Harm reduction program benefits many at North America’s only supervised injection site

Behind a small, understated storefront on East Hastings Street in Vancouver is Insite, the only legal, free-standing supervised injection site in North America.

The line to get into Insite each morning starts on the street well before opening at 10 a.m. More than 550 people use the facility everyday.

Many Insite users are long-term intravenous drug users, some who have spent most of their lives addicted to heroin. They are originally from all parts of Canada, and now find themselves living in one of the poorest urban neighbourhoods, marginalized and disconnected from society.

Insite was started by Vancouver Coastal Health (VCH) in 2003. It is a harm reduction program, set up when HIV transmission rates in the area were among the highest in the world. Within a short time, the health benefits were evident.

“In addition to reducing the risk of overdose deaths, there is a reduction in high risk injection behaviour associated with HIV and Hepatitis C transmission among users,” says Dr. Patricia Daly, VCH’s Chief Medical Health Officer. “There is a reduction in behaviour that increases risk of other serious infections including sepsis and endocarditis. Insite nurses also treat skin and soft tissue infections and provide immunizations,” she adds.

More than 30 research studies, many of them from the BC Centre of Excellence in HIV/AIDS, have been published in international medical journals that conclude that Insite saves lives and is a health benefit.

One of the recent articles was published in the Lancet last year. It showed that drug overdoses decreased by 35 per cent within 500 metres of Insite over its several years of operation compared to only a nine per cent decrease in the rest of Vancouver.

One of Insite’s most telling stats has to do with fatalities. There are none. No one has died of an overdose inside the facility despite at least 20 clients overdosing every month.

In 2007, VCH enhanced the health services provided at Insite to include a detox centre on the floor above. It is called Onsite. The success rate of Onsite last year was 43  per cent of clients who finished the program. This is an excellent number when you consider these clients are hard-to-reach, often lifelong drug addicts whose previous attempts to treat their addiction were unsuccessful.

Insite’s annual operating budget is $3.0 million out of a total VCH addiction services budget for Vancouver of $44 million, which focuses primarily on prevention of drug use and treatment of addiction.

Insite has garnered much publicity and a court challenge to the top court in the land.

Insite started as a three-year pilot project to assess medical benefits. VCH applied and was granted a Health Canada exemption to federal drug laws. This exemption could be renewed yearly but around 2005 the federal government appeared to be indicating an exemption renewal would not occur.

Insite clients linked to the Vancouver Area Network of Drug Users (VANDU) and Portland Hotel Society filed a civil suit for the facility’s continued operation. VCH had standing in this court case that went to the Supreme Court of Canada. Late last year, the court ruled that Insite had proven health benefits and did not cause an increase in crime or any negative society consequences so the federal health minister should grant the exemption for Insite to operate as it is the minister’s discretion to do so. All legal arguments against Insite’s continued operation were not recognized.

Other cities in Canada and the United States have indicated that they are interested in developing their own supervised injection sites. Currently, VCH is supporting the Dr. Peter Centre in Vancouver in their application to Health Canada for an exemption in order to provide supervised injection services, and we are considering adding supervised injection services to clinics that support other harm reduction programs for addicts.

Harm reduction services are an important and necessary tool to prevent harms associated with drug use. They keep drug users alive and reduce the risk and spread of life-threatening infections while we work to engage drug users in treatment for their addiction.

VCH is responsible for the delivery of $2.9 billion in community, hospital and residential care to more than one million people in communities including Richmond, Vancouver, the North Shore, Sunshine Coast, Sea to Sky corridor, Powell River, Bella Bella and Bella Coola. VCH also provides the rest of the province with complex health care services for organ transplants, major trauma and burns. The health authority also includes the VCH Research Institute, and has teaching and practice relationships with universities and colleges across BC. VCH is one of five health authorities in British Columbia.
For more information visit: http://supervisedinjection.vch.ca/home/ or http://www.vch.ca/


Insite user statistics
From January 1 to December 31, 2010, there were:
•    312,214 visits to by 12,236 unique individuals;
•    an average of 587 injections daily;
•    221 overdose interventions with no fatalities;
•    3,383 clinical treatment interventions;
•    26 per cent of participants were women;
•    17 per cent of participants identified as Aboriginal;
•    principle substances reported were heroin (36% of instances), cocaine (32%) and morphine (12%);
•    5,268 referrals to other social and health services, the vast majority of them were for detox and addiction treatment;
•    458 admissions to Onsite detox.