Canada: Insite Drug-Injection Facility Awaits Fate Amid Controversy

Vancouver's supervised drug-injection facility Insite opened in 2003, and since then 30 peer-reviewed studies have found it helps reduce disease and overdose deaths. But its political future is far from secure.

"There's really no academic debate about Insite anymore," said Dr. Thomas Kerr, a researcher with the British Columbia Center for Excellence in HIV/AIDS.

By preventing new hepatitis C and HIV infections, Insite could save the Canadian health system $14 million (US $12 million) over 10 years, according to a 2008 Canadian Medical Association Journal study. Up to 1,517 HIV infections could be averted, according to the findings, which included a "decrease in needle sharing and reuse of syringes." A 2007 B.C. Center study observed a 30 percent increase in detox clients, and it noted that drug users accessing Insite were more likely to seek long-term treatment after it opened. A 2008 center study tracked 1,004 overdoses resulting in 453 medical treatments at Insite from March 2004 to July 2008; it concluded the program prevented 12 overdose deaths per year.

However, some studies bolstering Insite's efficacy have been shown by three review papers to be poorly designed, according to Dr. Don Hedges, a New Westminster addiction expert. The $3 million (US $2.6 million) spent on Insite, Hedgers said, "would pay for hundreds of people to attend detox and residential treatment, and would obviously prevent many more than one overdose death" -- the maximum benefit suggested by the critical reviews.

Despite support from the province, city, and public health officials, the federal government is appealing a lower court's ruling that Insite provides drug users a constitutionally protected service.

If the government's appeal is lost, Insite operator Portland Hotel Society plans to set up another supervised facility. If the appeal is successful, PHS plans to take the case to the Supreme Court of Canada and keep Insite open while the case is pending. Closing Insite "is immoral because we know in doing that, people will die. People don't need to die because they have an addiction to drugs," said Mark Townsend, PHS executive director.

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