In 2003, in response to ongoing epidemics of HIV and overdose among local injection drug users, health officials in Vancouver, Canada opened North America’s first supervised injection facility (SIF). In the SIF, injection drug users can inject pre-obtained illicit drugs under the supervision of nurses and receive referrals to health and social services. Approximately 75 SIFs are in operation in several countries in Europe, and single pilot SIFs exist in Australia and Canada.

After four years of evaluation, scientists working at the British Columbia Centre for Excellence in HIV/AIDS have published 24 studies demonstrating that the opening of the SIF was associated with decreases in public disorder, reductions in syringe sharing, and increased enrollment in detoxification and addiction treatment programs. In fact, SIFs provide a safe environment for drug users: There have been close to 1000 overdose events at the SIF in British Columbia and to date no one has died there.

Despite the wealth of peer-reviewed studies demonstrating the benefits of the Vancouver SIF, the Canadian government recently cut off funding for the SIF evaluation and placed a moratorium on further SIF research nationally. In discussing the SIF, the Canadian Minister of Health stated "…the only thing the research to date has proven is drug addicts need more help to get off drugs."

While SIFs represent one small component of a larger drug policy response, the evidence indicates that these programs can help improve public health and public order. Given the ongoing harms associated with injection drug use globally, it is critical that policy makers take action to support rather than misrepresent the science surrounding innovative interventions that reduce drug-related harm.

Thomas Kerr, PhD is a research scientist at the British Columbia Centre for Excellence in HIV/AIDS, and Assistant Professor at the University of British Columbia.  Evan Wood, PhD, MD is also a research scientist at the British Columbia Centre for Excellence in HIV/AIDS, and Associate Clinical Professor at University of British Columbia.

The U.S. in the midst of a heated debate regarding immigration, and a renewed debate on health care reform has begun in anticipation of the 2008 presidential election. A common theme in newspaper articles and opinion pieces of late is that immigrants, especially the undocumented, overburden the health care safety net and take away from "deserving" families. However, data do not support this contention. Studies have consistently shown that immigrants in general, and the undocumented in particular, use relatively little health care, probably due in part to their greater likelihood of being uninsured and their younger and healthier profiles. Even after considering health insurance and underlying health status, however, non-citizen adults and U.S. citizen children of non-citizen parents are consistently less likely than U.S. citizens to seek care, and overall use less care, including emergency department care.

Analyses of national data have found that expenditures for immigrant adults are 55% lower and for immigrant children 74% lower than their U.S. born counterparts, even after adjusting for age, income, insurance status, and health status. Another study demonstrated that the foreign-born, especially the undocumented, account for disproportionately fewer expenditures than the native-born (the foreign-born represent approximately 13.1% of the population but only 8.5% of the expenditures, and the undocumented represent 3.2% of the population but only 1.5% of the expenditures). The lower health care utilization and expenditures of immigrants, particularly the undocumented, may be exacerbated further by the current political climate, which discourages immigrants from seeking care out of fear of deportation and/or being seen as a "public charge."

The evidence therefore belies the rhetoric about undocumented immigrants and the safety net. However, the potential consequences of immigrants’ poor access to and utilization of care should be of concern. Immigrants often experience better health outcomes, including lower mortality, than their U.S.-born counterparts, but their health often deteriorates over time in the United States. Poor access to both personal medical services and public health services and programs likely play a role. Poor access to and poor performance of the health care and public health systems vis-à-vis immigrants have serious implications for the health of immigrants, their children, and, ultimately, for the health of the nation.

Kathryn Pitkin Derose and Nicole Lurie are health policy researchers for the RAND Corporation.