Pubdate: Tue, 25 Nov 2008 Source: Vancouver Sun (CN BC) Copyright: 2008 The Vancouver Sun Contact: http://www.canada.com/vancouversun/letters.html Website: http://www.canada.com/vancouversun/ Details: http://www.mapinc.org/media/477 Bookmark: http://www.mapinc.org/find?142 (Supervised Injection Sites) Bookmark: http://www.mapinc.org/opinion.htm (Opinion) HUMAN CONSIDERATIONS ASIDE, INSITE'S BENEFITS FAR OUTWEIGH THE COSTS The more than two dozens studies on Insite, Vancouver's supervised injection site, have revealed many positive outcomes associated with the facility: A decrease in needle-sharing, public injections and publicly discarded syringes, and increased uptake of detoxification and treatment services. The research has also suggested a lack of negative outcomes, including no apparent increase in crime near the site, and no increase in new drug users. Despite this, naysayers continue to lament the existence of the site, often arguing that it is simply eating up too much money to justify its existence. Now, in a world of limited resources, we do have to use our money wisely. But new research from Ahmed Bayoumi of St. Michael's Hospital and the University of Toronto, and Gregory Zaric of the Ivey School of Business at the University of Western Ontario, suggests that the site is likely to produce a cost savings over a 10-year period. The research, published in the current issue of the Canadian Medical Association Journal, uses a sophisticated computer model to assess the impact on Vancouver over the next decade, with and without Insite. Bayoumi and Zaric first estimated cost savings based on a conservative assumption -- that the only benefit of Insite is that it reduces needle sharing among injection drug users. Even with this limited benefit, the computer simulation predicted that Insite would result in a gain of 920 life-years over the next decade (because fewer drug users would become infected by potentially fatal viruses such as HIV.) For those whose concern is economics, the simulation also estimated that this reduction in infections would result in a savings of $14 million over the next 10 years. Bayoumi and Zaric then considered the benefit of Insite if it were assumed that the site produced both a decrease in needle sharing and an increase in safer injecting practices, such as the use of bleach to sterilize needles. Based on this assumption, Insite is estimated to produce a gain of 1,070 life-years, and a savings of $20 million over the next decade. This suggests that even if we look at things from a strictly financial point of view (ignoring drug users' improved quality of life), Insite is well worth the money it costs. Of course, as with all computer simulations, the results will depend on the accuracy of the researchers' assumptions. In this regard, New York research-ers Don Des Jarlais, Kamyar Arasteh and Holly Hagan, in an accompanying commentary in the CMAJ, do question some of the assumptions made by Bayoumi and Zaric. But even under different assumptions, Des Jarlais, Arasteh and Hagan still estimate that Insite could avert some 250-350 HIV infections in 10 years. And given the $150,000 estimated lifetime cost of treating HIV infection, Insite would still produce significant savings. Furthermore, Bayoumi and Zaric did not consider other potential economic benefits of Insite, including a decrease in overdose, the transmission of hepatitis B, and skin infections resulting from unhygienic injection. Were these factors considered, the economic benefits of Insite would probably be magnified. Hence, even if we resist concerning ourselves with the welfare of drug users, its clear that Insite will likely produce benefits for all taxpayers. And that means it's good for everyone. - --- MAP posted-by: Larry Seguin