Ehsan Jozaghi

Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada?

BackgroundThis article reports qualitative findings from a sample of 31 purposively chosen injection drug users (IDUs) from Vancouver, Surrey and Victoria, British Columbia interviewed to examine the context of safe injection site in transforming their lives. Further, the purpose is to determine whether the first and only Supervised injection facility (SIF) in North America, InSite, needs to be expanded to other cities.MethodsSemi-structured qualitative interviews were conducted in a classical anthropological strategy of conversational format as drug users were actively involved in their routine activities. Purposive sampling combined with snowball sampling techniques was employed to recruit the participants. Audio recorded interviews were transcribed verbatim and analyzed thematically using NVivo 9 software.ResultsAttending InSite has numerous positive effects on the lives of IDUs including: saving lives, reducing HIV and HCV risk behavior, decreasing injection in public, reducing public syringe disposal, reducing use of various medical resources and increasing access to nursing and other primary health services.ConclusionsThere is an urgent need to expand the current facility to cities where injection drug use is prevalent to reduce overdose deaths, reduce needle sharing, reduce hospital emergency care, and increase safety. In addition, InSite’s positive changes have contributed to a cultural transformation in drug use within the Downtown Eastside and neighboring communities.

The Point of Diminishing Returns: An Examination of Expanding Vancouver’s Insite

North America’s only government-sanctioned supervised injection facility, Insite, has been subjected to substantial research. This research has found evidence for numerous public health benefits: decreased risky injection behaviour, decreased fatal overdoses, increased probability of initiating and maintaining addiction treatment, and cost-effectiveness. To date, a small number of costing studies have emerged with none of them investigating Insite expansions. Such an analysis is reported in this paper and it is found that, based on benefit–cost ratios, Insite should be expanded. However, this expansion is dependent on altering injection drug user behaviour outside Insite.

A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada

BackgroundSmoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)—operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years—costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada.MethodsThe data pertaining to the attendance at the SSF was gathered in 2012–2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver’s Downtown Eastside (DTES).ResultsThe DTES SSF’s benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from

The role of drug users’ advocacy group in changing the dynamics of life in the Downtown Eastside of Vancouver, Canada

1,705 to

A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA

97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD

Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection

1.8 million dollars in taxpayer’s money.ConclusionsFunding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.

Morality versus the scientific evidence: the story behind Bill C-2

The Downtown Eastside (DTES) of Vancouver, Canada, has been the epicentre of HIV and drug overdose related to injection drug users (IDUs) since the mid 1990s. In response to growing government inaction, a drug user-run organization known as Vancouver Area Network of Drug User (VANDU) was formed. This study was conducted to capture the genesis and influence of VANDU over the past 14 years in shaping the neighbourhood. Semi-structured qualitative interviews were conducted with purposively chosen sample of 11 VANDU board members and those attending the services. Interviews were transcribed verbatim and analysed thematically using NVivo 9 software. Participants’ narratives indicate that VANDU has been instrumental in improving conditions of the DTES, altering the risky injection behaviour of its members. Moreover, VANDU has given a voice to the most marginalized members of society who otherwise would not be represented. Findings from this study highlight the important role that a drug user organization can play in creating new physical and conceptual space.

A Case Study of the Transformative Effect of Peer Injection Drug Users in the Downtown Eastside of Vancouver, Canada

Supervised injection facilities (SIFs) have been shown to reduce infection, prevent overdose deaths, and increase treatment uptake. The United States is in the midst of an opioid epidemic, yet no sanctioned SIF currently operates in the United States. We estimate the economic costs and benefits of establishing a potential SIF in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing SIFs. We consider potential savings from five outcomes: averted HIV and hepatitis C virus (HCV) infections, reduced skin and soft tissue infection (SSTI), averted overdose deaths, and increased medication-assisted treatment (MAT) uptake. We find that each dollar spent on a SIF would generate US

Is there a role for potential supervised injection facilities in Victoria, British Columbia, Canada?

2.33 in savings, for total annual net savings of US

The Potential Role for Supervised Injection Facilities in Canada’s Largest City, Toronto:

3.5 million for a single 13-booth SIF. Our analysis suggests that a SIF in San Francisco would not only be a cost-effective intervention but also a significant boost to the public health system.