North America's only government-sanctioned supervised injection facility, Insite, has been subjected to substantial research. This research has found evidence for numerous public health benefits: decreased risky injection behaviour, decreased fatal overdoses, increased probability of initiating and maintaining addiction treatment, and cost-effectiveness. To date, a small number of costing studies have emerged with none of them investigating Insite expansions. Such an analysis is reported in this paper and it is found that, based on benefit-cost ratios, Insite should be expanded. However, this expansion is dependent on altering injection drug user behaviour outside Insite.

BackgroundThis 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.MethodsSemi-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.ResultsAttending 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.ConclusionsThere 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.

The Downtown Eastside (DTES) of Vancouver, Canada, has been the epicentre of HIV and drug overdose related to injection drug users (IDUs) since the mid1990s. In response to growing government inaction, a drug user-run organization known as Vancouver Area Network of Drug User (VANDU) was formed. This study was conducted to capture the genesis and influence of VANDU over the past 14 years in shaping the neighbourhood. Semi-structured qualitative interviews were conducted with purposively chosen sample of 11 VANDU board members and those attending the services. Interviews were transcribed verbatim and analysed thematically using NVivo 9 software. Participants' narratives indicate that VANDU has been instrumental in improving conditions of the DTES, altering the risky injection behaviour of its members. Moreover, VANDU has given a voice to the most marginalized members of society who otherwise would not be represented. Findings from this study highlight the important role that a drug user organization can play in creating new physical and conceptual space.

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.

BackgroundThe role of peers (former or current drug users) in reducing risky behavior within methamphetamine and crack smokers has not been well described or researched. The current study not only explores the role of peers in reducing risk factors for morbidity within the illicit drug smoking population in the Downtown Eastside (DTES) community of Vancouver but it also investigates the changes in the nature of drug use after the closure of an unsanctioned smoking facility.MethodsThe data pertain to qualitative interviews with 10 peers and 10 illicit drug smokers. The semi-structured interviews were conducted through community-based research, and the digital transcripts were analyzed via NVivo 10 software.ResultsThe results indicate that peers (former and current drug users who are employed as educators) are instrumental in transferring risk reduction knowledge within crack and methamphetamine smokers. For example, these peers have been able to teach users about the risk of sharing pipes, using brillo, and using public drug. Furthermore, the Vancouver Area Network of Drug Users provides employment for crack and methamphetamine users in Vancouver who tend to have scarce sources of employment. However, since the closure of the unsanctioned inhalation facility, there has been significantly more public drug use and pipe sharing in the vicinity of the facility, placing drug smokers at significant risk of arrest, violence, and blood-borne infections.ConclusionsThe current study recommends expanding the harm reduction peer network for people who smoke illicit drugs in the DTES community of Vancouver who have historically been underserved.