Insite preventing overdose deaths, reducing hospital visits

published on July 20, 2006

(Vancouver) – Vancouver’s pilot supervised injection site, known as Insite, plays a significant role in managing overdoses, including saving lives and reducing hospital visits, reveals a new study authored by the B.C. Centre for Excellence in HIV/AIDS.

The study, published in the International Journal of Drug Policy, also provides a detailed picture of those most likely to overdose, type of drugs used and interventions made at Insite. Between the study period of March 1, 2004, and August 30, 2005, 285 individuals accounted for 336 overdose events. The overdose rate, 1.33 overdoses/1,000 injections, is similar to rates observed in supervised injection facilities in other countries, reports the study.

No overdose events at Insite resulted in a fatality. As a result of on-site intervention, the majority of overdose cases did not require a transfer to hospital or paramedic assistance. The findings suggest that a supervised injection site not only likely reduces overdose deaths, but alleviates demands made on traditional health-care services, says Dr. Thomas Kerr, Centre Research Scientist and one of the study’s senior authors.

“While the pilot facility is small in comparison to the drug-use volume in the Downtown Eastside, the data indicates a supervised injection facility can play a role in managing overdoses among IDUs and certainly save lives,” says Kerr. “Studies have shown that approximately 4 out of every 100 overdoses result in a death. This fact, coupled with reports from Insite users who have overdosed, suggest that Insite is most likely saving lives by providing immediate emergency response on-site.”

According to a cohort comprising Insite users, those overdosing were more likely to be female, involved in the sex trade, daily heroin users, and had prior history of overdose.

“These latest findings show that Insite is doing what we all hoped it would,” says Dr. David Marsh, Physician Leader, Addiction Medicine, Vancouver Coastal Health.

“Some of the most vulnerable and marginalized people in the Downtown Eastside are receiving health-care services that are improving health outcomes and saving lives,” says Marsh.

Data concerning drugs involved were available for 318 (95%) overdoses. Heroin accounted for 201 (71%) of these overdoses; cocaine, 36 (13%); speedballs (heroin and cocaine mixed together), 28 (10%); morphine, 6 (2%); dilaudid, 5 (1.7%); crack, 4 (1.4%); and, methadone, 2 (0.7%).

The most common interventions undertaken in response to overdoses, include: the administration of oxygen (87%); calling for an ambulance (39%); transfer to hospital (28%) and the administration of naloxone hydrochloride (27%). The recent findings follow several similarly positive studies published in leading medical journals over the past two years (See Backgrounder)

The Centre study has been published online for IJDP subscribers. The study will be published in-print in the next issue of IJDP.

Backgrounder

Past Insite-related studies have revealed:

Insite is leading to increased uptake into detoxification programs and addiction treatment. Regular use of the facility and any contact with the facility’s addictions counsellor, were both strongly tied to quicker initiation into detoxification. (New England Journal of Medicine)
Insite has not led to an increase in drug-related crime. (Substance Abuse Treatment, Prevention, and Policy)
Insite has reduced the number of people injecting in public and the amount of injection-related litter in the Downtown Eastside, both notable improvements for people who live and work in the neighbourhood. (Canadian Medical Association Journal)
Insite is attracting the highest-risk users – those more likely to be vulnerable to HIV infection and overdose, and who were contributing to problems of public drug use and unsafe syringe disposal. (American Journal of Preventive Medicine)
Insite has reduced overall rates of needle sharing in the community, and among those who used the supervised injection site for some, most or all of their injections, 70% were less likely to report syringe sharing. (The Lancet).
Nearly one-third of Insite users received information relating to safer injecting practices. Those who received help injecting from fellow injection drug users on the streets were more than twice as likely to have received safer injecting education at Insite (International Journal of Drug Policy).
Insite is not increasing rates of relapse among former drug users, nor is it a negative influence on those seeking to stop drug use. (British Medical Journal)

About Insite

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 (SEOSI), will evaluate changes in HIV risk behaviour, overdose rates, addiction treatment and public injecting over the duration of the pilot project.

BC Centre for Excellence in HIV/AIDS

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Insite preventing overdose deaths, reducing hospital visits

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