Insite receives new, four-year Health Canada exemption

“We are encouraged by Health Canada’s willingness to voluntarily move to a multi-year exemption for Insite,” says B.C. Health Minister Terry Lake. “It reflects an understanding of the tremendous value the facility has, and signals that Insite is an important part of health services within the Vancouver community in the eyes of the federal government.”

“Overdose deaths in Vancouver are on the rise, as is the presence of fentanyl in the illicit drug market in Vancouver and throughout B.C.,” says Dr. Patricia Daly, Chief Medical Health Officer at VCH. “Supervised injection services, like those provided at Insite and the Dr. Peter Centre, are needed now more than ever because they save lives and reduce the harms of drug use for people who are actively addicted to injectable drugs.”

Health Canada issued a two-year exemption in January to the Dr. Peter Centre, making it the second such exemption in Canada. Unlike Insite, supervised injection services are restricted to registered clients of the Dr. Peter Centre; they are not available to the public.

Supervised injection services are just one component in a range of harm reduction services offered by VCH and are an important part of a larger strategy to address complex and long-standing problems associated with addiction, disease, mental illness, homelessness and poverty.

Supervised injection sites such as Insite serve as a gateway to treatment, providing not only primary health care services—where clients can receive care for wound infections, tuberculosis and vaccinations for pneumonia and the flu—but also connecting clients to mental health workers and addictions counsellors. Once clients become more engaged with the health care system, they are more likely to pursue detox, addiction counselling and addiction treatment services. Onsite, a 12-room detox facility, is located directly above Insite, and can immediately accommodate clients who are ready to access withdrawal management.

VCH plans to seek further exemptions under Section 56 of the Controlled Drugs and Substances Act to incorporate supervised injection into other existing health care services for those suffering from addiction. By better integrating and connecting available services, VCH is aligning its continuum of care by supporting populations in the Downtown Eastside with seamless access to services including detox and primary health care—priorities in VCH’s Downtown Eastside Second Generation Health Strategy. As part of the new strategy, Insite began to open an hour earlier on Nov.1, 2015 to improve client outcomes by reducing wait times.

Stable access to supervised injections for people with injectable-drug addictions prevents infections, overdose deaths and the spread of disease, such as hepatitis C and HIV, while providing opportunities to engage with vulnerable populations in effective treatment including proper HIV care.

This was also the first time VCH applied for the exemption since the enactment of the Respect for Communities Act (Bill C-2) last year. In order to meet the 27 new conditions for exemption, VCH was required to submit additional volumes of information. In practical terms, these new requirements make it onerous for Insite and other supervised injection services to obtain an exemption. VCH is hopeful the federal government will review and change the legislation developed under the previous government. 

Insite opened in 2003 and since then more than two million injections have been carried out at the facility under the supervision of nurses. There have been no deaths from overdoses at Insite despite more than 1,500 overdose interventions; some of which have included full respiratory arrest. Currently, 600-800 clients per day visit the facility for supervised injections.

Insite is North America’s first legal supervised injection site. Vancouver Coastal Health provides funding, senior administrative and health care workers for the facility. PHS Community Services Society provides administrative and peer support services at Insite through contract with Vancouver Coastal Health.