Evidence Around Harm Reduction and Public Health-Based Drug Policies

Harm reduction, supervised consumption sites, and policies like decriminalization can offer opportunities to connect people to health care and voluntary treatment.

In a British Columbia Centre on Substance Use study, researchers found that the monthly prevalence of addiction treatment participation increased by around 4.5% after overdose prevention sites were opened in the area. (Harm reduction services and staff help connect people to support and healthcare resources they would otherwise not have easy access to.)

Study in journal Addiction; “Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis”; 2021 (link)

23% of people who were interviewed for one study related to Insite, North America’s first sanctioned supervised injection site, stopped injecting, and another 57% entered addiction treatment. (Harm reduction connects people to social and health care services that help them find stability and support.)

Study in journal Drug and Alcohol Dependence; “Injection drug use cessation and use of North America’s first medically supervised safer injecting facility”; 2011 (link)

In Portugal, where drug use was decriminalized in 2001:

– levels of drug use are below the European average

European Monitoring Centre for Drugs and Drug Addiction; “Drug policy profiles–Portugal” (link)

– drug use has declined among people aged 15-24, the population most at risk of initiating drug use

Balsa, C., Vital, C. and Urbano, C. (2013) ‘III Inquérito nacional ao consumo de substâncias psicoativas na população portuguesa 2012: Relatório Preliminar’, CESNOVA – Centro de Estudos de Sociologia da Universidade Nova de Lisboa (link)

– rates of past-year and past-month drug use among the general population-which are seen as the best indicators of evolving drug use trends-decreased

Balsa, C., Vital, C. and Urbano, C. (2013) ‘III Inquérito nacional ao consumo de substâncias psicoativas na população portuguesa 2012: Relatório Preliminar’, CESNOVA – Centro de Estudos de Sociologia da Universidade Nova de Lisboa, p. 59. (link)

– rates of dependant drug use and injecting drug use decreased

Brief by Transform Drug Policy Foundation (UK), “Drug Decriminalisation in Portugal: Setting the Record Straight”; 2018 (link)

After heroin-assisted treatment was implemented in Switzerland, the number of new heroin users has declined.

Swiss government data; as cited in North Carolina Health News; “Switzerland fights heroin with heroin”; 2019 (link)

Support drug policies based on evidence and compassion.

Harm reduction and supervised consumption sites may decrease public consumption, discarded needles and litter, while having no negative impact on crime.

In London (UK), there was no increase in the number of people who use drugs into the community following the opening of a medically supervised injectable maintenance clinic. Police figures show no significant changes in monthly or average annual crime levels in the local area.

Study in journal Mental Health and Substance Use; “The community impact of RIOTT, a medically supervised injectable maintenance clinic in south London”; 2010 (link)

In a British Columbia Centre on Substance Use study, researchers found that public injection and syringe sharing decrease by 5.5% after overdose prevention sites were opened in the area.

Study in journal Addiction; “Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis”; 2021 (link)

In Sydney (Australia), there was a significant decrease in the number of residents and businesses reporting public injecting and public discarded needles/syringes and other litter after the opening of a supervised injection site.

Study in International Journal of Drug Policy; “Five years on: What are the community perceptions of drug-related public amenity following the establishment of the Sydney Medically Supervised Injecting Centre?”; 2007 (link)

In Sydney (Australia), where a supervised injection site was located, there was no evidence of an increase in theft or robbery. There was also no evidence that the site led to an increase in “drug-related” loitering.

Study in journal Drug and Alcohol Review; “The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime”; 2009 (link)

Following the opening of the Sydney Medically Supervised Injecting Centre, there was no evidence of increased rates of robbery, theft, drug-related loitering or drug-related criminal offences in the surrounding neighbourhood.

Study in journal Drug and Alcohol Review; “The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime”; 2009 (link)

Among users of Insite-North America’s first sanctioned supervised injection site-involved in one study, 71% reported fewer public injections and 56% reported less unsafe needle disposal.

Study in journal Addictive Behaviors; “Injection drug users’ perceptions regarding use of a medically supervised safer injecting facility”; 2007 (link)

Insite was independently associated with reductions in public injecting, discarded needles, and other injection-related litter.

Study Canadian Medical Association Journal; “Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users”; 2004 (link)

One year after Insite opened, there were no increases in drug trafficking, assaults, robberies, and there was a significant decline in vehicle break-ins.

Study in journal Substance Abuse Treatment, Prevention, and Policy; “Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime”; 2006 (link)

In the 12-week period after Insite opened, there were reductions in public drug use, discarded syringes, and injection-related litter.

Study in Canadian Medical Association Journal; “Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users”; 2004 (link)

In 2017, the same year a supervised injection site began operating in Moss Park (Toronto), the number of criminal offences dropped, with fewer assaults and robberies…Existing research on drug injection sites suggests they don’t cause an increase in serious crime.

Toronto Star; “Do supervised injection sites bring crime and disorder? Advocates and residents disagree”; 2018 (link)

Supervised injection sites in Switzerland and Germany have reported reductions in the visibility of public drug use.

Study in journal Drug and Alcohol Review; “Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia”; 2000 (link)

After Portugal decriminalized drugs in 2001, the country saw a decrease in drug-related crime.

The Guardian; “Portugal’s radical drugs policy is working. Why hasn’t the world copied it?”; 2017 (link)

In Portugal, there was a reduction in thefts from homes and businesses, crimes typically associated with substance use.

Brief by Transform Drug Policy Foundation (UK), “Drug Decriminalisation in Portugal: Setting the Record Straight”; 2018 (link)

After heroin-assisted treatment was implemented in Switzerland, home thefts dropped by 98%.

Swiss government analysis as cited in North Carolina Health News; “Switzerland fights heroin with heroin”; 2019 (link)

To date (2021), peer-reviewed research has found no evidence linking supervised consumption sites (SCSs) to increased crime.

Study in Harm Reduction Journal; “Supervised consumption sites and crime: scrutinizing the methodological weaknesses and aberrant results of a government report in Alberta, Canada”; 2021 (link)

(More information here on the effect of supervised consumption services on crime and public order)

After heroin-assisted treatment was implemented in Switzerland, home thefts dropped by 98%.

Prohibition and criminalization cost taxpayers billions every year. Grounding drug policy in human rights and public health, and offering harm reduction supports may decrease societal health care costs

In 2017, Canada spent $4.8 billion on policing costs for illegal drugs. This includes policing, courts, and correctional services. (Despite this massive spending, the overdose crisis continues unabated. This is the money that is being wasted.)

Report by Canadian Centre for Substance Use and Addiction; “Canadian Substance Use Cost and Harms”; 2020 (link)

In a British Columbia Centre on Substance Use study, researchers found that public injection and syringe sharing decrease by 5.5% after overdose prevention sites were opened in the area. (Syringe sharing can lead to HIV infections. In Canada, treatment for one person with HIV is approximately $15,000 a year.)

Study in journal Addiction; “Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis”; 2021 (link)

Insite, North America’s first sanctioned supervised consumption site, saves the taxpayer system in excess of $6 million per year by preventing HIV infection and death.

Study in International Journal of Drug Policy; “A cost-benefit and cost-effectiveness analysis of Vancouver’s supervised injection facility”; 2010 (link)

Insite has saved taxpayers $18 million over 10 years by reducing disease transmission, needle sharing, and encouraging safer drug use practices.

Study in Canadian Medical Association Journal; “The cost-effectiveness of Vancouver’s supervised injection facility”; 2008 (link)

Once heroin-assisted treatment was implemented in Switzerland, HIV infections dropped by 84%. (In Canada, treatment for one person with HIV is approximately $15,000 a year.)

Swiss government analysis as cited in North Carolina Health News; “Switzerland fights heroin with heroin”; 2019 (link)

Legally regulating drugs for safety can support efforts to keep everyone safer, including youth.

Three years into the legalization of marijuana in Canada, there was no marked increase in cannabis usage among youth. This finding is consistent with analyses of youth in other countries.

Study in Journal of the Canadian Academy of Child Psychiatry; “Youth Cannabis use and Legalization in Canada – Reconsidering the Fears, Myths and Facts Three Years In”; 2021 (link)

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