‘Communities’ include people with addictions

The government continues to oppose effective harm reduction with its ‘Respect for Communities Act,’ writes Dr. Mark Tyndall. Meanwhile, lives are being destroyed.

On Sept. 29, 2011, the Supreme Court of Canada (SCC) ruled that the federal government could not close down Insite — North America’s only supervised injection facility. The ruling was clear: “applying the Controlled Drugs and Substances Act (CDSA) to Insite was arbitrary, undermining the very purposes of the CDSA, which include public health and safety. It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises.”

In 2003, when Insite was opened in Vancouver, there was strong opposition. However, by the time the 2011 SCC decision was announced, the community supported it, the public health department supported it, the municipality supported it, the police chief supported it, and the mayor supported it. Of the more than 10,000 individuals who had used drugs at Insite, nearly half had entered some form of drug treatment and all had been given the opportunity to connect with caring people. Those who were using drugs were helped to stay free of disease and connect with services that they needed. There were fewer drug overdoses, fewer HIV infections, and fewer hospital admissions. The community benefits included less crime, less drug dealing, less public drug use, happier shop owners, and higher property values. There was every expectation that cities with serious drug problems would embrace this intervention and make it a cornerstone of programming for harm reduction.

Instead of embracing a proven intervention to help deal with the enormous public health crisis of addiction and HIV infection in Canadian cities, the federal government was undeterred in its crusade to stamp out harm reduction initiatives; with supervised injection sites at the top of their hit list. On June 6, the federal health minister introduced new legislation that seems designed to kill any possibility that new facilities would be approved. Building on the general themes from the SCC ruling, but certainly not the spirit, the minister introduced 20 criteria that would need to be met before an approval would be granted. Instead of calling this legislation, “defying the Supreme Court of Canada act,” the new legislation was called the “Respect for Communities Act.” This announcement coincided with a mail out from the Conservative Party that thanked the Harper government (itself) for this new legislation that apparently would serve to “keep heroin out of your backyard.” Instead of acknowledging a health crisis, the strategy was fashioned after campaigns to block a new Walmart store, or oppose bicycle lanes, or debate the merits of a downtown Casino. Absurdly absent from the minister’s prepared statement was anything to do with health, like overdose deaths, HIV infections, hepatitis C infections, and serious injection-related infections — the very reasons for opening a supervised injection site in the first place.

Lost in all this rhetoric and intentional misinformation are the thousands of men and women, brothers, sisters, mothers, fathers, sons and daughters who have suffered immeasurable harm because of drug use and are desperate for our assistance. For many it is too late. Overdoses, AIDS, hepatitis, infections, and violence continue to kill at an alarming rate across the country. If people were dying like this from any other cause there would be public outrage and we would demand action from our government. But because this involves the poor and the undesirables in our society we go on like nothing is happening. Statements from the health minister claiming that her government favours prevention and treatment over “so-called” harm reduction are offensive to those impacted by addiction and show a total disconnect from the plight of inner-city drug addicts. Of course it would have been better to prevent the addiction in the first place, but it didn’t happen. Of course treatment would be great, but it isn’t available. What we have are simple, common-sense ways to prevent disease and suffering with the opportunity to engage people in care and treatment when they are ready and able to do it. This is called harm reduction. A supervised injection site is a few chairs, a table, and some clean needles where people can use their drugs under the care and supervision of a trained health care worker. What could be simpler than that?

The medical and public health community should also be held accountable for the current stalemate. We have been unable or uninterested in educating and convincing the general public that addiction is not a choice, that addiction is not a crime, and that addiction is very difficult to treat. We should be actively searching for alternatives to current engagement, care and treatment for drug users that go beyond supervised injection sites and develop a comprehensive drug strategy to help us out of this mess. Thousands of lives are being destroyed through policies that in essence take a serious medical condition and criminalize it.

What’s next for supervised injection sites in Canada? Those committed to helping people with addictions will continue to push for programs that make a difference and fight for health services that can address the suffering of drug users. Supervised injection sites will be opened in Canada and the government will be challenged for its callous and misinformed policies through legal avenues and whatever else it takes to do the right thing. Thousands of Canadians, the poor, the addicted, the mentally ill, our brothers and our sisters, are depending on us.

By Dr. Mark Tyndall, head of infectious diseases at the Ottawa Hospital.
Source: Ottawa Citizen