Citation

Pike G, Santamaria J, Reece S, Dupont R, Mangham C, Christian G. J. Glob. Drug Policy Pract. 2011; 5(3).

Copyright

(Copyright © 2011, Institute on Global Drug Policy)

DOI

unavailable

PMID

unavailable

Abstract

In an article published in The Lancet on April 18 2011, it was claimed that Vancouver's Insite Supervised Injection Facility, which commenced operations on 21 September 2003, was associated with a 35% decrease in overdose deaths in its immediate surrounding area compared with the rest of Vancouver which had decreases of 9%. However, the article contains serious errors which make that claim unsustainable. The Lancet article's claim that all overdose deaths in Vancouver declined between 2001 and 2005 is strongly influenced by the inclusion of the year 2001, a year of markedly higher heroin availability and overdose fatalities than all subsequent years. A study period starting from 2002 in fact shows an increasing trend of overdose deaths. The higher availability of heroin in 2001 was the subject of two previous journal articles by three of the Lancet article's researchers, but was not acknowledged in this current study. The Lancet article's researchers also failed to mention that 50-66 extra police were specifically assigned to the 12 city blocks surrounding Insite since April 2003 which are a significant part of the target area in which the questionable 35% reduction was said to occur. A change in policing such as this could account for any possible shift in overdose deaths from the vicinity of Insite. Remarkably, three of the Lancet article's researchers had previously published a detailed analysis of the effects of the changed policing, where they described drug users as 'displaced' from the area around Insite. The facility is statistically capable of saving just one life per year from fatal overdose, a reduction which would not be detectable at the population level. This estimate is backed by the European Monitoring Centre's methodology and avoids the error of naively assuming overdose rates in the facility match overdose rates in the community. In their unsubstantiated claim of decreased overdose deaths as a result of Insite's presence, the researchers further failed to mention that 41% of British Columbia's overdose fatalities are not even injection-related, and therefore not relevant to any putative impact Insite may have.

Language: en

Keywords

crime; Australia; Canada; human; suicide; naloxone; drug overdose; cocaine; article; drug legislation; prescription; retrospective study; population research; intravenous drug abuse; methodology; drug fatality; diamorphine; illicit drug; peer review; drug marketing; health hazard; Hepatitis C virus; Human immunodeficiency virus; infection risk; drug traffic; trend study; virus transmission