Why Ottawa needs some Insite

Last week's unanimous Supreme Court decision that allows Vancouver to operate Insite, North America's first supervised injection site, was a victory for harm reduction and a ringing endorsement for a more sensible approach to illicit drug use in Canada. The court battle essentially pitted a highly successful evidence-based program that saves lives, reduces drug use, and connects drug users to health care services against our federal government's commitment to stopping drug use through criminal deterrents.

In the spirit of full disclosure it should be stated that I am firmly on the side of harm reduction. Over the past 12 years I have been working as a physician and researcher on projects aimed to reduce the devastating effects of illicit drug use, including studies at Insite. During that time I have witnessed first-hand all of the serious health consequences of drug use including death from HIV, Hepatitis C, overdoses, and an encyclopedic list of infectious diseases. I have seen people inject drugs into their arms, legs, groins, neck, fingers and toes. I have seen people use filthy puddle water to mix their drugs and pick up used needles in hopes of finding the tiniest residue of heroin stuck to the side of a syringe. I have seen people lie, cheat, steal, and beat their friends for drugs. I have known women who have gone missing and were later found murdered as a consequence of drug addiction and prostitution. In short, I have seen the very worst of drug use and the physical, mental and social harms endured by individuals, their families and communities.

There are many misconceptions surrounding harm reduction that cloud the issue and confuse the debate. Simply put, harm reduction is a very pragmatic approach to problem drug use and offers support, care and treatment to people who are either not able or not willing to stop using drugs. The underlying principle is that people who use drugs have enough life challenges already and should not be sentenced to a life of homelessness, disease, and intermittent imprisonment because of the illegal drugs that they use. Harm reduction offers people the opportunity to connect with health and social services while recognizing that most addicted people will continue to use drugs.

Critics of harm reduction have used a number of arguments to undermine programs. However, there is not a shred of evidence that harm reduction interventions promote drug use, create new drug users, increase danger to the public, encourage criminal behaviours, or make it easy for organized crime or pimps to exploit the weak and the vulnerable. In fact, harm reduction has the opposite effect. On the other hand, the law enforcement approach to reducing illicit drug use has directly contributed to these problems. Even the most ardent supporters of this law enforcement admit that things are getting worse and cycling drug addicts through the criminal justice system is neither effective or sustainable.

In addition to criminalization, the federal government has stated their priorities are also aimed at prevention and treatment. On the surface it is hard to argue against these goals. However, there is a major difference between prevention of drug addiction in our society and preventing drug use among people who are already addicted. Preventing people from initiating drug use should indeed be a key component of our drug strategy and programs that are directed at the drivers of drug addiction should be addressed. But we cannot wait for our government to eliminate childhood poverty, build affordable housing, develop mental health programs, enhance youth employment opportunities, support single-parent families, and build strong communities. All of these could help in the future but will be too late for people who are currently addicted.

Addiction treatment is also important and the opportunities for street-entrenched drug users are woefully inadequate across Canada. The government should certainly be providing more resources for short-term detoxification, medium-term outpatient treatment and longterm residential facilities. There are many people who could be helped if treatment programs were available. However, there can be no treatment without the engagement of the very people who need treatment and there can be no engagement without low threshold, non-judgmental, and long-term facilities that can work with drug users. This is exactly what a supervised injection site provides.

Opponents of harm reduction also use an economic argument to deny services, stating that programs are too expensive in times of government cutbacks. However, the real concern should be directed at the costs of not initiating harm reduction programs. Who pays for ambulance calls, emergency room visits, hospital admissions, ICU care, and surgery to drain abscesses? Who pays for police calls, court costs, and jail time? Who pays the $250,000 lifetime cost of HIV care and treatment? If a supervised injection site could prevent just four cases of HIV per year, it would pay for itself. It is hard to think of more cost-effective health interventions than needle/syringe programs, methadone maintenance therapy, and supervised injection sites.

There are many lessons that can be learned from the Insite experience in Vancouver and it would be a serious mistake to start the debate from scratch in Ottawa. Although the drug situation in the downtown eastside of Vancouver is on a larger scale, everything else is much the same. In 2003 when Insite opened its doors, the municipal government, the police, and the local business community were all against the facility. Now they enthusiastically support it. Even public opinion polls that were overwhelmingly opposed to harm reduction have been transformed into a type of civic pride at the accomplishments of Insite.

Ottawa has many talented and committed community workers, nurses, physicians, and advocates who could really make a difference to our city. Although not a magic bullet, a comprehensive harm reduction program in Ottawa would reduce problem drug use, improve health outcomes, make our communities safer, connect the addicted to treatment, and stop the transmission of HIV among the cities drug users. The time is now to switch direction and treat addiction as a health issue and give hope to some of the most vulnerable people in our city.

By Dr. Mark Tyndall, professor of medicine at the University of Ottawa and chief of infectious diseases at The Ottawa Hospital

Source: Ottawa Citizen