UBC Reports | Vol. 49 | No. 1 | Jan. 2, 2003

Vancouver Ready for Safe Injection Sites, Say UBC Experts

Research indicates lives and money will be saved

By Hilary Thomson

There are few issues in Vancouver more controversial than the creation of safe injection sites for the addicts in the city’s Downtown Eastside. In a recent municipal election, this issue played a major role in the upset of an entire slate of city councillors.

Medical experts at UBC have not hesitated to wade into the debate.

Dr. Michael O’Shaughnessy, director of the B.C. Centre for Excellence in HIV/AIDS, says safe injection sites would improve what many health-care professionals are calling a public health crisis.

“These sites are not a perfect solution, nor will all addicts use them,” he says. “But it is clear that if there is a group of individuals who regularly use the safe site, the number of overdoses will decline.”

There are about 125,000 intravenous drug users in Canada according to the Canadian HIV/AIDS Legal Network. The network has cited a 1998 study that estimated the direct and indirect costs of HIV and AIDS attributed to intravenous drug use in Canada would mount to $8.7 billion by 2004 if current trends continue.

Also, intravenous drug users incur costs for doctor visits, emergency services, hospital admissions and medications to treat bacterial infections and other illnesses. In addition, there are policing and legal costs to enforce drug laws.

Health Canada is currently accepting proposals from cities interested in establishing safe injection sites and a federally approved site could be established sometime this year. It is not yet known how sites will be funded. The cost of establishing and monitoring a single facility in its first year could cost between $500,000 and $800,000, according to network officials.

With more than 2,000 overdose deaths since 1992, Vancouver’s Downtown Eastside has the country’s most visible drug addiction problem, says O’Shaughnessy. In addition, approximately 30 per cent of addicts are HIV positive and more than 90 per cent have hepatitis C virus.

Researchers and health-care practitioners in Vancouver have led the academic debate in Canada on the topic of safe injection sites, he says, and opinions are divided about the value of such sites.

Often confused with shooting galleries -- areas run by drug dealers where addicts can inject -- safe injection sites are health facilities. There, people who have purchased the drug can inject safely, using clean needles and equipment under the supervision of trained staff. Users have access to medical and social support services at the facility and can be referred to detox centres and drug treatment programs.

O’Shaughnessy is confident that users would participate in the sites, based on results from the Vancouver Injection Drug User study conducted by local researchers in 2001. Users were specifically asked if they would use such a site and the majority indicated they would. In addition, users stated that they continued to share needles despite the availability of a large needle exchange program.

“We have learned what not having a site leads to,” says O’Shaughnessy. “It is time for us to approach this epidemic with a view to reducing the incidence of overdoses and disease.”

In addition to health benefits, approximately 45 sites in a dozen cities in Europe and Australia are credited with limiting violence associated with drug use, reducing the public nuisance of people injecting on the street and the health risk of needles discarded in public places.

A key benefit of safe injection sites is the opportunity to establish relationships with addicted individuals to help them stabilize their lives, says Edward Kruk, associate professor of Social Work and an expert in addiction counselling.

In Europe, social workers staff the sites along with users or former users who serve as peer counsellors. Users can determine their own goals that may or may not include abstinence but might include finding housing and meaningful employment, seeing a doctor, improving nutrition, and obtaining social supports.

Kruk counters the argument that money for sites could be better spent on treatment facilities by pointing out that traditional treatment methods don’t work that well. In Frankfurt, Germany, the rate of recovery for those using safe injection sites is more than four times higher than for North Americans using traditional treatment therapies, he reports.

“We need to examine the whole issue of addiction treatment from the perspective of drug users and former users,” he says. “There’s been a huge shift in public and political sentiment here over the last three years and I think Vancouver is ready for safe injection sites.”