Social Policy in Ontario

Toronto should welcome safe injection sites

Posted on March 15, 2016 in Health Debates

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TheStar.com – Opinion/Commentary – For health, economic and moral reasons, Toronto should approve safe injection sites
Mar 15 2016.   By: Howard Ovens

I’ve been an emergency physician in downtown Toronto for more than 30 years, and I regularly see patients with health problems related to the injection of illicit drugs. The problems might be caused by the drug itself, such as an overdose, but often the woes I see are caused by the use of dirty or shared needles. These include abscesses, heart damage, and viral infections such as hepatitis C or HIV.

These complications not only make users ill, they also cost a lot of money and health care resources to treat; and they pose a danger to others by furthering the spread of infectious diseases.

These issues make injection drug use a public health problem that affects us all. And they are why we as a community should support the development of supervised injection services in Toronto, as our city’s medical officer of health recommended this week.

For years, many people have worried about how best to deal with illicit drug use. Criminalizing drugs to prevent their distribution has failed. Increasing the policing of areas where drug users congregate has been unsuccessful in reducing drug use and its resultant ills. It became clear that other strategies were needed to reduce the social and economic consequences of drug use, regardless of whether we were reducing drug use itself.

Providing clean needles was the first step. Many cities have needle exchange programs where intravenous drug users can get clean needles, no questions asked. Toronto has such a program, and it gives out 1.9 million clean needles every year.

Other cities have gone further. In Vancouver, a supervised injection service called Insite was established a dozen years ago. It does not provide drugs; it simply provides a safe place for those who are injecting to do so.
The experience in Vancouver is similar to that of dozens of other cities — mostly in Europe — where supervised injection services exist. There is no increase in drug use or crime. The societal problems of drug use — needles discarded in parks, apartment stairwells and public washrooms — are substantially reduced. The injection of drugs in public spaces is reduced. Emergency department visits made by injection drug users are reduced, too.

Individuals who use supervised injection services are less likely to suffer from the diseases experienced by other drug users. As well, they are offered support and the opportunity to try to end their addiction, and some have taken that route. Supervised injection services not only do no harm, they are also proven to do good.

These sites have proven to be a cost-effective way to reduce diseases associated with drug use. As a physician, I am very much against intravenous drug use, and I counsel my patients against it. My hope for those who don’t take my advice is that they use clean needles and inject in a safe location where help is available if they overdose.

Establishing supervised injection services in Toronto is the best help we can offer intravenous drug users who won’t stop, which is why I and many of my colleagues support the applications to permit supervised injection services in this city.

Given the proven health, social and economic benefits of these services (which even the Supreme Court of Canada recognizes), why don’t we have more such sites? Somehow this issue has become a moral and political concern rather than a public health one, and to those who framed it that way, evidence is irrelevant.

To those who object to supervised injection sites on moral grounds, or simply want them in someone else’s neighbourhood, let me share a few observations from my experience: injection drug users are vulnerable and often desperate people, but they are people. They can be your brother, sister, child, neighbour, friend or co-worker; you probably encounter some every day. Without help they can become sick and a drain on society. With just a little help at the right time and place, they can survive, be healthy, and lead meaningful lives.

To me the moral case for supervised injection services is just as compelling as the health and economic ones. As Pearl S. Buck wrote, “the test of a civilization is in the way that it cares for its helpless members.” Supporting the development of supervised injection services is an opportunity for Toronto to show it cares for all its citizens.

Howard Ovens is Chief of the Department of Emergency Medicine at Mount Sinai Hospital, and Toronto Central Local Health Integration Network and Ontario Expert Lead for Emergency Medicine.

< http://www.thestar.com/opinion/commentary/2016/03/15/toronto-should-welcome-safe-injection-sites.html >

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