InSite
Supervised Injection Site
Phone Number
view phone(604) 687 - 7483
Address
139 Hastings Street East Vancouver, British Columbia, Canada V6A 1N5URL
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Program Description
Since opening its doors in 2003, InSite has been a safe, health-focused place where people inject drugs and connect to health care services – from primary care to treat disease and infection, to addiction counselling and treatment, to housing and community supports.
InSite is the only legal supervised injection site in North America and is located in the Downtown Eastside (DTES) neighbourhood of Vancouver, British Columbia. The DTES had 4700 chronic drug users in 2000 and has been considered to be the centre of an "injection drug epidemic". The site provides a safe and health-focused location for injection drug use, primarily heroin, cocaine, and morphine.The clinic does not supply any drugs. Medical staff are present to provide addiction treatment, mental health assistance, and first aid in the event of an overdose or wound. In 2009, the site recorded 276,178 visits (an average of 702 visits per day) by 5,447 unique users; 484 overdoses occurred with no fatalities, due to intervention by medical staff.Health Canada has provided $500,000 per year to operate the site, and the BC Ministry of Health contributed $1,200,000 to renovate the site and cover operating costs. Insite also serves as a resource for those seeking to use a harm reduction approach for people who inject drugs around the world. In recent years, delegations from a number of countries are on record touring the facility, including Colombia and Brazil
The BC Ministry of Health Services provides operational funding for Insite through Vancouver Coastal Health, which operates the facility in conjunction with PHS Community Services Society.
Insite operates on a harm-reduction model, which means it strives to decrease the adverse health, social and economic consequences of drug use without requiring abstinence from drug use.
Clients are supported by a team of nurses, counsellors and support staff
Vancouver Coastal Health and PHS Community Services Society work together to provide a comprehensive support network at InSite, including a front line team of nurses, counsellors, mental health workers and peer support workers.
InSite has 12 injection booths where clients inject pre-obtained illicit drugs under the supervision of nurses and health care staff.
InSite also supplies clean injection equipment such as syringes, cookers, filters, water and tourniquets. If an overdose occurs, the team, led by a nurse, are available to intervene immediately.
Nurses also provide other health care services, like wound care and immunizations. Although there have been 1418 overdoses at InSite between 2004 and 2010, staff were able to successfully intervene each time. There has never been a fatality at InSite since opening. In fact, research shows that since InSite opened, overdoses in the vicinity of the site have decreased by 35% - compared to a 9% decrease in the city overall.
InSite also has addictions counselors, mental health workers, and peer staff who connect clients to community resources such as housing, addictions treatment, and other supportive services.
InSite was not designed to be a stand-alone facility. It's part of a continuum of care for people with addiction, mental illness and HIV/AIDS. It was designed to be accessible to injection drug users who are not well connected to health care services. Partnering with PHS Community Services Society enabled Vancouver Coastal Health to bring health services to the Downtown East Side community in a way that was more accessible and pertinent.
For people with chronic drug addiction, InSite is the first rung on the ladder from chronic drug addiction to possible recovery; from being ill to becoming well.
InSite and Onsite, services that exist together InSite and Onsite are wrap-around programs that exist one above the other in the same Hastings Street location.
When clients, usually InSite users, are ready to access withdrawal management, they can be immediately accommodated at Onsite. On the second floor of OnSite people have access to 12 rooms with private bathrooms where they can detox. Mental health workers, counselors, nurses and doctors work together to help people stabilize and plan their next steps. People can then move up to the 3rd floor transitional recovery housing for further stabilization and connection to community support, treatment programs and housing.
An overview of Insite - 10 years later
Over the last 10 years InSite has been focused on creating a safe environment by operating on the harm-reduction model. This model works to decrease adverse health, social and economic consequences of drug use without requiring abstinence from drug use.
In a submission that was published in the Vancouver Sun, doctors Julio Montaner and Thomas Kerr of the BC Centre for Excellence in HIV/AIDS summarized the successful history of North America's first supervised injection site with legal standing.
By Thomas Kerr and Julio Montaner - Vancouver Sun
It has been nearly 10 years since Insite, Vancouver's supervised injection site opened and two years since the Supreme Court of Canada unanimously determined that it should remain open to protect public health.
A large body of scientific evidence demonstrates that Insite and other harm reduction programs, such as needle exchanges, are effective in reducing the harms associated with illicit drug use. Sadly, ideological debate about harm reduction continues, despite widespread agreement among health authorities, including the World Health Organization, that such programs are essential to the fight against HIV/AIDS and other drug-related harms.
A recently released report summarizing 15 years of data on the drug situation in Vancouver provides further evidence that harm reduction programs have helped reduce illicit drug use and improve public health: fewer people are injecting drugs; more are accessing addiction treatment; and HIV transmission related to injection drug use has plummeted.
Likewise, a large body of scientific evidence shows that Insite is meeting its objectives. Peer-reviewed studies involving dozens of researchers from Canada, Australia, Britain and the U.S. demonstrate clearly that Insite does not increase crime or perpetuate active drug use. More than 30 peer-reviewed studies show that Insite saves lives and health care dollars, reduces disease transmission, and promotes entry into addiction treatment.
The program now has the support of leading national health organizations such as the Canadian Medical Association, the Canadian Association of Nurses, and the Canadian Public Health Association. Health organizations in other parts of Canada are now advocating for similar programs in their jurisdictions.
Still, critics continue to launch personal attacks against scientists, misrepresent existing research, and cite bogus reports that have never been subjected to scientific scrutiny or published in recognized journals, reducing public discourse about harm reduction to the same level as past debates about global warming and the harm of cigarette smoking.
The most vocal of those arguing against Insite is the Drug Prevention Network of Canada (DPNC). This is an organization that covertly accepted RCMP funding to produce pseudo-scientific reports on Insite. Ultimately the RCMP acknowledged their wrongdoing and distanced themselves from the reports, admitting the reports were commissioned to "provide an alternative analysis" to existing research and "did not meet conventional academic standards." Ironically, when a Supreme Court justice asked lawyers representing the federal government if they had any scientific evidence indicating that Insite was not meeting its objectives, they did not offer one of the DPNC reports - they offered nothing.
David Berner and the DPNC continue to get the facts all wrong. Anyone who has spent any time in Vancouver's Downtown Eastside knows that Insite was opened and continues to be operated by the Portland Hotel Society and Vancouver Coastal Health. It was not created or ever operated by the B.C. Centre for Excellence in HIV/AIDS. Rather, our centre was contracted, through an open and competitive process, to conduct an arm's-length scientific evaluation of Insite.
Recently, the DPNC has repeated claims that drug overdose deaths in Vancouver's Downtown Eastside have increased since the facility opened. This is not only false, but in citing data from the B.C. Vital Statistics agency, they continue to recklessly lump all drug-related deaths together, including many causes of death that bear no relevance to Insite.
The claim stands in stark contrast to a 2011 study published in the prestigious medical journal, The Lancet, which showed overdose deaths around Insite had declined by 35 per cent. The Lancet study systematically reviewed each recorded death and involved the use of appropriate statistical methods. Dr. Chris Beyrer, a professor at Johns Hopkins School of Public Health who was invited by The Lancet to write a commentary to accompany the article, stated:
"Supervised injection facilities clearly have an important part to play in communities affected by injection drug use. They should be expanded to other affected sites ... on the basis of the life-saving effects."
Harm reduction programs should remain essential components of our response to illicit drug use. Still, we must do more to further reduce drugrelated harm.
In doing so we must recognize that we have an ethical duty to base our responses to drug-related harm on the best available evidence.
By now, that evidence should be resoundingly clear: Harm reduction - including Insite - saves lives.
Dr. Thomas Kerr is the is the co-director of the Urban Health Research Initiative at the British Columbia Centre for Excellence in HIV/AIDS and associate professor in the Department of Medicine at the University of British Columbia. Dr. Julio Montaner is the director of the British Columbia Centre for Excellence in HIV/AIDS, the chair in AIDS Research and head of division of AIDS in the Faculty of Medicine, University of British Columbia, and the past-president of the International AIDS Society.