Vancouver Regional Health Authority Opens North America’s
First Supervised Injection Site
By Clay Adams, ABC
On 21 September 2003, the doors opened to North America’s
first Supervised Injection Site (SIS) Scientific Research
Pilot in Vancouver, British Columbia, Canada. A supervised
injection site (SIS) is a safe, clean facility where users
inject drugs under supervision of clinical staff. Users must
bring their own drugs (none are supplied) and inject themselves
(clinical staff on hand are there to supervise, not guide
or assist). By injecting in a clean, safe location there is
reduced risk of infection through second-hand needles or contaminated
water, and staff can provide medical support in the event
of an overdose incident. Access to counseling and rehab treatment
are also available.
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Vancouver Coastal Health (VCH), one of five
regional health authorities in the Canadian province of British
Columbia, operates the North American site, which is located
in Vancouver’s Downtown Eastside (DTES). The Downtown
Eastside is a neighborhood plagued by poverty, homelessness,
prostitution and crime—all of which contribute to a
relatively high rate of injection drug use and, associated
with it, infectious disease.
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In the City of Vancouver, there are approximately
8,000 intravenous drug users. More than 50 percent of these
are located in the Downtown Eastside. It is a problem that
impacts not just those who are injecting the drugs, but also
results in huge financial costs for the larger health system.
According to the BC Centre for Disease Control, 30-40 percent
of injection drug users in the Downtown Eastside have HIV
and more than 90 percent have hepatitis C. The cost for treating
these conditions is estimated at CDN$150,000 per person, or
more than CDN$700 million, excluding additional costs for
emergency medical intervention for overdoses, infections,
wounds, etc.
 In
March 2003, VCH submitted an application to create an SIS
under new guidelines issued by the federal department of health.
VCH’s media relations team focused on one particular
reporter at Vancouver’s leading and best-read daily
newspaper, The Vancouver Sun. This reporter has a reputation
for accurate reporting on drug use, Vancouver’s DTES
and other injection sites worldwide. With an average daily
circulation of 512,000 and a target readership of educated
men and women between 35-64 years old, the Sun was a key tool
in reaching the wider public with key messages. VCH also worked
closely with the local Chinese media, given its interest in
the SIS from the neighboring Chinatown business community.
Through the execution of a carefully planned media launch,
VCH achieved impressive results. When the Vancouver SIS opened
its doors, site use numbers in the first eight hours of operation
were almost 10 times those of the comparable Australian site,
Kings Cross. On the first full day of operation, the numbers
were 114, as compared to 12 visitors in the first 24-hour
period at Kings Cross. Since then, VCH’s numbers have
continued to climb. After one month of operation, the site
was experiencing an average of 250 injections per day, compared
to the Australian site where, after one month of operation,
the total number of injections was 496. The Vancouver site
is now averaging around 550 injections per day, with heroin
and cocaine being the drugs of choice.
As the nine-month milestone for North America’s first
legal supervised injection site approaches, VCH continues
to attract significant interest. Media calls are constant,
mainly seeking to explore whether or not the site is making
a positive impact on the health of injection drug users and
the safety of the surrounding community. Over the next two
and a half years, evaluators will examine the project to determine
if the scientific data supports the value of such a concept.
Support appears to be growing in the community. Some Chinatown
business leaders have been quoted in local media as claiming
the number of needles on city streets appears to be declining,
and that there is now less visible drug injecting taking place
in public areas.
While the jury is still out on the effectiveness of the Vancouver
SIS in reducing drug use and crime and improving the health
of drug users, other Canadian cities (Victoria, Toronto and
Montreal) are reportedly looking at establishing similar sites
in an effort to address the health issues associated with
illegal drug use in their jurisdictions.
Clay Adams, ABC is Director of Issues Management at Vancouver
Coastal Health, British Columbia, Canada.
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