protect insite (updated)

When I attended the Global Village at the 2006 AIDS Conference, I learned that InSite, North America's only safe injection site, is in danger of being closed. I meant to blog about this right away, then didn't... then I thought it was too late. JenJJP, a friend of wmtc, woke me up. It's not too late, and it's vitally important.

To operate legally, Health Canada granted Vancouver Coastal Health an exemption under Section 56 of the Controlled Drugs and Substances Act. Health Canada has not yet committed to allowing Insite to operate beyond September 12, 2006.

This is an important program that offers humane drug treatment and saves lives. Jen's site, Protect InSite, says it all, so I'll going to quote extensively from it.
How a Safe Injection Site works (pers. comm. from my tour and the Insite webpage).

-Clients in the waiting area sign in the first time and sign waiver
-12-seat injection room where they can inject their own drugs under the supervision of trained medical staff.
-Self report drugs and recieve equipment and instruction for proper use.
-Have access to clean injection equipment including spoons, tourniquets and sterile water, aimed at reducing the spread of infectious diseases. All equipment must be left in the injection room.
-Average time in injection room: 20 minutes.
-After injecting, they move to a post-injection room where, if appropriate, staff can connect clients with other on-site services. These include primary care for the treatment of wounds, abscesses and other infections; addiction counseling and peer support; and referral to treatment services such as withdrawal management, opiate replacement therapy and other services.

Why this is important and necessary

- Injection drug users have access to resources the rest of us take for granted: an interdisciplinary healthcare team, clean equipment, social services and outreach.
- There is access to injection site assessment for abcesses, infection, safe injection technique.
- All equipment is safely disposed of, not left in the streets, alleys, public trash.
- Common practice prior to the site opening included using any available water source for injecting, for example puddle water.
- Individuals are giving the dignity to shoot up in a private space and public order is improved as there is now less conflict between injection drug users and other members of the community (for example business owners, like the Chinatown Merchants Association, who, while initially sceptical or opposed to the site, are now overwhelmingly supportive)
- There is a reduction in crime in the community
- Individuals inject individually, and equipment can't leave Insite; so, there is no chance of shared needles


Along with the on-site coordinator, two registered nurses are present at all times with an addiction counsellor and physician support available on-call. Program assistants from our partner, the PHS Community Services Society, help greet and register people, as well as provide peer contact to encourage safe injection practices and orient drug users to use the site.

Facts and Figures (from Insite homepage and pers. comm from my tour)

-People using Insite are more likely to enter a detox program, with one in five regular visitors beginning a detox program
-Over a two year period 4,084 referrals were made with 40 per cent of them made to addiction counseling
-To date there have been over 500 overdoses at Insite. Thanks to prompt medical attention there have been no deaths.
-Daily average visits: 607
-Number of nursing care interventions: 6,227
-Number of nursing interventions for abscess care: 2,055
-Busiest day: May 25, 2005 (933 visits in 18 hours). So, nearly 1000 needles kept off of the street, nearly 1000 instances where a needle was not shared.1000 instances where an individual had the opportunity to access the healthcare system, not only for drug-related treatment but also for mental health, HIV/AIDS care, pregnancy testing and maternity care, social work services, counseling and peer-support.

Key Research Findings (thanks to S. Evans, VCH)

-Insite has attracted and retained a high risk population of injection drug users, including those at high risk for HIV, overdose, and involved in public disorder.
-The opening of Insite has been associated with improved public order, including reductions in public injecting and discarded syringes
-Insite is associated with reduced syringe sharing. Data obtained before Insite opened showed that the reduction in syringe sharing only emerged after the opening of Insite. These are the first ever published findings to demonstrate an impact of a Supervised Injecting Facility on syringe sharing among Intravenous Drug Users.
-The opening of Insite did not lead to negative changes in community drug use patterns. Therefore, the recently reported benefits of Insite on HIV risk behaviour and on public order have not been offset by negative community impacts.
-Use of Insite and any contact with the facility's addictions counselor were both independently associated with more rapid entry into a detoxification program.
Jen also offers tips for effective letter writing, as well as who to write to.

Many thanks to Jen, a nursing student, for doing this work and posting this information.

Please take a few minutes to contact the people who can keep InSite open.


Update: I was later than I thought. Update from CBC News:
Federal Health Minister Tony Clement announced Friday his department wouldn't give another three-year exemption to Vancouver's safe-injection site for heroin addicts, adding that the site will remain open until a decision is made by the end of 2007.

Clement said in a statement that before a decision is made, additional studies will be conducted into how supervised injection sites affect crime prevention and treatment.

"Do safe injection sites contribute to lowering drug use and fighting addiction? Right now the only thing the research to date has proven conclusively is drug addicts need more help to get off drugs," Clement said.

"Given the need for more facts, I am unable to approve the current request to extend the Vancouver site for another three and a half years."
CBC story here, with some good background links. Thanks to Impudent Strumpet for bringing me up to speed.

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