Harm reduction: keeping the public's health in sight.

The article by Harvard et al. (in this issue of the Journal) on the distribution of harm reduction products in British Columbia provides an opportunity to revisit the recent controversy surrounding Insite, the Vancouver safe injection facility. Started in 2003, Insite is North America’s first legal supervised injection site. Funded by the BC Ministry of Health and operated by Vancouver Coastal Health in partnership with Portland Hotel Society Community services, Insite is one of this country’s important public health successes. Each year, over a quarter of a million visits are registered by over 10,000 individuals for clean and medically supervised drug injection. Insite targets marginalized populations and decreases needle sharing, prevents mortality from overdose, decreases harmful drug-related behaviours and offers both primary health care and addiction counseling and treatment to its clients. In particular, because HIV and hepatitis C infections are endemic among IV drug users (18% and 87%, respectively, of Insite clients), decreasing the risk of transmission is a public health no-brainer. However, the public’s health is at risk of being overtaken by opposition to Insite voiced at the Canadian Medical Association meeting in Montreal last August by the then federal Minister of Health. Although the BC Supreme Court recently extended Insite’s exception to the Controlled Drugs and Substances Act, this decision is being appealed by the federal government which has stated that it would like to see Insite closed. There is strong and consistent evidence that harm reduction strategies have substantial benefits for the health of high-risk, marginalized and hard-to-reach populations. In particular, several independent scientific evaluations by the BC Centre for Excellence in HIV/AIDS have shown not only that Insite has had an important public health impact since its opening, but also that the feared potential increase in crime rates, drug abuse and drug dealing in the community failed to materialize. 1 Quite to the contrary, there was a 30% increase in detoxification service use among Insite clients and no change in drug-related crimes was reported by the police after introduction of the facility. Decision makers sometimes assert that research results are not informative enough to support policy making. In this case, there are ample research results, as well as local community endorsement, in support of a clear-cut, evidence-based policy. Public health must speak loudly and of one voice in support of Insite and for extending this effective intervention model to other high-risk areas in Canada.