hc-sc dot gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng dot php

Reducing the Transmission of Blood-Borne Viral Infections & Other Injection Related Infections

"Self-reports from users of the INSITE service and from users of SIS services in other countries indicate that needle sharing decreases with increased use of SISs. Mathematical modeling, based on assumptions about baseline rates of needle sharing, the risks of HIV transmission and other variables, generated very wide ranging estimates for the number of HIV cases that might have been prevented. The EAC were not convinced that these assumptions were entirely valid.

SISs do not typically have the capacity to accommodate all, or even most injections that might otherwise take place in public. Several limitations to existing research were identified including:

Caution should be exercised in using mathematical modelling for assessing cost benefit/effectiveness of INSITE, given that:

There was limited local data available regarding baseline frequency of injection, frequency of needle sharing and other key variables used in the analysis;

While some longitudinal studies have been conducted, the results have yet to be published and may never be published given the overlapping design of the cohorts;

No studies have compared INSITE with other methods that might be used to increase referrals to detoxification and treatment services, such as outreach, enhanced needle exchange service, or drug treatment courts.

Some user characteristics relevant to understanding their needs and monitoring change have not been reported including details of baseline treatment histories, frequency of injection and frequency of needle sharing.

User characteristics and reported changes in injection practices are based on self-reports and have not been validated in other ways. More objective evidence of sustained changes in risk behaviours and a comparison or control group study would be needed to confidently state that INSITE and SISs have a significant impact on needle sharing and other risk behaviours outside of the site where the vast majority of drug injections still take place."

"It has been estimated that injection drug users inject an average six injections a day of cocaine and four injections a day of heroin. The street costs of this use are estimated at around $100 a day or $35,000 a year. Few injection drug users have sufficient income to pay for the habit out through employment. Some, mainly females get this money through prostitution and others through theft, break-ins and auto theft. If the theft is of property rather than cash, it is estimated that they must steal close to $350,000 in property a year to get $35,000 cash. Still others get the money they need by selling drugs."

seattletimes dot com/seattle-news/health/is-vancouvers-safe-drug-use-site-a-good-model-for-seattle/

"Although Insite is paired with a drug-treatment center, called Onsite, Berner and other critics point out that completion rates are low. Of the 6,500 people who visited Insite last year, 464 were referred to Onsite’s detox center. Of those, 252 finished treatment."