Social Policy in Ontario

Doug Ford wants to stop doctors from handing out clean needles. Here’s why they shouldn’t listen

Posted on September 16, 2024 in Health Policy Context

Source: TheStar.com — Authors: Philip Berger

TheStar.com – Opinion/Contributors
Sept. 14, 2024.   Philip Berger, Contributor

The Ontario government’s plan to shut down certain consumption and treatment services, at which drug users can inject drugs under supervision, has triggered a vigorous public debate. Unfortunately that debate has been tainted by the spread of misinformation by the government itself.

The government’s plans include prohibiting provincially funded community health centres with consumption services from distributing clean needles and providing safer supply of opioids and other prescriptions. The government alleges that needle distribution and safer supply threaten community safety and are ineffective ways to treat substance dependent people. The government is wrong on both counts.

In fact, many studies conducted across the world including Canada show the opposite. It has been established for over 35 years that public health is protected by providing clean needles (ideally when also collecting used needles) and the prescribing of opioids reduces overdose-related mortality.

The government’s plan would appear to prevent doctors from doing either. But there may be a way around these two prohibitions.

In the awful days of the AIDS epidemic in the late 1980s/90s, HIV infection was rampaging through injection drug user communities across Canada.

In 1988 some AIDS doctors began giving out needles from their medical offices. They did so because by then, peer-reviewed evidence had been published showing that giving clean needles to users dramatically lowered rates of HIV infections. The Star covered the action of these doctors in an article published on Oct. 15, 1988 (“Some MDs giving out needles to addicts to combat AIDS”), though only one agreed to be interviewed about the practice.

The Toronto police threatened the doctors with arrest for providing drug paraphernalia. But the then registrar of the College of Physicians and Surgeons endorsed the practice. At the same time, these doctors prescribed opioids to those dependent on heroin and other addictive drugs under cover of treating AIDS related pain. That move was not sanctioned by the CPSO, and it was definitely a choice by the AIDS physicians. But their patients’ and the public’s safety were paramount. The doctors were undeterred.

Since then, needle exchange programs have become widely available. In December 2019, the College of Physicians and Surgeons of Ontario issued permissive guidelines to the profession on “safer supply” of hydromorphone and other drugs to drug dependent people. Doctors could prescribe such drugs without fear of disciplinary action by the CPSO.

It is a lesson on how doctors might react to the current government’s plan. Community health centre boards and administrative staff cannot intrude into the privacy of the doctor patient interaction at these centres, or tell doctors what to prescribe or how to treat patients. Physicians employed at community health centres are accountable to the CPSO and are obliged to act in the best interests of their patients. That means that these doctors can provide clean needles in the privacy of their community health centre offices and prescribe opioids and other addictive drugs to substance dependent people.

It would take some courage for community health centre physicians to appear to be defying the government. In fact they would only be doing their jobs, and would be meeting their regulatory obligations to offer one part of the standard of care for drug users. If AIDS doctors in the early years of the epidemic could do it at risk to themselves, then community health centre doctors should follow suit today. The government’s plan threatens to take us back over 3 decades in the treatment available to substance users. Lives and community safety depend on resisting it.

Philip Berger is an Officer of the Order of Canada and a retired long time downtown Toronto physician.

https://www.thestar.com/opinion/contributors/doug-ford-wants-to-stop-doctors-from-handing-out-clean-needles-heres-why-they-shouldnt/article_032617d2-6eba-11ef-a823-37383c37fe5f.html

Tags: Health, ideology, jurisdiction, mental Health, pharmaceutical

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