WILL DRAMATIC DROP IN OVERDOSE DEATHS BE ENOUGH TO SAVE INSITE?

Despite Indisputable Proof That Supervised Injection Site Has Saved Countless Lives, Federal Government Forges Ahead With Bid to Shut It Down

When Insite, Vancouver's supervised injection site, opened in the
fall of 2003, critics set for it what seemed an impossible task: The
facility could not be considered a success, they argued, unless it
represented a cost-effective way of increasing drug users' use of
detox and treatment services, reducing needle sharing and public
disorder and, perhaps most important of all, reducing overdose deaths.

In the first few years of its existence, Insite surprised nearly
everyone by satisfying virtually all of these criteria. And better
yet, it did this while attracting the drug users who are at the
highest risk of overdose and HIV-infection, as well as many of the
hardest to reach addicts.

But there was one thing that had yet to be confirmed -the reduction
in overdose deaths, the very thing many critics believed to be the
single most important criterion. One can, of course, debate whether
it really is the most important criterion, since by increasing users'
uptake of treatment services, Insite is undoubtedly saving lives, and
increasing the quality of the lives it saves.

But treatment takes time, and we don't usually see what becomes of
people who enter a treatment facility. Overdoses, on the other hand,
provide an immediate and dramatic example of a life-or-death
situation, and it's therefore difficult to deny the worth of a
facility that prevents overdose deaths.

It's surprising, then, that despite the existence of some 65
supervised injection facilities throughout the world, there has been
little solid research assessing the sites' ability to prevent
overdose deaths. Fortunately, though, the prestigious medical journal
The Lancet has today published a paper by researchers at the B.C.
Centre for Excellence in HIV/AIDS, and the paper provides precisely
the evidence we need.

The researchers compared the number of drug-related overdose deaths
that occurred in Vancouver before and after Insite opened. While the
number of deaths decreased dramatically post-Insite, this is not the
best measure of the facility's effectiveness, since drug users who
live a long way from Insite are unlikely to use the facility. Indeed,
some 70 per cent of daily Insite users live within four blocks of the
site. Consequently, the researchers compared pre-and post Insite
overdose mortality rates within four blocks of the site to the
pre-and post mortality rates in the rest of the city. And the results
were again dramatic.

Overdose mortality rates outside the four-block area decreased by
nine per cent, though that result was not statistically significant
and could have been the result of chance fluctuations. In contrast,
overdose mortality decreased by an impressive 35 per cent within the
four-block zone, a difference that is both statistically and
practically significant.

Although we can't conclude definitely that Insite was wholly
responsible for the reduction, it's evident that something produced
this dramatic change. And since there were no other major changes in
the pre-and post-Insite periods, it's reasonable to assume Insite
played a significant role in the reduction of overdose deaths.

If we look a little more closely, we find some even more dramatic
- -and disturbing -numbers. The number of overdose deaths among first
nations' people and women dropped by about 50 per cent within the
four-block area, yet roughly doubled in the rest of the city.

This suggests that Insite might be particularly important to the
welfare of women and aboriginals, two groups that are especially
vulnerable to drug-related problems.

But, of course, all drug users are vulnerable, and not just to the
drugs themselves. They are vulnerable as well to the whims of
unscrupulous politicians who would remove from them a lifesaving
medical service.

So, on May 12, the federal government, a two-time loser in court on
this issue, will try to prove to the Supreme Court of Canada that it
is justified in shutting Insite down -that it is justified in denying
vulnerable people a service that could save their lives. And in so
doing, it will prove only its own moral and intellectual bankruptcy.