Abstract: After one year of operation, Insite has provided a secure environment for over 3,000 people who inject illicit drugs in Vancouver. Attendance has been consistently high, and now averages nearly 600 injections per day. Although heroin and other opiates are the most common drugs used at Insite, there are a substantial number of individuals using stimulant drugs. The facility has been very well managed and the staff is highly rated by the clients. Although there have been over 100 observed overdoses, there have been no fatalities and only one episode where CPR was required. This is very likely due to rapid staff interventions including oxygen therapy and in some cases Narcan. The SEOSI cohort is collecting in-depth prospective information on a randomly selected group of Insite clients and baseline demographics show that women, people of Aboriginal origin and those with unstable housing are availing themselves of the service in high numbers. There have been a large number of referrals made to addiction counseling and withdrawal management services by the counselors at Insite. Efforts to document the health outcomes associated with the site are ongoing and will be disseminated throughout the 3-year evaluation period and beyond.