Supervised injection: injecting the facts
23 Jun 2011, Posted by Trevor Thomas in Backpages, 0 Comments
Coupled with the exemption to the Controlled Drugs and Substances Act was a requirement that Insite be subject to a variety of rigorous scientific evaluations upon its opening. This was to demonstrate whether such a controversial facility was actually improving the Downtown Eastside or if it was actually promoting drug use, the chief fear of those opposed to supervised injection. The first several years of studies have yielded many different scientific reports, including more than 30 peer-reviewed articles in some of the world’s most prominent journals, all of which support Insite and validate the success of supervised injection. There has not been a single article or empirically based critique of Insite that shows it to be ineffective or hazardous to public sanctity. It is important that people become familiar with the objective data from examinations and judge them in lieu of outrageous political statements and policy-based lobbying.
I’ll begin with the chief fear mentioned above: does Insite promote drug use? An article published in The American Journal of Public Health shows that it does not. Researchers found that the average Insite user has been injecting for 16 years—in fact, only one participant in the study reported performing their first injection at the facility. These results excellently mirror what I experienced while volunteering. None of the users with whom I spoke had begun injecting at Insite, and only one of the nurses mentioned that she once helped an elderly participant as he injected for the first time. A study in the British Medical Journal produced similar results. By examining the drug use behavior of 871 injection drug users one year prior to and one year after the opening of Insite, the study found that there was no statistically significant increase in the rate of relapse among former users after 2003—it was 17 percent before Insite opened and 20 percent after.
The injection room within Insite contains 12 booths where participants can use whatever drugs they bring to the facility. Each booth has a mirror so the nurses can observe the faces of the participants and look for signs of overdose.
The prevention of overdose death is likely Insite’s most important achievement. A study by the Lancet puts numbers behind this statement: since Insite opened in 2003, it has been found that overdose rate within 500 meters of the site has decreased by 35 percent. Overdoses occurring beyond a 500-meter radius (in the rest of the city) have decreased by 9 percent since the facility began operating. An additional study by the journal PLoS ONE attempted to estimate the number of overdose deaths potentially averted as a result of Insite’s operation. The authors found that 37 percent of the total overdose deaths in the community were prevented by virtue of the facility—there could have been as many as 51 more overdose fatalities in the Downtown Eastside had Insite not been an available option.
The backdrop of all these studies, furthermore, is one exceptional fact about North America’s only SIF: there has never been a fatal overdose at Insite. I was able to witness several overdoses during my time as a volunteer, but during each one, the nurses knew precisely what to do. I recall my first: this middle-aged man had injected a “speedball,” which is slang for an intravenous combination of heroin and cocaine, and he began seizing on his way out of the injection room. The nurses swiftly reacted, giving him oxygen and monitoring his vitals, and the man was eventually resuscitated and moved to the hospital for further observation. I can’t help but wonder what would have happened if he had overdosed in an alley or alone in his home, if he had one. Without Insite as a safe option for injection, he may have become one of the 51 potential fatalities mentioned in the PLoS ONE. In the words of a female Insite client, “Dead people are found in their rooms. They are not found at Insite.”
In addition to providing assistance in the situation of an overdose, the staff at Insite also provides addiction counseling and reference to detoxification programs. While many people feared that an injection facility would actually deter drug users from seeking treatment, a study by the New England Journal of Medicine found that Insite users are significantly more likely to enter a detox program than those who do not use the SIF. Just one year after Insite opened, there was a 33 percent increase in the use of detox services, as reported in the journal, Addiction.
One of the most significant contributors to the HIV rate in the Downtown Eastside is syringe sharing. By providing clean needles and other sterile equipment, Insite is positioned to attack the significant HIV statistics representing the Downtown Eastside—and it has done so quite effectively, as described by another article in the Lancet. Researchers found that Insite users are 70 percent less likely to share syringes than injection drug users who do not utilize the facility. A second article in the American Journal of Infectious Diseases examined the syringe sharing of users in the Downtown Eastside and did not find a single instance of used syringe lending of HIV-positive individuals who reported exclusive use of Insite. The journal, Addiction, compiled another study of SIFs in Spain and Insite in Vancouver and found that regular users of SIFs have a 69 percent less chance of sharing syringes, further supporting these results.
One final topic researched at Insite is its cost effectiveness. With the use of conservative estimates in regard to the number of HIV cases and overdose deaths prevented by the SIF, the International Journal of Drug Policy featured an article that concluded that Insite saves about $6 million of governmental revenue every year. In 2008, an article in the Canadian Medical Association Journal found that decreased needle sharing alone would save approximately $14 million over ten years while increased knowledge of safe injection practices and referral to methadone maintenance through Insite saves $18 million. It is clear that, in addition to being the incredibly beneficial to the recovery of the Downtown Eastside, Insite is also an effective and efficient use of public healthcare resources, especially when compared to other methods of dealing with the injection drug epidemic.
This is the second part of a three-part series about supervised injection and Trevor Thomas’ experience at Insite. Part 1 of the series, Supervised injection: “state-sponsored suicide”, gave an overview of Insight and the motivations behind supervised injection and part 3, Supervised Injection: Insight and the Supreme Court, will discuss Insite’s success in the Supreme Court.
