Supervised injection site not discouraging those wishing to stop injecting

published on January 30, 2006

(Vancouver) – The benefits of Vancouver’s pilot supervised injection site have not been offset by negative impacts on drug use in the community, reveals a new study authored by the B.C. Centre for Excellence in HIV/AIDS.

The new study, published in the current issue of the British Medical Journal, showed that the supervised injection site is not increasing rates of relapse among former drug users, nor is it a negative influence on those seeking to stop drug use.

In total, 871 injection drug users (IDUs) enrolled in the Vancouver Injecting Drug Users Study were surveyed. Individual changes in drug use before and after the opening of the facility, officially known as Insite, were examined. “Relapse” was defined as a change from reported non-injection to reported injecting in follow-up interviews with IDUs. “Stopping” was defined as a change from reported injecting to reported non-injection.

Results of the two-year evaluation reveal no substantial differences in the rate of relapse into injected drug use or the rate of stopping injected drug use, says Dr. Thomas Kerr, one of the study’s authors.

“The study indicates that Insite was not associated with measurable negative changes in the use of injected drugs,” says Kerr. “Interestingly, we found a substantial reduction in binge drug use, suggesting Insite is not leading to higher frequency drug use.”

Similar supervised injection sites have been established in Europe and Australia. However, there has been a lack of formal evaluations to date. The study findings directly counter assertions that such facilities may encourage drug use by increasing rates of relapse among former injecting drug users, and, by facilitating drug use, discourage current users from seeking treatment.

Additional findings in another recent Centre study reveal Insite is reducing rates of syringe lending by HIV-positive drug users and syringe borrowing by HIV-negative drug users. The recent findings underline the supervised injection site’s impact on reducing HIV risk in the Downtown Eastside.

The study, published in the current issue of the American Journal of Infectious Diseases, surveyed 594 users of the facility. Only 16% of HIV-positive IDUs reported having lent a used needle in the past six months, while 10% of HIV-negative IDUs said they borrowed a used syringe during the same time period. Importantly, no instances of syringe lending or borrowing were observed among individuals who reported performing all of their injections within Insite in the month previous to initial interview. Regular use of Insite was associated with reduced syringe sharing.

The needle-sharing rates for Insite users are markedly lower than those of the general IDU population, says Kerr. A previous Centre study, published before the opening of Insite, revealed 28% of IDUs reported either lending or borrowing used needles during a six-month time period.

“Although syringe sharing outside of Insite continues for a minority of the facility’s users, the rates are substantially lower, especially among regular Insite clients” says Kerr. “The fact that Insite’s HIV-infected drug users are not sharing used needles means the facility may be playing a key role in breaking the cycle of HIV transmission in the Downtown Eastside.”

The findings, along with previous Insite-related studies, show the facility is attracting its intended target population and meeting its objectives, says Dr. David Marsh, Physician Leader, Addiction Medicine, Vancouver Coastal Health.

“Insite is improving public order, reducing risks associated with the transmission of infectious disease and providing a means for marginalized individuals to access the health-care system, including addiction treatment," says Marsh.

Syringe sharing by HIV-negative subjects was strongly linked to reports of public drug use and requiring help shooting up. Those HIV-positive individuals who reported having lent needles were likely to be daily cocaine injectors and shooting-gallery users.

Potential obstacles to accessing Insite should be strongly considered, the study recommends. Reducing wait times, extending operating hours and performing outreach into shooting galleries may all be helpful in addressing these concerns, the study suggests.

The recent findings follow several similarly positive studies published in leading medical journals over the past two years.

Insite is the first government-sanctioned facility of its kind in North America. The facility was opened by Vancouver Coastal Health (VCH) in partnership with the Portland Hotel Society. The B.C. Centre for Excellence in HIV/AIDS was contracted to conduct an arms-length evaluation of the impact of Insite on public order and public health. The Centre project, formally known as the Scientific Evaluation of Supervised Injecting (SEOSI), will evaluate changes in HIV risk behaviour, overdose rates, addiction treatment and public injecting over the duration of the pilot project.

Past Insite-related studies have revealed:

Insite has reduced the number of people injecting in public and the amount of injection-related litter in the Downtown Eastside, both notable improvements for people who live and work in the neighbourhood. (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)
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 IDUs on the streets were more than twice as likely to have received safer injecting education at Insite (The International Journal of Drug Policy).

BC Centre for Excellence in HIV/AIDS

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Supervised injection site not discouraging those wishing to stop injecting

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