Evidence seems to support safe injection sites

Advocates and opponents of a plan to set up safe drug consumption sites in King County have been trying to sway voters to their sides ahead of the February vote on Initiative 27, often with contradictory information.

People promoting the sites say similar facilities have helped cut HIV and disease rates as well as prevent overdoses, while those opposed have questioned their effectiveness.

The initiative (I-27), would bar publicly funded consumption sites throughout the county and is being proposed by a group known as Safe King County.

Safe consumption sites are facilities that are staffed by medical professionals where drug users can go to inject, smoke or otherwise use drugs.

The guiding idea behind these facilities is one of harm reduction.

A Harvard study on consumption sites worldwide, of which there were at the time of the report 92, outlined the broad philosophical idea behind harm reduction.

“While traditional drug control policies focus primarily on restricting access to illegal drugs, harm reduction approaches instead emphasize preventing and mitigating ‘negative consequences associated with risky activity,’” it read.

Anna Marie D’Angelo is the spokesperson for Vancouver Coastal Health, which operates the injection site located in the Downtown Eastside of Vancouver, British Columbia.

“We understand that for some people, it’s a black and white issue, they don’t accept harm reduction, but it is scientifically supported,” she said.

Insite provides clean needles, overdose response and an open door for people to get into the treatment facility located directly above Insite, known as Onsite.

Dr. M-J Milloy, a research scientist for the B.C. Center on Substance Use and an assistant professor of medicine at the University of British Columbia, said Insite has proved to be a success.

“There may be arguments against Insite, however, these arguments are not based in medical evidence because, indeed, the scientific evidence is clear,” he said.

Insite was set up to reduce the risk of contracting diseases like HIV, reducing the risk of overdose and to increase the use of medical care, including addiction treatment, Milloy said.

In a 2005 study published in the medical journal Lancet, Milloy said it was found that people who use the facility were 70 percent less likely to share needles than people who were not using it.

Insite could look very much like ones that may be set up in King County.

Last year, the King County Council directed a task force to study ways to fight the opioid epidemic that has been sweeping the country in recent years.

Among many other recommendations, the task force recommended establishing two safe injection sites.

Proponents of I-27 say they support the other measures in the task force’s recommendation, like increasing treatment options, but are opposed to the sites.

They have cited concerns over the possibility of an increase in crime, the aesthetics of the Insite neighborhood based on driving around it and concerns that not enough users enter into treatment.

Most of these claims have not been backed up by provided data, and an email sent to the I-27 campaign for documentation backing their concerns was not returned by the time of publication. The campaign’s website is also barren of any supporting documentation.

Insite has received either neutral or positive results from multiple studies conducted since it was opened in 2003.

Many critics of the sites say the condition of the Downtown Eastside neighborhood in Vancouver is proof that the consumption sites increase crime and a concentration of drug users.

D’Angelo said this isn’t a correct assumption.

The neighborhood is roughly a 10-block radius with one of the poorest postal codes in a Canadian urban center. It has a long history of people with mental illness and drug addiction living there, she said.

This partially stems from the climate in Canada, making Vancouver one of the only places in the country where the homeless can live all year.

This has led to a concentration of both homeless peoples and drug use well predating Insite.

“It is meeting a need, it is not creating a need,” D’Angelo said.

Insite is equipped with oxygen and the overdose-reversing drug called naloxone, which can resuscitate people who are overdosing on opioids like heroin.

In recent years, however, up to 90 percent of the drugs Insite has tested for users have registered as being cut with fentanyl, a synthetic opioid many times stronger than heroin.

Consequently, D’Angelo said overdoses have increased from 30 a month to nearly eight every day.

Without Insite, the body count for the epidemic would likely be higher, especially in the Downtown Eastside neighborhood.

According to a study in The Lancet journal, published in 2011 before the fentanyl epidemic started, there was already a 35 percent reduction in overdoses in the vicinity of Insite. This was compared to a 9.3 percent reduction in other parts of Vancouver.

According to MyNorthwest, 359 people died of overdoses in King County in 2016, with more than 61 percent of them stemming from opioid use.

D’Angelo pointed to the fact that of the 3.5 million drug injections that have occurred at Insite since it opened, there have been no deaths.

Critics of safe consumption sites have also claimed that only a small percentage of people who use Insite end up in the treatment center Onsite.

A report by King County noted that of safe consumption sites worldwide, there were no significant increases in locals who injected drugs, were on methadone therapy to get off opioids and no increase in relapse rates.

There was also no significant reduction in the number of people injecting drugs.

But harm reduction doesn’t just mean getting people clean at first, it means helping to prevent the spread of co-morbid diseases like HIV.

According to the B.C. Centre for Excellence in HIV/AIDS, as quoted in the Canadian Macleans magazine, the outbreak of HIV in Vancouver prior to the opening of Insite was “the most explosive epidemic of HIV infection that has been observed outside of sub-Saharan Africa.”

Milloy said in the years following 1996 while the outbreak was in its peak, the number of drug users who injected with HIV jumped from 2 percent to more than 25 percent.

One study published by the Medical College of Wisconsin in 2010, said Insite could prevent around 80 infections each year, or around 50 percent of the total, with millions in health care savings.

Milloy said there had been a reduction in new HIV infections year-over-year, in part due to the clean needles provided by Insite.

“That’s been the result not only of Insite, which has reduced the likelihood that drug users share the number of drug needles, but also other public health intervention,” he said.

However, the extent to which these numbers can be trusted was called into question by another study, although it did say Insite prevented some infections.

But Milloy said the value of a facility like Insite has been thoroughly vetted by the medical community.

“Since the facility opened in 2003, the scientific evaluation has published dozens of studies, including studies in top medical journals… which have shown the positive benefits of the facility on people who use drugs,” he said.

He said this was validated when the conservative government took Insite to court. The case ended up in front of the Canadian Supreme Court in 2011, where Milloy said when lawyers opposed to the facility were asked for scientific evidence contradicting the effectiveness of Insite, they couldn’t provide any.

The Canadian Supreme Court voted unanimously to keep Insite open.

“Based on evidence? No,” Milloy said. “There is not any scientific evidence that I’m aware of that contradicts our findings that Insite has a beneficial impact on the health and well-being of the people who use drugs.”

Aside from costs associated with disease, overdoses themselves can be expensive, D’Angelo said.

Treating people at Insite instead of at an emergency room is much cheaper due to first responders not being called to the scene automatically.

“That’s a huge, huge draw on your first responders, which are paid through taxpayer dollars,” she said.

There was not a substantial increase in crime in the neighborhood in the years following when Insite was opened, according to The Globe and Mail.

D’Angelo also drove home that point, saying when the site was first proposed, some neighbors and businesses were opposed to it.

But as the site continued to operate, many neighbors and local businesses accepted it, she said.

“The reality is,” Milloy said. “People use drugs via injection, and either we provide them a supervised, hygienic location to do drugs, or they will do drugs in unhygienic conditions with no supervision and more of them will die.”

If two consumption sites are approved by the King County Council, one would be located in Seattle and the other elsewhere.

The Capitol Hill neighborhood in Seattle has already show interest in hosting one location.

Cities were given the option to ban the sites as well, and so far five cities in the county have voted to either permanently or temporarily bar the sites from setting up.

I-27 will be presented to King County voters on the February special election ballot.