Suddenly, safe-injection sites are mainstream politics

Posted on January 12, 2017 in Health Debates – Full Comment
January 10, 2017.   CHRIS SELLEY

One of the problems with being politically conservative in the most basic sense of the word — genetically suspicious of change — is that you can wind up looking lost and silly and backward when mainstream opinion on any given topic slingshots past you, as it often does in Canada. It only took about five years for opposition to same-sex marriage to go from a mainstream Liberal position to fodder for Liberal attack ads. About 15 minutes after the assisted dying law took effect, the news was full of people complaining children and people living in remote rural areas might be denied access.

We may now be at that point with safe-injections sites.

In Vancouver, Insite has been chugging along for 13 years, fending off court challenges and skeptics by … well, by saving the lives of 100 per cent of the hundreds of people who have overdosed on its premises. But the model hasn’t really spread, and not just because Ottawa has made it difficult. People like Ottawa mayor Jim Watson insist every penny spent on these facilities must go toward addiction treatment. People like Toronto city councillor Stephen Holyday argue governments shouldn’t provide a venue for illegal activity lest it sanction that activity.

Health Minister Jane Philpott supports supervised injection facilities. So do Montreal mayor Denis Coderre and his Toronto counterpart John Tory, formerly a skeptic. (Obviously we should offer treatment but in the meantime many are “needlessly dying alone,” Tory aptly observed.)

The number of opiate overdoses is pretty staggering: from January to October of last year, Vancouver officials attributed 374 fatalities to fentanyl alone. Toronto’s problem is not nearly so great, but it is growing in leaps and bounds. In the United States, the opioid epidemic takes 15,000 lives a year.

In Toronto, things certainly haven’t moved quickly: it was nearly six months ago that City Council approved the opening of supervised injection sites in three existing medical facilities. But this week, provincial Health Minister Eric Hoskins signalled there was funding to proceed. As soon as the feds sign off, it should finally be ready to go.

And the opposition in Canada’s largest city has been remarkably tepid. The vote at City Council was 36-3. The police are fine with it. The provincial Tories simply insisted on community consultations (which there were); interim federal Conservative leader Rona Ambrose simply insisted the law be followed (which it is being).

What opposition there has been came off as rote and weak: in addition to his general opposition, Holyday complained the facilities wouldn’t keep long enough hours to help that many people. (Pick a lane, man!) Ambrose’s health critic at the time, Kellie Leitch, observed that “the drugs that are used at these sites … are dangerous and addictive” — which is rather the point. Indeed, many harm reduction opponents sound like they’ve signed some kind of contract binding them to oppose the practice, and are scrambling to justify it.

When conservatives argue supervised injection doesn’t free people of addiction or society of addiction’s tragic and costly burden, they are quite correct. But then, treatment programs aren’t getting that job done either. And there is no policy on the table that would solve one of the biggest problems here, which is that people can never be sure what they’re injecting.

Fentanyl isn’t inherently deadly. It just happens to be vastly more powerful than most other opioids on the street. And its emergence as a leading overdose killer is in part thanks to efforts to stop people abusing much less dangerous drugs like oxycodone: “abuse-proof” versions, which can’t be ground up, drove people away from a pharmaceutical grade product and toward whatever might today be on the market as “heroin.” Well played, everyone!

If you’re a politician and you genuinely want to solve big, intractable problems like that, you’re going to have propose some pretty radical policy. We could, for example, provide addicts with pharmaceutical-grade drugs, on more or less exactly the grounds the Liberals use to support legalizing marijuana: people know what they’re getting and it shuts down the black market.

I don’t expect I’ll live to see that; I’m not even sure I think it’s a good idea. But in the meantime, politicians could at least admit intractable problems are intractable and support half-measures. If hundreds of people are dying easily preventable deaths and your political orthodoxy prevents you from supporting a demonstrably effective remedial measure, maybe there’s something wrong with your political orthodoxy. Maybe, pretty soon, you’re going to look lost, silly and backward.

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