Looming drug-overdose crisis prompts Ottawa's health unit to back a safe injection site

The capital is on the brink of an injection-drug crisis, the city’s top public-health doctor believes, and now is the time to open a safe drug-injection site to try to head it off.

“In Ottawa, we are on the cusp of this larger trend, and we have dodged it because we have been lucky so far,” says Dr. Isra Levy, the city’s medical officer of health.

Monday night, after years of equivocating, his health unit released a report saying the city should have at least one supervised facility aimed at chronic users of injection drugs, where they can shoot up with clean needles and have nurses on hand to help if they overdose.

Such facilities “may be a useful part of the spectrum of clinical health services in communities that wish to have such services,” Levy said lamely in 2014, when the idea first arose seriously here. Now, he’s come to believe they’re a necessity.

Levy never had any doubt that providing a safe place for addicts to use drugs was good medicine — “I could have said that to you when I started my career 30 years ago,” he says — but the rise in overdose deaths we’ve had here already, and sharp increases they’ve seen elsewhere in the country, have convinced him that a safe injection site is good public policy.

“I have been skeptical, to be honest, about some of the overdose information that we have received,” Levy says. But now he believes he’s standing on firm ground, since health-unit epidemiologists have spent the last two months studying Ottawa’s drug use.

Between 30 and 40 Ottawans die of drug overdoses each year, he said, a number that jumped sharply in 2009. Opiates like morphine and heroin, which are often injected, cause a large and growing percentage of those deaths. Levy attributes the increase a few years ago to powdered fentanyl, a powerful opiate where the difference between a “normal” dose and a deadly one is tiny.

Since 2012, Ottawa’s drug users have had growing access to a drug called naloxone, which can counteract opiate overdoses. Levy says the health unit’s stats say naloxone has saved about 60 lives since then — but the final number of overdose deaths hasn’t fallen. In other words, naloxone is holding opiate overdoses off. Otherwise, we’d have more and more.

In British Columbia, the provincial public-health authority declared an emergency in April over rising numbers of ODs.

Here, a couple of hundred people each year survive overdoses with emergency-room treatment. Emergency-room visits for drug overdoses are up 60 per cent. Paramedic calls are up, too.

Drug overdoses here are not a stable problem.

Safe injection sites in Vancouver and in Europe have cut overdoses, reduced the spread of bloodborne diseases, and given chronic addicts contact with the health system they might otherwise not have.

There’s zero proof from Vancouver that its longstanding safe-injection site in the Downtown Eastside promotes crime there. InSite, as it’s called, is in a poor, and troubled neighbourhood but one that has business owners and landlords and residents; research commissioned by the federal Conservatives, who wanted to shut the site down, could find no sign that crime got worse on or around East Hastings Street after InSite opened.

The argument that a safe-injection site promotes crime is not supported by evidence.

InSite is a comparatively expensive standalone facility, costing about $3 million a year, but the evidence is that it covers its costs in averted HIV cases alone. Not one person has died there of an overdose.

The argument that a safe-injection site costs money we could better spend some other way is not supported by evidence.

More drug users live in the Rideau-Vanier ward than anywhere else in Ottawa. It’s why the Sandy Hill Community Health Centre wants to add a small safe-injection facility to its existing drug-treatment clinic.

The health unit sums its conclusion up in one epic three-breath sentence:

“Given the ongoing challenges outlined in this report, the evolving conversation about the expansion of harm reduction services in Ottawa and in other Canadian jurisdictions, and the evidence in support of SIS (supervised injection services) as part of the continuum of care for persons living with problematic drug use, staff is recommending that Ottawa’s Board of Health declare that, from a public health perspective, SIS are an effective, well-researched and evidence-based treatment option that have a place in any comprehensive approach to working with people who inject drugs.”

Levy also wants to look at the possibility of a mobile site, possibly a sort of minibus that could travel to drug users on demand. It sounds odd but that’s how needle-exchange vans work.

The health unit acknowledges that it knows of only three in the world — in Berlin, Barcelona and Copenhagen. There’s a lot less research on them than there is on fixed-location sites, and drug users themselves don’t see the appeal. Also, nobody here has proposed one.

But the epidemiologists point out that while injection-drug problems are concentrated in a couple of downtown neighbourhoods, Ottawa’s a big city and there’s hardly any part of it that hasn’t had overdoses. A mobile site could visit different places and keep odd hours. So we should be “exploring with partner agencies the benefits and considerations of implementing a mobile SIS in addition to fixed services,” the health unit’s report says.

For Levy, outreach is vital. Heavy drug users might not have the wherewithal, or the time, to travel a kilometre to get to a safe injection site, so if one could come to them, they could still be served.

“There are some practical considerations,” he acknowledges. The health unit’s existing needle-exchange van doesn’t have the room for resuscitation equipment that would be an injection site’s major reason for being. It could only be in one place at a time, with one user at a time. Levy’s personally attached to the idea but his own staff aren’t sure it’s workable. More study is the compromise.

He says he understands the argument that it’s unethical to condone, or at least ignore, drug abuse. He’s had long, long talks about it with police-chief-turned-senator Vern White in particular. How can Levy, as a doctor, let a person shoot up with poison while he looks on?

“I see an ethical problem with throwing that person out of my office because he’s going to do something I don’t agree with,” Levy says. Doctors attend to patients all the time who’ve done harmful things to themselves. They set bones broken in stupid teenage stunts. They treat obese diabetics and sun-worshippers with skin cancer and smokers with emphysema. They urge patients to make healthier choices and do all they can to support them when they’re ready to.

“As a physician, I’m here to help. That’s my reason for being here,” Levy says.

Next, the board of health he advises will decide what to do with his advice. It’s a body set up explicitly to depoliticize decisions that should be based on science. It’s to debate Levy’s recommendation next Monday night.

The transformation puts the health unit in conflict with both Mayor Jim Watson and Chief Charles Bordeleau of the Ottawa police, who are both against a safe injection site here. Well, Watson doesn’t quite say that — he says he’d prefer to spend the money on rehabilitation programs.

“I’m hopeful that we can find common ground,” Levy says. “I think we have common ground already, in fact. … This is about people who need help. It’s our job to provide that help. These aren’t ‘those people,’ these are Ottawans, these are part of our family.”

By David Reevely
Source: Ottawa Citizen