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A primer on Vancouver's safe-injection sites

VANCOUVER — A look at Vancouver's safe-injection sites as Toronto considers the health benefits of integrating supervised injection into existing harm-reduction programs.

What exists right now?

There are two supervised injection sites in Vancouver.

Insite became North America's first legal clinic in 2003 and operates under Vancouver Coastal Health, which provides all funding and senior administrative and health-care workers.

The Dr. Peter AIDS Foundation has run a safe-injection program since 2002. The centre became the first health-care facility to integrate the service into its model of care after the B.C. College of Nurses clarified that supervised injection is within the scope of practice for nurses.

What's the history?

Insite was opened as part of a harm-reduction plan to tackle an epidemic of HIV-AIDS and drug overdose deaths in Vancouver.

The former Conservative government waged a long legal battle against the site, but the Supreme Court of Canada ruled the facility could stay open because it provided addicts with needed health care.

Who does it serve?

Insite has about 12,000 registered users, with more than one-third living in the city's Downtown Eastside neighbourhood. The clinic has been visited more than two million times, its website says.

The principle substances reported being used were heroin, cocaine and methamphetamine.

The Dr. Peter Centre has 350 patients in its day program, says its executive director, Maxine Davis.

What's the track record?

There have been no overdose deaths at Insite, despite more than 1,500 overdose interventions.

What does it cost?

Insite's operational budget for the 2013 fiscal year was $2,821,325.

What other programs has it spawned?

Health authorities in Vancouver and Victoria have begun discussions about providing supervised services in clinics that already help people with addictions, such as clean needle programs. Vancouver Coastal Health is now considering applying for a single exemption with the federal government to cover multiple sites.

What interest has it generated?

International delegations have visited Insite, including government officials from Colombia and Brazil in 2013.

Several cities across Canada, including Montreal, Toronto, Ottawa and Thunder Bay, Ont., have contacted the Dr. Peter Centre for its expertise.

Island Health recently started active discussions with Victoria city officials and police about offering the service in community sites.

Is there any relationship with the local crime rate?

An article by Julio Montaner and Thomas Kerr of the British Columbia Centre for Excellence in HIV/AIDS says peer-reviewed studies have shown Insite saves lives and health-care money, reduces disease transmission, and promotes entry into addiction treatment.

They say peer-reviewed studies done by researchers from Canada, Australia, Britain and the U.S. show Insite does not increase crime or perpetuate active drug use.

What's the position of the Vancouver police?

Officers have used media releases to warn local drug addicts to use Insite after overdose deaths in the community.

The department strives to balance the need for access to harm-reduction initiatives in public health care with ensuring disorder and violence is kept under control, says a 2006 drug policy document. It says harm-reduction practices must be fundamentally lawful.

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