Editing Supervised injection site (section)

== Evaluations ==

In the late 1990s there were a number of studies available on consumption rooms in Germany, Switzerland and the Netherlands. "The reviews concluded that the rooms contributed to improved public and client health and reductions in public nuisance but stressed the limitations of the evidence and called for further and more comprehensive evaluation studies into the impact of such services."<ref>EMCDDA{{cite web|url=http://www.emcdda.europa.eu/attachements.cfm/att_2944_EN_consumption_rooms_report.pdf|title=European report on drug consumption rooms|access-date=2010-04-28|date=2004|page=27|archive-date=2020-03-26|archive-url=https://web.archive.org/web/20200326022000/http://www.emcdda.europa.eu/attachements.cfm/att_2944_EN_consumption_rooms_report.pdf|url-status=dead}}</ref> To that end, the two non-European injecting facilities, Australia's Sydney Medically Supervised Injecting Centre (MSIC) and Canada's Vancouver Insite Supervised Injection Site have had more rigorous research designs as a part of their mandate to operate.<ref>EMCDDA {{cite web |url=http://www.emcdda.europa.eu/publications/monographs/harm-reduction |title=Harm Reduction: Evidence, Impacts and Challenges |access-date=2010-06-09|date=2010|page=308}}</ref>

The [[New South Wales|NSW]] state government has provided extensive funding for ongoing evaluations of the Sydney MSIC, with a formal comprehensive evaluation produced in 2003, 18 months after the centre was opened. Other later evaluations studied various aspects of the operation{{snd}}service provision (2005), community attitudes (2006), referral and client health (2007) and a fourth (2007) service operation and overdose related events.<ref>{{cite web |url=http://www.sydneymsic.com/Bginfo.htm |year= 2008 |title=MSIC Evaluations |access-date=2010-01-09}}</ref> Other evaluations of drug-related crime in the area were completed in 2006, 2008 and 2010, the SAHA International cost-effectiveness evaluation in 2008 and a final independent KPMG evaluation in 2010.

The Vancouver Insite facility was evaluated during the first three years of its operation by researchers from the BC Center for Excellence in HIV/AIDS with published and some unpublished reports available. In March 2008 a final report was released that evaluated the performance of the Vancouver Insite against its stated objectives.

Some posit that safe injection sites help reduce improperly discarded needles in public.<ref>{{cite news |last= Townsend |first= Mark |date= 17 August 2019 |title= Safe injection rooms are key to halting rise in drug deaths – expert |url= https://www.theguardian.com/society/2019/aug/17/safe-injection-rooms-key-to-reducing-drug-deaths-home-office-opposition |work= The Guardian |access-date= 1 December 2021}}</ref><ref>{{cite news |last= Holpuch |first= Amanda |date= 8 August 2017 |title= Secret supervised drug injection facility has been operating at US site for years |url= https://www.theguardian.com/society/2017/aug/08/secret-supervised-drug-injection-facility-us-opioids-overdoses |work= The Guardian |access-date= 1 December 2021}}</ref><ref>{{cite news |last= Smith |first= Callum |date= 9 August 2019 |title= Discarded needles prompt calls for safe injection sites, more addictions supports in N.B. |url= https://globalnews.ca/news/5748415/needles-safe-injection-sites-nb/ |work= Global News |access-date= 1 December 2021}}</ref><ref>{{cite news |last= Dubinski |first= Kate |date= 2 May 2018 |title= Why this children's mentoring program is supporting supervised consumption sites |url= https://www.cbc.ca/news/canada/london/london-ontario-big-brothers-big-sisters-of-london-and-area-supervised-drug-consumption-site-injection-1.4644426 |work= CBC |access-date= 1 December 2021}}</ref> This was found to be the case in a report by the [[Canadian Mental Health Association]] in 2018.<ref>{{cite news |last= MacLean |first= Cameron |date= 18 April 2018 |title= Supervised injection site needed for drug users in Manitoba: Canadian Mental Health Association report |url= https://www.cbc.ca/news/canada/manitoba/opioid-report-safe-injection-site-1.4624248 |work= CBC News |access-date= 1 December 2021}}</ref> Prior to the establishment of a supervised injection site in [[Vesterbro, Copenhagen]] in Denmark in 2012, up to 10,000 syringes were found on its streets each week. Within a year of the supervised injection site opening this number fell to below 1,000.<ref name= "The Guardian, November 2018"/>

There has been some attempt to standardise evaluation reporting across supervised injection sites in a type of [[Core outcome set]] with researchers from the United States funded by [[Drug Policy Alliance]] available;<ref>[https://astrosstudy.org/corequestionnaire.html here.]</ref> however, the intermediary process of how this consensus set was generated is unpublished.

The Expert Advisory Committee found that Insite had referred clients such that it had contributed to an increased use of detoxification services and increased engagement in treatment. Insite had encouraged users to seek counseling. Funding has been supplied by the Canadian government for detoxification rooms above Insite.<ref name="hc-sc.gc.ca">see {{cite web |url= http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php#insite |title=Final Report of the Vancouver Insite Expert Advisory Committee |access-date=2010-04-19|date=2008-04-03 }}</ref>

=== SIS sites and social disorder ===

A longitudinal study{{snd}}Urban Social Issues Study (USIS){{snd}}from January 2018 and February 2019{{snd}}undertaken by [[University of Lethbridge]]'s professor Em M. Pijl and commissioned by the [[Lethbridge|City of Lethbridge]], [[Alberta]], Canada explore "any unintended consequences" of supervised consumption services (SCS) within the "surrounding community".<ref name="Pijl_20200113">{{cite report|url=https://agendas.lethbridge.ca/AgendaOnline/Documents/ViewDocument/ATTACHMENT%202_%20REPORT.pdf?meetingId=2605&documentType=Agenda&itemId=66113&publishId=51948&isSection=false|title=Urban social issues study: Impacts of the Lethbridge supervised consumption site on the local neighbourhood|last=Pijl|first=Em M.|date=January 13, 2020|publisher=[[University of Lethbridge]] for the [[Lethbridge|City of Lethbridge]]|pages=102|access-date=January 26, 2020}} Report commissioned by the [[Lethbridge|City of Lethbridge]]</ref>{{rp|16}} The USIS study was undertaken in response to a drug crisis in Lethbridge that impacted "many neighbourhoods in many different ways." Researchers studied the "perceptions and observations of social disorder by business owners and operators" in a neighborhood where SCS was introduced.<ref name="Pijl_20200113"/>{{rp|16}} The report cautioned, that drug abuse-related antisocial behavior in Lethbridge, in particular, and in cities, in general, has increased, as the "quantity and type of drugs in circulation" increases. As the use of [[crystal meth]] eclipses the use of opiates, users exhibit more "erratic behavior". Crystal meth and other "uppers" also "require more frequent use" than "downers" like opiates.<ref name="Pijl_20200113"/>{{rp|11}} The report also notes that not all social disorder in communities that have a SCS, can be "unequivocally and entirely attributed" to the SCS, partly because of the "ongoing drug epidemic."<ref name="Pijl_20200113"/>{{rp|11}} Other variables that explain increased anti-social behaviour includes an increase in the number of people aggregating outdoors as part of seasonal trends with warmer temperatures.<ref name="Pijl_20200113"/>{{rp|16}}

[[Philadelphia]]'s ''[[WPVI-TV]]'' Action News team traveled to [[Toronto]], Canada in 2018 to make first hand field observations of several safe consumption sites already in operation. A drug addict interviewed by the reporter said she visits the site to obtain supply, but did not stick around and used the supplies to shoot up drugs elsewhere and acknowledged the site attracts drug users and drug dealers. A neighbor interviewed by the reporter said there was drug use before, but he reports it has increased since the site opened.<ref name=":1">{{Cite news|last=Pradelli|first=Chad|url=https://6abc.com/health/opioid-crisis-action-news-investigates-safe-injection-sites/3790196/|title=Opioid Crisis: Action News investigates safe injection sites in Canada|date=July 18, 2018|work=WPVI-TV Action News|access-date=March 22, 2020}}</ref>

WPVI-TV's Chad Pradelli narrated the news team's observation as: <blockquote>Over the two days we sat outside several of Toronto's safe injection facilities, we witnessed prevalent drug use out front, drug deals, and even violence. We watched as one man harassed several people passing by on the sidewalk, even putting one in a chokehold. One guy decided to fight back and security arrived.<ref name=":1" /></blockquote>

==== Sydney, Australia ====
The Sydney MSIC client survey conducted in 2005, found that public injecting (defined as injecting in a street, park, public toilet or car), which is a high risk practice with both health and public amenity impacts, was reported as the main alternative to injecting at the MSIC by 78% of clients. 49% of clients indicated resorting to public injection if the MSIC was not available on the day of registration with the MSIC. From this, the evaluators calculated a total 191,673 public injections averted by the centre.<ref name="ReferenceA">NCHECR, {{cite web |url=https://kirby.unsw.edu.au/sites/default/files/kirby/report/EvalRep4SMSIC.pdf|title= Sydney Medically Supervised Injecting Centre Evaluation Report No. 4 |access-date= 2019-02-06 |url-status= live |archive-url= https://web.archive.org/web/20180417040816/https://kirby.unsw.edu.au/sites/default/files/kirby/report/EvalRep4SMSIC.pdf |archive-date= 2018-04-17 }} 2007 pp. 7, 39</ref>

==== Vancouver, Canada ====
Observations before and after the opening of the [[Vancouver]], [[British Columbia]], Canada Insite facility indicated a reduction in public injecting. "Self-reports" of INSITE users and "informal observations" at INSITE, Sydney and some European SISs suggest that SISs "can reduce rates of public self-injection."<ref name="hc-sc.gc.ca" />{{quantify|date=May 2019}}

==== Alberta, Canada ====
In response to the opioid epidemic in the province of Alberta, the [[Alberta Health Services]]'s (AHS), [[Ministry of Health (Alberta)|Alberta Health]], Indigenous Relations, Justice and Solicitor General including the Office of the Chief Medical Examiner, and the [[College of Physicians and Surgeons of Alberta]] met to discuss potential solutions. In the November 2016 Alberta Health report that resulted from that meeting, the introduction of supervised consumption services, along with numerous other responses to the crisis, was listed as a viable solution.<ref name="AHS_OpioidReport_20161130">{{Cite journal| title = Responding to Alberta's Opioid Crisis |access-date=January 26, 2020 |journal=Alberta Health Services (AHS), Office of the Chief Medical Officer of Health |series= Public progress report |pages=9|date=November 30, 2016 |url=https://open.alberta.ca/dataset/274226b9-b947-401a-93de-b34212824b03/resource/29e3d001-2114-4269-bac4-92a839c4149e/download/CMOH-Opioid-Progress-Report-2016-01.pdf }}</ref>{{rp|1}} The 2016 Alberta Health report stated that, SIS, "reduce overdose deaths, improve access to medical and social supports, and are not found to increase drug use and criminal activity."<ref name="AHS_OpioidReport_20161130"/>{{rp|3}}

According to January 2020 ''[[Edmonton Journal]]'' editorial, by 2020 Alberta had seven SIS with a "100-per-cent success rate at reversing the more than 4,300 overdoses" that occurred from November 2017{{snd}}when the first SIS opened in the province{{snd}}until August 2019.<ref name="edmontonjournal_20200124">{{Cite news | series = Editorial |title=Balanced view of consumption sites required |newspaper= [[Edmonton Journal]] |first1=Colin |last1=McGarrigle |first2=Dave |last2=Breakenridge |first3=Bill |last3=Mah|access-date=January 26, 2020| date =January 24, 2020| url = https://edmontonjournal.com/opinion/editorials/editorial-balanced-view-of-consumption-sites-required}}</ref>

===== Calgary: Safeworks Supervised Consumption Services (SCS) =====
Safeworks was located at the [[Sheldon M. Chumir Centre|Sheldon M. Chumir Health Centre]], which operated for several months, as a temporary facility, became fully operational starting April 30, 2018 with services available 24 hours, 7 days a week.<ref name="AHS_SCS_20190426">{{Citation|work=[[Alberta Health Services]] (AHS)|access-date=January 26, 2020|date=April 11, 2019 | url = https://www.albertahealthservices.ca/assets/info/amh/if-amh-sup-con-chumir-2019-03.pdf |series=Safeworks Monthly Report |title= March 2019: Supervised Consumption Services |pages=4}}</ref>{{rp|1}} From the day it initially launched in October 30, 2017 to March 31, 2019, 71,096 people had used its services<ref name="AHS_SCS_20190426" />{{rp|1}} The staff "responded to a total of 954 overdoses."<ref name="AHS_SCS_20190426" />{{rp|2}} In one month alone, "848 unique individuals" made 5,613 visits to the SCS.<ref name="AHS_SCS_20190426" />{{rp|1}} Its program is monitored by the Province of Alberta in partnership with the Institute of Health Economics.<ref name="AHS_SCS_20190426" />{{rp|2}}

In the City of Lethbridge's commissioned 2020 102-page report, the author noted that "Calgary's Sheldon Chumir SCS has received considerable negative press about the "rampant" social disorder around the SCS, a neighbourhood that is mixed residential and commercial."<ref name="Pijl_20200113"/>{{rp|15}} According to a May 2019 ''Calgary Herald'' article, the 250 meter radius around the safe consumption site Safeworks in [[Calgary]] located within the [[Sheldon M. Chumir Centre]] has seen a major spike in crime since its opening and described in a report by the police as having become "ground zero for drug, violent and property crimes in the downtown." Within this zone, statistics by the police in 2018 showed a call volume increase to the police by 276% for drug related matters 29% overall increase relative to the three-year average statistics.<ref name="CalgaryHearld_Hudes">{{Cite web|url=https://calgaryherald.com/news/crime/incremental-improvement-but-crime-still-plagues-area-around-safe-consumption-site-in-beltline |first=Sammy |last=Hudes |date=May 21, 2019 |access-date=January 26, 2020|title=Crime near Calgary's only safe consumption site remains a concern |newspaper= Calgary Herald}}</ref> In May 2019, the ''Calgary Herald'', said that [[Health Canada]] announced in February 2019 of approval for Siteworks to operate for another year, conditional to addressing neighborhood safety issues, drug debris and public disorder.<ref>{{Cite web|url=https://calgaryherald.com/opinion/columnists/breakenridge-fix-crime-issues-around-safeworks-or-risk-losing-its-valuable-service|title=Breakenridge: Fix crime issues around Safeworks or risk losing it {{!}} Calgary Herald|last=Breakenridge|first=Rob|work=calgaryherald |date=2019-02-05|language=en|access-date=2019-10-11}}</ref> There has been a plan for mobile safe consumption site intending to operate in the [[Forest Lawn, Calgary|Forest Lawn, Calgary, Alberta]], however in response to the statistics at the permanent site at the Sheldon M. Chumir Centre, community leaders have withdrawn their support.<ref>{{Cite web|url=https://calgaryherald.com/news/local-news/forest-lawn-community-leaders-withdraw-support-for-mobile-safe-consumption-vehicle|title=Forest Lawn withdraws support for mobile safe consumption vehicle {{!}} Calgary Herald|last=Logan|first=Shawn|work=calgaryherald |date=2019-02-05|language=en|access-date=2019-10-11}}</ref>

By September 2019, the number of overdose treatment at Safeworks spiked. The staff were overwhelmed and 13.5% of their staff took psychological leave.  They have had dealt with 134 overdose reversals in 2019 which was 300% more than the same time period from the previous year. The center's director reported they're dealing with an average of one overdose reversal every other day.<ref>{{Cite news|url=https://calgary.ctvnews.ca/spike-in-overdose-treatments-overwhelms-staff-at-calgary-shelters-1.4589807|title=Spike in overdose treatments overwhelms staff at Calgary shelters|last=Villani|first=Mark|date=September 12, 2019|work=CTV News Calgary|access-date=October 25, 2019}}</ref>

===== Lethbridge: ARCHES (Closed August 2020) =====
In response to the mounting death toll of drug overdose in Lethbridge, the city opened its first SCS in February, 2018.<ref name="Pijl_20200113"/>{{rp|15}} The controversial<ref>{{Cite web|last=Goulet|first=Justin|title=ARCHES ceases supervised consumption services in Lethbridge|url=https://lethbridgenewsnow.com/2020/08/31/arches-ceases-supervised-consumption-services-in-lethbridge-2/|access-date=2020-09-26|website=Lethbridge News Now|language=en}}</ref> SCS, known as [[ARCHES Lethbridge|ARCHES]] was once the busiest SCS in North America.<ref name=":3" />

The province defunded ARCHES after an audit ordered by government discovered misuse and mismanagement of public monies. Around 70% of ARCHES funding comes from the province,<ref name=":4" /> and it chose to shut it down on August 31, 2020 after the funding was revoked.<ref name=":3">{{Cite news|last=Fletcher|first=Robson|date=September 23, 2020|title=Opioid overdoses spike amid COVID-19 pandemic, with more than 3 Albertans dying per day|work=CBC|url=https://www.cbc.ca/news/canada/calgary/alberta-q2-2020-opioid-deaths-1.5735931}}</ref> The audit found “funding misappropriation, non-compliance with grant agreement [and] inappropriate governance and organizational operations.”<ref name=":4">{{Cite web|title=MLA Shannon Phillips and others react to ARCHES losing provincial funding after government-ordered audit|url=https://globalnews.ca/news/7189990/arches-lethbridge-supervised-consumption-audit-reaction/|access-date=2020-09-26|website=Global News|language=en-US}}</ref> The Alberta government requested that the site be investigated for possible criminal misuse of funds.<ref name=":2">{{Cite web|last1=Bourne|first1=Kirby|last2=Therien|first2=Eloise|date=July 16, 2020|title=Government pulls grant funding from Lethbridge safe consumption site citing fund mismanagement|url=https://globalnews.ca/news/7184155/arches-lethbridge-grant-funding-safe-consumption-site/|access-date=2020-09-26|website=Globalnews.ca|language=en-US}}</ref> Shortly afterwards, Lethbridge Police Service announced that the funds, which had previously been reported as missing, had been present and accounted for in bank accounts belonging to the SCS. Acting Inspector Pete Christos stated that the initial auditors did not have the means to determine whether money was missing, and confirmed that, during police interviews with Arches staff, all spent funds had been accounted for. Police Chief Shahin Mehdizadeh told reporters that the Alberta Justice Specialized Prosecutions Branch supported the police's findings and were not recommending criminal charges.<ref name=":LPSfunds">{{cite news |last1=Vogt |first1=Terry |title=Missing ARCHES funds accounted for: Lethbridge police |url=https://calgary.ctvnews.ca/missing-arches-funds-accounted-for-lethbridge-police-1.5241779 |access-date=25 April 2023 |work=CTV News Calgary |publisher=CTV News |date=December 22, 2020}}</ref>

The City of Lethbridge commissioned a report that included an Urban Social Issues Study (USIS) which examined unintended consequences of the SIS site in Lethbridge.<ref name="Pijl_20200113" /> The research found that in smaller cities, such as Lethbridge, that in communities with a SCS, social disorder may be more noticeable. The report's author, [[University of Lethbridge]]'s Em M. Pijl, said that news media tended to the "personal experiences of business owners and residents who work and/or live near an SCS", which contrasts with "scholarly literature that demonstrates a lack of negative neighbourhood impacts related to SCSs."<ref name="Pijl_20200113" />{{rp|14}}

=== Impact on community levels of overdose ===

Over a nine-year period the Sydney MSIC managed 3,426 overdose-related events with not one fatality<ref>name=KPMG {{cite web |url= http://www.health.nsw.gov.au/resources/mhdao/pdf/msic_kpmg.pdf |title=Further Evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011) |access-date=2010-10-23}} p. 2</ref> while Vancouver’s Insite had managed 336 overdose events in 2007 with not a single fatality.

The 2010 MSIC evaluators found that over 9 years of operation it had made no discernible impact on heroin overdoses at the community level with no improvement in overdose presentations at hospital emergency wards.<ref name="KPMG">{{cite web |url= http://www.health.nsw.gov.au/resources/mhdao/pdf/msic_kpmg.pdf |title=Further Evaluation of the Medically Supervised Injecting Centre during its extended Trial period (2007-2011) |access-date=2010-10-23}}</ref>{{rp|19–20}}

Research by injecting room evaluators in 2007 presented statistical evidence that there had been later reductions in ambulance callouts during injecting room hours,<ref>{{Cite journal |last1= Salmon |first1= Allison |last2= Van Beek |first2= Ingrid |last3= Amin |first3= Janaki |last4=Kaldor |first4= John |last5= Maher |first5= Lisa |author-link5=Lisa Maher |date=February 2010 | title = The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia | journal = Addiction | volume = 105 | issue = 4 | pages = 676–683| doi = 10.1111/j.1360-0443.2009.02837.x | url =http://www3.interscience.wiley.com/journal/123278060/abstract?CRETRY=1&SRETRY=0 | archive-url =https://archive.today/20130105111346/http://www3.interscience.wiley.com/journal/123278060/abstract?CRETRY=1&SRETRY=0 | url-status =dead | archive-date =2013-01-05 |pmid=20148794 |url-access= subscription }}</ref><ref name="pmid18172151">{{cite journal
| last1 = Beletsky |first1= Leo |last2= Davis |first2= Corey S |last3= Anderson |first3= Evan |last4= Burris |first4= Scott
| title = The law (and politics) of safe injection facilities in the United States
| journal = American Journal of Public Health
| volume = 98
| issue = 2
| pages = 231–7
|date=February 2008
| pmid = 18172151
| pmc = 2376869
| doi = 10.2105/AJPH.2006.103747
}}</ref><ref name="pmid17689337">{{cite journal
| last1 = Kerr |first1= Thomas |last2= Kimber |first2= Jo |last3= Rhodes |first3= Tim
| title = Drug use settings: an emerging focus for research and intervention
| journal = The International Journal on Drug Policy
| volume = 18
| issue = 1
| pages = 1–4
|date=January 2007
| pmid = 17689337
| doi = 10.1016/j.drugpo.2006.12.016
}}</ref> but failed to make any mention of the introduction of sniffer dog policing, introduced to the drug hot-spots around the injecting room a year after it opened.<ref>{{cite web |url=http://www.abc.net.au/news/newsitems/200205/s558480.htm|title=Police to crack down on Kings Cross drug trade |website=[[Australian Broadcasting Corporation]] |access-date=2010-01-09}} 2003</ref>

A March 2025 study exploring the association of safer supply and decriminalization policy with opioid overdose outcomes in British Columbia, Canada, found that neither policy "appeared to mitigate the opioid crisis, and both were associated with an increase in opioid overdose hospitalizations."<ref>{{Cite journal |last=Nguyen |first=Hai V. |last2=Mital |first2=Shweta |last3=Bugden |first3=Shawn |last4=McGinty |first4=Emma E. |date=2025-03-21 |title=Safer Opioid Supply, Subsequent Drug Decriminalization, and Opioid Overdoses |url=https://jamanetwork.com/journals/jama-health-forum/fullarticle/2831562 |journal=JAMA Health Forum |volume=6 |issue=3 |pages=e250101 |doi=10.1001/jamahealthforum.2025.0101 |issn=2689-0186|pmc=11929020 }}</ref><ref>{{Cite news |last=JOANNOU |first=ASHLEY |date=2025-03-25 |title=B.C. drug decriminalization and safer supply associated with more overdoses, study shows |url=https://www.theglobeandmail.com/canada/british-columbia/article-bc-drug-decriminalization-and-safer-supply-associated-with-more/ |access-date=2025-04-02 |work=The Globe and Mail |publisher=The Canadian Press |language=en-CA}}</ref>

=== Site experience of overdose ===
While overdoses are managed on-site at Vancouver, Sydney and the facility near Madrid, German consumption rooms are forced to call an ambulance due to naloxone being administered only by doctors. A study of German consumption rooms indicated that an ambulance was called in 71% of emergencies and naloxone administered in 59% of cases. The facilities in Sydney and Frankfurt indicate 2.2-8.4% of emergencies resulting in hospitalization.<ref>Hedrich, D {{cite web|url=http://www.emcdda.europa.eu/attachements.cfm/att_2944_EN_consumption_rooms_report.pdf|title=A Report on European Consumption Rooms|access-date=2010-05-28|archive-date=2020-03-26|archive-url=https://web.archive.org/web/20200326022000/http://www.emcdda.europa.eu/attachements.cfm/att_2944_EN_consumption_rooms_report.pdf|url-status=dead}} EMCDDA 2004 p. 46</ref>

Vancouver’s Insite yielded 13 overdoses per 10,000 injections shortly after commencement,<ref>Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E. {{cite web |url=http://www.harmreduction.org/downloads/Kerr_Overdose_IJDP.pdf |year= 2008 |title=Drug-related overdoses within a medically supervised safer injection facility |access-date=2010-05-01}}</ref> but in 2009 had more than doubled to 27 per 10,000.<ref>see {{cite web |url=http://supervisedinjection.vch.ca/research/supporting_research/ |year= 2009 |title=User Statistics |access-date=2010-05-01}}</ref> The Sydney MSIC recorded 96 overdoses per 10,000 injections for those using heroin.<ref>2003 MSIC Evaluation Committee {{cite web |url= http://www.druginfo.nsw.gov.au/__data/page/1229/NDARC_final_evaluation_report4.pdf#Final%20Report%20of%20the%20MSIC%20Evaluation |title= Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre |access-date= 2010-01-09 |url-status= dead |archive-url= https://web.archive.org/web/20091029190140/http://www.druginfo.nsw.gov.au/__data/page/1229/NDARC_final_evaluation_report4.pdf#Final%20Report%20of%20the%20MSIC%20Evaluation |archive-date= 2009-10-29 }} 2003 p. 24</ref>  Commenting on the high overdose rates in the Sydney MSIC, the evaluators suggested that,
: “In this study of the Sydney injecting room there were 9.2 (sic) heroin overdoses per 1000 heroin injections in the centre. This rate of overdose is higher than amongst heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room.<ref>2003 MSIC Evaluation Committee {{cite web |url= http://www.druginfo.nsw.gov.au/__data/page/1229/NDARC_final_evaluation_report4.pdf#Final%20Report%20of%20the%20MSIC%20Evaluation |title= Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre |access-date= 2010-01-09 |url-status= dead |archive-url= https://web.archive.org/web/20091029190140/http://www.druginfo.nsw.gov.au/__data/page/1229/NDARC_final_evaluation_report4.pdf#Final%20Report%20of%20the%20MSIC%20Evaluation |archive-date= 2009-10-29 }} 2003 p. 59</ref>

===People living with HIV/AIDS===
The results of a research project undertaken at the Dr. Peter Centre (DPC), a 24-bed residential HIV/AIDS care facility located in Vancouver, were published in the Journal of the International AIDS Society in March 2014, stating that the provision of supervised injection services at the facility improved health outcomes for DPC residents. The DPC considers the incorporation of such services as central to a "comprehensive harm reduction strategy" and the research team concluded, through interviews with 13 residents, that "the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services", in addition to creating a setting in which drug use could be discussed honestly. [[Management of HIV/AIDS|Highly active antiretroviral therapy (HAART)]] medication adherence and survival are cited as two improved health outcomes.<ref>{{cite journal|last=McNeil|first=R|title=Impact of supervised drug consumption services on access to and engagement with care at a palliative and supportive care facility for people living with HIV/AIDS: a qualitative study|journal=Journal of the International AIDS Society|date=13 March 2014|volume=17|issue=1|pages=18855|doi=10.7448/IAS.17.1.18855|pmid=24629844|display-authors=etal|pmc=3955762}}</ref>

=== Crime ===

The Sydney MSIC was judged by its evaluators to have caused no increase in crime<ref name="druginfo.nsw.gov.au">2003 MSIC Evaluation Committee {{cite web |url= http://www.druginfo.nsw.gov.au/__data/page/1229/NDARC_final_evaluation_report4.pdf#Final%20Report%20of%20the%20MSIC%20Evaluation |title= Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre |access-date= 2010-01-09 |url-status= dead |archive-url= https://web.archive.org/web/20091029190140/http://www.druginfo.nsw.gov.au/__data/page/1229/NDARC_final_evaluation_report4.pdf#Final%20Report%20of%20the%20MSIC%20Evaluation |archive-date= 2009-10-29 }} 2003 p. xvi</ref> and not to have caused a ‘honey-pot effect’ of drawing users and drug dealers to the Kings Cross area.<ref>2003 MSIC Evaluation Committee {{cite web |url= http://www.druginfo.nsw.gov.au/__data/page/1229/NDARC_final_evaluation_report4.pdf#Final%20Report%20of%20the%20MSIC%20Evaluation |title= Final Report of the Evaluation of the Sydney Medically Supervised Injecting Centre |access-date= 2010-01-09 |url-status= dead |archive-url= https://web.archive.org/web/20091029190140/http://www.druginfo.nsw.gov.au/__data/page/1229/NDARC_final_evaluation_report4.pdf#Final%20Report%20of%20the%20MSIC%20Evaluation |archive-date= 2009-10-29 }} 2003 p. 204</ref>

Observations before and after the opening of Insite indicated no increases in drug dealing or petty crime in the area. There was no evidence that the facility influenced drug use in the community, but concerns that Insite ‘sends the wrong message’ to non-users could not be addressed from existing data.<ref name="ReferenceC">see Executive Summary of {{cite web |url= http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php#insite |title=Final Report of the Vancouver Insite Expert Advisory Committee |access-date=2010-04-19|date=2008-04-03 }}</ref> The European experience has been mixed.<ref>see Sections A7 to A9 of Appendix B {{cite web |url= http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php#insite |title=Final Report of the Vancouver Insite Expert Advisory Committee |access-date=2010-04-19|date=2008-04-03 }}</ref>

==== Financial impropriety by SCS service providers ====
An audit of Lethbridge ARCHES SCS by accounting firm Deloitte, ordered by the Alberta provincial government, found the SCS had $1.6 million in unaccounted funds between 2017 and 2018; additionally they found that led{{clarify|date=October 2024}} $342,943 of grant funds had been expended on senior executive compensation despite the grant agreement allowing only $80,000. Beyond this, an additional $13,000 was spent on parties, staff retreats, entertainment and gift cards,<ref name=":2" /> and numerous other inappropriate expenditures.<ref name=":2" />

The Lethbridge Police Service and Alberta Justice Specialized Prosecutions Branch later contradicted these findings, stating that all funds were present and accounted for in accounts belonging to the agency. When asked why these funds had previously been reported as missing, LPS Acting Inspector Pete Christos stated that the initial auditors did not have the means to investigate the agency's finances, and that all spending had been accounted for during the criminal probe.

Premier [[Jason Kenney]] did not dispute the results of the investigation, but declined to reinstate funding, claiming that the site's management had lost the confidence of his government.<ref name=":LPSfunds" />

=== Community perception ===

The Expert Advisory Committee for Vancouver’s Insite found that health professionals, local police, the local community and the general public have positive or neutral views of the service, with opposition decreasing over time.<ref name="ReferenceC"/>

=== Predicted cost effectiveness ===

The cost of running Insite per annum is CA$3 million. Mathematical modeling showed cost to benefit ratios of one dollar spent ranging from 1.5 to 4.02 in benefit. However, the Expert Advisory Committee expressed reservation about the certainty of Insite’s cost effectiveness until proper longitudinal studies had been undertaken. Mathematical models for HIV transmissions foregone had not been locally validated and mathematical modeling from lives saved by the facility had not been validated.<ref name="hc-sc.gc.ca"/>