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Supervised Injecting / Insite

Insite evaluation publications      Supervised injecting publications (general)

Insite research - summary:  English   French

Insite research - full report:  English   French


 Supervised injecting facilities, where injection drug users can inject illicit drugs under medical supervision, have been in operation in European cities for decades. The primary purposes of these facilities are to reduce the acute risks of disease and overdose death associated with injection drug use, to connect drug users to available addiction treatment and other health and social services, and to reduce public drug use, discarded needles and other related public order problems. Typically, such facilities provide drug users with sterile injecting equipment, emergency care in the event of overdose, primary medical care and referral to addiction treatment services.

In North America, Vancouver's Downtown Eastside has been for many years an epicentre of public injection drug use and its related harms. In response, affected communities called for the establishment of supervised injecting facilities in Vancouver and, in September 2003, Insite was opened as a pilot study – the first of its kind in North America. The legal exemption by the Canadian government that would allow the facility to operate for a three-year trial period was granted on condition that a rigorous external scientific evaluation of its impacts be conducted.

A team of scientists led by UHRI principal investigators Thomas Kerr and Evan Wood was chosen to conduct this evaluation. To date, UHRI researchers have published the findings of their studies in more than two dozen papers in the world's top peer-reviewed scientific and medical journals.

In short, the evaluation has found that Insite has had an overall positive impact on the community in which it is located. Specifically, Insite has:

  • Reduced the kinds of drug using behaviours that increase the risk of HIV transmission and overdose death
  • Led to increased use of addiction treatment services among the people who inject at Insite
  • Reduced the amount of public injecting
  • Not led to an increase in injection drug use
  • Not led to an increase in drug-related crime

Publications from the Scientific Evaluation of Supervised Injecting (SEOSI)

  • Lloyd-Smith E, Tyndall M, Zhang R, Grafstein E, Sheps S, Wood E, Montaner J, Kerr T. Determinants of cutaneous injection-related infections among injection drug users at an emergency department. Open Infectious Diseases, 2012; 6(1): 5-11.
  • Small W, Moore D, Shoveller J, Wood E, Kerr T. Perceptions of risk and safety within injection settings: Injection drug users’ reasons for attending a supervised injecting facility in Vancouver, Canada. Health, Risk & Society, 2012; 14(4): 307-324.
  • DeBeck K, Kerr T, Lai C, Buxton J, Montaner J, Wood E. The validity of reporting willingness to use a supervised injecting facility on subsequent program use among people who use injection drugs. American Journal of Drug and Alcohol Abuse, 2012; 38(1): 55-62. PubMed
  • Reddon H, Wood E, Tyndall M, Lai C, Hogg R, Montaner J, Kerr T. Use of North America’s first medically supervised safer injecting facility among HIV-positive injection drug users. AIDS Education and Prevention, 2011; 23(5): 412-422. PubMed
  • Small W, Shoveller J, Moore D, Tyndall M, Wood E, Kerr T. Injection drug users’ access to a supervised injection facility in Vancouver, Canada: The influence of operating policies and local drug culture. Qualitative Health Research, 2011; 21(6): 743-756. PubMed Summary
  • Small W, Ainsworth L, Wood E, Kerr T. IDU perspectives on the design and operation of North America’s first medically supervised injection facility. Substance Use & Misuse, 2011; 46(5): 561-568. PubMed Summary
  • Debeck K, Kerr T, Bird L, Zhang R, Marsh D, Tyndall M, Montaner J, Wood E. Injection drug use cessation and use of North America’s first medically supervised safer injecting facility. Drug and Alcohol Dependence, 2011; 113(2-3): 172-176. PubMed Summary
  • Milloy MJS, Kerr T, Zhang R, Tyndall M, Montaner J, Wood E. Inability to access addiction treatment and risk of HIV infection among injection drug users recruited from a supervised injection facility. Journal of Public Health, 2010; 32(3): 342-349. PubMed Summary
  • Milloy MJS, Wood E, Tyndall M, Lai C, Montaner J, Kerr T. Recent incarceration and use of a supervised injection facility in Vancouver, Canada. Addiction Research & Theory, 2009; 17(5): 538-545.
  • Small W, Van Borek N, Fairbairn N, Wood E, Kerr T. Access to health and social services for IDU: The impact of a medically supervised injection facility. Drug and Alcohol Review, 2009; 28(4): 341-346. PubMed Summary
  • Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montanter JSG, Kerr T. Determinants of cutaneous injection-related infection care at a supervised injecting facility. Annals of Epidemiology, 2009; 19(6): 404-409. PubMed
  • Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montaner JSG, Kerr T. Risk factors for developing a cutaneous injection-related infection among injection drug users: a cohort study. BMC Public Health, 2008; 8(1): 405. PubMed Summary
  • Fast D, Small W, Wood E, Kerr T. The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility. Harm Reduction Journal, 2008; 5(1): 32. PubMed Summary
  • Milloy MJ, Kerr T, Tyndall M, Montaner J, Wood E. Estimated drug overdose deaths averted by North America’s first medically-supervised safer injection facility. PLoS ONE 2008; 3(10): e3351. PubMed Summary
  • Marshall B, Wood E, Zhang R, Tyndall M, Montaner JS, Kerr T. Condom use among injection drug users accessing a supervised injecting facility. Sexually Transmitted Infections, 2009; 85(2): 121-126. PubMed Summary
  • Small W, Wood E, Lloyd-Smith E, Tyndall M, Kerr T. Accessing care for injection-related infections through a medically supervised injecting facility: A qualitative study. Drug and Alcohol Dependence. 2008; 98(1-2): 159-162. PubMed Summary
  • Richardson L, Wood E, Zhang R, Montaner J, Tyndall M, Kerr T. Employment among users of a medically supervised safer injection facility. American Journal of Drug and Alcohol Abuse, 2008; 34(5): 519-525. PubMed Summary
  • Fairbairn N, Small W, Shannon K, Wood E, Kerr T. Seeking refuge from violence in street-based drug scenes: Women’s experiences in North America’s first supervised injection facility. Social Science & Medicine, 2008; 67(5): 817-823. PubMed Summary
  • DeBeck K, Wood E, Zhang R, Tyndall M, Montaner J, Kerr T. Police and public health partnerships: Evidence from the evaluation of Vancouver’s supervised injection facility. Substance Abuse Treatment, Prevention, and Policy, 2008; 3: 11. PubMed Summary
  • Wood RA, Wood E, Lai C, Tyndall MW, Montaner JS, Kerr T. Nurse-delivered safer injection education among a cohort of injection drug users: Evidence from the evaluation of Vancouver’s supervised injection facility. International Journal of Drug Policy, 2008; 19(3): 183-188. PubMed Summary
  • Milloy MJS, Kerr T, Mathias R, Zhang R, Montaner JS, Tyndall Mark, Wood E. Non-fatal overdose among a cohort of active injection drug users recruited from a supervised injection facility. American Journal of Drug and Alcohol Abuse, 2008; 34(4): 499-509. PubMed Summary
  • Stoltz JA, Wood E, Miller C, Small W, Li K, Tyndall MW, Montaner J, Kerr T. Characteristics of young illicit drug injectors who use North America’s first medically supervised safer injecting facility. Addiction Research & Theory, 2007; 15(1): 63-69.
  • Petrar S, Kerr T, Tyndall MW, Zhang R, Montaner JS, Wood E. Injection drug users’ perceptions regarding use of a medically supervised safer injecting facility. Addictive Behaviors, 2007; 32(5): 1088-1093. PubMed
  • Stoltz JA, Wood E, Small W, Li K, Tyndall MW, Montaner JSG, Kerr T. Changes in injecting practices associated with the use of a medically supervised safer injection facility. Journal of Public Health, 2007; 29(1): 35-39. PubMed
  • Kerr T, Tyndall M, Zhang R, Lai C, Montaner J, Wood E. Circumstances of first injection among illicit drug users accessing a medically supervised safer injecting facility. American Journal of Public Health, 2007; 27(7): 1228-1230. PubMed
  • Wood E, Tyndall MW, Zhang R, Montaner JS, Kerr T. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction, 2007; 102(6): 916-919. PubMed
  • McKnight I, Maas B, Wood E, Tyndall MW, Small W, Lai C, Montaner JS, Kerr T. Factors associated with public injecting among users of Vancouver’s supervised injection facility. American Journal of Drug and Alcohol Abuse, 2007; 33(2): 319-325. PubMed
  • Kerr T, Small W, Moore D, Wood E. A micro-environmental intervention to reduce the harms associated with drug-related overdose: Evidence from the evaluation of Vancouver’s safer injection facility. International Journal of Drug Policy, 2007; 18(1): 37-45. PubMed
  • Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. Attendance, drug use patterns, and referrals made from North America’s first supervised injection facility. Drug and Alcohol Dependence, 2006; 3(27): 193-198. PubMed
  • Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E. Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy, 2006; 17(5): 436-441.
  • Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. Canadian Medical Association Journal, 2006; 175(11): 1399-1404. PubMed
  • Wood E, Tyndall MW, Zhang R, Stoltz J, Lai C, Montaner JSG, Kerr T. Attendance at supervised injecting facilities and use of detoxification services. New England Journal of Medicine, 2006; 354(23): 2512-2514. PubMed
  • Kerr T, Stoltz JA, Tyndall M, Li K, Zhang R, Montaner J, Wood E. Impact of a medically supervised safer injection facility on community drug use patterns: A before and after study. British Medical Journal, 2006; 332(7535): 220-222. PubMed
  • Wood E, Tyndall MW, Qui Z, Zhang R, Montaner JSG, Kerr T. Service uptake and characteristics of injection drug users utilizing North America’s first medically supervised safer injecting facility. American Journal of Public Health, 2006; 96(5): 770-773. PubMed
  • Wood E, Tyndall MW, Lai C, Montaner JSG, Kerr T. Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Substance Abuse Treatment, Prevention, and Policy. 2006; 1(1): 13. PubMed
  • Tyndall MW, Wood E, Zhang R, Lai C, Montaner JSG, Kerr T. HIV seroprevalence among participants at a supervised injection facility in Vancouver Canada: Implications for prevention, care and treatment. Harm Reduction Journal, 2006; 3(36). PubMed
  • Wood E, Tyndall MW, Li K, Lloyd-Smith, Small W, Montaner JSG, Kerr T. Do supervised injection facilities attract higher-risk injection drug users? American Journal of Preventive Medicine, 2005; 29(2): 126-130. PubMed
  • Wood E, Tyndall MW, Stoltz J, Small W, Zhang R, O'Connell J, Montaner JSG, Kerr T. Safer injecting education for HIV prevention within a medically supervised safer injecting facility. International Journal of Drug Policy, 2005; 16(4): 281-284.
  • Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet, 2005; 366(9482): 316-318. PubMed
  • Wood E, Tyndall MW, Stoltz JA, Small W, Lloyd-Smith E, Zhang R, Montaner JSG, Kerr T. Factors associated with syringe sharing among users of a medically supervised safer injecting facility. American Journal of Infectious Diseases, 2005; 1(1): 50-54.
  • Wood E, Kerr T, Stoltz J, Qui Z, Zhang R, Montaner JSG, Tyndall MW. Prevalence and correlates of hepatitis C infection among users of North America’s first medically supervised safer injection facility. Public Health, 2005; 119(12): 1111-1115. PubMed
  • Wood E, Kerr T, Small W, Li K, Marsh D, Montaner JS, Tyndall MW. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal, 2004; 171(7): 731-734. PubMed
  • Wood E, Kerr T, Lloyd-Smith E, Buchner C, March DC, Montaner JSG, Tyndall MW. Methodology for evaluating Insite: Canada’s first medically supervised safer injection facility for injection drug users. Harm Reduction Journal, 2004; 1(9). PubMed
  • Wood E, Kerr T, Montaner JS, Strathdee SA, Wodak A, Hankins C, Schechter MT, Tyndall MW. Rationale for evaluating North America’s first medically supervised safer-injecting facility. Lancet Infectious Diseases, 2004; 4(5): 301-306. PubMed
Additional Publications on Supervised Injecting
  • Zlotorzynska M, Wood E, Montaner JS, Kerr T. Supervised injection sites: Prejudice should not trump evidence of benefit. Canadian Medical Association Journal, 2013; 185(15): 1303-1304. PubMed
  • McNeil R, Small W, Lampkin H, Shannon K, Kerr T. “People knew they could come here to get help”: An ethnographic study of assisted injection practices at a peer-run ‘unsanctioned’ supervised drug consumption room in a Canadian setting. AIDS and Behavior, 2013 Jun 25 [Epub ahead of print].
  • Marshall BDL, Milloy M-J, Wood E, Montaner JSG, Kerr T. Overdose deaths and Vancouver’s supervised injection facility—Authors’ reply. Lancet, 2012; 379(9811): 118-119. Summary
  • Marshall BDL, Milloy M-J, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: A retrospective population-based study. Lancet, 2011; 377(9775): 1429-1437. PubMed
  • DeBeck K, Kerr T. The use of knowledge translation and legal proceedings to support evidence-based drug policy in Canada: Opportunities and ongoing challenges. Open Medicine, 2010; 4(3): 167-170.
  • Krüsi A, Small W, Wood E, Kerr T. An integrated supervised injecting program within a care facility for HIV-positive individuals: A qualitative evaluation. AIDS Care, 2009; 21(5): 638-644. PubMed Summary
  • Milloy M-J, Wood E. Emerging role of supervised injecting facilities in human immunodeficiency virus prevention. Addiction, 2009; 104(4): 620-621. PubMed
  • Kerr T, Montaner J, Wood E. Supervised injecting facilities: Time for scale up? Lancet, 2008; 372(9636): 354-355. PubMed
  • Kerr T, Montaner JS, Wood E. Misrepresentation of science undermines HIV prevention efforts. Canadian Medical Association Journal, 2008; 178(7): 964.
  • Wood E, Montaner JS, Kerr T. Illicit drug addiction, infectious disease spread and the need for an evidence-based response. Lancet Infectious Diseases, 2008; 8(3): 412-413. PubMed
  • Wood E, Kerr T, Tyndall MW, Montaner JSG. The Canadian government’s treatment of scientific process and evidence: Inside the evaluation of North America’s first supervised injecting facility. International Journal of Drug Policy, 2008; 19(3): 220-225. PubMed Summary
  • Kerr T, Kimber J, DeBeck K, Wood E. The role of safer injection facilities in the response to HIV/AIDS among injection drug users. Current HIV/AIDS Reports, 2007; 4(4): 158-164. PubMed
  • Kerr T, Oleson M, Tyndall MW, Montaner JS, Wood E. A description of a peer-run supervised injection site for injection drug users. Journal of Urban Health, 2005; 82(2): 267-275. PubMed Summary
  • Kerr T, Oleson M, Wood E. Harm-reduction activism: A case study of an unsanctioned user-run safe injection site. Canadian HIV/AIDS Policy & Law Review, 2004; 9(2): 13-19. PubMed Summary
  • Kerr T, Wood E, Palepu A, Wilson D, Schechter MT, Tyndall MW. Responding to an explosive HIV epidemic driven by frequent cocaine injection: Is there a role for safe injecting facilities? Journal of Drug Issues, 2003; 33(3): 579-608.
  • Wood E, Kerr T, Spittal PM, Li K, Small W, Tyndall MW, Hogg RS, O’Shaughnessy MV, Schechter MT. The potential public health and community impacts of safer injecting facilities: Evidence from a cohort of injection drug users. Journal of Acquired Immune Deficiency Syndromes, 2003; 32(1): 2-8. PubMed
  • Kerr T, Wood E, Small D, Palepu A, Tyndall MW. Potential use of safer injecting facilities among injection drug users in Vancouver’s Downtown Eastside. Canadian Medical Association Journal, 2003; 169(8): 759-763. PubMed
  • Kerr T. Supervised injection sites: Health Canada approves Vancouver pilot sites, but concerns remain. Canadian HIV/AIDS Policy Law Review, 2003; 8(2): 18-20. PubMed
  • Wood E, Tyndall M, Kerr T, Spittal P, O’Shaughnessy M, Schechter M. Safer injection facilities for injection drug users: The debate continues. Canadian Medical Association Journal, 2002; 166(4): 422-424.
  • Kerr T, Palepu A. Safer injection facilities for injection drug users: The debate continues. Canadian Medical Association Journal, 2002; 166(4): 424.
  • Wood E, Tyndall MW, Spittal PM, Li K, Kerr T, Hogg RS, Montaner JS, O’Shaughnessy MV, Schechter MT. Unsafe injection practices in a cohort of injection drug users in Vancouver: Could safer injecting rooms help? Canadian Medical Association Journal, 2001; 165(4): 405-410. PubMed