Canadian Drug Facility Cut Overdose Deaths: Study

Since the opening of Vancouver's supervised injection facility (SIF), overdose deaths in the immediate neighborhood have dropped 35 percent, a new study shows. However, North America's only authorized SIF, Insite, remains controversial. Next month, Canada's Supreme Court is scheduled to hear the federal government's appeal to shut it down.

High rates of overdose deaths among injection drug users in the 1990s prompted Insite's creation in Downtown Eastside, a neighborhood known for its HIV epidemic, open drug-selling and use, drug-related disorder, homelessness, and low-cost housing. Insite began as a pilot project to reduce overdose deaths, while also aiming to reduce public injection drug use and IDU-related infectious disease transmission, and to improve primary care and addiction treatment access.

At Insite, staff members give clients sterile syringes to inject themselves with pre-obtained illegal drugs under a nurse's supervision. To date, no deaths have occurred at Insite, the study relates. After injecting themselves, clients are allowed to stay in a "chill-out" room before leaving. Insite is modeled on European SIFs. More than 65 SIFs are known to exist worldwide.

The fatal overdose rate within 500 meters of Insite's location dropped after its establishment, from 253.8 deaths to 165.1 deaths per 100,000 person-years (p=0.048). "By contrast, during the same period, the fatal overdose rate in the rest of the city decreased only 9.3 percent, from 7.6 to 6.9 deaths per 100,000 person-years (p=0.049)," noted Thomas Kerr and his colleagues from the British Columbia Center for Excellence in HIV/AIDS.

SIFs "clearly have an important part to play in communities affected by injection drug use," Dr. Chris Beyrer, of John Hopkins Bloomberg School of Public Health, wrote in an accompanying commentary.

The full report and commentary, "Reduction in Overdose Mortality After the Opening of North America's First Medically Supervised Safer Injection Facility: A Retrospective Population-Based Study" and "Safe Injection Facilities Save Lives," were published online ahead of the print edition of Lancet (2011;doi:10.1016/S0140-6736(10)62353-7 and doi:10.1016/S0140-6736(11)60132-3).

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