Vancouver's safe-injection site will save the health-care system at least $14-million and prevent more than 1,000 HIV infections over a 10-year period, according to a new study about the controversial program.
The study, published today in the Canadian Medical Association Journal, is the latest piece of research to suggest the potential social benefit of Insite in helping curb substance abuse, and reducing the spread of hepatitis C, HIV and other infectious diseases.
"We were a bit surprised. The model really suggests that there are very considerable benefits," said Ahmed Bayoumi, lead author and scientist at the Centre for Research on Inner City Health in Toronto.
Vancouver's drug scene is considered to be worsening, and many government and non-profit programs aim to curb the problems associated with it. Yesterday, the federal government announced $200,000 in new funding to help Vancouver's Drug Treatment Court, which uses treatment programs to help drug users charged with crimes to stop using illicit substances.
But the safe-injection site, where drug users are given clean needles in order to reduce needle sharing and subsequent spread of disease, has been riddled with controversy since it opened in 2003. Critics of the program say that it enables drug use and that there is no credible proof it helps curb drug addiction or the spread of infectious diseases.
The federal government is in the process of appealing a decision by a B.C. court this year that allowed Insite to remain open. The court had ruled that it would violate a drug user's Charter rights to be denied access to Insite's health-care services.
But a growing amount of scientific evidence indicates the program helps reduce public disorder, overdoses and disease as well as providing users with an avenue for treatment. The World Health Organization has also endorsed the site.
In the analysis, researchers used sophisticated computer models to try to forecast what effect Insite would have in Vancouver over a 10-year period. They also used a model to determine what would happen if Insite didn't exist.
The models were created using current data in a range of categories, such as the number of people with HIV and hepatitis C, the number of drug users, and the number users seeking treatment in Vancouver. If Vancouver-specific data were unavailable, researchers used information from medical literature, giving particular emphasis to North American studies.
"We put all of those things together in a fairly sophisticated computer model," Dr. Bayoumi said.
They found that Insite has the potential to save $14-million in health-care dollars and 920 life years over the next decade, while averting 1,191 cases of HIV and 54 cases of hepatitis C.
Those savings were calculated by taking into account how much the decreased incidence of needle sharing could curb the spread of infectious disease and the associated costs of treatment.
When researchers ran the model again considering the effect of decreased needle sharing, as well as the increased use of safer practices during shared injections such as using bleach to sterilize needles, the savings rose to $20-million, with 1,070 life years saved.
"I think the most important message is that, compared to other health-care interventions, investing in the supervised injection facility represents very good value for money," Dr. Bayoumi said. "Even though the facility itself has operating costs that are considerable, the potential health benefits and potential savings down the line are considerable and that all has to be taken into account."
It's impossible to predict the future with 100-per-cent accuracy, Dr. Bayoumi said. But the researchers used current information on the population of intravenous drug users in Vancouver, and the rate of disease among that population, to forecast what would happen over a long period of time.
The researchers also ran models in which they changed the data - such as lowering the number of intravenous drug users in the city - to see whether it would have an impact on Insite's estimated benefits.
They found that the safe-injection site remained a viable use of health-care dollars in nearly all circumstances. The only scenario in which the cost of Insite outweighed its benefits was when researchers assumed there was very little needle sharing in Vancouver and low HIV rates in the city.
"The finding that investing in the facility was a good use of health-care resources didn't change," Dr. Bayoumi said. "Only in very extreme circumstances did we start to find it wasn't good value for money."
Dr. Bayoumi's work is supported by an award from the Ontario HIV Treatment Network. Gregory Zaric, second study author and associate professor of epidemiology and biostatistics at the University of Western Ontario's Richard Ivey School of Business, received a grant from the National Institute on Drug Abuse. No other external funding was received for the study and the authors didn't accept any financial compensation for the research.
----------------------------------------
CARLY WEEKS
From Tuesday's Globe and Mail
November 18, 2008 at 9:38 AM EST
http://www.theglobeandmail.com/serv...ialScienceandHealth/home?cid=al_gam_mostemail
The study, published today in the Canadian Medical Association Journal, is the latest piece of research to suggest the potential social benefit of Insite in helping curb substance abuse, and reducing the spread of hepatitis C, HIV and other infectious diseases.
"We were a bit surprised. The model really suggests that there are very considerable benefits," said Ahmed Bayoumi, lead author and scientist at the Centre for Research on Inner City Health in Toronto.
Vancouver's drug scene is considered to be worsening, and many government and non-profit programs aim to curb the problems associated with it. Yesterday, the federal government announced $200,000 in new funding to help Vancouver's Drug Treatment Court, which uses treatment programs to help drug users charged with crimes to stop using illicit substances.
But the safe-injection site, where drug users are given clean needles in order to reduce needle sharing and subsequent spread of disease, has been riddled with controversy since it opened in 2003. Critics of the program say that it enables drug use and that there is no credible proof it helps curb drug addiction or the spread of infectious diseases.
The federal government is in the process of appealing a decision by a B.C. court this year that allowed Insite to remain open. The court had ruled that it would violate a drug user's Charter rights to be denied access to Insite's health-care services.
But a growing amount of scientific evidence indicates the program helps reduce public disorder, overdoses and disease as well as providing users with an avenue for treatment. The World Health Organization has also endorsed the site.
In the analysis, researchers used sophisticated computer models to try to forecast what effect Insite would have in Vancouver over a 10-year period. They also used a model to determine what would happen if Insite didn't exist.
The models were created using current data in a range of categories, such as the number of people with HIV and hepatitis C, the number of drug users, and the number users seeking treatment in Vancouver. If Vancouver-specific data were unavailable, researchers used information from medical literature, giving particular emphasis to North American studies.
"We put all of those things together in a fairly sophisticated computer model," Dr. Bayoumi said.
They found that Insite has the potential to save $14-million in health-care dollars and 920 life years over the next decade, while averting 1,191 cases of HIV and 54 cases of hepatitis C.
Those savings were calculated by taking into account how much the decreased incidence of needle sharing could curb the spread of infectious disease and the associated costs of treatment.
When researchers ran the model again considering the effect of decreased needle sharing, as well as the increased use of safer practices during shared injections such as using bleach to sterilize needles, the savings rose to $20-million, with 1,070 life years saved.
"I think the most important message is that, compared to other health-care interventions, investing in the supervised injection facility represents very good value for money," Dr. Bayoumi said. "Even though the facility itself has operating costs that are considerable, the potential health benefits and potential savings down the line are considerable and that all has to be taken into account."
It's impossible to predict the future with 100-per-cent accuracy, Dr. Bayoumi said. But the researchers used current information on the population of intravenous drug users in Vancouver, and the rate of disease among that population, to forecast what would happen over a long period of time.
The researchers also ran models in which they changed the data - such as lowering the number of intravenous drug users in the city - to see whether it would have an impact on Insite's estimated benefits.
They found that the safe-injection site remained a viable use of health-care dollars in nearly all circumstances. The only scenario in which the cost of Insite outweighed its benefits was when researchers assumed there was very little needle sharing in Vancouver and low HIV rates in the city.
"The finding that investing in the facility was a good use of health-care resources didn't change," Dr. Bayoumi said. "Only in very extreme circumstances did we start to find it wasn't good value for money."
Dr. Bayoumi's work is supported by an award from the Ontario HIV Treatment Network. Gregory Zaric, second study author and associate professor of epidemiology and biostatistics at the University of Western Ontario's Richard Ivey School of Business, received a grant from the National Institute on Drug Abuse. No other external funding was received for the study and the authors didn't accept any financial compensation for the research.
----------------------------------------
CARLY WEEKS
From Tuesday's Globe and Mail
November 18, 2008 at 9:38 AM EST
http://www.theglobeandmail.com/serv...ialScienceandHealth/home?cid=al_gam_mostemail
