Insight into Insite

One of the main values of YouthCO is Harm Reduction.

That’s why it was so great to see a new paper on Insite from former YouthCO board member, Brandon Marshall. (Full disclosure: Brandon is a friend and former colleague of mine).

As many of you probably know, Insite is a facility operated by Vancouver Coastal Health, where people can access clean injection equipment to use their own drugs, while being supervised by trained nurses who can intervene in an emergency such as a drug overdose.

Insite opened in Vancouver in 2003 in response to the high rates of drug use and high HIV prevalence in the Downtown Eastside. Associated with use of Insite, there has been decreased needle-sharing, and increased uptake of detoxification. Despite these documented benefits of Insite that have been published in top-tier journals like the Lancet and the New England Journal of Medicine, and despite two court rulings to keep it open, the Conservative federal government  has continually opposed the facility and is now appealing to the Supreme Court of Canada to close Insite.

Now there is new evidence that Insite has lowered drug overdose deaths in the area by 35%.

In the Marshall paper published in the Lancet, the authors compiled each overdose death from a registry of the BC Coroners Service. They then painstakingly charted every single accidental overdose death in Vancouver to the precise location where that death occurred (see the map from the article). The years they looked at were a five year period (January 1, 2001 to December 31, 2005) that included years before and after Insite opened on September 20, 2003.

There’s a plain language summary of the article available here.

The authors then used information from the SEOSI study to determine where most people lived who used Insite. They found that over 70% of people who regularly used Insite lived within a half-kilometre area around the facility (approximately 4 blocks in each direction). So, they set this as their area of interest, and looked if there was a difference in the rate of overdose deaths comparing the pre-Insite years to the post-Insite years in this area.

The approach the authors took for calculating the rate is able to account for both the time spent at risk for overdose death (number of years they lived in the area) and any population changes that might have occurred in the area.

They found a 35% decrease in the rate of overdose deaths after Insite opened.

The authors then checked to see if this decrease was simply an overall trend in Vancouver of fewer overdose deaths, rather than the influence of Insite. However, when they looked at the rest of Vancouver, there was a decrease in the rate, but it was only 9%. This indicates that the strongest decrease in overdose deaths occurred in the area immediately around Insite, and that this decrease could not be accounted for by an overall trend in Vancouver of fewer overdoses.

The authors also checked to see if this decrease in overdose deaths could be accounted for by there being more people on methadone therapy in the area near to Insite compared to the area further from Insite. If more people were taking methadone instead of heroin, that might be able to account for the drop in overdose deaths. However, again, this alternative explanation did not account for the change seen. There were very similar numbers of people on methadone maintenance therapy in the nearby Insite area compared to the rest of Vancouver (about 1 in 4 people who used heroin in the SEOSI study).

Every way they looked at it, the effect of lower overdose deaths could best be accounted for by how close people lived to Insite and not other factors. Closeness to Insite actually explained 58% of the variance in the reduction in fatal overdose death rates after the facility opened, with little to no effect seen once they looked ~1km away.

So with this clear association between how close someone is to a safe injection facility, and their lower risk for dying from a drug overdose, why aren’t we opening up MORE around Vancouver to keep up these life-saving results, instead of taking this medical facility to court to try to shut it down?

Insite saves lives.


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