Supervised Injection Sites for Alberta

Lyndon Woytuck, BSc

Why?• Interviews with Edmonton inner-city drug users in 2014 found 90%

had injected drugs in last 6 months, 80% had injected in public and 26% had shared needles• A safe injection clinic would save lives

“When people inject in public, they basically increase every risk associated with injecting drugs. That's because people who are injecting on the streets or alleys or bathrooms typically don't have access to sterile supplies. They don't have access to sterile water that's necessary for injecting and they're more likely as a result to potentially share needles.”

Elaine Hyshka, School of Public Health at the University of Alberta

The Canadian West: Two Provinces

British Columbia• Population 4,400,057• Urban population 86%• Life expectancy at birth: 81.12 years• 19% of new HIV infections (72 new

infections) are in injectable users

Alberta• Population 3,645,257• Urban population 83%• Life expectancy at birth: 80.7 years• 17% of new HIV infections (42 new

infections) are in injectable users

People who inject drugs represent 0.3% of the Canadian population13,960 (19%) people living with AIDS have used injection drugs (IDU) Total direct costs of HIV/AIDS in IDUs are about $114 million a year

Map of population density in Canada, 2006

Edmonton

Vancouver

HIV/AIDS costs• In Canada, IDUs are 59 times more likely to get HIV• New HIV infections in Aboriginal people (45%) and women (21%) are IDU

related; trending towards vulnerable populations

“The dollar cost of preventing a case of HIV/AIDS is only a fraction of the cost of treating and caring for someone once he or she becomes infected”

• The loss in human capital is greater for HIV/AIDS than for any other cause of death (car accidents, suicide, stroke and heart attack), because it claims its victims at a younger age• Indirect costs estimated 2.4 times the direct costs

Intervention• Supervised injection sites

• access to health and addiction care; reduce overdose fatalities; reduce transmission of injection related infections; and improve public order

• 4 proposed sites in inner city Edmonton (capital) • New HIV incidence 7.9/100,000 persons per year (AB average 5.7)

• Uptake and effectiveness in BC• Over 8,000 people have visited INSITE to inject drugs; 18% or 1,506 people account for

86% of the overall visits• < 5% of all inner city injections, but > 220,000 injections in total

• Reduction in overdose mortality• over 336 overdose interventions since 2006 • INSITE saves about one life a year

Benefits of Intervention• Vancouver's INSITE prevents 35 new cases of HIV and almost 3 deaths each year.

societal benefit > $6 million per year after costs• average benefit-cost ratio of 5.12:1.

• # potentially prevented new HIV infections• prevention of up to 78% new cases in geographic area served 19 new cases of 100 (25 IDU) in Edmonton (2015)

• $ saved in preventing direct and indirect costs• $150 000 mean lifetime cost of HIV per person, assuming 17-year survival• Fatal losses to society of $500 000 (HIV infection) estimated 1 per year (5%)• or $660 000 (fatal overdose) estimated 1 per year (2%)

• Assuming retirement at 65, there are 30 years of lost productivity/wages from an overdose death. In HIV, there are 20 years of lost productivity/wages, as expected survival of newly infected IDUs is 10 years

• $1.5 million cost per site with >$4 million in cost savings per year

Evaluation• Structure

• Provincial government funding supported by municipal government and police• Full integration with social and outreach services• Distribution targeting of vulnerable groups• Alberta Health Services to supervise and educate

• Process• Info distribution by newspapers, radio, television, and local healthcare• Scheme initiation and maintenance• Monitor use by user survey at point of service and households in community

• Outcome• Reduction in infection rate of HIV/HCV and drug related mortality• Increase in citizen education and awareness• Less money spent on drug related overdose treatment and complications of infection

References• Safe injection site planned for Edmonton By Radio Active, CBC News Posted: Mar 22, 2016 7:08 AM MT Last

Updated: Mar 22, 2016 7:08 AM MT http://www.cbc.ca/news/canada/edmonton/safe-injection-site-planned-for-edmonton-1.3501765

• Keven Drews B.C. safe-injection site applies to Health Canada for drug law exemption, The Canadian Press Published Friday, February 14, 2014 6:23AM EST http://www.ctvnews.ca/canada/b-c-safe-injection-site-applies-to-health-canada-for-drug-law-exemption-1.1686054

• Canadian Alcohol and Drug Use Monitoring Survey 2012 http://hc-sc.gc.ca/hc-ps/drugs-drogues/stat/_2012/summary-sommaire-eng.php#s4

• Challacombe L The epidemiology of HIV in people who inject drugs in Canada Author(s): Published: 2017 http://www.catie.ca/fact-sheets/epidemiology/injection-drug-use-and-hiv-canada

• Statistics Canada http://www.statcan.gc.ca/ • Vancouver's INSITE service and other Supervised injection sites: What has been learned from research?

Final report of the Expert Advisory Committee Mar 31 2008 http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php

• Andresen MA1, Boyd N. Int J Drug Policy. A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility. 2010 Jan;21(1):70-6. doi: 10.1016/j.drugpo.2009.03.004. Epub 2009 May 6.