In the late 1990s, Vancouver, Canada had the highest reported incidence of H.I.V. infection among any injection drug using population anywhere in the world, and nearly 200 people were dying in the city every year from drug overdoses.
A public health emergency was declared, and Insite, North America’s first supervised injection facility, opened in September 2003. Insite has 12 injection booths where clients inject their illicit drugs under the supervision of nurses and health care staff. Insite supplies clean injection equipment such as syringes, cookers, filters, water and tourniquets. If an overdose occurs, the team, led by a nurse, intervenes immediately. Nurses also provide other health care services, like wound care and immunizations.
In its first 2 1/2 years of operation, drug overdoses in the neighborhood around Insite dropped 35 percent while they dropped less than 10 percent in the rest of the city. There have been more than 1,000 overdoses observed at Insite since it opened but, thanks to the presence of clinic staff, there have been no deaths.
The number of new H.I.V. infections among Vancouver’s injection drug using population hasdeclined steadily since Insite opened.
Extensive research has demonstrated the benefits of Insite and found no harms. In addition to reducing overdose deaths and harmful injection practices that risk infection, thousands of people attending Insite have been referred for addiction treatment, including to a detox facility located in the same building. Public disorderin the neighborhood around Insite decreased after its opening and there has been no increase in neighborhood crime. The presence of Insite has not led to higher rates of relapse among former injection drug users and, overall, injection drug use in Vancouver appears to be declining.
Drug addiction is a chronic, recurring medical condition that is extremely difficult to treat. Over the last decade, Vancouver Coastal Health, the public health authority in Vancouver, has invested far more in prevention and addiction treatment than in harm reduction services such as Insite. Some argue that it is more important to prevent young people from using illicit drugs, and providing treatment to current addicts, than to provide harm reduction services to prevent the serious consequences of drug use. But no vaccine prevents addiction and no simple pill cures it, so the full spectrum of services, including prevention programs, needle exchange, supervised injection and multiple options for addiction treatment are necessary.
While we continue to research and invest in new treatments, harm reduction services such as Insite are needed to keep people alive. Those with addiction are often marginalized, living in poverty and suffering from mental illness. Many experienced trauma in early childhood at a time of important brain development. These people – who are mothers, fathers, brothers, sisters and our children – deserve evidence-based medical services that prevent overdose deaths and reduce the risk of life-threatening infections.