Canada

Subsections:

Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

61. Insite Evaluations

"The British Columbia Centre for Excellence in HIV/AIDS was commissioned to evaluate Insite. A study published in 2006 showed that there was an increase in uptake of detoxification services and addiction treatment.13 Another study published that year showed that Insite did not result in increased relapse among former drug users, nor was it a negative influence on those seeking to stop drug use.14 Results of studies using mathematical modelling showed that about one death from overdose was averted per year by Insite.1 A subsequent study estimated 2–12 deaths averted per year.15 Although these studies did not have sufficient power to detect any difference in incidence of blood-borne infections, Kerr and colleagues did find that Insite users were 70% less likely to report needle-sharing than those who did not use the facility.16 Before the opening of Insite, those same individuals reported needle-sharing that was on par with cohort averages. As for public order, Wood and colleagues found that there was no increase in crime following the opening of the facility.17 In fact, there had been statistically significant decreases in vehicle break-ins and theft, as well as decreases in injecting in public places and injection-related litter."

Dooling, Kathleen and Rachlis, Michael, "Vancouver’s supervised injection facility challenges Canada’s drug laws," Canadian Medical Association Journal (Ottawa, Ontario: September 21, 2010), Vol. 182, Issue 13, p. 1441.
http://www.ncbi.nlm.nih.gov/pu...
http://www.cmaj.ca/content/182...

62. Canada - Insite - 11-6-11

(Reduced Overdose Mortality) "In this population-based analysis, we showed that overdose mortality was reduced after the opening of a SIF [supervised injecting facility]. Reductions in overdose rates were most evident within the close vicinity of the facility—a 35% reduction in mortality was noted within 500 m of the facility after its opening. By contrast, overdose deaths in other areas of the city during the same period declined by only 9%. Consistent with earlier evidence showing that SIFs are not associated with increased drug injecting (panel),38,39 these findings indicate that such facilities are safe and e!ective public-health interventions, and should therefore be considered in settings with a high burden of overdose related to injection drug use."

Marshall, Brandon D L; Milloy, M-J; Wood, Evan; Montaner, Julio S G; Kerr, Thomas, "Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study," The Lancet (London, United Kingdom, April 2011), p. 7.
http://www.communityinsite.ca/...

63. Detox and Treatment Service Use

"In summary, the present study demonstrates that the SIF was associated with increased use of detoxification service use and that residential detoxification was associated with increased rates of methadone use and other forms of addiction treatment. Given the known role of methadone and other forms of addiction treatment in reducing levels of injection drug use, and given that detoxification programme use was associated with reduced injecting at the SIF, our findings imply that the SIF has probably helped to reduce rates of injection drug use among users of the facility."

Wood, Evan; Tyndall, Mark W.; Zhang, Ruth; Montaner, Julio S.G.; and Kerr, Thomas, "Rate of Detoxification Service Use and its Impact among a Cohort of Supervised Injecting Facility Users," Addiction (2007), Vol. 102, p. 918.
http://www.ncbi.nlm.nih.gov/pu...

64. Detox Service Use

"The present study demonstrates that the opening of the Vancouver SIF was associated with a greater than 30% increase in the rate of detoxification service use among SIF users in comparison to the year prior to the SIF's opening. Subsequent analyses demonstrated that detoxification service use was associated with increased use of methadone and other forms of addiction treatment, as well as reduced injecting at the SIF."

Wood, Evan, Tyndall, Mark W., Zhang, Ruth, Montaner, Julio S.G., and Kerr, Thomas, "Rate of Detoxification Service Use and its Impact among a Cohort of Supervised Injecting Facility Users," Addiction (2007), Vol. 102, p. 918.
http://www.ncbi.nlm.nih.gov/pu...

65. Benefits From Supervised Consumption Facilities

"Evaluation of the Vancouver facility has shown that its opening has been associated with reductions in public drug use and publicly discarded syringes and reductions in syringe sharing among local injecting drug users. Our study suggests that these benefits have not been offset by negative changes in community drug use."

Kerr, Thomas, Jo-Anne Stoltz, Mark Tyndall, Kathy Li, Ruth Zhang, Julio Montaner, Evan Wood, "Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study," British Medical Journal, Vol. 332, Jan. 28, 2006, p. 222.
http://www.bmj.com/content/332...
http://www.ncbi.nlm.nih.gov/pu...

66. Insite and Overdose Mortality

"In this population-based analysis, we showed that overdose mortality was reduced after the opening of a SIF. Reductions in overdose rates were most evident within the close vicinity of the facility—a 35% reduction in mortality was noted within 500 m of the facility after its opening. By contrast, overdose deaths in other areas of the city during the same period declined by only 9%. Consistent with earlier evidence showing that SIFs are not associated with increased drug injecting (panel),38,39 these findings indicate that such facilities are safe and effective public-health interventions, and should therefore be considered in settings with a high burden of overdose related to injection drug use.
"In both the primary and sensitivity analyses, we saw no significant reductions in overdose mortality further than 500 m from the SIF. This finding is not surprising, since over 70% of frequent SIF users reported living within four blocks of the facility. Although the facility operates at capacity with over 500 supervised injections per day on average,23 it is a pilot programme with only 12 injection seats in a neighbourhood with about 5000 injection drug users.40 Therefore, and since previous studies have shown that waiting times and travel distance to the facility are barriers to SIF use,41 larger reductions in community overdose mortality would probably require an expansion of SIF coverage."

Marshall, Brandon D L; Milloy, M-J; Wood, Evan; Montaner, Julio S G; Kerr, Thomas, "Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study," The Lancet (London, United Kingdom: April 18, 2011) Volume 377, Issue 9775, pp. 1429-1437.
Abstract: http://www.thelancet.com/journ...

67. Insite Users and Other Drug Use

In an evaluation of the Vancouver supervised injection facility Insite, researchers concluded that: "Although there was a substantial increase in the number of participants who started smoking crack cocaine, it is unlikely that the facility, which does not allow smoking in the facility, prompted this change. These findings are relevant to a recent review of supervised injection facilities by the European Monitoring Centre on Drugs and Drug Addiction, which highlighted concerns that these facilities could potentially 'encourage increased levels of drug use' and 'make drug use more acceptable and comfortable, thus delaying initiation into treatment.'"

Kerr, Thomas, Jo-Anne Stoltz, Mark Tyndall, Kathy Li, Ruth Zhang, Julio Montaner, Evan Wood, "Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study," British Medical Journal, Vol. 332, Jan. 28, 2006, p. 222.
http://www.ncbi.nlm.nih.gov/pu...
http://www.bmj.com/content/332...

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