The idea of a drug-use facility funded with $3 million in taxpayer money every year may be controversial. But some studies have found it useful.
A November 2008 Canadian Medical Association Journal report found that Insite, the Downtown Eastside’s supervised drug-injection site that opened in 2003, could save lives and spare the Canadian health system $14 million over 10 years by preventing new HIV and hepatitis-C infections.
It found a “decrease in needle sharing and reuse of syringes, fewer people injecting drugs in public, an increase in referrals to social services and addiction counselling, a decrease in the number of publicly discarded syringes, no apparent increase in police reports of drug-dealing or crime and no increase in new initiates into drug use.”
Insite could avert up to 1,517 HIV infections in 10 years, the report found. It costs $15,500 a year to treat a person with HIV, $2,650 to treat hepatitis C, $3,900 in intravenous-drug-user health care, $3,100 for a methadone user and $6,000 for the methadone itself. By contrast, a non-intravenous user costs the system $1,300 a year.
A 2007 B.C. Centre for Excellence in HIV/AIDS study found a 30-per-cent increase in the number of drug users accessing detox, and that Insite users were more likely to pursue long-term treatment after Insite opened.
A 2008 study by the centre tracked 1,004 overdoses at Insite from March 2004 to July 2008, of which 453 resulted in medical treatment, but none resulted in death. It concluded the service prevented between two and 12 overdose deaths per year.
Dr. Thomas Kerr, a research scientist with the centre, says Insite has proven its worth: 30 peer-reviewed studies have proven its success in reducing disease and death.
Mark Townsend, executive director of the Portland Hotel Society, which runs Insite, says the endless cycle of studies is “a joke.”
“I don’t think there is any other program to get people off drugs that has had so much money spent on it being assessed. The results are in. We don’t need any more studies. That money could be better spent researching something else or providing something more useful.”
“There’s really no academic debate about Insite anymore,” Kerr concurs.
But the moral and political debate continues to rage, and select studies, backed by the RCMP and a report by a Health Canada committee, question the conclusions about Insite, citing lack of longitudinal research and reliance on self-reporting by users.
Some medical professionals also question the studies evaluating Insite. New Westminster addictions medicine expert Dr. Don Hedges has treated more than 8,000 addicts over the past 19 years. He doesn’t support Insite and says that, after he spoke out about his views last May, his offices were picketed.
“Those who do not support Insite are so often vilified personally that there is no possibility for dispassionate discussion. Supporters of Insite, including those with a vested interest in keeping it open, are somehow assumed to be free of bias,” says the Canadian Society of Addiction Medicine member.
Hedges, co-author of Stepping Forward: Improving Addiction Care in British Columbia, the new policy paper of the B. C. Medical Association, says studies “proving” Insite’s effectiveness have been shown in three review papers to be poorly designed, and that the data show Insite has not reduced crime or rates of HIV or hepatitis C transmission and, at most, has prevented one overdose per year.
He believes such alternatives can’t be justified when life-saving detox and treatment beds are so scarce.
In his view, “if health-care funding is a zero-sum game, as it seems to be, then $3 million per year for Insite means $3 million less for detox and treatment facilities, an amount that would pay for hundreds of people to attend detox and residential treatment, and would obviously prevent many more than one overdose death.”
Vancouver police union president Tom Stamatakis has called Insite a “well-intentioned but expensive failure.”
And despite support from the province, the city of Vancouver and public-health officials, the federal government began a B.C. Court of Appeal process in late April to overturn a lower court ruling that Insite was a service to which users have a constitutional right. The appeal decision is pending.
If the appeal is struck down, Townsend says the PHS will look to set up another location in the 100-block of Hastings, adding an inhalation site and methadone clinic. If the appeal is successful, he says they will take it to the Supreme Court of Canada and Insite will remain open pending resolution.
Closing Insite, he maintains, “is immoral because we know in doing that, people will die. People don’t need to die because they have an addiction to drugs.”
For now, Insite remains open, but its fate is as uncertain as that of the addicts of the Downtown Eastside.
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