The Personal and Financial costs of INSITE in Vancouver, Canada

I have read with interest the article in “The Province” Newspaper from British Columbia dated February 16th, 2009 entitled “Huge Price Tag Leads to Call for Audit, and then the articles in the Ottawa Citizen recommended an injection site in Ottawa of Intravenous Drug users.
The newspaper investigated the cost of funding the “Downtown Eastside” in Vancouver dealing with providing housing and support for the residents. This is the first time such an investigation takes place and the result are staggering given the cost was approximately $360 million dollars per year. The article mentions that is cost approximately $ 1 million dollars a day with most of that for the roughly 5,000 disabled people in the community.
It further states that this spending continues to go unabated, with no one in control of the purse strings as conditions continue to deteriorate at street level.
Given these staggering statistics, I believe it would be a good time for the city of Ottawa to do a cost study of their homeless and addicted population to ascertain the cost before going forth with any other programs especially the recommendation for an injection site for intravenous drug users. It would be best practice to evaluate the pilot project in Vancouver when one reads Dr. Raymond R. Corrado’s and Dr. Irwin Cohen “Analysis of the Research Literature on INSITE: Vancouver’s Injection Site Summary”, and the Health Canada report on Vancouver’s Insite.
The stated Insite objectives were:
– Increasing access to health and addiction care;
– Reducting overdose fatalities;
– Reducing the transmission of blood borne viral infections like HIV and hepatitis C;
– Reducing other injection related infections such as skin abscesses; and
– Improving public order.
My question is, have they met their stated objective and if not should we not reconsider it’s effectiveness.
Dr. Carrado states:
“The pilot of a supervised injection site in Vancouver Downtown Eastside was established as a response to high rates of blood born disease (Hepatitis B, Hepatitis C and HIV/AIDS) and a large number of overdoses among intravenous drug users population”
Here are some of their findings:
Blood-borne diseases::
“Dr. Corrado states that there was a “GOOD LIKELIHOOD” that there was a reduction in the spread of blood-borne diseases since several of Insite clients stopped sharing syringes. However, he also underlines that due to the lack of direct measures of blood-borne diseases, it’s not possible to estimate the extent of the reduction.”
In the final report of Health Canada, the Expert Advisory Committees on Vancouver’s INSITE and other Supervised Injections Sites: What has been learned from research from Health Canada states:
Page 11
“There is no direct evidence that SIS’s reduce the spread of HIV infection, and the mathematical models used are based on assumption that may not be valid.
Baseline rates of needle sharing have not been reported for SIS users.
Self-reports of changes in needle sharing beyond the walls of SISs have been validated.
More objective evidence of sustained changes in risk behaviors and a comparison or control group study would be needed to confidently state that SISs have a significant impact on these behaviors.”
Dr. Carraro then states:
” Insite did achieve its objective of reducing the number of fatal drug overdoses. In fact, drug overdoses were minimized and deaths were avoided.”
The Health Canada report states:
Page 11
“There is no direct evidence that SIS influence overdose death rates and large scale and long term, case-controlled studies would be needed to show that SISs influence overdose death rates among those who use INSITE. Mathematical modeling is based on assumptions that may not be valid.”
The overdose rates increased in Vancouver since the Injection site opened it’s doors.
Dr. Irwin Cohen states in his report:
“Several limitations exist within the research and evaluation on supervised injection sites. There are methodological problems regarding outcome measures, as well as an overall lack of research rendering it difficult to compare supervised injection sites to other types of interventions ( i.e.: needle exchange programs and methadone treatment programs). Furthermore, the limitations also result in restricting comparisons of research findings form one study to another.
Health Canada study states the following with regards to limitations of research in the Cost-Effectiveness and Cost Benefit section on page 13 of report.
” While some longitudinal studies have been conducted, the results have yet to be published and may never be published given the overlapping design of the cohorts. Until these studies have been undertaken it will not be possible to show with any certainty that INSITE is cost-effective or to show that the economic benefits exceed the costs.
Mathematical models used to estimate benefit-cost ratios use estimates of the frequency of needle
sharing involving HIV positive and HIV negative injection drug users and estimates of HIV transmission rates have not been locally validated.
Mathematical models used to estimate benefit-cost ratios with respect to lives saves have incorporated an assumption about the economic value of the lives of injection drug users that has not been validated.”
In summary, on page 3 of the Health Canada report, Insite accounts for less than 5% of injections at the site. Many people have been referred to health and addiction care but have not been followed up to see how many have actually gone or how many have successfully recovered from their addiction? The report on page 11 states that Insite saves about one life a year as a result of intervening in overdose events, but overdose rates have increased in Vancouver. I’ve addressed the HIV/HepC results. In the area of Public order what they fail to mention is that the police presence was increased which could explain why there was no increase in crime and loitering. I do not feel that Insite has accomplished it’s stated objectives.
Given the above direct quotes from the Insite report and others, Ottawa should investigate if the site has met these objectives and if not then question the validity of the pilot project and should question whether it should follow suite based on these findings. The fact that it is costing $360 million dollars per year to manage the poorest postal code region in Canada without any improvement in the lifestyle of its residents should be audited and whatever change is required should be implemented without delay. The price tag speaks for itself.
Will Ottawa be next with these statistics given we are modeling Vancouver’s Downtown Eastside philosophy based on Harm Reduction as best practices.
Andre Bigras,
Drug Prevention Network of Canada.

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