Study: Supervised injection site attracts highest risk users
published on July 19, 2005
More vulnerable to HIV infection and overdose, says detailed profile
Vancouver’s pilot supervised injection site has shown to attract the highest risk users, reveals a new study authored by the B.C. Centre for Excellence in HIV/AIDS.
The study, published in the American Journal of Preventive Medicine, provides one of the first detailed profiles of injection drug users who frequent the facility, known as Insite. Results from the study indicate Insite is attracting injection drug users who have shown to be at elevated risk of HIV infection and overdose, and who were contributing to problems of public drug use and unsafe syringe disposal, says lead author Dr. Evan Wood.
“The behaviours of those using Insite were specifically those same risk factors that were shown to be associated with elevated risk of HIV infection in previous studies,” says Wood. “There was some doubt whether facilities like Insite only attract older individuals, or those at low risk of HIV and overdose. Our study shows that Insite attracted the most at-risk drug users in the Downtown Eastside.”
Overall, 400 active injection drug users were surveyed. Those who had used Insite were more likely to be younger, public injection drug users, homeless or residing in unstable housing, daily heroin users, and have had a recent non-fatal overdose.
Insite clients were also 1.6 times more likely to be daily cocaine injectors, the specific risk behaviour that led to the HIV outbreak in the Downtown Eastside. Previous to Insite’s opening, there was some concern the facility would only attract those who inject heroin, says fellow senior study author Dr. Thomas Kerr.
“It is noteworthy that frequent cocaine injectors initiated Insite use, given that there has been substantial debate regarding the willingness of cocaine users to use a medically supervised injection facility,” says Kerr.
The study suggests Insite may be effective in attracting highest-risk IDUs, as the facility provides a hygienic environment where medical care and referral to addiction treatment are offered on site, and emergency response is available in the event of overdose.
“We are encouraged to learn that Insite is being accessed by the population most at risk for HIV infection and drug overdose,” says Chris Buchner, Manager, HIV/AIDS Services, Vancouver Coastal Health. “The study findings highlight that Insite is ideally positioned to be an effective means for intervention with high-risk injection drug users.”
Two previous Centre studies on Insite revealed further positive findings. A study published in the March issue of The Lancet showed Insite led to reduced needle-sharing – and potential for hepatitis C and HIV infection – among high-risk drug users. A 2004 study published in the Canadian Medical Association Journal revealed Insite’s opening was associated with significantly improving public order by reducing injection drug use and syringe disposal in public spaces.
Insite is the first government sanctioned facility of its kind in North America. The facility was opened by Vancouver Coastal Health (VCH) in partnership with the Portland Hotel Society. The B.C. Centre for Excellence in HIV/AIDS was contracted to conduct an arms-length evaluation of the impact of Insite on public order and public health. The Centre project, formally known as the Scientific Evaluation of Supervised Injecting Study (SEOSI), will evaluate changes in HIV risk behaviour, overdose rates, addiction treatment and public injecting over the duration of the pilot project.