Safe Injection Sites Are Controversial But They're Good Policy
Opinion by Maggie Smith.
The following article contains a discussion of drug use. This may be considered disturbing or difficult by some readers. We recommend that readers prepare themselves before continuing.
Addiction is a disease. When someone suffers from an illness, a critical part of the road to recovery includes management of the condition. Safe injection sites (SIS) are one of the tools that help manage addiction and ensure the safety of users [1]. Despite being a widely contested initiative, as of 2018, there are over 100 SIS operating around the world [2]. Some worry that SIS encourage drug use and enable harmful drug activity. A popular criticism is that the government should not be facilitating drug use with taxpayer dollars. However, by examining the statistics, we can see that the positives outweigh the negatives and that safe injection sites are crucial to fighting drug addiction and Canada's opioid crisis.
"SIS alone prevented an estimated 230 deaths [6]. Insite reports a total of 6,440 "overdose interventions" since 2003, with no recorded deaths [7]."
SIS function as "safe spaces" in which individuals with prior histories of intravenous drug abuse can be monitored by medical professionals. Drugs are not provided by the site; rather, individuals bring their own for supervised use [3]. Safe injection sites are newer than the epidemic that is widespread drug use. The first Canadian SIS was introduced and run by Insite in 2003 in British Columbia. This site continues to operate in the Vancouver area. In early 2016, intravenous drug use and subsequent overdoses, particularly the abuse of opioids, were deemed a Public Health Emergency in B.C., and multiple methods of overdose intervention were introduced on a larger level in response to the emergency [4]. These methods of intervention include naloxone kits and SIS. Injection sites in Canada must be approved by the federal government and are usually run by a combination of healthcare workers and volunteers [5].
A study from the Society for the Study of Addiction found that such initiatives prevented approximately 3,030 opioid-related deaths between April 2016 (when the Public Health Emergency was first declared) and December 2017. SIS alone prevented an estimated 230 deaths [6]. Insite reports a total of 6,440 "overdose interventions" since 2003, with no recorded deaths [7].
A single SIS costs approximately $4.1 million a year to operate [8]. In contrast, in 2017, opioid-related healthcare costs totaled $438.6 million in Canada [9]. Indeed, the cost of operating Safe Injection Sites in Canada is inexpensive compared to the total average cost of opioid-related healthcare [10].
A study published in the Canadian Medical Association Journal found that the net cost of SIS (specifically the Vancouver Insite location) was negative, meaning that SIS actually save money. The study also examined the costs associated with needle sharing, which they found decrease with the implementation of SIS. For example, an estimated cost of $20,100 per case for HIV infection and $444,500 for hepatitis C infection were averted through the prevention of needle sharing. The total costs saved due to SIS—through decreased needle sharing, increased referral to methadone clinics and the promotion of other safer practices connected to drug use—were estimated to be $18 329 800 over the course of 10 years [11]. Currently, there are only 37 Sites offering services [12], but investing in expanding this service will actually take some of the strain off Canada's healthcare system, ultimately saving taxpayer dollars.
Clearly, SIS are essential to combatting Canada's opioid crisis. They save lives by greatly reducing the number of drug overdoses. They also reduce the strain on the healthcare system, both financially and by preventing the need for medical care due to drug overdose. Finally, they provide invaluable services to vulnerable populations, through access and connection to detox programs, information on safer drug practice and access to other relevant services, such as mental health services. Carefully regulated, SIS are a fantastic method of providing support to vulnerable communities and are crucial in the battle against Canada’s drug abuse crisis.
Canadian Centre for Addictions, “What are safe injection sites, and do they work?” August 26, 2020, https://canadiancentreforaddictions.org/safe-injection-sites/.
Gordon, Elana, “What's the evidence that supervised drug injection sites save lives?” September 7, 2018, https://www.npr.org/sections/health-shots/2018/09/07/645609248/whats-the-evidence-that-supervised-drug-injection-sites-save-lives
Government of Canada, “Supervised Consumption Sites and Services: Explained,” July 28, 2020. https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/explained.html
Vancouver Coastal Health, “Supervised consumption sites,” 2020, http://www.vch.ca/public-health/harm-reduction/supervised-consumption-sites
Government of Canada, January 13, 2021, https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/status-application.html
Michael A. Irvine, Margot Kuo, Jane A. Buxton, Robert Balshaw, Michael Otterstatter, Laura Macdougall, M‐J. Milloy, Aamir Bharmal, Bonnie Henry, Mark Tyndall, Daniel Coombs, Mark Gilbert, “Modelling the combined impact of interventions in averting deaths during a synthetic‐opioid overdose epidemic,” Society for the Study of Addiction 114, no. 9 (2019): https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14664
Vancouver Coastal Health, “Supervised Consumption Site.”
Canadian Government Executive, “A Shot in the Arm for Supervised Injection Site Proponents,” 2010, http://canadiangovernmentexecutive.ca/wp-content/uploads/2016/07/CGE22_4_dashboard.pdf
Canadian Centre for Addictions, “What are safe injection sites and do they work?”
Government of Canada.
Ahmed M. Bayoumi and Gregory S. Zaric, “The Cost-Effectiveness of Vancouver's Supervised Injection Facility,” Canadian Medical Association Journal 179, no. 11 (2008): 1143-1151.
Government of Canada, 2020.