Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada?

Harm Reduction Journal

Martin A Andresen¹  Ehsan Jozaghi¹ 

[1] School of Criminology, Simon Fraser University, 8888 University Drive, B.C. V5A 1S6, Burnaby Canada

关键词: Drug policy;    Harm reduction;    Supervised injection facility;   

Others  :  809932
DOI  :  10.1186/1477-7517-10-1

 received in 2012-04-15, accepted in 2013-02-11,  发布年份 2013

【 摘 要 】

Background

This article reports qualitative findings from a sample of 31 purposively chosen injection drug users (IDUs) from Vancouver, Surrey and Victoria, British Columbia interviewed to examine the context of safe injection site in transforming their lives. Further, the purpose is to determine whether the first and only Supervised injection facility (SIF) in North America, InSite, needs to be expanded to other cities.

Methods

Semi-structured qualitative interviews were conducted in a classical anthropological strategy of conversational format as drug users were actively involved in their routine activities. Purposive sampling combined with snowball sampling techniques was employed to recruit the participants. Audio recorded interviews were transcribed verbatim and analyzed thematically using NVivo 9 software.

Results

Attending InSite has numerous positive effects on the lives of IDUs including: saving lives, reducing HIV and HCV risk behavior, decreasing injection in public, reducing public syringe disposal, reducing use of various medical resources and increasing access to nursing and other primary health services.

Conclusions

There is an urgent need to expand the current facility to cities where injection drug use is prevalent to reduce overdose deaths, reduce needle sharing, reduce hospital emergency care, and increase safety. In addition, InSite’s positive changes have contributed to a cultural transformation in drug use within the Downtown Eastside and neighboring communities.

【 授权许可】

   
2013 Jozaghi and Andresen; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Picard A: A changing epidemic: Canada’s AIDS rate on the rise. The Globe and Mail 2010, 23:A1-A8.
• [2]Wood E, Montaner JSG, Li K, Zhang R, Barney L, Strathdee SA: Burden of HIV infection among Aboriginal injection drug users in Vancouver, British Columbia. Amer J of Public Health 2008, 98(3):515-519.
• [3]Urban Health Research Initiative: Drug situation in Vancouver, British Columbia Center for Excellence in HIV/AIDS: Vancouver. http://uhri.cfenet.ubc.ca/ webcite
• [4]Miller JS: HIV, Hepatitis, and injection drug use in British Columbia: Pay now or pay later?. Victoria: BC: B.C. Ministry of Health; 1998:1-39.
• [5]Fischer B, Rehm J, Kim G, Robins A: Safer injection facilities (SIFs) for injection drug users (IDUs) in Canada: a review and call for an evidence-focused pilot trial. Can J Public Health 2002, 93(5):336-338.
• [6]Remis RS, Strathdee SA, Millson M, Leclerc L, Degani N, Palmer RWH: Consortium to characterize injection drug users in Montreal, Toronto, and Vancouver, Canada. Ottawa: Health Canada; 1998.
• [7]Kerr T, Wood E, Palepu A, Wilson D, Schechter MT, Tyndall MW: Responding to an explosive HIV epidemic driven by frequently cocaine injection: Is there a role for safe injecting facilities? J Drug Issues 2003, 22(426):579-608.
• [8]Martin RE, Gold F, Murphy W, Remple V, Berkowitz J, Money D: Drug use and risk of blood born infections: a survey of female prisoners in British Columbia. Can J Public Health 2005, 96(2):97-101.
• [9]Mass B, Fairbairn N, Kerr T, Li K, Montaner JSG, Wood E: Neighborhood and HIV infection among IDU: place of residence independently predicts HIV infection among a cohort of injection drug users. Health Place 2007, 13:432-439.
• [10]Andresen MA, Boyd N: A cost-benefit and cost-effectiveness analysis of Vancouver’s supervised injection facility. Int J Drug Policy 2010, 21(1):70-76.
• [11]Hunter J: No decision on InSite, court told. The Globe and Mail 2011, 13:S1-S2.
• [12]Kerr T, Small W, Moore D, Wood E: A micro-environmental intervention to reduce the harms associated with drug-related overdose: evidence from the evaluation of Vancouver’s safer injection facility. Int J Drug Policy 2007, 18:37-45.
• [13]Smith C: InSite parties for the right to fight Harper. http://www.straight.com/article-173337/insite-parties-its-right-fight-harper webcite
• [14]Health Canada: Vancouver’s Insite service and other supervised injection sites: What has been learned from research? Final report of the export advisory committee. Ottawa (ON): Health Canada; 2008. http://www.hc-sc.gc.ca/ahc-asc/pubs/_site-lieux/insite/index-eng.php webcite
• [15]Hogg RS, Strathdee S, Kerr T, Wood E, Remis R: HIV Prevalence among aboriginal British Columbians. Harm Reduction J 2005, 2(26):1-6.
• [16]McKnight I, Mass B, Wood E, Tyndall MW, Small W, Lai C: Factors associated with public injecting among users of Vancouver’s supervised injection facility. Amer J Drug and Alcohol Abuse 2007, 33(2):319-325.
• [17]Marshall BDL, Milloy MJ, Wood E, Montaner JSG, Kerr T: Reduction in overdose mortality after the opening of North America’s first medically supervised safer injection facility: a retrospective population-based study. Lancet 2011, 377(9775):1429-1437.
• [18]McKnight J: Reducing the harms from illegal drug use in Fraser Health: Can FHA allow municipal bylaws to spread disease?. Vancouver: Fraser Health Authority; 2009. http://www.fraserhealth.ca/media/boardmtg_druguse_110210.pdf webcite
• [19]Bourgois P, Martinez A, Kral A, Edlin BR, Schonberg J, Ciccarone D: Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach. PLoS Med 2006, 10(3):1805-1815.
• [20]Silverman D, Marvasti A: Doing qualitative research: a comprehensive guide. Los Angeles, CA: Sage Publications; 2008.
• [21]Hammersley M: Reading ethnographic research: A critical guide. London: Longmans; 1990.
• [22]Des Jarlais DC, Semaan S: HIV prevention research: cumulative knowledge or accumulating studies? an introduction to the HIV/AIDS prevention research synthesis project supplement. J Acquired Immune Deficiency Syndromes 2002, 30(S1):S1-S7.
• [23]Vancouver Coastal Health: From the ground up: Insite’s role in accessing treatment and care. 2007. http://www.vch.ca webcite
• [24]Ivsins A, Chow C, Marsh D, Macdonald S, Stockwell T, Vallance K: Drug use trends in Victoria and Vancouver, and changes in injection drug use after the closure of Victoria’s fixed site needle exchange. Victoria, BC: University of Victoria; 2010. http://www.carbc.ca/Portals/0/PropertyAgent/2111/Files/299/CARBC_Bulletin6.pdf webcite
• [25]Petrar S, Kerr T, Tyndall MW, Zhang R, Montaner JSG, Wood E: Injection drug users’ perceptions regarding use of a medically supervised safer injecting facility. Addict Behav 2007, 32:1088-1093.