visitors to this space from both stories and building ends. Offices, a break room and locker room are also located on the north end of the first floor for staff. Reception desks are located at both building ends near each staircase. This allows staff to provide information and direct visitors to appropriate spaces upon entry.

All consumption spaces are located on the second floor for visitor sensitivity. The south stairs are designed to accommodate seating and circulation in order to facilitate social interaction among visitors if desired. Throughout the first floor are built-in seats that appear to grow out of the floor. This design technique is remnant of the injection booths on the second floor.

BREAKROOM LOCKER ROOM

GROUP THERAPY

IND. THERAPY

IND. THERAPY

GROUP THERAPY

IND. THERAPY IND. THERAPY

MECHANICAL

WAITING AREA / LOBBY

STOR.

RECEPTION

UP

Fig. 5.2: Supervised Injection Facility First Floor Plan

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ALLEYWAY

AMBULANCE DOCK

OFFICE

OFFICE

KITCHENETTE

STORAGE

STOR. DN

WAITING AREA / LOBBY

UP

OFFICE

OFFICE

COPY / SUPPLIES

COOL DOWN

EMERG. MED

RECEP.

Atop the south stairs is an observation desk where substances can be tested for purity rates by staff. Also, atop the stairs is a waiting room where users of opioids can relax or socialize before entering the injection room. Before ntering, however, they can be screened for sobriety or given a general health exam. The injection room contains 25 booths, each providing a different experience. Within the injection room are two observation booths for staff. Adjacent to the injection room is a covered outdoor courtyard where users can cool down after consumption. An emergency medical room is directly north of the injection booth where overdoses can be stabilized and monitored before EMTs arrive. Visitors can leave the injection room through the door the entered or by means of a north exit. Directly north of the injection room is a second cool down lobby. Once cool down is finished, visitors can walk down the stairs and exit into the alleyway or walk through the building’s core and exit through the front entrance. The alleyway exit allows users of opioids to leave the facility in a discreet, unseen fashion.

OBSERVATION / DISPOSAL

BREAKROOM

LOCKER ROOM

SMOKE ROOM

GROUP THERAPY

IND. THERAPY

IND. THERAPY

EXAM

GROUP THERAPY

IND. THERAPY

IND. THERAPY

MECHANICAL

EXAM

WAITING AREA / LOBBY

STOR.

OBSERVE

OUTDOOR COURTYARD / COOLDOWN

INJECTION ROOM (25 BOOTHS) OBSERVATION / CHECK-IN / DISPOSAL

RECEPTION

UP

Fig. 5.3: Supervised Injection Facility Second Floor Plan

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DN

Fig. 5.4: Axonometric of Spatial / Activity Sequence

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Humanizing the Machine

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Reducing harm during opioid consumption creates many significant design challenges. Strict observation and safety requirements unfortunately often cause safe consumption spaces to be reminiscent of typical medical and institutional processes. In order to counteract these tendencies, experiences during the injection process must be unique to each visitor. Users of opioids must also be able to choose what experience they wish to receive. The proposed injection spaces are designed to create choices for visitors. What they visually experience during injection and the volume in which they consume are two choices visitors can make.

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Injection Rooms Safe, hygienic consumption requires many considerations. Furniture must provide a posture suitable for injecting via syringe while allowing room for emergency response from medical professionals in case of an overdose. All surfaces must be non-absorbent and adequate light is a necessity. Observation by facility staff into the booth must also be provided for visitor safety. Due to these requirements, injection booth designs have only been able to offer an institutional, nearly mechanical experience. While the primary draw for users of opioids to the center is the ability to consume legally and safely, providing an intimate, humanized experience will certainly help. Adequately designed booths can also remind users of opioids that their life has value, and that humanity not just an afterthought. Simple in concept but acute in complexity, injection booths can have a positive, resilient impact on center visitors.

Fig. 6.1: Injection Room Precedent Study

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Fig. 6.2: Injection Room Study Sketches

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The proposed injection room meets all standard observation requirements while facilitating a unique experience. The space is centrally located on the second floor for security and visitor privacy.

Injection booths are located on the north, south and west walls in a horseshoe layout. In the center of the injection room is the primary observation space and a double-volume light well. A second observation space is located on the north end, near the primary exit and equipment disposal. Visual access into each booth is provided from either of the two observation spaces. A singular corridor creates simple circulation and allows fast and efficient emergency response. The key differentiating feature of this room, however, is its ability to offer three different visual experiences within the injection booth.

Fig. 6.3: Injection Room Observation Diagram

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Injection Booth View to Light Well

Injection Booth View to Front Plaza

Injection Booth View to Art Gallery Fig. 6.4: Injection Room Visual Experience Diagram

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Dissecting the Booth Safe, hygienic consumption requires many considerations. Furniture must provide a posture suitable for injecting via syringe while allowing room for emergency response from medical professionals in case of an overdose. All surfaces must be non-absorbent and adequate light is a necessity. Observation by facility staff into the booth must also be provided for visitor safety. Due to these requirements, injection booth designs have only been able to offer an institutional, nearly mechanical experience. While the primary draw for users of opioids to the center is the ability to consume legally and safely, providing an intimate, humanized experience will certainly help. Adequately designed booths can also remind users of opioids that their life is of value, not just an afterthought. Simple in concept but acute in complexity, injection booths can have a positive, resilient impact on center visitors.

Fig. 6.5: Injection Booth Precedent Study

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Fig. 6.6: Injection Booth at H17 36

Fig. 6.7: Injection Booth at Uniting Medically Supervised Centre 37

Fig. 6.8: Injection Booth at Insite Supervised Injection Center 38

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A New Model The proposed booth design was intended to fulfill all safety requirements while still facilitating a positive experience. Users of opioids slide onto a wooden bench that wraps the ceiling and folds downward into a table. This singular form provides warmth and protection while still allowing natural light to filter in on both sides. The exterior metal screen generates patterns across the booth’s continuous surface using natural light. The booth is also illuminated by a built-in light fixture while a mounted mirror opposite of the seating space allows staff to observe from multiple angles. The booth fits between two metal screens like casework and is suspended from the ground, providing a distinct transition from public to private space.

The height of each booth varies, allowing visitors to pick from a variety of experiences.

Shorter booths create more privacy and intimacy while larger models allow more light and views in for observation staff. This is another aspect of the power of choice, which this facility aims to provide for a humanized experience.

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Fig. 6.9: Injection Booth Study Model

Fig. 6.10: Injection Booth Study Model

Fig. 6.11: Perspective of Proposed Injection Booth

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A Complete Experience

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Power of Procession A humanized experience in the injection room is achieved by providing users of opioids with choices on which architectural phenomena they endure. Throughout the remaining building, various levels of intimacy decrease the common institutional feel of SIFs. This was achieved primarily by utilizing natural light, but materiality and space proportions also contributed. Public spaces such as the main stairwell central light-well are filled with natural light, creating ideal environments for social interaction. More solemn areas such as the cool-down spaces and some waiting lobbies are dimly lit to create a calming sensation.

Natural light penetration is primarily controlled by a metal screen that flows throughout the entire building. The screens contain a brick relief pattern to resemble St. Louis’s rich history of masonry construction. Another consistent material used in this project is wood, which provides warmth in a typically high-stress environment. The procession created by these unique spaces provides users of opioids with a powerful experience while moving through the space. Safe consumption is still the primary role of this facility, but a positive, influential experience can help users of opioids recover in the long-term.

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Fig. 7.1: Experience at Supervised Injection Center Entry

Fig. 7.2: Experience at Front Reception

Fig. 7.3: Experience at Staircase

Fig. 7.4: Experience at Waiting Room

Fig. 7.5: Experience at the Injection Room

Fig. 7.6: Experience at Cool-Down Lobby

Fig. 7.7: Experience at Building Exit

Fig. 7.8: Experience at Light-Well

Fig. 7.9: Supervised Injection Facility Building Section

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After nearly ten months of research and design development, this thesis successfully generated a consumption space that could potentially prevent opioid overdoses and be integrated into the urban fabric of St. Louis. The three separate programs on site provide a service for the community at three different scales. This permanence will create a platform for the supervised injection facility to break negative stigmas revolving around opioid use.

The injection facility itself has established new standards for safe consumption spaces by offering additional counseling programs and rethinking how the injection process can be safely facilitated. Current institutional and medical process have been broken down to provide visitors with a humanized experience. From a phenomenological standpoint, it also has the ability to draw more users of opioids to recovery through uplifting experiences.

Overall, this facility successfully provides methods of harm reduction and ways to positively impact users of opioids and, in return positively influences communities that are struggling with drug reliance issues.

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Progress Marches On A vast amount of research and design iteration has been performed in order to meet the primary goal of this thesis. What yet remains, however, is evidence-based validity in the proposed methods for achieving these goals. Supervised injection facilities have yet to become a common space through our terrain. This lack of SIF design precedent and post-occupancy research forced the design to house a great deal of speculation. From a practicality standpoint, testing the proposed design techniques and concepts would certainly be required in order to deem it a success. This applies to the project at multiple scales. The proposed injection booth design should be tested in order to insure proper patient observation and injection techniques can be achieved. Failure to reduce harm in this small space alone could devastate the entire project. Booth and injection room mock-ups should be built to ensure health and safety goals can be achieved. Community feedback should be given for this project as well to gauge the resistance or support for this type of program. As mentioned, urban integration is necessary for the resilience of SIFs and users of opioids, making community forum significant.

The dawn of SIFs in the United States is here. These buildings will potentially be introduced within the next few years in the U.S. The research gathered and design proposed in this project should be used as a tool for stakeholders seeking to open a safe consumption space. This material will be sent to organizations across the country who are looking to open such a facility. It will also be sent to local, state, and national government representatives who are lobbying to legalize these facilities. Equally important, this thesis will be shared with organizations who are in direct contact with users of opioids.

Providing this material to users of opioids throughout the United States will inform them that support and empathy does exists. It should be a testament to the progress being made societally and publicly, even if it appears to be slow moving. Personally, I hope to use this information as a stepping stone for an impactful career in architecture and potentially academia. I hope that it can continue to define my interests as a designer and humanitarian.

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My Experience

84

Developing this thesis over the past 9 months has been very challenging. Although I knew of the opioid crisis and safe consumption spaces previously, I could not confidently claim I fully supported this harm-reduction policy. Having never been exposed directly to opioids or those reliant on them growing up, I found it initially difficult to encompass the proper amount of empathy for users of opioids. My thesis research, however, quickly shed light on the depth of this crisis and the dire need for architectural intervention. The design process required me to revisit my opinions and stance on this issue constantly. Everything from proper terminology to design or graphic expression was questioned heavily throughout my thesis process. For instance, I had to deplete words such as “addict� from my vocabulary. No longer was I also allowed to affiliate opioid use with mental illness or other substance reliance. What emerged out of these struggles however was a new sense of responsibility as a designer and global citizen. My attitude toward opioids and those who consume them has been changed for the better.

Fig. 7.10: Injection Booth Perspective Iteration

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Researching this topic and designing spaces for consumption has certainly been a distressing task. The thought of syringes alone has always made me cringe and feel deeply uncomfortable. I even avoid giving blood because of my fear of needles. While this fear is still present, my ability to talk confidently about opioid reliance and injection has drastically benefited from this thesis. My emotional response to this topic has even become noticeably sensitized by the process. On April 26th, a semi-truck was pulled over in Nebraska that contained 120 pounds of Fentanyl, which is enough substance to kill around 26 million people. Upon reading this article, I erupted in an emotional fury. The emotion I felt regarding all 26 million potential drug overdoses was a wave I have never experienced before. Until last September, I didn’t even know what fentanyl was. I couldn’t sleep that night, knowing the pain so many users of opioids are experiencing and the lack of help they are receiving. It is only by shear luck that 26 million people had their lives saved from this epidemic. I realize that this fortune should not be expected in the future and that we as humans need to collaborate to win the war.

The crisis still rages on however and likely for many years to come.

Thanks to this experience however, I am energized and eager to be a significant part of it and a contribute to the change that can be made.

Fig. 7.11: Supervised Injection Center Wall Section Iteration

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Fig. 7.12: Final Thesis Presentation

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Endnotes 1. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/ 2. Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2016. NCHS Data Brief, no 293. Hyattsville, MD: National Center for Health Statistics. 2017.

3. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.

4. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.

5. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.6.

6. “Council of Economic Advisers Report: The Underestimated Cost of the Opioid Crisis.” The White House. Accessed June 02, 2018. https://www.whitehouse.gov/briefings-statements/cea-report-underestimated-cost-opioid-crisis/.

7. Gutstein H, Akil H. Opioid Analgesics. In: Goodman & Gilman’s the Pharmacological Basis of Therapeutics. 11th ed. McGraw-Hill; 2006:547-590.

8. “Types of Opioids.” TheNerdyPoppies. Accessed June 02, 2018. https://thenerdypoppies.wikispaces.com/Types of Opioids.

9. Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2016. NCHS Data Brief, no 293. Hyattsville, MD: National Center for Health Statistics. 2017.

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10-11. Baer, Drake. “5 Countries Experimenting with Liberal Drug Laws.”

Business Insider. March 30, 2016. Accessed April 10, 2018. http://www.businessinsider.com/countries-experimenting-with-liberal-drug-laws-2016-3#portugal-decriminalized-all-drugs-in-2001-3.

12. “Supervised Injection Facilities.” Drug Policy Alliance. Accessed April 24, 2018. http://www.drugpolicy.org/issues/supervised-injection-facilities.

13. “Drug Consumption Rooms: An Overview of Provision and Evidence.”

EMCDDA | Cannabis Profile (chemistry, Effects, Mode of Use, Pharmacology, Medical Use, Control Status). June 07, 2018. Accessed June 01, 2018. http:// www.emcdda.europa.eu/topics/pods/drug-consumption-rooms.

14. H17 Drug Consumption Center. PLH Architecture. Accessed April 20, 2018. http://www.plh.dk/en/projects/drug-consumption-center/.

15. Sydney Medically Supervised Injecting Centre. Uniting Medically Supervised Injecting Centre. In Yes to SCS California. Accessed May 05, 2018. https://www.yestoscscalifornia.org/facts/.

16. Wikimedia Commons.,“Insite, a Safe Injection Facility Located in Vancouver,” digital photo. In Billy Penn. March 01, 2018. Accessed March 12, 2018. https://billypenn.com/2018/03/01/poll-shows-san-francisco-residents-in-favorof-safe-injection-sites-what-about-philly/.

17. Staircase at Square Inc. Headquarters, digital image, ArchDaily, September 22, 2014, accessed October 10, 2017, https://www.archdaily.com/548445/ square-headquarters-bohlin-cywinski-jackson.

18. Iwan Baan, Exterior of Center for Earth Architecture, digital image, ArchDaily, September 12, 2011, accessed October 10, 19. T+E, Screen Covered Corridor at Bamboo Teahouse, digital image, ArchDaily, January 24, 2013, accessed October 10, 2017, https://www.archdaily. com/323464/bamboo-courtyard-teahouse-harmony-world-consulting-design.

20. Andy Ryan, Light Well in Ceiling at Nelson-Atkins Museum, digital image, ArchDaily, July 30, 2008, accessed October 09, 2017, https://www.archdaily. com/4369/the-nelson-atkins-museum-of-art-steven-holl-architects.

21. Ron Tandberg, Supervised Injection Centers, cartoon, The Sydney Morning Herald, February 11, 2017, accessed October 10, 2017, http://www.smh. com.au/comment/why-australia-needs-more-supervised-injecting-centres 20170210-gua5ch.html.

22. Matteo Rigosa, “Inner Demons,” digital image, Cultartes, November 12, 2015, accessed October 10, 2017, http://cultartes.com/artist-faces-his-own-inner-demons-in-these-stunning-photographs/.

Endnotes 23. Pro-Ject, Autoinjector, digital image, Special Feature, September 04, 2014, accessed October 10, 2017, http://www.drug-dev.com/Main/Back-Issues/SPECIAL-FEATURE-Injectable-Drug-Delivery-Safer-Sim-749.aspx.

24. “St. Louis, Missouri (MO) Income Map, Earnings Map, and Wages Data.”

Anderson, Indiana (IN) Profile: Population, Maps, Real Estate, Averages, Homes, Statistics, Relocation, Travel, Jobs, Hospitals, Schools, Crime, Moving, Houses, News, Sex Offenders. Accessed November 10, 2017. http://www. city-data.com/income/income-St.-Louis-Missouri.html.

25. “Chart of the Week: Mapping Unemployment in St. Louis | National Equity Atlas.” The Atlas | National Equity Atlas. Accessed January 21, 2018. http:// nationalequityatlas.org/data-in-action/StLouisUnemployment.

26. Fischer, Eric. “Race and Ethnicity 2010.” Flickr. June 10, 2018. Accessed November 10, 2017. https://www.flickr.com/photos/walkingsf/albums/72157626354149574.

27. “St. Louis, Missouri (MO) Income Map, Earnings Map, and Wages Data.”

Anderson, Indiana (IN) Profile: Population, Maps, Real Estate, Averages, Homes, Statistics, Relocation, Travel, Jobs, Hospitals, Schools, Crime, Moving, Houses, News, Sex Offenders. Accessed November 10, 2017. http://www. city-data.com/income/income-St.-Louis-Missouri.html.

28. Chikwendiu, Jahi. In St. Louis, Delmar Boulevard Is the Line That Divides a City by Race and Perspective. August 22, 2014. Accessed May 22, 2018. https://www.washingtonpost.com/national/in-st-louis-delmar-boulevard-is-theline-that-divides-a-city-by-race-and-perspective/2014/08/22/de692962-a2ba4f53-8bc3-54f88f848fdb_story.html?utm_term=.7e3e93d4b01c.

29. “Delmar Loop Map Directory.” Visit The Loop. November 15, 2016.

Accessed February 10, 2018. https://visittheloop.com/explore/delmar-loop-map-directory/.

30. Kochanek KD, Murphy SL, Xu JQ, Arias E. Mortality in the United States, 2016. NCHS Data Brief, no 293. Hyattsville, MD: National Center for Health Statistics. 2017.

31. “NASEN | North American Syringe Exchange Network.” NASEN - North American Syringe Exchange Network. Accessed February 02, 2018. https:// nasen.org/.

32. Bogan, Jesse, and Blythe Bernhard. “Solutions Hard to Find as Opioid Epidemic Keeps Hitting St. Louis Hard.” Stltoday.com. December 12, 2017.

Accessed January 10, 2018. https://www.stltoday.com/lifestyles/health-med-fit/ solutions-hard-to-find-as-opioid-epidemic-keeps-hitting-st/article_f99f223ee173-5a2c-93a1-39b7e1e1a12f.html.

33. Bogan, Jesse, and David Carson. “A Mass Killer: St. Louis Heroin Deaths

Hit New High.” Stltoday.com. February 20, 2017. Accessed January 10, 2018. https://www.stltoday.com/news/local/metro/a-mass-killer-st-louis-heroindeaths-hit-new-high/article_2fd6130c-3c35-524a-891e-e51eff2e40b4.html.

34. “Chart of the Week: Mapping Unemployment in St. Louis | National Equity Atlas.” The Atlas | National Equity Atlas. Accessed January 21, 2018. http:// nationalequityatlas.org/data-in-action/StLouisUnemployment.

35. “St. Louis, Missouri (MO) Income Map, Earnings Map, and Wages Data.”

Anderson, Indiana (IN) Profile: Population, Maps, Real Estate, Averages, Homes, Statistics, Relocation, Travel, Jobs, Hospitals, Schools, Crime, Moving, Houses, News, Sex Offenders. Accessed November 10, 2017. http://www. city-data.com/income/income-St.-Louis-Missouri.html.

36. H17 Drug Consumption Center. PLH Architecture. Accessed April 20, 37. Sydney Medically Supervised Injecting Centre. Uniting Medically Supervised Injecting Centre. In Yes to SCS California. Accessed May 05, 2018. https://www.yestoscscalifornia.org/facts/.

38. Wikimedia Commons.,“Insite, a Safe Injection Facility Located in Vancouver,” digital photo. In Billy Penn. March 01, 2018. Accessed March 12, 2018. https://billypenn.com/2018/03/01/poll-shows-san-francisco-residents-in-favorof-safe-injection-sites-what-about-philly/.

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List of Figures Fig. 1.1: 2016 Opioid Data Graph by Author Fig. 1.2: Types of Opioids Graph by Author Fig. 1.3: Timeline of Opioids and Opioid Use Graph by Author Fig. 1.4: Typical Supervised Injection Facility Goals Graph by Author Fig. 1.5: Sequence of Consumption Activities within SIFs Graph by Author Fig. 1.6: H17 Injection Facility Photo Courtesy of PLH Architecture Fig. 1.7: Uniting Medically Supervised Injecting Centre Photo Courtesy of Uniting Medically Supervised Injecting Centre Fig. 1.8: Insite Supervised Injection Facility Photo by Wikimedia Commons Fig. 2.1: Staircase at Square Inc Headquarters Photo Courtesy of Bohlin Cywinski Jackson Fig. 2.2: Exterior of Center for Earth Architecture Photo Courtesy of Iwan Baan Fig. 2.3: Screen Covered Corridor at the Bamboo Teahouse Photo Courtesy of T+E Fig. 2.4: Light Well in Ceiling at Nelson-Atkins Museum Photo Courtesy of Andy Ryan Fig. 2.5: Political Cartoon of Safe Consumption Spaces Photo Courtesy of Ron Tandberg Fig. 2.6: Inner Demons Photo Courtesy of Matteo Rigosa Fig. 2.7: Pro-ject, Autoinjector Photo Courtesy of Drug-Dev Fig. 2.8: Field Diagram of Research Diagram by Author Fig. 3.1: St. Louis Law Enforcement Facilities Map by Author Fig. 3.2: St. Louis Primary Vehicular Routes Map by Author Fig. 3.3: St. Louis Household Income Levels Map by Author

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Fig. 3.4: St. Louis Public Spaces Map by Author Fig. 3.5: St. Louis Public Transit Routes Map by Author Fig. 3.6: St. Louis Hospital and Counseling Centers Map by Author Fig. 3.7: St. Louis Compiled Analysis Map by Author Fig. 3.8: Unemployment Rate Around Delmar Boulevard Map by Author Fig. 3.9: Demographics Around Delmar Boulevard Map by Author Fig. 3.10: Household Income Rate Around Delmar Boulevard Map by Author Fig. 3.11: Existing Conditions Around Delmar Boulevard Map by Author Fig. 3.12: Art Related Programs Along Delmar Boulevard Map by Author Fig. 3.13: Program Map of the Delmar Loop Diagram by Author Fig. 3.14: Project Program Relationship Diagram by Author Fig. 3.15: Project Program Objectives Diagram by Author Fig. 3.16: Site Selection Tracking Diagram by Author Fig. 4.1: Project Site Location Diagram by Author Fig. 4.2: Project Site Analysis and Street Section Diagrams by Author Fig. 4.3: Surrounding Site Context Diagram by Author Fig. 4.4: Project Footprint Study Diagram by Author Fig. 4.5: Project Program Organizational Study Diagram by Author Fig. 4.6: Project Program Influence Diagram by Author

List of Figures Fig. 4.7: Massing Study Models Photo by Author Fig. 4.8: Material Study Model Photo by Author Fig. 4.9: Material Study Model Photo by Author Fig. 4.10: Building Front Elevation Iteration Drawing by Author Fig. 4.11: Business Incubator First Floor Plan Drawing by Author Fig. 4.12: Art Gallery First Floor Plan Drawing by Author Fig. 4.13: Compiled First Floor Plan Drawing by Author Fig. 4.14: Study Model Photo by Author Fig. 4.15: Study Model Photo by Author Fig. 4.16: Study Model Photo by Author Fig. 4.17: Final Front Elevation Drawing by Author Fig. 4.18: Final Exterior Perspective Drawing by Author Fig. 5.1: Supervised Injection Facility Program Diagram Drawing by Author Fig. 5.2: Supervised Injection Facility First Floor Plan Drawing by Author Fig. 5.3: Supervised Injection Facility Second Floor Plan Drawing by Author Fig. 5.4: Axonometric of Spatial / Activity Sequence Drawing by Author Fig. 6.1: Injection Room Precedent Study Diagram by Author Fig. 6.2: Injection Room Study Sketches Drawing by Author Fig. 6.3: Injection Room Observation Diagram Drawing by Author Fig. 6.4: Injection Room Visual Experience Diagram Drawing by Author

Fig. 6.5: Injection Booth Precedent Study Drawing by Author Fig. 6.6: Injection Booth at H17 Photo Courtesy of Bohlin Cywinski Jackson Fig. 6.7: Injection Booth at Uniting Medically Supervised Centre Photo Courtesy of Uniting Medically Supervised Injecting Centre Fig. 6.8: Injection Booth at Insite Supervised Injection Center Photo Courtesy of Wikimedia Commons Fig. 6.9: Injection Booth Study Model Photo by Author Fig. 6.10: Injection Booth Study Model Photo by Author Fig. 6.11: Perspective of Proposed Injection Booth Drawing by Author Fig. 7.1: Experience at Supervised Injection Center Entry Drawing by Author Fig. 7.2: Experience at Front Reception Drawing by Author Fig. 7.3: Experience at Staircase Drawing by Author Fig. 7.4: Experience at Waiting Room Drawing by Author Fig. 7.5: Experience at the Injection Room Drawing by Author Fig. 7.6: Experience at Cool-Down Lobby Drawing by Author Fig. 7.7: Experience at Building Exit Drawing by Author Fig. 7.8: Experience at Light-Well Drawing by Author Fig. 7.9: Supervised Injection Facility Building Section Drawing by Author Fig. 7.10: Injection Booth Perspective Iteration Drawing by Author Fig. 7.11: Supervised Injection Center Wall Section Iteration Drawing by Author Fig. 7.12: Final Thesis Presentation Photo Courtesy of Karen O’Donnell Stein

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