Illicit drug overdose deaths in Vancouver's Downtown Eastside dropped by 35 per cent after the establishment of Insite, North America's first supervised injection facility, according a new study by researchers at the University of British Columbia and the British Columbia Centre for Excellence in HIV/AIDS.
Published April 18 in The Lancet, the study is the first to assess the impact of supervised injection sites on overdose mortality. Researchers compared nearly 300 case reports from the British Columbia Coroners Service documenting all illicit drug overdose deaths in Vancouver between January 1, 2001 and December 31, 2005.
Compared to the 35 per cent reduction in overdose deaths in the immediate vicinity of Insite following its opening in September 2003, overdose deaths in the rest of Vancouver declined only nine per cent over the same period. No overdose deaths have been recorded at Insite since the facility's opening. The researchers also noted that there was no evidence of significant changes in drug supply or purity during the study period.
"This study provides the first unequivocal scientific evidence of the benefits of supervised injection facilities, and clearly demonstrates that facilities such as Insite are saving lives and playing a vital role in reducing the harms associated with illicit drug use," says co-author Dr. Julio Montaner, director of the BC-CfE and Chair of AIDS Research at the UBC Faculty of Medicine.
"Research results clearly show facilities such as Insite could literally be the difference between life and death for many people," says senior author Dr. Thomas Kerr, an associate professor at UBC and co-director of the Urban Health Research Initiative (UHRI), a program of the BC-CfE.
Insite is a pilot facility with 12 injection seats in a neighbourhood with an estimated 5,000 injection drug users. Currently operating at capacity, Insite staff supervise more than 500 injections on an average day. Larger reductions in overdose deaths would require an expansion of the facility.
Established in 2003 in response to an HIV epidemic and escalating overdose death rates in Vancouver's Downtown Eastside, Insite enables injection drug users to consume pre-obtained drugs under the supervision of nurses. Counsellors are also available onsite to provide support and referrals to programs, including addiction treatment. An extensive scientific evaluation by UHRI researchers has previously demonstrated the facility's ability to reduce HIV risk behaviour, increase access to addiction treatment and primary health care services, and reduce healthcare costs in the long term.
On January 15, 2010, the BC Court of Appeal upheld a decision by the BC Supreme Court and ruled that Insite, a health care facility, is under provincial jurisdiction. An earlier BC Supreme Court decision also ruled that Insite helped ensure the constitutional right to health by providing an essential health service.
The federal government has submitted an appeal to the Supreme Court of Canada. The case is scheduled to be heard on May 12, 2011. Several groups and organizations, including the Canadian Medical Association, the Canadian Public Health Association, and the Canadian Nurses Association have obtained intervener status in the upcoming Supreme Court of Canada case, and will be calling for the continued operation of Insite.
- Brandon DL Marshall, M-J Milloy, Evan Wood, Julio SG Montaner, Thomas Kerr. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. The Lancet, April 18, 2011 DOI: 10.1016/S0140-6736(10)62353-7
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