“The time is now” for safe injection sites, says prominent Ottawa doctor

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A prominent Ottawa doctor says he’s ready to lead an effort to bring a safe injection site for drug addicts to the nation’s capital. But he’ll have to overcome strong opposition from Ottawa’s mayor and chief of police first.

In an interview following Friday’s Supreme Court ruling that rejected the federal government’s efforts to shut down Vancouver’s Insite injection facility, Dr. Mark Tyndall, head of the Ottawa Hospital’s division of infectious diseases, said “the time is now” to offer a similar service here. “The supervised site has been an overwhelmingly important and successful intervention in Vancouver, and I think Ottawa could benefit from a similar facility,” said Tyndall, a former co-lead investigator at Insite who moved to Ottawa 10 months ago.

Ottawa has “possibly the highest rate of new HIV infections among drug users in all Canada,” he said. “There’s a health crisis going right here and as people tiptoe around the issues, time is running out for some people.”

Tyndall said many of Ottawa’s addicts are abusing prescription drugs such as OxyContin, Percocet and morphine. “They’re traded like money on the streets.”

Offering the city’s estimated 6,000 intravenous drug users a clean, safe and legal place in the downtown core to inject drugs would be a “very important component” of a strategy to combat HIV infection and transmission, he said.

But Ottawa Mayor Jim Watson and police chief Vern White quickly lined up in opposition to the idea.

“I do not support locating a safe injection site in Ottawa, and was very clear about that in the last election,” Watson said in a statement released by his office.

The mayor said his priority is to continue work he started as minister of health promotion in Ontario’s Liberal government and provide funds and support to drug prevention programs. “Using scarce public health dollars for these drug treatment centres will continue to be my focus when it comes to helping young people addicted to drugs.”

White warned that such a facility would have “an extreme negative impact” on nearby residents, including a heightened risk to public safety. During visits to Insite in the past, “I certainly didn’t feel as safe in that area of Vancouver as I did in other areas of Vancouver,” White said. “I’ve spoken to police officers who will say the same thing.”

Insite has been operating since 2003 under a special federal exemption to the Controlled Drug and Substances Act. In 2008, Tony Clement, then minister of health, refused to extend Insite’s exemption, triggering a legal battle resolved by Friday’s Supreme Court ruling.

The court found the federal government’s action violated Section 7 of the Charter of Rights and Freedoms, which protects the life, liberty and security of individual Canadians. It ordered an immediate exception for Insite, allowing the facility to remain open indefinitely.

While the federal government still must grant exemptions before other safe injection sites can open, the court’s ruling narrows the grounds for refusal.

If a supervised injection site decreases the risk of death and disease without clear evidence that it will harm public safety, “the minister should generally grant an exemption,” the court said. In light of that, the ruling has opened the door for more injection sites in Canadian cities, including Ottawa.

Tyndall said he’s already discussed the possibility of opening an injection site with some city councillors, whom he declined to name. “Everything’s kind of off the record,” he said, adding: “I wasn’t told the door was closed, but nobody’s come forward and said they’d spearhead this.” That’s one reason he’s prepared to take on a leadership role, he said. “What I have is experience with this from another city.” But, he said, “clearly it would be a group effort. There’s a lot of good people doing good things in Ottawa right now, and I’m slowly meeting them over time.”

His former Insite colleagues have offered to help establish a similar facility here, Tyndall said. “As far as the expertise and coming up with procedures and training, a lot of that material could be imported quickly from Vancouver. We wouldn’t have to go through a lot of the learning curve they went through.”

Among his supporters in Ottawa, Tyndall said there’s concern that Ottawans could be “quite hostile to these kinds of interventions” compared to Vancouverites. “I always try to assure people that it’s really not the case,” he said. “Vancouver’s not that much different. People are people, and if you show a reasonable approach that will actually improve their communities and reduce the burden of ill-health, then most people will listen.”

Before an injection site could open in Ottawa, city council would have to zone a property for that use. And someone — presumably the provincial Ministry of Health — would have to fund it. Insite’s annual budget is about $1.5 million a year. But Tyndall said those costs are insignificant compared to the potential savings to the health care system. The health consequences of drug addiction “are just outrageous,” he said. One week in hospital for an overdosed addict can cost upwards of $100,000.

Tyndall said an Ottawa site should also have facilities to test and treat people for HIV, something now lacking here. “The supervised site would be an excellent way to connect with people who are not currently in any kind of care and treatment.”

Because experience shows that drug addicts won’t travel long distances to use injection sites, any facility in Ottawa would have to be centrally located, most likely in the ByWard Market area, Tyndall said.

He acknowledged that could be a problem. “I’m sure the city wants to make that the diamond of their city and have it very attractive to tourists. But these kind of things really help the community.” White said he’d be “absolutely blown away” if many downtown residents would welcome a safe injection site in their neighbourhood. “I have yet to hear anyone say I’d love it next to my house.”

The police chief has been to Insite several times. “I can tell you it’s an absolute mess around the supervised injection site.” Before the government issues any new exemptions, he said, it should carefully consider the safety of the public in surrounding areas.

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, 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’s exactly what city police would do. “I’m not going to have a no-go zone for trafficking of drugs, and that’s what it literally is,” he said. “People are allowed to possess and traffic in drugs in a small area. I don’t see that as a positive thing for this city or any other city in this country.”

The police chief acknowledged that Ottawa, like all Canadian cities, has a “real problem” with drug addiction, particularly crack cocaine. But he said not enough is being done to deal with the root causes, including homelessness and mental health issues, or to provide necessary treatment.

Tyndall said people “who don’t really understand drug use and addiction” still believe the problem can be controlled with a combination of heavy law enforcement and treatment.

“That experience has been done in Canada and elsewhere for decades, and it’s not working. If you speak to most people in the community, they’ll say the problem’s getting worse.”

While Insite is the only supervised injection site in North America, similar harm-reduction facilities are common in Europe and Australia, Tyndall said. “Nobody thinks twice about it any more.”

By Don Butler
Source: Ottawa Citizen