In 2018, opioid-related overdoses took one life every two hours in Canada. Opioid-related death rates have risen consistently throughout the last few years, with British Columbia being at the forefront of this crisis. Opioids and other drugs are prescribed to patients as painkillers, alleviating pain of varying degrees. However, issues arise when patients grow dependent on these drugs. When prescriptions end, some individuals resort to less safe alternatives often contaminated with toxic substances such as fentanyl and carfentanil. The government’s policy approach emphasizes “compassion and evidence,” with a focus on ensuring the safety of users as opposed to criminalizing them. In accordance with the federal government’s approach,  Vancouver has instated a supervised injection site - Insite. Insite’s results indicate that supervised injection sites help alleviate several issues that have arisen from the opioid crisis, such as reducing death rates and HIV transmission, and aiding in addiction treatment. However, these results have also spurred ethical and institutional concerns.

Insite is a government-sanctioned facility that was established in 2003 in an attempt to lessen the number of drug-related deaths in Vancouver. Users inject illicit drugs of their own “in an anxiety and stress-free atmosphere, under hygienic and low risk conditions,” under the supervision of nurses who are equipped to provide treatment in the case of potential overdoses. The site operates under an exemption under the Controlled Drugs and Substances Act, meaning that users face no legal penalties for the consumption of illicit substances, incentivizing them to seek aid in doing so safely. The operation has been controversial, facing several suspensions, and attempted closures between 2006 and 2011. Yet, despite significant political and social pressure to terminate the facility, the Supreme Court of Canada ruled against its closure on Sept. 30th, 2011, thus, “legitimizing Insite as an effective and humane health care response to the suffering of injection drug users.” 

Data gathered by Vancouver Coastal Health favours keeping the facility open, indicating that it has successfully reduced deaths. There were 189,837 visits to Insite in 2018 alone, with 1,466 lives saved through overdose interventions. Analyses of other similar operations claim that safe injection sites not only decrease overdose-related deaths, but also significantly decrease the rates of HIV and hepatitis C transmittance through the reduction of syringe sharing. Taking into account the healthcare costs related to HIV, hepatitis C, and overdose treatment, Insite’s operations have resulted in net savings of nearly 18 million dollars. Furthermore, the Ontario HIV Treatment Network argues that supervised injection sites can aid in the treatment process of clients by reducing injecting behaviour and making addiction treatment services more accessible. 

A significant factor contributing to the social pressure against Insite regards the morality of their operations. Critics claim that the constitutional exception granted to users in the site allowing them to use illicit drugs not only facilitates drug use, but also does nothing to help the users. Furthermore, intergenerational spillover effects are also a concern, as young people might consider illicit drug use if they know that facilities are available to them for safe consumption. Additionally, these injection sites may appear to publicly display a federally approved process of satiating drug users’ dependencies. It can be argued that the exposure of these processes can tempt youth to try these substances not only because they would not be criminalized, but also because their safety would be closely monitored. These effects could potentially increase the number of opioid users as opposed to decreasing it. 

Institutional limitations exist as well. With the opioid crisis escalating, it is unlikely that supervised injection sites will have the capacity to meet the growing demand for supervised facilities. Long lines not only dissuade users from using the facility, but also create negative spillover effects for the public within the general vicinity. These third-party effects may include congestion of public areas and the aforementioned impact on young individuals. 

Insite continues to accommodate clients, undeniably reducing the various health and financial costs associated with the opioid crisis. However, ethical and institutional concerns subsist and have to be considered for future implementations or expansions of supervised injection sites.