IFCS HomeInSite for Community SafetyImportant Facts
Supporting a Safer Vancouver

The Science

Published Science, Reports and Evaluations 

 Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study

"The fatal overdose rate in [Vancouver's Downtown Eastside] decreased by 35% after the opening of the SIF"… “Supervised injection facilities clearly have an important part to play in communities affected by injection drug use. “

 Brandon D L Marshall, M-J Milloy, Evan Wood, Julio S G Montaner, Thomas Kerr THE LANCET

Insite Shown To Be Effective But Still Under Siege By Federal Government

Despite medical research that indicates Vancouver's supervised injection facility, Insite, reduces needle-sharing and overdose deaths, the facility's fate is uncertain

 Dooling K., Rachlis M. 2010. Vancouver's supervised injection facility challenges Canada's drug laws Canadian Medical Association Journal.

 Supervised Injection Facilities Can Help People Quit Drugs

A study has found that supervised injection facilities such as Vancouver's InSite connect clients with addiction treatment, which in turn resulted in greater likelihood of stopping injection drug use for at least six months.

DeBeck K, Kerr T, Zhang R, Marsh D, Tyndall M, Montaner J, Wood E. 2010. Injection drug use cessation and use of North America's first medically supervised safer injecting facility. Drug and Alcohol Dependence.

 Increased Use of Addiction Treatment

The Safe Injection Facility's opening was associated independently with a 30% increase in detoxification service use, and this behaviour was associated with increased rates of long-term addiction treatment initiation and reduced injecting at the SIF.

Evan Wood, Mark W. Tyndall, Ruth Zhang, Julio S. G. Montaner & Thomas Kerr, et al. 2007. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users Society for the Study of Addiction

 

Attendance and Detoxification

Reports that weekly use of InSite and any contact with the facility's addictions counselor were both independently associated with more quicker entry into a detoxification program.

Wood E, Tyndall MW, Zhang R, J.Stoltz, Lai C, et al. 2006. Attendance at Supervised Injecting Facilities and Use of Detoxification Services. New England Journal of Medicine 354:2512-4

 

 

Syringe Sharing

Reports that InSite appears to have reduced syringe sharing.

Kerr T, Tyndall MW, Li K, Montaner JS, Wood E. 2005. Safer Injecting Facility Use and Syringe Sharing Among Injection Drug Users. Lancet 366:316-8

 

 

 

Impact on Drug-Use Patterns

Reports that the opening of InSite did not adversely affect community drug use, including relapse into injected drug use, stopping injected drug use, and seeking treatment. InSite appears to have improved public order and reduced syringe sharing.

Kerr T, Stoltz J, Tyndall M, Li K, Zhang R, et al. 2006. Impact of a Medically Supervised Safer Injection Facility on Community Drug Use Patterns: A Before and After Study. British Medical Journal 332:220-2

 

Culture Change Case Study

Highlights the ideas, processes and historical events that contributed to a cultural transformation that was critical to opening the InSite in Vancouver.

Small D, Palepu A, Tyndal MW. 2006. The establishment of North America's first state sanctioned supervised injection facility: a case study in culture change. International Journal of Drug Policy 17:73-82

 

 

Attendance, drug use patterns, and referrals

Reports that InSite has successfully been integrated into the community, has attracted a wide cross section of community injection drug users, has intervened in overdoses and initiated over 2000 referrals to counseling and other support services.

Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. 2005. Attendance, Drug Use Patterns, and Referrals Made From North America's First Supervised Injection Facility. Drug and Alcohol Dependence.

 

Evaluation Methodology

Lays out the method by which the health and community impacts of InSite will be measured and evaluated.

Wood E, Kerr T, Buchner C, Marsh D, Montaner JS, Tyndall MW. 2004. Methodology for Evaluating InSite: Canada's First Medically Supervised Safer Injection Facility for Injection Drug Users. Harm Reduction Journal 1:1-5

 

Rationale for Evaluation

Outlines the rationale for evaluating InSite and reasons that if the InSite study is able to show public-health and/or community benefits it may provide a public-health model with the potential to address many of these drug-related harms that plague many North American cities.

Wood E, Kerr T, Montaner JS, Strathdee S, Kerr T, et al. 2004. Rationale For Evaluating North America's First Medically Supervised Injecting Facility. Lancet Infectious Diseases 4:301-6

 

Changes in Public Order

Reports that the opening of InSite appears to have lead to improvements in public order, including reduced public injection drug use and public syringe disposal.

Wood E, Kerr T, Small W, Li K, Marsh D, et al. 2004. Changes In Public Order After The Opening of a Medically Supervised Safer Injection Facility for Injection Drug Users. Canadian Medical Association Journal 171:731-4

 

Impact on Drug Related Crime

Examines crime rates in the neighborhood surrounding InSite during the year before versus the year after InSite opened. It finds no increases in drug trafficking or assaults/robbery, and a decline in vehicle break-ins/vehicle theft.

Wood E, Tyndall MW, Lai C, Montaner JSG, Kerr T. 2006. Impact of a Medically Supervised Safer Injecting Facility on Drug Dealing and Other Drug- Related Crime. Substance Abuse Treatment, Prevention and Policy 1:1-4

 

Attraction of Higher-Risk Injection Users

Reports that InSite attracted injection drug users (IDUs) with elevated risks of blood-borne disease infection and overdose, and IDUs who were contributing to public drug use and unsafe syringe disposal problems stemming from public injection drug use.

Wood E, Tyndall MW, Li K, Lloyd-Smith E, Small W, et al. 2005. Do Supervised Injecting Facilities Attract Higher-Risk Injection Drug Users? American Journal of Preventive Medicine 29:126-30

 

Service Uptake

Reports that

  • InSite has been well accepted among injection drug users in the community.
  • Homelessness, a common factor in public injection drug use, is associated with frequent use of InSite
  • Daily safe injection facility use is associated with several risk behaviors that have been linked to elevated rates of HIV transmission in this community, including frequent cocaine injection.

Wood E, Tyndall MW, Qui Z, Zhang R, Montaner JS, Kerr T. 2006. Service Uptake and Characteristics of Injection Drug Users Utilizing North America's First Medically Supervised Safer Injection Facility. American Journal of Public Health 96:770-3

 

Syringe Sharing Factors

Reports that the use of InSite by injection drug users is associated with reduced syringe sharing.

Wood E, Tyndall MW, Stoltz J, Small W, Lloyd-Smith E, et al. 2005. Factors Associated with Syringe Sharing Among Users of a Medically Supervised Injecting Facility. American Journal of Infectious Diseases 1:50-4

 

 

HIV Education

Reports that individuals requiring help injecting - a risk factor previously associated with HIV incidence - are receiving safer injecting education at InSite.

Wood E, Tyndall MW, Stoltz J, Small W, Zhang R, et al. 2005. Safer Injecting Education for HIV Prevention Within a Medically Supervised Safer Injecting Facility. International Journal of Drug Policy 16:281-4

 

Preventing Overdose Deaths

Reports that there have been a large number of overdoses within the SIF, and that none of these overdoses resulted in a fatality. These findings suggest that SIF can play a role in managing overdoses.

Thomas Kerr, Mark W. Tyndall, Calvin Lai, Julio S.G. Montaner, Evan Wooda, et al. 2006. Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy

 

Preventing HIV/AIDS

The purpose of this analysis is to measure the prevalence and correlates of baseline HIV among those who are using the SIF, to determine if InSite could be used as a site for HIV related care and treatment.

Mark W Tyndall, Evan Wood, Ruth Zhang, Calvin Lai, Julio SG Montaner, Thomas Kerr, 2006. HIV seroprevalence among participants at a medically supervised injection facility in Vancouver, Canada: Implications for prevention, care and treatment. Harm Reduction Journal

 

Reducing Harms Associated With Drug-Related Overdose

Conventional drug overdose prevention strategies have been criticised for failing to address the macro- and micro-environmental factors that shape drug injecting practices and compromise individual ability to reduce the risks associated with drug-related overdose.Safer injection facilities (SIFs) constitute one such intervention, although little is known about the impact of such facilities on factors that mediate risk for overdose.

Thomas Kerr, Will Small, David Moore, Evan Wood, 2006. A micro-environmental intervention to reduce the harms associated with drug-related overdose: Evidence from the evaluation of Vancouver's safer injection facility. International Journal of Drug Policy

 

Changing Injecting Practices

Consistent SIF use was compared with inconsistent use on a number of self-reported changes in injecting practice variables.More consistent SIF use is associated with positive changes in injecting practices, including less reuse of syringes, use of sterile water, swabbing injection sites, cooking/filtering drugs, less rushed injections, safe syringe disposal and less public injecting.

Jo-Anne Stoltz, Evan Wood, Will Small, Kathy Li, Mark Tyndall, Julio Montaner, Thomas Kerr, 2007. Changes in injecting practices associated with the use of a medically supervised safer injection facility. Journal of Public Health

 

SIS Evaluation Review

In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users. Vancouver's safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use.

Evan Wood, Mark W. Tyndall, Julio S. Montaner, Thomas Kerr, 2006. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. Canadian Medical Association Journal

Commentary: The need to promote public health in the field of illicit drug use. Dr. Mark A. Wainberg, McGill University AIDS Centre, Jewish General Hospital, 2006 Canadian Medical Association Journal

 

Drug Users' Perceptions Regarding InSite

This study was undertaken to explore injection drug users' experiences and opinions regarding North America's first SIF in Vancouver, Canada.

Steven Petrar, Thomas Kerr, Mark W. Tyndall, Ruth Zhan, Julio S.G. Montaner, Evan Wood, 2007 Addictive Behaviors

 

 

Limiting Hepatitis C Infection

The SIF has attracted injection drug users with a high burden of HCV infection and a substantial proportion of uninfected individuals. Although crosssectional, this study provides some insight into historical risks for HCV infection among this population, and prospective follow-up of this cohort will be useful to determine if use of the SIF is associated with reduced risk behaviour and HCV incidence.

E. Wooda, T. Kerra, J. Stoltza, Z. Quia, R. Zhanga, J.S.G. Montanera, M.W. Tyndalla, 2005 The Royal Institute of Public Health.

 

InSite saves over $6 million per year

Through the use of conservative estimates, InSite prevents on average 35 new cases of HIV and 3 deaths each year. After program costs are taken into account, this prevention method is generating a societal benefit in excess of $6 million per year and is an effective and efficient use of public health care resources.

M. Andresen, N. Boyd, 2009  A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility. International Journal of Drug Policy

 

 

Neighbourhood residents and businesses view InSite as making a positive contribution to public order

This report explored the impact of InSite on public order in the surrounding neighbourhood. By detailing various kinds of property crime and violent crime the researchers found that no change in the rate of crime can be traced to the establishment of the InSite. Furthermore, 60% of those living/working in the area reported feeling that the site had a positive impact on public order; and more than 80% indicated that InSite should be either expanded, retained or modified.

N. Boyd et al 2008 Vancouver: Health Canada

 

Canada's national police force concludes that supervised injection sites do not increase crime

This study, lead by the RCMP, Canada's national police force, analyzed previous research and found that supervised injection sites achieve many of the expected benefits and that there was no evidence that they increased the number of drug users, made drug users more resistant to treatment or decreased public order by expanding drug scenes or attracting drug users and dealers from other locations.

Dr. Cohen 2006 Potus Consulting, RCMP

 

There has never been a fatal overdose at InSite

This study attempted to estimate the number of overdose deaths potentially averted by the implementation of InSite. Based on a conservative estimate of the local ratio of non-fatal to fatal overdoses, the potentially fatal overdoses in the supervised injection facility during the study period could have resulted in between 8 and 51 deaths had they occurred outside the facility. The authors found that potentially fatal overdoses at InSite during this period prevented between 6 and 37% of the total overdose deaths in the community.

M - J. Milloy, T. Kerr, M. Tyndall, J. Montaner, E. Wood 2008  Estimated Drug Overdose Deaths Averted by North America's First medically Supervised Safer Injection Facility. PLoS One

Vancouver police officers support the efforts of InSite and work in tandem with the facility to improve public order

Study examined the role of police in referring injection drug users to InSite and found that the supervised injection site provides an opportunity to coordinate policing and public health efforts in a positive manner thereby improving both health and public order.

K. DeBeck, E. Wood, R. Zhang, M. Tyndall, J. Montaner, T. Kerr 2008 Police and Public Health Partnerships: Evidence from the evaluation of Vancouver's supervised injection facility. Substance Abuse Treatment, Prevention and Policy

 

InSite saves the city, government and health care system money

This study examines the cost-effectiveness of Vancouver's supervised injection site. InSite was found to decrease needle sharing which alone saves $14 million and 920 life-years over 10 years. Increased knowledge of safe injection practices and referral to methadone maintenance through InSite saves $18 million and 1175 life years over 10 years. The study also considered the health effect of increased use of safe injection practices, the incremental net savings increased to more than $20 million and the number of life-years gained to 1070.

A. Bayoumi, G. Zaric 2008 Cost-effectiveness of the Vancouver Safe Injection Facility Canadian Medical Association Journal

 

InSite does not increase rates of overdose

These findings show that the proportion of individuals reporting recent non-fatal overdoses did not change as a result of access to InSite. Drug users who use InSite for 75% or more of their injections are less likely to overdose than those who use the site less often.

M. Milloy, T. Kerr, R. Mathias, R. Zhang, J. Montaner, M. Tyndall, E. Wood 2008 Non-fatal overdose among a cohort of active injection drug users recruited from a supervised injection facility American Journal of Drug and Alcohol Abuse

 

InSite does not promote drug use

Responding to concerns that InSite promotes initiation into injection drug use, this study found that InSite users have been injecting for an average of 16 years, and that only 1 participant reported having first injected at the site. The report concludes that the benefits of InSite have not been offset by a rise in drug use.

T. Kerr, M. Tyndall, R. Zhang, C. Lai, J. Montaner, E. Wood 2007  Circumstances of First Injection Among Illicit Drug Users Accessing a Medically Supervised Safer Injecting Facility.  American Journal of Public Health

 

InSite reduces strain on the health care system

Specialized and relevant onsite care is proven to reduce ER visits and hospitalizations among local injection drug users. Nurses well versed in the health challenges facing injection drug users provide wound care, safer injection education, intervene in overdose situations and treat infections.

W. Small, E. Wood, E. Lloyd-Smith, M. Tyndall, T. Kerr 2008 Drug and Alcohol Dependence

 

Demand for InSite access too high for just one facility to meet

This study considers why some injection drug users resist using InSite, and continue to inject publicly. It has been found that injection drug users prefer InSite but are deterred by long wait times an limited operating hours. The study concludes that an expansion of services would decrease public injecting.

I. McKnight, B. Maas, E. Wood, M. Tyndall, W. Samll, C. Lai, J. Montaner, T. Kerr 2007 Factors Associated with Public Injecting Among Users of Vancouver's Supervised Injection Facility. American Journal of Drug and Alcohol Abuse

 

Supervised injection facilities have a place in comprehensive HIV care models

This study explored the concept of integrating supervised injection programming into an HIV focused care facility in Vancouver. The study indentified mechanisms through which integrated supervised injection programs may better facilitate access to comprehensive care for HIV-positive injection drug users.

A. Krusi, W. Small, E. Wood, T. Kerr 2009 An integrated supervised injecting program within a care facility for HIV-positive individuals: a qualitative evaluation. AIDS Care

 

InSite provides a variety of integrated health care services

This study examined the factors associated with receiving care for cutnaeous injection-related infections among InSite users. The findings show that those most likely to receive care are the individuals engaged with treatment regimens similar to those provided at InSite.

E. Lloyd-Smith, E. Wood, R. Zhang, M. Tyndall, J. Montaner, T. Kerr 2009 Determinants of Cutaneous Injection-Related Infection Care at a Supervised Injecting Facility. Annals of Epidemiology

 

InSite does not impede employment opportunities for injection drug users

Critics of InSite argue that the program impedes drugs users ability to obtain meaningful employment and reintegrate into mainstream society. This study explores the rate of employment among InSite users. The findings suggest that InSite is not having an adverse effect on efforts to seek employment.

L. Richardson, E. Wood, R. Zhang, J. Montaner, M. Tyndall, T. Kerr 2008 Employment among users of a medically supervised safer injection facility. The American Journal of Drug and Alcohol Abuse

 

Harm reduction programming essential to reducing spread of disease in Canadian Penal System

This study found that incarceration and injecting while incarcerated were independently associated with syringe sharing and highlights the need to expand appropriate harm-reduction measures in Canada's prisons.

M. Milloy, E. Wood, M. Tyndall, T. Kerr, C. Lai, J. Montaner, W. Small 2008 Incarceration experiences in a cohort of active injection drug users. Drug and Alcohol Review

 

Critical thinking, critical to the survival of InSite

This article makes the case for harm reduction approach to public health and drug use while also noting that policy is being increasingly influenced by lobby groups and opinion pieces as opposed to evidence-based health policy. The author argues that policy makers must rely on evidence-based research when drafting policy, all of which supports a harm reduction model to drug policy.

E. Wood, J. Montaner, T. Kerr 2008 Illicit drug addiction, infectious disease spread, and the need for an evidence-based response. The Lancet

 

Harm reduction needs to be a global initiative

This report summarizes the historical political setting within which the development of progressive drug policy is nested. The authors make the case that the ongoing harms associated with drug dependency warrant a global 'scale-up' of evidence-based public health initiatives such as supervised injection facilities.

T. Kerr, J. Montaner, E. Wood 2008 Supervised injecting facilities: Time for scale-up? The Lancet

 

Through regular access to nursing staff, InSite is successful in educating injection drug users on safer injection practices

Study participants notes that the overall environment at the facility encouraged them to adopt the safer practices and to make a habit of using them both within and outside the facility. Additionally, participants reported feeling safe, secure and empowered to ask questions and seek assistance.

D. Fast, W. Small, E. Wood, T. Kerr 2008 The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility. Harm Reduction Journal

 

InSite reduces mortality rates from injection-related infection

This report identifies and summarizes the risks of infection associated with injection drug use. The report outlines the effectiveness of InSite in reducing serious complications from skin infections such as abscess and cellulitis.

E. Lloyd-Smith, E. Wood, M. Tyndall, T. Kerr, R. Zhang, J. Montaner 2008  Risk factors for developing a cutaneous injection-related infection among injection drug users: a cohort study. BMC Public Health

 

InSite supports safer sex practices by providing condoms to clients

While consistent condom use by users of InSite was low at the beginning of 2003, by the end of 2005 condom use had increased by 30% among thoise with regular partners and by 13% among those who were single or casually dating. This study suggests that InSite is effective in supporting safer sex practices and preventing the spread of sexually transmitted diseases.

B D L Marshall, E. Wood, M. Tyndall, T. Kerr, R. Zhang, J. Montaner 2009 Condom use among injection drug users accessing a supervised injecting facility. Sexually Transmitted Infections

 

Outdated ideology and the 'War on Drugs' endangers the future of InSite

This article outlines how the politicization of science by corporations and lobby groups skews the research on harm reduction. The authors argue that the HIV pandemic is among the world's greatest public health challenges and necessitates an increase in access to prevention programs such as InSite.

T. Kerr, E. Wood 2008  Misrepresentation of science undermines HIV prevention efforts.  Canadian Medical Association Journal

 

Supervised Injection Facilities: An important component in the battle against HIV transmissions

This article reviews the emerging literature regarding supervised injection sites in Europe, North America and Australia. The authors note that the impact of supervised injection facilities and resulting reductions in HIV transmission is a recurring theme in global research on this topic.

M-J. Milloy, E. Wood 2009  Emerging role of supervised injecting facilities in human immunodeficiency virus prevention. Addiction

 

InSite is committed to the community it serves

This study highlights the ways in which InSite can be further developed to respond effectively with high quality and relevant services that meet the needs of an evolving community. Areas of focus include HIV testing, HIV disease monitoring, directly observed therapy, and substitution therapies.

T. Kerr. J.Kimber, K. DeBeck, E. Wood 2007 The role of safer injection facilities in the response to HIV/AIDS among injection drug users. Current HIV/AIDS Reports

 

Partisan politics overshadowing scientific evidence

This commentary describes the Canadian government's handling of the scientific evaluation of InSite and the circumstances that led to a moratorium on safer injecting facilities in other Canadian cities. The authors urge the public to engage in greater public scrutiny of the Canadian government's handling of addiction research and drug policy.

E. Wood, T. Kerr, M. Tyndall, J. Montaner 2007  The Canadian government's treatment of scientific process and evidence: Inside the evaluation of North America's first supervised injecting facility.
International Journal of Drug Policy

 

InSite nurses reaching high risk female injection users

This report demonstrates that relationship building and one-on-one support between clients and nurses is proving to be a successful delivery of care model. 48% of clients received injection training from nurses at InSite. Younger and female injection drug users are notoriously difficult to reach, but have been particularly responsive to the initiative.

R. Wood, E. Wood, C. Lai, M. Tyndall, J. Montaner, T. Kerr 2008 Nurse-delivered safer injection education among a cohort of injection drug users: Evidence from the evaluation of Vancouver's supervised injection facility. International Journal of Drug Policy

 

57% of drug users under 30 years of age use InSite regularly

Younger InSite users are more likely to use heroin daily, to have experienced a drug overdose, to engage in binge drug use, share needles, to have been in jail, and to have been homeless. This study examined how successful InSite has been at attracting this demographic and found that 57% of those included in the study reported using InSite regularly.

J-A M. Stoltz, E. Wood, C. Miller, W. Small, K. Li, M. Tyndall, J. Montaner, T. Kerr 2007  Characteristics of young illicit drug injectors who use North America's first medically supervised safer injecting facility.  Addiction Research and Theory

 

InSite addresses street-based violence against women and survival sex trade workers 

Women who are entrenched in the street-level drug scene live with the constant threat of arrest, robbery, physical abuse, sexual assault and murder. The research demonstrates that InSite is meeting its goal to reduce harms associated with injection drugs by offering a safe environment that serves as a temporary refuge for women.

N. Fairbairn, W. Small, K. Shannon, E. Wood, T. Kerr 2008  Seeking refuge from violence in street-based drug scenes: Women's experiences in North America's first supervised injection facility. Social Science and Medicine

 

Downtown Eastside community demanded the opening of a safer injection site and related services

This study found that 92% of injection drug users in Vancouver's Downtown Eastside community expressed a willingness to use a safer injection facility if it was provided in a low barrier non-judgmental setting.

T. Kerr, E. Wood, D. Small. A. Palepu, M. Tyndall 2003  Potential use of safer injecting facilities among injection drug users in Vancouver's Downtown Eastside. Canadian Medical Association Journal

 

 

 

 

 

 

 

 

 

 

 


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