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Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime Wood, Evan; Tyndall, Mark W; Lai, Calvin; Montaner, Julio S; Kerr, Thomas May 8, 2006

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ralSubstance Abuse Treatment, ssBioMed CentPrevention, and PolicyOpen AcceShort ReportImpact of a medically supervised safer injecting facility on drug dealing and other drug-related crimeEvan Wood*1,2, Mark W Tyndall1,2, Calvin Lai1, Julio SG Montaner1,2 and Thomas Kerr1,2Address: 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver BC V6Z 1Y6, Canada and 2Department of Medicine, University of British Columbia, 3300 - 950 West 10th Avene, Vancouver BC V5Z 4E3, CanadaEmail: Evan Wood* - ewood@cfenet.ubc.ca; Mark W Tyndall - mtyndall@cfenet.ubc.ca; Calvin Lai - calvin@cfenet.ubc.ca; Julio SG Montaner - jmontaner@cfenet.ubc.ca; Thomas Kerr - tkerr@cfenet.ubc.ca* Corresponding author    AbstractNorth America's first medically supervised safer injecting facility (SIF) recently opened inVancouver, Canada. One of the concerns prior to the SIF's opening was that the facility might leadto a migration of drug activity and an increase in drug-related crime. Therefore, we examined crimerates in the neighborhood where the SIF is located in the year before versus the year after the SIFopened. No increases were seen with respect to drug trafficking (124 vs. 116) or assaults/robbery(174 vs. 180), although a decline in vehicle break-ins/vehicle theft was observed (302 vs. 227). TheSIF was not associated with increased drug trafficking or crimes commonly linked to drug use.IntroductionDespite existing interventions [1,2], illicit injection druguse continues to fuel infectious disease and fatal overdoseepidemics in many settings, and has prompted substantialcommunity concern [3-5]. Public health programmingaimed at reducing the harms of illicit drug use commonlyface community and legal opposition due to concerns thatthese services may lead to increases in criminal activity intheir vicinity [6].In an effort to address longstanding epidemics of HIV anddrug-related overdose, Vancouver opened North Amer-ica's first medically supervised safer injection facility (SIF)on September 22, 2003. Consistent with most SIF [7],within the facility, injection drug users (IDU) can injectavailable on site [8]. A major concern prior to the openingof the SIF was that the facility would result in increasedmigration of IDU and drug dealers to the city's DowntownEastside where the facility is located, and subsequentlyprompt increases in criminal activity [8-11]. To examinethese concerns, the present study was therefore conductedto examine patterns of criminal activity (drug traffickingand other drug-related crime) in the city's DowntownEastside since the facility opened.MethodsFor the present analyses, we accessed Vancouver PoliceDepartment statistics regarding charges for drug traffick-ing (which is defined to include selling, administering,giving, transferring, transporting, sending, or deliveringPublished: 08 May 2006Substance Abuse Treatment, Prevention, and Policy2006, 1:13 doi:10.1186/1747-597X-1-13Received: 22 March 2006Accepted: 08 May 2006This article is available from: http://www.substanceabusepolicy.com/content/1/1/13© 2006Wood et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 4(page number not for citation purposes)pre-obtained illicit drugs under the supervision of medicalstaff, and an addictions counsellor and nursing care areillicit drugs), assaults and robberies, and vehicle break-insand vehicle theft in the neighborhoods broadly defined asSubstance Abuse Treatment, Prevention, and Policy 2006, 1:13 http://www.substanceabusepolicy.com/content/1/1/13Page 2 of 4(page number not for citation purposes)Monthly crude total number of charges for drug trafficking (Panel A), assaults and robbery (Panel B), and vehicle theft (Panel C) in the yea  before versus the year aft r the SIF openedFigure 1Monthly crude total number of charges for drug trafficking (Panel A), assaults and robbery (Panel B), and vehicle theft (Panel C) in the year before versus the year after the SIF opened.Substance Abuse Treatment, Prevention, and Policy 2006, 1:13 http://www.substanceabusepolicy.com/content/1/1/13the Downtown Eastside area (Downtown Eastside proper,Chinatown, Gastown, Victory Square, and Strathcona).These indicators were selected for several reasons. First,although a reduction in public drug use and publicly dis-carded syringes has been attributed to the opening of theSIF [12], the potential influx of drug dealers to sell drugsto the SIF's clientele has not been thoroughly investigated.Second, rates of assaults and robberies and vehicle break-ins and vehicle thefts were evaluated to assess the poten-tial of an increase in drug-related crime, since these activ-ities have been attributed to a concentrated illegal drugscene in the neighborhood [12]. The categories of assaultsand robberies and vehicle break-ins and theft were com-bined in the source data file and it was not possible to sep-arate these indicators.We compared the monthly average number of charges forthese activities in the Downtown Eastside between Octo-ber 1, 2003 and September 30, 2004 (pre-SIF year) versusthe monthly average during the period October 1, 2004and September 30, 2005 (post-SIF year). Since there werea limited number of data points to compare trendsbetween years, data were plotted on line graphs, and aver-age annual levels for each of the three indicators (drugtrafficking, assaults and robbery, and vehicle break-ins/theft) were compared using paired t-tests.ResultsThe crude monthly totals for the year prior versus the yearafter the SIF opened are shown in Figure 1. As shown here,there were no obvious differences between the two yearswith respect to the various indicators of drug-relatedcrime.Similarly, using a t-test, no increases were seen withrespect to: drug trafficking (124 [SD = 94] vs. 116 [SD 24];mean difference = 7.9, t-stat = 0.26, df = 11, p = 0.803) andassaults/robbery (174 [SD = 25] vs. 180 [SD = 21]; meandifference = -6.2, t-stat = -0.59, df = 11, p = 0.565),although significant declines in vehicle break-ins/theftwere observed (302 [SD = 57] vs. 227 [SD = 48]; mean dif-ference = 75.7, t-stat = 4.22, df = 11, p = 0.001).DiscussionIn the present study, when we compared annual periodsbefore and after the opening of the Vancouver SIF, wefound that rates of arrest for drug trafficking, assaults, androbbery were similar after the facility's opening, althoughrates of vehicle break-ins/theft declined significantly.These results are consistent with a recent study of theimpact of Australia's first SIF which concluded that theSydney facility was not associated with an increase in theproportion of drug use or supply offences [13].The present study has several limitations. Most impor-tantly, some crime statistics may be confounded by discre-tionary policing practices and levels of police deployment.Because of these issues, we did not investigate reports ofdrug possession, since the Vancouver Police Departmenthas a discretionary approach towards drug possession.Specifically, in many instances police have directed orescorted IDU to the SIF, whereas during other periods anincreased number of possession charges have been laidagainst IDU injecting in public reportedly as a police strat-egy to maximize use of the SIF and to reduce public disor-der. Nevertheless, with respect to public drug use, anearlier study reported reductions in public drug use asmeasured by four independent measures [12]. In contrastto their approach to drug possession, the local police havea zero tolerance approach towards drug trafficking. Never-theless, this measure suffers from uneven levels of policedeployment between periods, which was evident in thedrug trafficking data. Specifically, there are periodicincreases in police activity that cannot be accounted for,and there was a spike in the drug trafficking data in thepre-SIF year coinciding with a well described police crack-down [14], and hence the small decline in drug traffickingcharges in the post-SIF year is due to this effect. Finally,although the statistically significant decrease in vehiclebreak-ins/thefts in the post-SIF period does not appear tobe due to the police crackdown in the pre-SIF period, dueto the above concerns, we caution against inferring thatthis reduction was due to the SIF. Instead, we believe ouroverall findings suggest that the SIF was not associatedwith a marked increase in drug-related criminal activity.In summary, the present study suggests that the openingof North America's first medically supervised safer inject-ing facility was not associated with a marked increase indrug trafficking or acquisitive crimes in the year after thefacility opened. These findings suggest that the benefits ofthe SIF on public drug use and HIV risk behavior have notbeen offset by an increase in criminal activity in the neigh-borhood [12,15]. These findings should make a valuablecontribution to the ongoing debates regarding the valueof SIF, and for the cities in Canada and elsewhere that areconsidering initiating SIF trials [8-10,16-19].Competing interestsThe author(s) declare that they have no competing inter-ests.Authors' contributionsEW, CL, and TK designed the study. CL conducted the sta-tistical analyses. EW wrote the first draft and compiled theco-authors' suggestions. All authors participated in thedrafting of the manuscript and approved the final version.Page 3 of 4(page number not for citation purposes)AcknowledgementsPublish with BioMed Central   and  every scientist can read your work free of charge"BioMed Central will be the most significant development for disseminating the results of biomedical research in our lifetime."Sir Paul Nurse, Cancer Research UKYour research papers will be:available free of charge to the entire biomedical communitypeer reviewed and published immediately upon acceptancecited in PubMed and archived on PubMed Central Substance Abuse Treatment, Prevention, and Policy 2006, 1:13 http://www.substanceabusepolicy.com/content/1/1/13The authors wish to thank the staff of the InSite SIF and Vancouver Coastal Health (Chris Buchner, David Marsh, Heather Hay). We also thank Aaron Eddie, Suzy Coulter, Megan Oleson, Peter Vann, Dave Isham, Steve Gaspar, and Deborah Graham for their research and administrative assistance. Par-ticular thanks goes to Daniel Kane for his assistance with data acquisition. The SIF evaluation has been made possible through a financial contribution from Health Canada, though the views expressed herein do not represent the official policies of Health Canada.References1. National Institutes of Health/National Consensus Development Panelon Effective Medical Treatment of Opiate Addiction: Effective med-ical treatment of opiate addiction.  JAMA 1988, 280:1936-1943.2. Wood E, Tyndall MW, Spittal PM, Li K, Anis A, Hogg RS, MontanerJS, O'Shaughnessy MV, Schechter MT: Impact of supply-side poli-cies for control of illicit drugs in the face of the AIDS andoverdose epidemics: investigation of a massive heroin sei-zure.  CMAJ 2003, 168:165-169.3. Karon JM, Fleming PL, Steketee RW, De Cock KM: HIV in theUnited States at the turn of the century: an epidemic in tran-sition.  Am J Public Health 2001, 91:1060-1068.4. Garfield J, Drucker E: Fatal overdose trends in major US cities:1990–1997.  Addictions Research and Theory 2001, 9:425-436.5. Doherty MC, Garfein RS, Vlahov D, Junge B, Rathouz PJ, Galai N,Anthony JC, Beilenson P: Discarded needles do not increasesoon after the opening of a needle exchange program.  Am JEpidemiol 1997, 145:730-737.6. Paone D, Des Jarlais DC, Caloir S, Clark J, Jose B: Operationalissues in syringe exchanges: the New York City tagging alter-native study.  J Community Health 1995, 20:111-123.7. Kimber J, Dolan K, van Beek I, Hedrich D, Zurhold H: Drug con-sumption facilities: an update since 2000.  Drug Alcohol Rev 2003,22:227-233.8. Wood E, Kerr T, Montaner JS, Strathdee SA, Wodak A, Hankins CA,Schechter MT, Tyndall MW: Rationale for evaluating NorthAmerica's first medically supervised safer-injecting facility.Lancet Infect Dis 2004, 4:301-306.9. Yamey G: UN condemns Australian plans for "safe injectingrooms".  BMJ 2000, 320:667.10. Gandey A: US slams Canada over Vancouver's new drug injec-tion site.  CMAJ 2003, 169:1063.11. Election may have doomed Victoria safe-injection site  VictoriaTimes Colonist  [http://www.mapinc.org/tlcnews/v06/n171/a05.htm?142]. February 9, 200612. Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JSG, TyndallMW: Changes in public order after the opening of a medicallysupervised safer injecting facility for illicit injection drugusers.  CMAJ 2004, 171:731-734.13. Freeman K, Jones CG, Weatherburn DJ, Rutter S, Spooner CJ, Don-nelly N: The impact of the Sydney Medically SupervisedInjecting Centre (MSIC) on crime.  Drug Alcohol Rev 2005,24:173-184.14. Wood E, Spittal PM, Small W, Kerr T, Li K, Hogg RS, Tyndall MW,Montaner JSG, Schechter MT: Displacement of Canada's largestpublic illicit drug market in response to a police crackdown.CMAJ 2004, 170:1551-1556.15. Kerr T, Tyndall M, Li K, Montaner JS, Wood E: Safer injection facil-ity use and syringe sharing in injection drug users.  Lancet2005, 366:316-318.16. Strang J, Fortson R: Supervised fixing rooms, supervised inject-able maintenance clinics – understanding the difference.  BMJ2004, 328:102-103.17. Wright NM, Tompkins CN: Supervised injecting centres.  BMJ2004, 328:100-102.18. Green TC, Hankins CA, Palmer D, Boivin JF, Platt R: My place, yourplace, or a safer place: the intention among Montreal inject-ing drug users to use supervised injecting facilities.  Can J PublicHealth 2004, 95:110-114.19. Malkin I, Elliott R, Mcrae R: Supervised injecting facilities andinternational law.  J Drug Issues 2003, 33:539-578.yours — you keep the copyrightSubmit your manuscript here:http://www.biomedcentral.com/info/publishing_adv.aspBioMedcentralPage 4 of 4(page number not for citation purposes)

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