The number of drug-overdose deaths on Vancouver’s notorious downtown Eastside fell sharply after the opening of a safe injection site, new research shows.
The study, published online Monday in the medical journal The Lancet, shows that fatal overdoses dropped 35 per cent in the vicinity of Insite in the two years after it opened. By comparison, OD deaths dropped only 9 per cent in the rest of Vancouver in that same period.
“No one has ever been able to demonstrate a substantial reduction in overdose deaths due to the presence of a safe injection site, but we have done so,” Thomas Kerr of the Urban Health Research Initiative at St. Paul’s Hospital in Vancouver said in an interview.
Until now, research has shown that Insite reduces behaviours that lead to deadly infections like HIV and hepatitis C, and it reduces public disorder by getting intravenous drug use off the streets.
But the federal government has argued that the evidence of benefit is unclear and tried to shut down Insite.
This has lead to a protracted legal battle – one that has become an important jurisdictional struggle between the provincial and federal governments. Both the B.C. Liberals and New Democrats support Insite and the program has the strong backing of the provincial health officer.
In January of 2010, the B.C. Court of Appeal decided 2-1 that the province has jurisdiction over the facility since it provides IV drug users with a health-care service, which is within provincial jurisdiction.
Its ruling upheld a 2008 trial decision by the B.C. Supreme Court, which found that the application of the federal drug law would violate IV drug users’ Charter rights to life, liberty and security of the person.
The case will be heard in the Supreme Court of Canada on May 12.
“The Conservatives can no longer go around saying the evidence is unclear because the evidence is clear – Insite saves lives,” Dr. Kerr said.
The new study, which examined coroners’ reports, shows that between 2001 and 2005, there were 290 overdose deaths in Vancouver.
Eighty-nine of those deaths occurred within a 500-metre radius of Insite, which is located in the heart of Vancouver’s skid row.
The safe-injection facility opened on Sept. 20, 2003, when the Liberal government was in power. Nurses can supervise IV drug users because the facility was specifically exempted from federal drug possession and trafficking laws. The Conservatives oppose this approach, saying it flies in the face of their anti-drug strategy.
In the two years prior to the opening, there were 56 OD deaths in the neighbourhood; in the two years subsequent, there were 33.
There have been more than 2,000 overdoses at the facility but not a single death. Insite provides booths, along with clean syringes, where intravenous users can inject. Nurses can also revive users who OD – which happens frequently because the purity of street drugs is unpredictable.
The authors argue that having overdoses occur in a controlled setting is much more cost-effective because it takes pressure off the health system.
“The nurse saved my life when I ODed,” said Gary Kyle, who has been an IV drug user on-and-off since 1977. By contrast, he once overdosed on the street, which required the intervention of paramedics, a visit to emergency and hospitalization.
“I’ve shot up in an alley, in the McDonald’s bathroom, the library, you name it. When I do it in public, I’m rushed and careless. At Insite, it’s safer,” Mr. Kyle said.
Conservative Senator Pierre Claude Nolin, a long-time supporter of Insite, said he was reluctant to speak during a federal election campaign, but the new evidence is clear.
“Public health programs like this need to be evidence-based, not politically driven,” he said. “And the new evidence proves that it works, that Insite reduces overdoses,” he said.
An earlier study, by the same group of researchers, found that there were more than 900 overdose deaths in British Columbia between 2001 and 2005, and that aboriginal people were disproportionately at risk. About 12 per cent of the OD deaths involved first nations people, who make up less than 4 per cent of the province’s population.