The Evaluation of Vancouvers Medically Supervised Safer Injection Facility

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The Evaluation of Vancouvers Medically
Supervised Safer Injection Facility

• Thomas Kerr
• Mark Tyndall
• Will Small
• Kathy Li
• Ruth Zhang
• Calvin Lai
• Julio Montaner
• Evan Wood

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SIS Evaluation Structure
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Published Findings to Date

• Two Lines of Inquiry
• Evidence of positive health and community
  benefits
• Evidence of adverse health and community impacts
• All findings are subject to scientific
  peer-review

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Summary of Findings to Date

• The SIS has attracted and retained a high risk
  population of IDU who are at heightened risk for
  HIV infection and overdose
• Wood et al., American Journal of Preventative
  Medicine, 2005
• Wood et al., American Journal of Public Health,
  2006
• The SIS supervises 600 injections per day, over
  6500 IDU have used the SIS, and thousands of
  referrals are made each year
• Tyndall et al., Drug and Alcohol Dependence,
  2006
• The SIS has been associated with reductions in
  public disorder related to injection drug use
• Wood et al., Canadian Medical Association
  Journal, 2004

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Summary of Findings to Date

• Use of the SIS has been associated with
  reductions in syringe sharing
• Kerr et al., The Lancet, 2005,
• Wood et al., American Journal of Infectious
  Diseases, 2005
• Many individuals at high risk for HIV infection
  are receiving safer injection education at the
  SIS
• Wood et al., International Journal of Drug
  Policy, 2005
• Use of the SIS has been associated with increased
  uptake of detoxification services
• Wood et al., New England Journal of Medicine,
  2006
• The SIS is playing a major role in successfully
  managing overdoses
• Kerr et al., International Journal of Drug
  Policy, 2006

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Summary of Findings to Date

• The establishment of the SIS has not prompted
  adverse changes in community drug use patterns
• Kerr et al., British Medical Journal, 2005
• The establishment of the SIS has not been
  associated with increases in drug-related crime
• Wood et al., Substance Abuse Treatment
  Prevention and Policy, 2006

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Changes in Detoxification Service Use among
Injection Drug Users Following the Opening of a
Supervised Injection Site
Evan Wood Mark W. Tyndall Ruth Zhang Calvin
Lai Julio S.G. Montaner Thomas Kerr
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Circumstances of first injection amongillicit
drug users accessing a medically supervised safer
injection facility
Thomas Kerr Mark Tyndall Ruth Zhang Calvin
Lai Julio Montaner Evan Wood
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Table 1. Circumstances of initiation into
injection drug use among users of Vancouvers SIF
(n 1065).
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The Impact of a Supervised Injection Site on
Overdose Results from a Qualitative Study
Thomas Kerr Will Small Nadia Fairbairn Evan Wood
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Impact on Overdose Fatality

• R It was about eleven oclock at night, and I
  had gone in and I actually had gotten a huge
  amount of heroin five papers it was like
  lights outI come to Im laying on my back and
  I dont even know where Im at. Im very scaredI
  just remember seeing the Insite lady talking to
  me, holding my hand, telling me that everything
  was gonna be okay. There was an officer there,
  and there was a paramedic there. Because Im also
  epileptic too, they were also concerned about
  thatIf I had gone home and did that I probably
  wouldnt be here, cause no-one was at home. I
  was by myself, so I definitely would have
  overdosed and I probably would have ended up
  killing myself.

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Conclusions

• A great deal of rigorous scientific evidence on
  the impact of InSite has demonstrated significant
  positive impacts and ruled out potential negative
  effects
• Given the positive public health and community
  impacts of Insite that have been observed, it is
  clear that Insite should remain open
• The closure of the site could result in a
  deterioration of public order, the potential for
  elevated HIV incidence, and lives lost due to
  fatal overdose
• The SIS should continue to be rigorously
  evaluated