incite insight insight and insight . insite type non profit organization industry health care supervised injection site founded 2003 headquarters vancouver british columbia canada area served downtown eastside neighborhood website supervisedinjection.vch.ca insite is the first legal supervised drug injection site in north america located at 139 east hastings street in the downtown eastside dtes neighbourhood of vancouver british columbia . 1 the dtes had 4700 chronic drug users in 2000 and has been considered to be the centre of an injection drug epidemic . the site provides a safe and health focused location for injection drug use primarily heroin . 2 3 the clinic does not supply any drugs . 4 medical staff are present to provide addiction treatment mental health assistance and first aid in the event of an overdose or wound . in 2009 the site recorded 276 178 visits an average of 702 visits per day by 5 447 unique users ; 484 overdoses occurred with no fatalities due to intervention by medical staff . 5 health canada has provided 500 000 per year to operate the site and the bc ministry of health contributed 1 200 000 to renovate the site and cover operating costs . insite also serves as a resource for those seeking to use a harm reduction approach for people who inject drugs around the world . in recent years delegations from a number of countries are on record touring the facility including colombia and brazil . 6 contents 1 operation 2 research 3 reception 4 government and legal controversy 5 references 6 external links operation edit insite is operated in tandem by vancouver coastal health and the portland hotel society . between september 2003 and july 2008 the site operated under a special exemption of section 56 of the controlled drugs and substances act granted by the liberal government via health canada . 7 the site was slated to close on september 12 2006 as the exemption was for a three year pilot project . 8 the conservative minority government granted a temporary extension 9 then added another six month extension that was to end in mid 2008 . 10 a constitutional challenge was heard by the supreme court of british columbia to keep insite open after federal health minister tony clement refused to renew the exemption beyond july 2008 . the court ruled that laws prohibiting possession and trafficking of drugs were unconstitutional because they denied drug users access to insite s health services . justice ian pitfield gave ottawa until 30 june 2009 to amend the controlled drugs and substances act and bring it in line with the constitutional principle of fundamental justice section seven of the canadian charter . 11 the house of commons did not amend the law meaning insite currently operates under a constitutional exception to the controlled drugs and substances act . 12 research edit when founded insite acquired legal exemption under the condition that its impacts be thoroughly evaluated . 13 consequently the site has been the focus of more than thirty studies 14 published in 15 peer reviewed journals . 15 the research indicates an array of benefits including reductions in public injecting and syringe sharing and increases in the use of detoxification services and addiction treatment among patients . in addition studies assessing the potential harms of the site have not observed any adverse effects . 14 16 preliminary observations published in 2004 in the journal harm reduction indicate that the site successfully attracted injecting drug users and thus decreased public drug use . however the researchers cautioned that a full assessment of the site would take several years . 13 additional research in the canadian medical association journal suggests that the site has reduced public injections neighbourhood litter and needle sharing . 17 two studies in the journal addiction and in the new england journal of medicine indicate that patients at the site have increased their use of detoxification services and long term addiction treatment . 18 19 furthermore research in the lancet indicates that the site substantially reduces the sharing of syringes . 20 a study in the journal substance abuse treatment prevention and policy revealed that local police facilitate use of insite especially among high risk users . the researchers concluded that the site provides an opportunity to ... resolve some of the existing tensions between public order and health initiatives . 21 a 2008 cost benefit analysis of the site in the canadian medical association journal observed net savings of 18 million and an increase of 1175 life years over ten years . 22 another cost benefit analysis published in the international journal of drug policy in 2010 determined that the site prevents 35 cases of hiv and about 3 deaths per year indicating a yearly net societal benefit of more than 6 million . 23 a 2011 study in the lancet found overdose deaths have dropped 35 % in the insite area since it opened much more than 9 % drop elsewhere in vancouver . 24 an editorial in the canadian medical association journal noted that after three years of research a remarkable consensus that the facility reduces harm to users and the public developed among scientists criminologists and even the vancouver police department . 15 reception edit people crowd the sidewalk during a fundraiser for insite in 2008 letters of support and surveys show that health professionals local police the local community and the general public have positive or neutral views of insite services and the majority wish to see the service continue . final report of the expert advisory committee for tony clement 25 insite enjoys strong local support . 26 while insite is well liked throughout british columbia its popularity is highest inside vancouver where some 76 % of residents expressed support for the facility . 25 furthermore according to a 2007 national survey by mustel group some 63 % of canadians believe the federal government should renew the insite s mandate while 27 % oppose . support is lowest among conservatives only half of whom believe the site should continue operating . 25 among clients 95 % or greater rated the facility s services as excellent or good and its staff as reliable respectful and trustworthy . 25 partners of insite include the city of vancouver the vancouver police department and the phs community services society . 27 the site has the support of vancouver s mayor gregor robertson 28 former mayor sam sullivan 29 former premier of british columbia gordon campbell 30 and former vancouver mayors larry campbell mike harcourt and philip owen . 31 the international aids society b.c. centre for excellence in hiv aids and the canadian union of public employees have also expressed support for insite . 32 33 though initially opposed to the safe injection site the chinatown and gastown merchants associations now support it . 31 international supporters include the uk based think tank senlis council 34 the australian parliamentary group for drug law reform 29 and the american drug policy alliance . 35 the site drew criticism from the bush administration ; the director of the white house office of national drug control policy called insite state sponsored suicide on its opening . 29 in 2006 the canadian police association voted unanimously to encourage the federal government to stop funding insite and instead invest in a national drug strategy . 36 moreover federal health minister tony clement branded insite an abomination telling the vancouver sun that allowing and or encouraging people to inject heroin into their veins is not harm reduction ... it is a form of harm addition . 26 the royal canadian mounted police rcmp has also criticized insite . this is despite a report commissioned by the rcmp and conducted by two criminologists that concluded in favour of the injection site . 36 the rcmp in british columbia had agreed to announce their support for insite in 2009 at a joint news conference with the bc centre for excellence in hiv aids ; they planned to note an extensive body of canadian and international peer reviewed research reporting the benefits of supervised injection sites and no objective peer reviewed studies demonstrating harms and they were to admit that reports commissioned by the rcmp criticizing insite did not meet conventional academic standards . however the rcmp in british columbia were ordered by headquarters in ottawa to cancel the news conference days before the event . 37 the most significant published criticism has been an article by colin mangham the director of research for the drug prevention network of canada in the online only journal of global drug policy and practice jgdpp which is said to be posing as open access peer reviewed scientific journal 26 38 39 in the article mangham claims that the published evaluations and especially reports in the popular media overstate findings downplay or ignore negative findings report meaningless findings and overall give an impression the facility is successful when in fact the research clearly shows a lack of program impact and success . 40 he also claimed that interviews with area treatment centres revealed no referrals from insite and that police presence was deliberately bolstered in the area . 40 based on this article tony clement told an august 2007 meeting of the canadian medical association that his belief that insite should close had been reaffirmed . clement stated that there has been more research done and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with insite . 38 the journal of global drug policy and practice that clement was referring to is run by the drug free america foundation and received much of its initial funding in a 1.5 million grant from a u.s. department of justice agency now under investigation for corruption . 26 mangham s article has been questioned because it dismisses more than 20 peer reviewed studies published in reputable medical journals such as the lancet the new england journal of medicine and the british medical journal all of which indicate that insite has a positive effect . 41 the journal of global drug policy and practice jgdpp article which was commissioned and financed by the rcmp drew further criticism in the journal open medicine where a commentary described it as being fraught with a host of outright factual inaccuracies and unsubstantiated claims . 42 more than 130 scientists signed a petition endorsing the commentary which also criticized the government s evaluation of insite as distortive and politicized . 38 another commentary in the international journal of drug policy characterized the government s evaluation as what may be a serious breach of international scientific standards . 43 in 2011 the lancet published a study by a team of researchers from the university of british columbia ubc claiming 35 % decreases in overdose deaths around insite due to its presence . in the next issue of the scientific journal an international team of medical doctors affiliated with anti drug organizations demanded the retraction of the study in a letter to the editor . the ensemble headed by gary christian the research director of drug free australia claimed that any decreases in overdose mortality can be sufficiently explained by drug user displacement due to a police crackdown in the area . they claimed that the crackdown with 48 72 added police commencing 6 months before insite opened in the four city blocks around its present location and continuing until this day in an expanded 12 block area around insite initially reduced indicators of drug use and users in the targeted area by 46 % in 2003 . any reductions in crime public drug use and litter should therefore be accorded to policing . 44 the authors reply in the same issue noted that the police crackdown did in fact end a few weeks after the start of the insite project and that decreases after that