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Supervised Drug Injection Clinic in Vancouver Finds Success

A counterintuitive approach to addiction in “Canada’s poorest postal code.”
The Downtown Eastside neighborhood of Vancouver, Canada. (PHOTO: PUBLIC DOMAIN)

The Downtown Eastside neighborhood of Vancouver, Canada. (PHOTO: PUBLIC DOMAIN)

When the 2010 Winter Olympics shone the international spotlight on sleek and modern Vancouver, some of the light also spilled onto Downtown Eastside, a particularly troubled neighborhood blocks away from the opening ceremony.

“Methamphetamine and crack-cocaine users shoot up on the street yards from a police station,” wrote the Guardian a month before the Games began, and quoted homeless people there as being worried about being victims of “The clean-up.” NPR called it “the original ‘Skid Road’” and mentioned that its reputation still suffered from a notorious serial killer who roamed free for decades. A New York Timesreporter depicted a Tuesday afternoon there: one man openly smoking a crack pipe, another man urinating on a wall, two more fighting in the street. All three media outlets referred to Downtown Eastside as “the poorest postal code in Canada.”

What better place for a radical approach to public health?

A new study by the B.C. Centre for Excellence in HIV/AIDS of drug use over 15 years in Downtown Eastside has found that public health improved, and drug use actually dropped, when the city opened a safe-injection clinic, reports The Globe and Mail.

“A public health emergency was declared here because we saw the highest rates of HIV infection ever seen outside of sub-Saharan Africa—in this community,” said Dr. Thomas Kerr, co-director of the Urban Health Research Initiative and one of the authors of the report, in a presentation of his findings. “At the same time, the community was being leveled by an overdose epidemic.”

So, in 2003, Vancouver responded to the crisis with an aggressive “harm reduction” strategy, which included the opening of Canada’s first supervised injection site (which we've previously written about both here and here). According to the study, this approach appears to have made headway:

There were fewer people sharing needles in 2011, and there were fewer new infections of HIV and Hepatitis C related to sharing needles, the study found.

In 1996, almost 40 per cent of drug users reported sharing needles, but by 2011, that had dropped to 1.7 per cent. About 25 per cent of Vancouver’s drug users are HIV positive, and about 90 per cent suffer from Hepatitis C.

Drug users were more healthy overall, and more of them were seeking treatment at methadone clinics, the study found.

Unfortunately, the gains were only limited to injection drugs; perhaps the city’s drug of choice has shifted. In the time period in question, mortality rates among drug users overall has only dropped slightly, and there was actually an increase in crystal meth use in the city.

So ... will Downtown Eastside see a crystal meth dispensary next?

Probably not. The Globe and Mail continues:

Earlier this month, the federal government introduced the Respect for Communities Act, which will require applicants of drug injection sites to consult with the community, provincial and municipal authorities and law enforcement officials, before setting up new facilities.


The Supreme Court of Canada ordered the Conservatives to keep the Vancouver clinic open, despite their objections, but proponents of the site say the federal legislation would make it almost impossible to open another.

Vancouver isn’t the first city to see positive results from a supervised injection experiment. Several clinical trials run by the National Addiction Centre at Kings College London over the past 15 years have shown that supervised “medical grade” heroin injection can be far more effective in treating otherwise-persistent addicts who aren’t responding to methadone or other treatment options.

But in order for these programs to thrive, of course, policy has to align with science. Dr. Thomas Kerr, who co-authored the Vancouver report, also commented on the London trials, where he and his colleagues mentioned similar programs in Australia and Switzerland that had been shut down prematurely.

“History tells us that availability of heroin prescription can be dictated more by special interests and politics than evidence,” they wrote.