BackgroundThis paper will determine whether expanding Insite (North America’s first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users.MethodsBy analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal.ResultsWith very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV.ConclusionsFunding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.

BackgroundSupervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada’s capital city, Ottawa.MethodsThe current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed.ResultsThe sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases – when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent.ConclusionsFunded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.

Sentencing in Canada is beset by many problems yet one weakness stands above the rest: the disproportionately high rates of Aboriginal incarceration. This article documents current and historical trends in levels of Aboriginal incarceration at the provincial/territorial and federal levels since 1978. We pay particular attention to the years following two important Supreme Court judgments (in 2001 and 2012) which directed courts to use custody with greater restraint when sentencing an Aboriginal offender. The primary data derive from the annual Adult Correctional Services (ACS) Survey conducted by Statistics Canada. In 2014, Aboriginal persons accounted for just over one quarter of all provincial and territorial admissions, significantly higher than the percentage recorded in 1978 (16%). In fact, over the last 20 years all jurisdictions save one have experienced an increase in the percentage of Aboriginal admissions to provincial correctional institutions. Despite judgments from the Supreme and provincial courts of appeal, and a number of other remedial interventions such as the creation of so-called 'Gladue' courts and an alternate form of custody served in the community, the problem of Aboriginal over-incarceration has worsened, not improved.

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