The Science
Published Papers on Vancouver’s Supervised Injection Facility:
Click the title of a topic below to open the document (PDF format).
1. Increased Use of Addiction Treatment
The SIF’s opening was associated independently with a 30% increase in detoxification service use, and this behaviour was associated with increased rates of long-term addiction treatment initiation and reduced injecting at the SIF.
Evan Wood, Mark W. Tyndall, Ruth Zhang, Julio S. G. Montaner & Thomas Kerr, et al. 2007. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users Society for the Study of Addiction
2. Attendance and Detoxification
Reports that weekly use of Insite and any contact with the facility’s addictions counselor were both independently associated with more quicker entry into a detoxification program.
Wood E, Tyndall MW, Zhang R, J.Stoltz, Lai C, et al. 2006c. Attendance at Supervised Injecting Facilities and Use of Detoxification Services. New England Journal of Medicine 354:2512-4
Reports that Insite appears to have reduced syringe sharing.
Kerr T, Tyndall MW, Li K, Montaner JS, Wood E. 2005. Safer Injecting Facility Use and Syringe Sharing Among Injection Drug Users. Lancet 366:316-8
4. Impact on Drug-Use Patterns
Reports that the opening of Insite did not adversely affect community drug use, including relapse into injected drug use, stopping injected drug use, and seeking treatment. Insite appears to have improved public order and reduced syringe sharing.
Kerr T, Stoltz J, Tyndall M, Li K, Zhang R, et al. 2006. Impact of a Medically Supervised Safer Injection Facility on Community Drug Use Patterns: A Before and After Study. British Medical Journal 332:220-2
Highlights the ideas, processes and historical events that contributed to a cultural transformation that was critical to opening the Insite in Vancouver.
Small D, Palepu A, Tyndal MW. 2006. The establishment of North America's first state sanctioned supervised injection facility: a case study in culture change. International Journal of Drug Policy 17:73-82
6. Attendance, drug use patterns, and referrals
Reports that Insite has successfully been integrated into the community, has attracted a wide cross section of community injection drug users, has intervened in overdoses and initiated over 2000 referrals to counseling and other support services.
Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. 2005. Attendance, Drug Use Patterns, and Referrals Made From North America's First Supervised Injection Facility. Drug and Alcohol Dependence.
Lays out the method by which the health and community impacts of Insite will be measured and evaluated.
Wood E, Kerr T, Buchner C, Marsh D, Montaner JS, Tyndall MW. 2004a. Methodology for Evaluating Insite: Canada's First Medically Supervised Safer Injection Facility for Injection Drug Users. Harm Reduction Journal 1:1-5
Outlines the rationale for evaluating Insite and reasons that if the Insite study is able to show public-health and/or community benefits it may provide a public-health model with the potential to address many of these drug-related harms that plague many North American cities.
Wood E, Kerr T, Montaner JS, Strathdee S, Kerr T, et al. 2004b. Rationale For Evaluating North America's First Medically Supervised Injecting Facility. Lancet Infectious Diseases 4:301-6
Reports that the opening of Insite appears to have lead to improvements in public order, including reduced public injection drug use and public syringe disposal.
Wood E, Kerr T, Small W, Li K, Marsh D, et al. 2004c. Changes In Public Order After The Opening of a Medically Supervised Safer Injection Facility for Injection Drug Users. Canadian Medical Association Journal 171:731-4
10. Impact on Drug Related Crime
Examines crime rates in the neighborhood surrounding Insite during the year before versus the year after Insite opened. It finds no increases in drug trafficking or assaults/robbery, and a decline in vehicle break-ins/vehicle theft.
Wood E, Tyndall MW, Lai C, Montaner JSG, Kerr T. 2006a. Impact of a Medically Supervised Safer Injecting Facility on Drug Dealing and Other Drug- Related Crime. Substance Abuse Treatment, Prevention and Policy 1:1-4
11. Attraction of Higher-Risk Injection Users
Reports that Insite attracted injection drug users (IDUs) with elevated risks of blood-borne disease infection and overdose, and IDUs who were contributing to public drug use and unsafe syringe disposal problems stemming from public injection drug use.
Wood E, Tyndall MW, Li K, Lloyd-Smith E, Small W, et al. 2005a. Do Supervised Injecting Facilities Attract Higher-Risk Injection Drug Users? American Journal of Preventive Medicine 29:126-30
12. Service Uptake
Reports that
- Insite has been well accepted among injection drug users in the community.
- Homelessness, a common factor in public injection drug use, is associated with frequent use of Insite
- Daily safe injection facility use is associated with several risk behaviors that have been linked to elevated rates of HIV transmission in this community, including frequent cocaine injection.
Wood E, Tyndall MW, Qui Z, Zhang R, Montaner JS, Kerr T. 2006b. Service Uptake and Characteristics of Injection Drug Users Utilizing North America's First Medically Supervised Safer Injection Facility. American Journal of Public Health 96:770-3
Reports that the use of Insite by injection drug users is associated with reduced syringe sharing.
Wood E, Tyndall MW, Stoltz J, Small W, Lloyd-Smith E, et al. 2005b. Factors Associated with Syringe Sharing Among Users of a Medically Supervised Injecting Facility. American Journal of Infectious Diseases 1:50-4
14. HIV Education
Reports that individuals requiring help injecting – a risk factor previously associated with HIV incidence – are receiving safer injecting education at Insite.
Wood E, Tyndall MW, Stoltz J, Small W, Zhang R, et al. 2005c. Safer Injecting Education for HIV Prevention Within a Medically Supervised Safer Injecting Facility. International Journal of Drug Policy 16:281-4
15. Preventing Overdose Deaths
Reports that there have been a large number of overdoses within the SIF, and that none of these overdoses resulted in a fatality. These findings suggest that SIF can play a role in managing overdoses.
Thomas Kerr, Mark W. Tyndall, Calvin Lai, Julio S.G. Montaner, Evan Wooda, et al. 2006c. Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy
The purpose of this analysis is to measure the prevalence and correlates of baseline HIV among those who are using the SIF, to determine if InSite could be used as a site for HIV related care and treatment.
Mark W Tyndall, Evan Wood, Ruth Zhang, Calvin Lai, Julio SG Montaner, Thomas Kerr, 2006. HIV seroprevalence among participants at a medically supervised injection facility in Vancouver, Canada: Implications for prevention, care and treatment. Harm Reduction Journal
17. Reducing Harms Associated With Drug-Related Overdose
Conventional drug overdose prevention strategies have been criticised for failing to address the macro- and micro-environmental factors that shape drug injecting practices and compromise individual ability to reduce the risks associated with drug-related overdose.Safer injection facilities (SIFs) constitute one such intervention, although little is known about the impact of such facilities on factors that mediate risk for overdose.
Thomas Kerr, Will Small, David Moore, Evan Wood, 2006. A micro-environmental intervention to reduce the harms associated with drug-related overdose: Evidence from the evaluation of Vancouver’s safer injection facility. International Journal of Drug Policy
18. Changing Injecting Practices
Consistent SIF use was compared with inconsistent use on a number of self-reported changes in injecting practice variables.More consistent SIF use is associated with positive changes in injecting practices, including less reuse of syringes, use of sterile water, swabbing injection sites, cooking/filtering drugs, less rushed injections, safe syringe disposal and less public injecting.
Jo-Anne Stoltz, Evan Wood, Will Small, Kathy Li, Mark Tyndall, Julio Montaner, Thomas Kerr, 2007. Changes in injecting practices associated with the use of a medically supervised safer injection facility. Journal of Public Health
In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users. Vancouver’s safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use.
Evan Wood, Mark W. Tyndall, Julio S. Montaner, Thomas Kerr, 2006. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. Canadian Medical Association Journal
Commentary: The need to promote public health in the field of illicit drug use. Dr. Mark A. Wainberg, McGill University AIDS Centre, Jewish General Hospital, 2006 Canadian Medical Association Journal
20. Drug Users' Perceptions Regarding InSite
This study was undertaken to explore injection drug users' experiences and opinions regarding North America's first SIF in Vancouver, Canada.
Steven Petrar, Thomas Kerr, Mark W. Tyndall, Ruth Zhan, Julio S.G. Montaner, Evan Wood, 2007 Addictive Behaviors
21. Limiting Hepatitis C Infection
The SIF has attracted injection drug users with a high burden of HCV infection and a substantial proportion of uninfected individuals. Although crosssectional, this study provides some insight into historical risks for HCV infection among this population, and prospective follow-up of this cohort will be useful to determine if use of the SIF is associated with reduced risk behaviour and HCV incidence.
E. Wooda, T. Kerra, J. Stoltza, Z. Quia, R. Zhanga, J.S.G. Montanera, M.W. Tyndalla, 2005 The Royal Institute of Public Health.