New Insite: The Benefits of Safe Injection Sites

Mohamed Sarraj

Imagine you are a child walking home from school in a cluttered downtown core. You trip in a heap of garbage and turn to realize there’s more to it. A woman who looks to be around 30 years old is buried beneath the trash. She is riddled with needle tracks; her body has just expunged all waste to try to flush out the toxins that have left an expression of terror frozen on her face. She’d died alone, stripped of her humanity, left to rot in the sun by the trash. But she isn’t trash. She is somebody’s daughter, somebody’s sister, somebody’s mother. She does not deserve that. 

In many areas, the sight of such extremely disadvantaged people is as common as it is wrong. The problem exists, but what can be done about it? 

Safe injection sites give intravenous drug users a supervised and legal environment to inject. Safe needles are provided, medical attention is at hand, and detoxification and rehab facilities are usually in the same building. Vancouver’s safe injection site, Insite, is an answer to the East Side’s drug pandemic. Needles were strewn over the streets, alleyways were a sure place to find a dead body, and public injection was rife. Proponents of safe injection sites in Vancouver and elsewhere have argued that they directly save lives, reduce addiction, and improve public order.

It is important to note that safe injection sites cater to the disadvantaged who would otherwise be injecting on the streets. Infectious diseases arising from needle sharing—such as HIV or hepatitis—are a fatal pronouncement for these people who would often rather die than approach the medical system. But the prevention of infectious disease in safe injection sites also saves the wider public from these diseases, which will inevitably spread. In fact, a study in the Canadian Medical Association journal showed that Insite could save the healthcare system $20 million and significantly increase life span in the next ten years by stemming the spread of infectious disease.

Infectious disease is not the only concern. Drug overdose kills, and kills frequently. It begins with slow respiratory failure that renders the user unable to respond and soon unable to effectively move. Nobody has ever died of drug overdose at Insite because medical staff is on hand to help. In fact, Insite has cut overall overdose deaths in the area by 35 percent according to a study in the Lancet Medical Journal.

 Beside dumpsters in dark alleyways, let’s just say medical staff is rare, at best.

Almost counter-intuitively, safe injection sites can help people overcome their addictions. Drug addiction is a terrifying reality that many of society’s disadvantaged live with. It’s a waking and sleeping horror. But what do addicts get on top of it? They’re labelled as criminals, scum, and trash. They’re shunned and confined to shooting up in terrible conditions. To give them this baseline respect puts them a step closer to even the most basic healthcare we guarantee for all citizens. 

In a clean and secure environment, addicts can develop a closer trust with staff that is essential for the physician-patient relationship. Many addicts stay away from rehabilitation or treatment facilities because of alienation, fear, and distrust. Bringing them into the heart of healthcare is a crucial step to treatment and care. In 2010, Insite made 5,000 referrals to other services including onsite rehabilitation, with record completion rates. The model has been successful. 

Others say, however, that to expand these facilities is to legitimize and encourage drug use. But I would argue that being treated as someone who is sick, surrounded by medical staff, and constantly monitored does not attract those who do not use drugs. They are seen as a blessing by those who are currently addicted, but first-time drug users never plan on being addicted and would hardly think about safe injection sites when considering drugs to start with.

Yet some may say that it is the very negative conditions surrounding drug use that discourage it, and safe injection sites only alleviate the deterrents of drug use. These deterrents include death, alienation, and legal troubles. But again, initial drug use is hardly rational, and even so, a life with drugs in Vancouver, or anywhere, is still obviously worse than one without. Even assuming that safe injection sites may encourage some drug use, the effect is minimal, and it is still for the greatest good to expand the sites. 

The issue of perception also plays a big part in safe injection sites. In Vancouver, Insite reduced the amount of discarded needles and public injections. Many argue that seeing this particular public disorder encourages and creates an environment in which crime thrives. However, others argued before that Insite would have led to a migration of drug trafficking into Vancouver. The data show little to no negative impact on crime.

Strict illegality should never take precedence over a policy that can help save citizens, improve general health, and reduce addiction. Insite has worked in Vancouver and it can work in other parts of the country. People deserve better, and stigma should not push us into shying away from real problems.

¹ http://vancouver.ca/people-programs/safe-injection-site-and-needle-exchange.aspx

² http://www.canada.com/reginaleaderpost/story.html?id=a4c0517f-77d6-493a-abfe-391b377b0e28

³ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62353-7/fulltext

⁴ http://supervisedinjection.vch.ca/research/supporting_research/