Reader Comments

Time for Reasoned Academic Debate on Safer Injection Facilities

by Evan Wood (2007-09-07)

As the external evaluators of the Vancouver medically supervised safer injection facility (SIF), we read the commentary by Dr. Stephen Hwang (REF Open Medicine Commentary) and the response by Colin Mangham with great interest.

We agree with Colin Mangham that increased funding to evidence-based approaches to drug use prevention and treatment is needed. However, we strongly disagree with several of his criticisms of the research evaluating Insite. With respect to his claims of bias, we wish to point out that the Vancouver SIF evaluation was designed to stand up to the highest level of scientific scrutiny. Specifically, the following safeguards were put in place. First, a regional SIF oversight committee was developed which included senior members of all stakeholders groups, including the Chief of the Vancouver Police Department and the Provincial Medical Health Officer. Second, in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) criteria for observational research, it was required that the methodology for the evaluation be subject to external peer review to ensure scientific rigour, and publication to ensure scientific openness. Finally, it was required that all findings of the evaluation be subject to external peer review and publication prior to dissemination, and many of these studies were published in top journals such as the New England Journal of Medicine.1 These safeguards are described in detail in a recent article.2

We stand by the published findings from the evaluation and believe that the limitations of the research are well described in these published reports. We agree with Colin Mangham, however, that there are many instances where media reports go beyond what is described in scientific studies. A colourful example of this is the large amount of media attention given to Mr. Mangham’s recent essay in the Journal of Global Drug Policy and Practice ( which was funded by the Royal Canadian Mounted Police.3

It should be pointed out that the Journal of Global Drug Policy and Practice is funded by the Drug Free America Foundation and is an effort of the Institute on Global Drug Policy. Neither organization is a scientific body. The stated goal of the Institute is outlined clearly on the Drug Free America Foundation web site:

“The Institute is charged with creating and strengthening international laws that hold drug users and dealers criminally accountable for their actions. It will vigorously promote treaties and agreements that provide clear penalties to individuals who buy, sell or use harmful drugs. … The institute supports efforts to oppose policies based on the concept of harm reduction.” []

As scientists, we are strongly in favour of scientific debate and academic critique, but we believe what is contained in Mr. Mangham’s essay falls well short of this. The paper is fraught with a host of outright factual inaccuracies and unsubstantiated claims, which we would be happy to list should the readers of Open Medicine wish. We strongly encourage the readers of Open Medicine to read Mr. Mangham’s essay alongside the various reports examining Insite’s impacts and to judge for themselves the state of the science in this area.


1. Wood E, Tyndall MW, Zhang R, Stoltz J, Lai C, Montaner JS, Kerr T. Attendance at supervised injecting facilities and use of detoxification services. N Engl J Med 2006;354(23):2512-4.

2. Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ 2006; 175(11):1399-404.

3. The Vancouver Province. Vancouver must be open to new ways to curb drug addiction. 2007 May 6, 2007; Sect. A22.

ISSN 1911-2092