The study examined whether North America’s first medically supervised safer injection facility (SIF) attracts young injection drug users (IDUs) who are at high risk of health-related harm. Prevalence of SIF use was determined based on data obtained after the SIF’s opening. Predictors of initiating future SIF use were determined based on behavioral information obtained from the participant’s study visit immediately preceding the SIF’s opening. The median duration between the acquisition of pre-SIF opening behavioral data and the more recent interview, where SIF use was measured, was 16 months. Characteristics of IDUs who did and did not subsequently initiate SIF use were statistically compared (N = 135). Data from the 6-month period prior to the SIF’s opening showed that youth initiating SIF use were significantly more likely to have been in jail, to use heroin daily, to have overdosed, to have binged on drugs, to have loaned needles, and to have been homeless. The study suggests that among IDUs 29 years of age or younger, those who used the SIF were at higher risk than those who were not.