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Public Health in Action

Public Health in Action. Safe Injection Sites. Introduction. A safe injection site is a legally sanctioned and supervised facility which is designed to reduce the health risk associated with taking illegal drugs intravenously (i.e. heroin).

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Public Health in Action

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  1. Public Health in Action Safe Injection Sites

  2. Introduction • A safe injection site is a legally sanctioned and supervised facility which is designed to reduce the health risk associated with taking illegal drugs intravenously (i.e. heroin). • They are also thought to reduce the public disturbance associated with these types of drugs and the drug litter.

  3. Where are they located? • There are very few in existence. • The majority are in Europe. • The European safe injection sites are merely drug consumption rooms, which means it is a place to legally shoot up and safely dispose of needles. • There are no health care people associated with these places.

  4. Any in the Commonwealth? • There are no safe injection sites in the United States. • There is one in Sydney, Australia. • There is one in Vancouver, Canada. • These sites are staffed by medical personnel. • They have safety equipment in case of overdose.

  5. Insite • Insite is Canada’s first and only safe injection site in North America! • It is in the downtown eastside (DTES) neighbourhood of Vancouver, which in 2000, had approximately 4700 drug addicts! • The B.C. provincial government says DTES is the “center of a drug injection epidemic in Vancouver.”

  6. Insite • The site provides a clean, safe location for injection drug use, primarily heroin, cocaine, and morphine. • Medical staff are present to provide addiction treatment, mental health assistance, and first aid in the event of an overdose or wound.

  7. Insite Stats • From January 1 to December 31, 2010, there were: • 312,214 visits to the site by 12,236 unique individuals • An average of 855 visits daily, up to a maximum of 1,110 visits daily • An average of 587 injections daily • 221 overdose interventions with no fatalities • 3,383 clinical treatment interventions • 26% of participants were women • 17% of participants identified as Aboriginal • Principle substances reported were heroin (36% of instances), cocaine (32%) and morphine (12%) • 5,268 referrals to other social and health services, the vast majority of them were for detox and addiction treatment • 458 admissions to OnSite detox

  8. Insite • 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.

  9. Insite • Insite was initially run as a three year pilot project from 2003-2006, however the provincial government extended its use to 2008. • In 2008, Health Minister, Tony Clement, wanted it shut down, but the BC Supreme Court ruled that laws prohibiting possession and trafficking of drugs were unconstitutional because they denied drug users access to Insite's health services, so Insite is still open today under a constitutional exemption to the Controlled Drugs and Substances Act. • Recently the Supreme Court of Canada upheld this decision (September 29th 2011) after lawyers in BC started to make a stink about it.

  10. Insite Supporters and Detractors Supporters Detractors • The current mayor and former mayor of Vancouver • The Premier of B.C. • The Vancouver Police Department • International AIDS society and the BC Centre for Excellence in HIV/AIDS • Chinatown and Gastown merchants • Australian Parliamentary Group for Drug Law Reform • Senlis Council from the U.K. • Bush Administration (called it “state-run suicide”) • The Canadian Police Association • The RCMP • The federal conservative government under Stephen Harper

  11. Insite Benefits • Insite is leading to increased uptake into detoxification programs and addiction treatment. (New England Journal of Medicine) • Insite has not led to an increase in drug-related crime, rates of arrest for drug trafficking, assaults and robbery were similar after the facility’s opening, and rates of vehicle break-ins/theft declined significantly. (Substance Abuse Treatment, Prevention, and Policy) • Insite has reduced the number of people injecting in public and the amount of injection-related litter in the downtown eastside. (Canadian Medical Association Journal) • Insite is attracting the highest-risk users – those more likely to be vulnerable to HIV infection and overdose, and who were contributing to problems of public drug use and unsafe syringe disposal. (American Journal of Preventive Medicine)

  12. Insite Benefits • Insite has reduced overall rates of needle sharing in the community, and among those who used the supervised injection site for some, most or all of their injections, 70% were less likely to report syringe sharing. (The Lancet) • Nearly one-third of Insite users received information relating to safer injecting practices. Those who received help injecting from fellow injection drug users on the streets were more than twice as likely to have received safer injecting education at Insite. (The International Journal of Drug Policy) • Insite is not increasing rates of relapse among former drug users, nor is it a negative influence on those seeking to stop drug use. (British Medical Journal) • Insite is preventing overdose deaths and reducing hospital visits (The International Journal of Drug Policy)

  13. Insite Negatives • Money goes away from where it can otherwise be used and is put into housing drug addicts. • It supports the habits of drug users and makes it easier for them to administer the drugs without fear of reprisal from the police. • May cause drug users to immigrate to that city/neighbourhood which people think will affect safety as well as lower property values.

  14. Future Injection Sites in Canada? • Currently, Montreal, Ottawa and Toronto are investigating whether a safe injection site in some of their neighbourhoods with heavy drug use and crime would benefit the city. • The Ontario government wants to put three in Toronto and two in Ottawa.

  15. Future Injection Sites in Canada? • Montrealers put up such an outrage at an SIS in the downtown core that the provincial government decided that if one is needed it would go in an already existing health facility.

  16. Homework • What is a safe injection site? • What is the difference between the safe injection sites in Europe compared to those in Australia and Canada? • Do you believe that safe injection sites are a good idea? Why or why not?

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