A stern letter to our city officials, composed one day after the INSITE Supreme Court ruling

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On October 1st 2011, one day after the Supreme Court delivered their ruling about INSITE, North America's only sanctioned safe injection facility, I wrote a very stern letter to some select city officials (some of which since moved on..). Here it is (*clears throat*):

Dear Mayor Jim Watson and (now former) Chief of the Ottawa Police Vern White,

My name is Frederique Chabot, I am an HIV prevention worker and a member of Campaign for Safer Consumption Sites in Ottawa. This letter is a response to both your public reaction about Supreme Court’s decision on Insite – North America’s only sanctioned safe injection facility. The Supreme Court rendered a unanimous decision that will allow Insite to continue to operate and save lives, prevent disease, provide access to health care and recovery services and a host of other proven benefits. It was an important victory of scientific evidence-based policy over ideological policy. Importantly, as community members, drug users, people who offer HIV prevention and support services in the community and/or health and social service providers, we are hopeful that this historic decision may open the doors to similar services throughout Canada and, more precisely, in our city where the rates of HIV and Hepatitis C infections among drug using communities is on the rise. Therefore, as concerned citizens, as social or health service providers and as members of community health service organizations, your position strikes us as startling, appalling, and ignorant to an evidence-based approach to health care.

The Supreme Court, in its unanimous decision, reiterated these facts by relying on expert testimonies as well as solid scientific proof. We consider that we are now presented with a great opportunity to engage with this topic in order to improve our service delivery and address these alarming trends in HIV infections. Again, the distribution of safer drug use materials and the provision of comprehensive harm reduction services have been repeatedly demonstrated to be a cost-effective effort in reducing the transmission of HIV, Hepatitis, and other diseases and therefore contribute to healthier and safer communities.

In Ontario, Needle Exchange Progams (NEPs) are legislated as a mandatory public health program in areas where injection drug use is recognized as a problem in the community (Ontario Ministry of Health and Long Term Care, 1997). The Mandatory Health Programs and Services Guidelines state that “The board of health shall ensure that injection drug users can have access to sterile injection equipment by the provision of needle and syringe exchange programs as a harm reduction strategy to prevent transmission of HIV, hepatitis B, hepatitis C and other blood-borne infections and associated diseases in areas where drug use is recognized as a problem in the community”.

If we take a close look at Ottawa’s rates of Hepatitis C and HIV in drug using communities, they are higher than any other city in Ontario, and, nationally, a close second after Vancouver. In numbers, it means that 78% of the estimated drug using community tests positive for Hepatitis C and 20% of them test positive for HIV. The majority of HIV positive drug users are coinfected with Hepatitis C which makes it harder to treat either of these two conditions.
In Mr White’s public reaction to the Supreme Court decision, he actually made it clear that, when it comes to our police services, not only do his personal views on drug users trump science, he is already actively directing the employees of a city service (OPS) to impede on a provincially mandated health program: “White’s opposition is a serious impediment for those hoping to open an injection site here. For such a facility to succeed there has to be some cooperation with police, (Dr. Mark) Tyndall said. “It doesn’t mean they have to fully endorse it, but they are in a position to undermine things by just arresting people in front of the site or in the site.” But White indicated that it is exactly what city police would do. (Ottawa Citizen “Mayor, Police Chief oppose safe injection site in Ottawa” Friday, September 30th 2011).
This is a repeat of another ideological cut to health services, courtesy of former Ottawa mayor, Larry O'Brien, who, in 2007, successfully campaigned to eliminate Ottawa's safer inhalation program while simultaneously pushing for increased street-level police enforcement. Both O’Brien and Ottawa Police Chief Vern White declared themselves opposed to the distribution of clean stems -- crack pipes – “because there is no evidence it stops addicts from sharing drug paraphernalia”. White then explained to an Ottawa Citizen reporter that: “I’m not a supporter of the crack pipe program; I have yet to see any evidence it does what it is purported to do. Sitting around a table, some of these initiatives make good sense. Once you drop them in the middle of the street, I’m not sure they do. But I’m not a doctor, I’m a cop”. Despite the conclusive scientific evidence declaring the exact opposite, they proceeded to override Ottawa’s Health officers’ advice on a matter of public health. Furthermore, drug users in Ottawa regularly report the destruction of their clean/unused drug paraphernalia; in particular crack pipes and syringes, both of which are distributed through community organizations. As we know, these losses can be devastating because of the potential health risks to which individuals are exposed as a consequence. The City of Ottawa’s own website states: “the availability of these programs has been deemed a necessary public health measure to prevent the spread of communicable diseases, primarily HIV and Hepatitis-C virus, and to minimize the risks associated with substance use in society.” It is tragically ironic that in Canada, police officers, with the blessing of our mayor, appear to undermine this public health approach and in the process put the lives of citizens at risk.

Mr Watson, Mr White, you are both in positions where you could positively impact the health outcomes of vulnerable groups in our community and, as such, improve all of our wellbeing as a diverse community. Behind addiction lay social challenges such as homelessness, poverty, isolation, and income inequality – none of which can be solved by imprisoning individuals hardest hit by these problems or heightening their risk to contract HIV or Hepatitis or die of an overdose.

This is a collective and pressing issue. We know full well that queer youth face discrimination, harassment and violence at astronomical levels. And we know that when queer youth do come out to their families, they're chased out of their homes and onto the streets far too often. The rates of homelessness and substance use of LGBTQ youth make the presence of a Safe Consumption site in Ottawa, a queer issue and a youth issue.

Mr. Watson declared October 4th to be 'Sisters in Spirit' Day. On that day, vigils took place across the country to demand justice for missing and murdered Indigenous women and his letter of support was read on the Hill. But, Mr Watson, you also declared a 'Respect for Life' Day in support of anti-choice groups and then, on the day the Supreme Court made its decision to keep Insite open, you publicly stated how you are against having a Safe Consumption Site in Ottawa. Your actions speak louder than your words when you speak of your "commitment" to women's health. Injection drug use accounted for about 46% of new HIV transmission among women in Canada in 2002 (Canadian HIV/AIDS Legal Network). The presence of a safe Consumption Site in Ottawa is a women’s health issue.

Indigenous women represent more than 60% of new HIV infections in their communities (compared to 16% for non-Aboriginal women) and are testing positive younger and at a higher rate because of drug injection. Indigenous women are overrepresented in all ‘health disparities’ categories. But Indigenous health concerns are relegated to a few ‘Aboriginal agencies’ instead of being put at the center of health initiatives across the board. This makes the presence of a Safe Consumption Site in Ottawa, an Indigenous Rights issue.

We could go on and on in terms of the wide impact of your current stance on harm reduction services.

Many organizations in Ottawa are proud community partners in Ottawa’s Safer Inhalation Program and Ottawa’s needle exchange program, which distributes safer drug use materials. Those who joined as community partners did so because of the demonstrated benefits of harm reduction services, and because of a strong belief in building upon successful practices. We believe that harm reduction goes both ways. Community members are concerned by the presence of drug use on their streets. It is possible to reconcile the needs of concerned community members with those of us who use drugs and it does not involve the creation of a revolving door with our jails, something that further marginalizes people and deepens the divide between members of the same communities. Instead of empty words or very real impediment of public health programs by police services, Ottawa needs to commit to such things as affordable housing, safer streets (for everybody), diverse harm reduction services (including a Safe Consumption Site), a just access to resources and services, mental health programming, addiction treatment beds and sensitivity trainings for our Police Service. This is where our energies should go as a community. While this reprioritization may strip us of the false sense of security created by imprisoning drug users for a couple of weeks, it will actually make a difference.

We as concerned community members and social and health service providers, urge you to revisit your statement regarding the presence of a Safe Consumption Site in our city. We urge you to consult health professionals regarding this public health matter and then respect their expertise. We urge you to ensure that the Ottawa Police Service does not impede people from accessing a provincially mandated health program.
We also inform you that, should you want to collaborate on this important health initiative, you can be assured that you’d find in us proud community partners in support of the opening of a Safe Consumption Site in our city.

Yours in promoting safe and healthy communities,
Frederique Chabot