Supervised Injection Sites and Needle Exchanges: Why harm reduction matters for public health

By Julia Burpee

“Addiction is a really lonely thing. You think you’re basically the only person on the planet … that’s the way I felt,” says Sean LeBlanc, 37, explaining that five years ago he was homeless and injecting heroin every day.

Harm reduction services helped him recover from his addiction, he says. Safe needle exchanges operated out of community health centres and mobile vans, referrals to addictions treatment, community outreach workers and peer support groups are part of the harm reduction public health model.

Insite: ‘Too early to tell’ if it works?

In the 1990s, Vancouver was Canada’s capital of drug-related crime and home to the fastest-growing AIDS epidemic in North America. Back then, drug users injecting were a common sight in the city’s Downtown Eastside. They were doing so against the backdrop of a changing HIV epidemic in Canada, with the concentration of the disease shifting from men who have sex with men to addicts sharing needles.

Thus, the city on Canada’s west coast was a fitting locale for Insite, the first safe-injection site on the continent. Allowing people to use pre-obtained drugs under medical supervision could potentially reduce the harms associated with this type of drug use—namely, the risk of overdose and infectious diseases such as HIV and hepatitis C.

Why Ottawa needs some Insite

Last week's unanimous Supreme Court decision that allows Vancouver to operate Insite, North America's first supervised injection site, was a victory for harm reduction and a ringing endorsement for a more sensible approach to illicit drug use in Canada. The court battle essentially pitted a highly successful evidence-based program that saves lives, reduces drug use, and connects drug users to health care services against our federal government's commitment to stopping drug use through criminal deterrents.

‘Dark ages thinking’ on harm reduction

While he was deputy chief of the Ottawa Police Service, Larry Hill fought for a harm reduction program for crack addicts – a crack pipe program – calling the prevailing view among police chiefs at the time “dark ages thinking” on harm reduction.

“The time is now” for safe injection sites, says prominent Ottawa doctor

A prominent Ottawa doctor says he’s ready to lead an effort to bring a safe injection site for drug addicts to the nation’s capital. But he’ll have to overcome strong opposition from Ottawa’s mayor and chief of police first.

Harm reduction at home

When Dr. Mark Tyndall moved to Ottawa from Vancouver earlier this year to take up the post of head of infectious diseases at the Ottawa Hospital, he was surprised at what he saw. The overdose rate among injection drug users seemed to be high, although it was difficult to find stats to confirm that, and the rate of HIV transmission was among the highest in the country. In Vancouver, those kinds of issues helped inspire the community to support a safe injection site, Insite, which the Supreme Court of Canada has just ruled should stay open.

Keep Vancouver's Insite open, Supreme Court rules

Vancouver's controversial Insite clinic can stay open, the Supreme Court said Friday in a landmark ruling.

In a unanimous decision, the court ruled that not allowing the clinic to operate under an exemption from drug laws would be a violation of the Charter of Rights and Freedoms.

The court ordered the federal minister of health to grant an immediate exemption to allow Insite to operate.

Cleaner and safer streets. Healthier communities.

The Campaign for Safer Consumption Sites in Ottawa was formed in response to an ongoing health crisis.

Ottawa has Ontario’s highest rate of new HIV infection among injection drug users. 11% of people who inject drugs in Ottawa are infected with HIV, while 70% have contracted hepatitis C. Someone dies of drug overdose every 8 days in our city — deaths that could be prevented with timely medical intervention.

Supervised consumption sites are public health facilities that offer a safe, hygienic place where people can use their own drugs under medical supervision. 

Canada’s first supervised injection site, Insite, has been operating since 2003 in downtown Vancouver. The evidence from Insite  – and from over 90 such sites around the world – proves that supervised consumption sites reduce the spread of diseases such as HIV, prevent overdose deaths, and improve access to addiction treatment programs. They have also been shown to encourage cleaner, safer streets by reducing public drug use and drug equipment litter.

Opening supervised drug consumption sites in Ottawa will:
  • Reduce the spread of HIV and hepatitis-C by providing sterile equipment and safe disposal for used needles
  • Prevent deaths caused by overdose
  • Decrease public drug use and drug-equipment litter
  • Provide access to health and social services, such as first aid treatment and addiction recovery programs


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