HUMAN CONSIDERATIONS ASIDE, INSITE'S BENEFITS FAR OUTWEIGH THE COSTS

The more than two dozens studies on Insite, Vancouver's supervised
injection site, have revealed many positive outcomes associated with
the facility: A decrease in needle-sharing, public injections and
publicly discarded syringes, and increased uptake of detoxification
and treatment services.

The research has also suggested a lack of negative outcomes, including
no apparent increase in crime near the site, and no increase in new
drug users.

Despite this, naysayers continue to lament the existence of the site,
often arguing that it is simply eating up too much money to justify
its existence.

Now, in a world of limited resources, we do have to use our money
wisely. But new research from Ahmed Bayoumi of St. Michael's Hospital
and the University of Toronto, and Gregory Zaric of the Ivey School of
Business at the University of Western Ontario, suggests that the site
is likely to produce a cost savings over a 10-year period.

The research, published in the current issue of the Canadian Medical
Association Journal, uses a sophisticated computer model to assess the
impact on Vancouver over the next decade, with and without Insite.

Bayoumi and Zaric first estimated cost savings based on a conservative
assumption -- that the only benefit of Insite is that it reduces
needle sharing among injection drug users. Even with this limited
benefit, the computer simulation predicted that Insite would result in
a gain of 920 life-years over the next decade (because fewer drug
users would become infected by potentially fatal viruses such as HIV.)

For those whose concern is economics, the simulation also estimated
that this reduction in infections would result in a savings of $14
million over the next 10 years.

Bayoumi and Zaric then considered the benefit of Insite if it were
assumed that the site produced both a decrease in needle sharing and
an increase in safer injecting practices, such as the use of bleach to
sterilize needles. Based on this assumption, Insite is estimated to
produce a gain of 1,070 life-years, and a savings of $20 million over
the next decade.

This suggests that even if we look at things from a strictly financial
point of view (ignoring drug users' improved quality of life), Insite
is well worth the money it costs. Of course, as with all computer
simulations, the results will depend on the accuracy of the
researchers' assumptions.

In this regard, New York research-ers Don Des Jarlais, Kamyar Arasteh
and Holly Hagan, in an accompanying commentary in the CMAJ, do
question some of the assumptions made by Bayoumi and Zaric.

But even under different assumptions, Des Jarlais, Arasteh and Hagan
still estimate that Insite could avert some 250-350 HIV infections in
10 years. And given the $150,000 estimated lifetime cost of treating
HIV infection, Insite would still produce significant savings.

Furthermore, Bayoumi and Zaric did not consider other potential
economic benefits of Insite, including a decrease in overdose, the
transmission of hepatitis B, and skin infections resulting from
unhygienic injection. Were these factors considered, the economic
benefits of Insite would probably be magnified.

Hence, even if we resist concerning ourselves with the welfare of drug
users, its clear that Insite will likely produce benefits for all
taxpayers. And that means it's good for everyone.