Since Vancouver, B.C., injection site opened, the city found more drug users entered detoxification programs, and overdose deaths in the area around the facility dropped.

Share story

AS Seattle and other U.S. cities struggle with escalating overdose epidemics, some policymakers are considering taking the radical step of creating safe places where people can inject illicit drugs under supervision.

Sound wild or perhaps asinine? Maybe. But if one takes the time to learn about experiences with supervised injection sites, it might seem crazier not to implement this very simple public-health intervention.

In the mid-1990s, the city of Vancouver, B.C., was in the midst of explosive epidemics of HIV infection and overdose in its impoverished downtown core. In response, local health officials declared a public-health emergency.

But then very little happened in the short term, except that city police continued to launch crackdowns in the drug scene, which had no lasting effects and actually pushed drug users away from public-health programs that reduce infection and overdose.

Realizing that there was no way to enforce one’s way out of a public-health crisis, city officials spearheaded what was called the Four Pillar Drug Strategy, which sought to balance enforcement, prevention, treatment and harm-reduction efforts.

The harm-reduction part included plans to establish a supervised injection site where local drug users could inject drugs under the supervision of nurses. In 2003, the new mayor of Vancouver, Larry Campbell, a former police officer and chief coroner, worked with the local health authority to open Insite, North America’s first supervised injection site.

Insite has now been in operation for 13 years. It is open 18 hours a day, from 10 a.m. to 6 a.m., has 12 booths for injecting and, on average, around 700 injections are supervised each day — that is 700 injections that would have otherwise likely occurred in public spaces. There are nurses on site to provide education and emergency response in the event of overdose, and counselors provide thousands of referrals to external services each year, including to addiction treatment.

Insite was allowed to open under the condition that it was subjected to a rigorous arm’s length evaluation. To date, more than 40 peer-reviewed studies about Insite have been published in many of the world’s best medical and public-health journals, including The Lancet and the New England Journal of Medicine.

This body of research shows that Insite is meeting its objectives. It very quickly helped reduce public disorder arising from drug use in public spaces. Syringe sharing, the behavior that causes most HIV and hepatitis C infections among drug users, also plummeted. Somewhat surprisingly, there was also a greater than 30 percent increase in the number of drug users entering detoxification programs, and there was a 35 percent reduction in overdose deaths in the area around the facility. Three separate studies have also found that Insite is highly cost effective.

The evaluation of Insite also focused on a range of possible negative impacts. It was found that the opening of Insite did not lead to increases in crime and did not encourage young people to start injecting.

Despite this success, the former conservative government of Canada tried to shut down Insite. This led to a showdown in the Supreme Court of Canada. Several major organizations intervened in the case to support Insite, including the Canadian Medical Association and the Canadian Association of Nurses.

The Supreme Court Justices ruled 9-0 in favor of the continued operation of Insite. In their decision, they stated: “Insite has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada.”

The new government of Canada has recently approved a second supervised injection site in Vancouver, and plans are under way to establish them elsewhere. This is not surprising given the experience in Europe. Although there was a time when only a few supervised injection sites operated in three countries, there are approximately 90 worldwide, with the number of countries with such facilities continuing to increase.

Allowing people to inject drugs under the supervision of health care professionals may seem like a radical idea, especially given that we have spent more than a century punishing people for using drugs. Sadly, that approach hasn’t gotten us anywhere and has caused all kinds of measurable harm.

At the same time, the evidence supporting the benefits of supervised injection sites has only grown. Given the immense preventable suffering and health-care costs associated with drug use in some U.S. cities, implementing supervised injection facilities may not seem like such a radical idea after all.