Individual+Research+Assignment+-+Insite

**Insite – Supervised Injection Site (SIS)** is North America’s first legal supervised injection site located in Vancouver British Columbia. It is accessible to any injection drug user with no connection to health care services to use their drugs in a safe, health focused place and connect to health care services. Services include primary care, disease and infection treatment, addiction counselling and treatment, as well as continuous care for people with HIV or AIDS (Vancouver Coastal Health Website). Clients who enter Insite are first assessed then led to an injection room where they can inject their own drugs under the supervision of trained medical staff. They have access to clean injection equipment which includes spoons, tourniquets (compressing device used to control venous and arterial circulation) and water (Wikipedia Encyclopedia). After injecting, clients are moved to a post-injection room where they can connect with other on site services (Vancouver Coastal Health Website).
 * [[image:intake_room_large.jpg width="399" height="258" caption="Intake Room"]] ||
 * Intake Room ||
 * [[image:injection_room_large.jpg width="399" height="258" caption="Injection Room"]] ||
 * Injection Room ||
 * [[image:chill_room_large.jpg width="399" height="258" caption="Post Injection Room"]] ||
 * Post Injection Room ||

The Vancouver Coastal Health (VCH) which included the City of Vancouver, Vancouver Police Department and The Downtown East Side community formed a partnership with the Portland Hotel Community Services Society, which is a nonprofit society that manages buildings that provide social housing and support, to begin planning a program for practicing safer injection options. After given a grant by the Federal Government of Canada to operate under a constitutional exception under section 56 of the Controlled Drugs and Substances Act, Insite was able to open their doors to the community in 2003 (Vancouver Coastal Health Website). The Supervised Injection Site is located at 139 Hastings Street, right in the heart of Vancouver’s downtown community. Following the guidelines set out by Health Canada for a supervised injection site scientific research pilot project, the Vancouver location was selected in accordance with other criteria that included accessibility to active injection drug users, costs and community impact. Injection drug use was a major issue and still remains a serious problem in Vancouver, so Insite’s ultimate goal was aimed at reducing the spread of infectious diseases in the Vancouver area (Vancouver Coastal Health Website). Now also provided with operational funding by the British Columbia Ministry of Health, Insite is able to serve men and women who use more than one drug, people who experience both addiction and mental illness, people with a history of trauma, people who are homeless or living in substandard conditions, people of Aboriginal descent as well as people who have been unsuccessful in quitting their bad habit (The Ubyssey University of British Columbia Newspaper Online). Since Insite opened as a scientific project, it has been subject to rigorous independent third party evaluations on Insite’s ability to reduce harm associated with injection drug use to the individuals and community. The research thus far has focused on Insite’s impact on overdoses, the health of the drug users and their appropriate use of health and social services. Conclusions have been published in a variety of peer-reviewed journals such as the New England Journal of Medicine, the British Medical Journal and the Canadian Medical Association Journal which have found the following (Vancouver Coastal Health Website): Tremendous positive health outcomes have resulted from the Insite facility, which have turned many sceptics into believers (Vancouver Coastal Health Website). Insite welcomes 750 to 800 visits per day which amounts to about 257, 575 visits per year. With just over 10, 000 unique individuals registered at Insite, each person is making an average of 11 visits per month (Vancouver Coastal Health Website). With Insite playing an active role in the community there are now absolutely no deaths with the 200 overdoses occurred each year. There are close to 4, 000 first aid and medical care interventions and over 2, 000 referrals to other social and health services specializing in each clients case (Vancouver Coastal Health Website). Using a model of underestimating the full range of benefits and overestimating the annual costs of operating Insite, the benefit of preventing HIV infections, other diseases and death has been estimated to be around $4 for every dollar Insite spends. That means Insite is actually beneficial to the rest of the non-injection drug using population because it lowers their taxes and allows the government to focus spending on other issues (Vancouver Coastal Health Website). Insite has consistently been an attraction of controversy, ethical debate and a divider between politicians and scientists. A research scientist at the University of British Columbia, Dr. Thomas Kerr, insists that anyone who thinks Insite should be closed down is putting ideology ahead of science and the basic principles of public health. Hedy Fry was the MP for Vancouver during Insite’s slow evolution and she also agrees that Insite saves lives. Many political candidates stress that Insite is beneficial because it targets harm reduction. However, the Torries government remain committed to opposing Insite and Health Minister Tony Clement questions the ethics of health care professionals supporting the distribution of drugs that are of an unknown purity or potency. Even Prime Minister Stephen Harper opposes Insite, stating, that Insite may slow the death spiral of drug users but it does not reverse it. Therefore to Prime Minister Harper, he does not regard Insite as a positive health outcome (The Ubyssey University of British Columbia Newspaper Online). Nevertheless, it is almost impossible to refute the number of real success stories that have emerged from the services provided at Insite. Sean is a man who was born to a First Nations family who struggled with the death of his parents when he was young, poverty and the effects of residential schooling. He started using drugs and was eventually a regular to the criminal justice system. Since then, the Insite staff has found Sean a treatment centre and transitional housing which has led to a life of clean recovery since (Vancouver Coastal Health Website). Bob is an older gentleman who was living on the streets, making money by selling garbage out a shopping cart while not being provided with the social assistance he was entitled to. He was also a regular user of heroin and frequently being incarcerated. After just a few months of being cared for at Insite, Bob has significantly reduced his drugs to virtually nothing and now able to provide the basic necessities to life on his own with a real job (Vancouver Coastal Health Website). Lily was a former health care worker who lives with fetal alcohol effect, a psychiatric illness and had been using intravenous drugs for ten years. She has been unable to quit her bad habits to make a better life for herself and children. Insite taught her how to live clean one day at a time and she has not used any drugs for twelve months now. Due to her invaluable experience at Insite she felt compelled to write Stephen Harper a letter outlining how Insite saved her life and pleading to keep the centre open (Vancouver Coastal Health Website).
 * Origin **
 * Research **
 * Insite is leading to an increased uptake of detoxification programs and addiction treatment.
 * Drug related crimes have not increased, in fact, the rates of vehicle break ins and theft has declined significantly since Insite’s opening.
 * Insite has reduced the number of public injections and consequently the amount of injection related paraphernalia in downtown Vancouver.
 * Insite is attracting the highest risk users who are most probable to spreading infectious diseases and are the biggest threats to public safety.
 * Insite has not increased the rate of relapse among former drug users nor does it have a negative effect on those seeking to stop their current use.
 * Insite is actually preventing the number of deaths by overdose as well as the number of hospital visits.
 * Facts **
 * Insite participants:**
 * 27 percent are female.
 * 19 percent are Aboriginal.
 * 17 percent are homeless.
 * 80 percent have a history of incarceration.
 * 73 percent have injected in public before.
 * Drug use:**
 * Heroin was used in 42 percent of injections.
 * Cocaine was used in 26 percent of injections.
 * Morphine was used in 11 percent of injections.
 * Harm reduction:**
 * Benefits to the Health Care system:**
 * Controversy **

Despite the international recognition and abundance of support, Insite is struggling to remain open due to the severe political opposition (Dr. Peter Centre care for HIV/AIDS Vancouver Website). Therefore, at this moment, there are currently no plans for opening any additional Insite centres (Vancouver Coastal Health Website). Vancouver Coastal Health Website. SIS Section. Accessed 26 January 2009 http://www.vch.ca/sis/
 * Future **
 * References **

Wikipedia Encyclopedia. Definition of tourniquet. Accessed 26 January 2009 http://en.wikipedia.org/wiki/Tourniquet

The Ubyssey University of British Columbia Newspaper Online. 3 October 2008. Accessed 27 January 2009http://www.ubyssey.ca/?p=4678

Dr. Peter Centre care for HIV/AIDS Vancouver Website. Accessed 27 January 2009http://www.drpeter.org/html/inthenews.htm

All images courtesy of Vancouver Coastal Health Supervised Injection Site Website.

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