Canada’s first supervised consumption site celebrates 20 years of saving lives
When Insite opened in September 2003, it wasn’t just the first sanctioned site in North America for supervised injection. It was a paradigm shift. People who used illicit drugs could walk into a welcoming space with trained staff and nurses on hand to respond to overdoses, deal with immediate health issues, and provide referral to addiction treatment. Participants could sit together over a coffee in the chill room, staffed by peers. The impact was profound: overdose deaths were averted, the rates of HIV and hepatitis C due to shared needles went down, and the number of people connected to health-care and recovery went up.
“With the unregulated drug supply becoming more and more toxic, the risk to people in the community has grown exponentially worse in the years since 2003. As a result we’ve had to evolve the harm reduction services we’re offering at Insite and in the community because they are needed now more then ever,” said Dr. Patricia Daly, Chief Medical Health Officer at Vancouver Coastal Health (VCH).
Co-managed by VCH and PHS Community Services Society, Insite is a front-line, harm reduction service for people who use drugs and may be reluctant to access health-care services, as well as a hub for community connections. Services offered by Insite include drug checking; supervised consumption; immunizations, wound care, opiate agonist therapy and referral to specialists; support with basic needs; case management; system navigation; support accessing housing; medication support; connection to cultural services, and more. Located above Insite is Onsite. Every weekday, two or three people transition from supervised drug consumption at Insite to substance use stabilization at Onsite. It offers a 12-bed, medically-supported substance use stabilization floor an 18-bed transitional housing floor that provides ongoing recovery support, and a modest temporary housing subsidies program that supports residents to transition back into the community.
“We now have more than 20 years of data that shows Insite saves lives. It does this directly, by reversing overdoses, and in less obvious ways, by providing access to health care and social supports,” Micheal Vonn, CEO of PHS Community Services Society. “Insite brings stability to chaotic lives. It provides a pragmatic approach to a complex social and medical issue.”
By the numbers (since the Insite database was implemented in 2004):
- Total number of visits: 4,602,125
- Total injection room visits: 2,924,473
- Overdoses reversed: 11,856
- Referrals to services provided offsite: 71,103
- Toxic drug/overdose deaths: zero
Over the course of 20 years, both the problem and the services provided have evolved. In 2003, the staff were mostly preventing overdoses by supervising clients’ use of heroin. Today, heroin is rarely available in the unregulated drug supply. The harm reduction services provided at Insite today are to prevent harms and death caused by the unpredictable toxicity of the unregulated drug supply.
“We’re not really talking about overdoses in 2023. That word suggests people know what they’re using and how potent it is, but they’re taking too much of it. That’s no longer the problem,” said Guy Felicella, a former client of Insite. “Now the problem is the drugs people think they’re using — opioids or stimulants — are contaminated with unknown, harmful substances, or the potency is unknown.” Felicella was one of the first through the door when Insite opened, and he credits it with saving his life. Now married with three kids, he works as a Peer Clinical Advisor for both Vancouver Coastal Health and the BC Centre on Substance Use, and is an in-demand harm reduction public speaker. He spent two decades using drugs in the Downtown Eastside. “They counted me visiting Insite more than 4,000 times over 10 years,” he said. “That place never enabled my addiction, it enabled my life so I was able to figure it out.
“The thing about harm reduction is that it builds trust. That’s a powerful thing when you are using substances. You need someone to be supportive of you, to be willing to build a relationship. And that’s what Insite does.”
Dr. Thomas Kerr, Director of Research, BC Centre on Substance Use; Head of the Division of Social Medicine in the Department of Medicine at the University of British Columbia (UBC)
"Two decades ago, when we began our independent scientific evaluation of Insite, there was tremendous pushback against this type of service despite being in the midst of an HIV epidemic. While we observed many benefits — including reducing fatal overdose and infectious disease transmission — it was the absence of anticipated negative outcomes that surprised many in the community. Our research found that Insite didn’t make drug use patterns or crime in the community worse and, in fact, people were going to abstinence-based programs at a higher rate than before Insite opened. The findings are consistent with what has been observed in jurisdictions around the world — an important reminder as we once again hear anti-science arguments against health services for people who use drugs.”
Dr. Bonnie Henry, Provincial Health Officer, British Columbia
“Insite has been a beacon of hope for people who use drugs in the Downtown Eastside community, and we acknowledge with gratitude the incredible work of all the clinicians, peers, and support workers who have made such a tremendous difference in the lives of so many. Now more than ever, we need to build on what we have learned through Insite about the importance of a safe place for people who use drugs to make those live-saving connections.”
Jennifer Whiteside, Minister of Mental Health and Addictions
"Two decades ago, InSite opened its doors with a clear vision: to save lives and connect people living with substance use challenges with vital resources to support them in their journey to recovery. This shook the world at the time and InSite continues to adapt and innovate to meet the needs of the people it serves. Congratulations on this important milestone, and the remarkable work accomplished to date. ”
Vancouver Coastal Health is committed to delivering exceptional care to 1.2 million people, including the First Nations, Métis and Inuit in our region, within the traditional territories of the Heiltsuk, Kitasoo-Xai'xais, Lil'wat, Musqueam, N'Quatqua, Nuxalk, Samahquam, shíshálh, Skatin, Squamish, Tla'amin, Tsleil-Waututh, Wuikinuxv, and Xa'xtsa. VCH is British Columbia’s hub of health-care innovation, research and academic excellence, providing specialized care to patients throughout the province. Learn more at vch.ca.
PHS Community Services Society provides housing, healthcare, harm reduction and health promotion for some of the most under-served people in Vancouver and Victoria. We are North American leaders in low barrier housing and harm reduction. PHS operates more than 1,600 units of supportive housing, along with programs and clinical services for marginalized communities. We provide safe consumption sites for people who use drugs, and community programming that includes a medical clinic, affordable dentistry and a credit union branch.