IS THE END INSITE?

Controversial Safe-Injection Site Is Up for Renewal

"It is widely accepted in Canada that the health of the individual
cannot be separated easily from the health of society" - Health Canada

The Insite clinic in Vancouver's downtown East side has been
operating for three years as a pilot project, offering drug users a
safe and legal injection site with medical assistance and information
on other drug harm reduction services, all without the threat of
police intervention or criminal prosecution. It was originally
launched as a facility for scientific research, to be conducted by
the B.C Centre for Excellence in HIV/AIDS connected with the
University of British Colombia, towards which Health Canada invested
1.5 million over three years. Currently they have an average rate of
607 people each day. Of those visitors, 26% are women and 18% are
Aboriginal people.

Recently their exemption expired, and, along with their application
for renewal, a debate has been sparked. Harper's minority
Conservative Government hesitated in granting Insite the ability to
continue their work, finally agreeing on a 6 month extension. During
the throne speech earlier this fall, the Federal government announced
their plan for a new national "Anti-Drug Strategy", replacing the
Liberals' "National Drug Strategy".

While this may seem an issue far away from our doorstep, it calls
into question the ability of political decisions to override medical
findings. This initiative has taken a lead in the field of treating
drug addictions in North America, is based on scientific proof, and
has shown effective results. In fact, the support is overwhelming.

The past three mayors of Vancouver, along with the present one, have
all endorsed the work of Insite and its need to continue. At the AIDs
conference in Toronto, Stephen Lewis, representing the UN special
envoy for HIV/AIDS, endorsed Insite, as did former US president Bill
Clinton. There has been plenty of research done by organizations
including Health Canada proving the benefits of this clinic in its community.

Still, you may be asking, does this type of practice not support and
even encourage drug use?

Drug addictions go way beyond the scientific scope, which must be
considered when looking at a solution, however here we will focus on
what the medical and public health communities have to say.

History

Safe needle injection programs have a history as part of a larger
strategy to address the risky behaviour of users that resulted in
increased crime and health risks, for both themselves and the general
public. Around 30 years ago we started to see harm reduction or
minimization strategies, for example needle exchanges, that were
organised to address, among other problems, the spread of infectious
diseases such as Hepatitis C and B. Later such programs were adopted
more widely in response to the rapid spread of HIV/AIDS.

The Situation in Vancouver

There are numerous social and economic issues facing the Downtown
East side of Vancouver, where drug addiction is high on the list. In
response, the city has adopted a "Four Pillar" approach, which is
based in prevention, enforcement, treatment and harm reduction. Keep
in mind that Health Canada calls injection drug use a health and
social issue, as opposed to criminal activity.

Prevention

Education and promotion of awareness, especially among youth at-risk,
is necessary as a long-term solution. Targeting these groups through
outreach in schools and on the streets are a key way of discouraging
the development of a dependency on drugs. This one is a no-brainer
for policy makers looking to eradicate illegal drug use in the future.

Enforcement

Police and health officials needs to work together.

The confiscation of needles by police only makes the problem worse.
An American study by the National Centre for Biotechnology
Information, focusing on drug users in Vancouver, shows that users of
illicit drugs are likelier to engage in even more riskier behaviour
when their needles are taken away by the authorities. This can lead
the user to look for other needles, which have often been already
used, and can spread diseases such as hepatitis and HIV/AIDS.

Furthermore, if a client is at risk of scrutiny by the authorities
while receiving healthcare treatment, they will be less likely to
seek that option.

Treatment

Also known as rehabilitation, the availability of options for
managing drug addictions needs to reflect the many faces of this
health issue. Just as there is not only one type of user, there are
diverse philosophies on treatment options. These fields include
individual and group counseling, to help people stop using, as well
continuing care in the form of drug relapse prevention therapy.
Another example is Methadone maintenance treatment, where the drug is
prescribed to decrease the consumption of more lethal drugs, most
commonly heroin, as the alternative. Of course this needs to be
offered in close partnership with rehabilitation programs, helping to
integrate the client into a healthier lifestyle.

However, there are cases where people continue to abuse substances,
despite treatment efforts. In many cases this long-term behaviour
relates back to deeper issues of social and economic disadvantages,
as well as possible associations with mental illness.

Needle Injection

It is estimated that up to 125,000 people in this country inject
drugs. This is costly to the healthcare system because of unsafe
practices resulting in higher rates of communicable diseases. Safe
needle programs are common in Canada. They usually come in the form
of services that offer a clean needle in exchange for a used one,
although the actual injection of illegal drugs will then take place
in an uncontrolled environment, where there are risks of overdose and
infection.

This is where harm reduction plays an important role. At a supervised
injection facility such as Insite the potential for complications are
minimized. The drugs most commonly seen are heroin, cocaine and
morphine. It works as a safer option: 70% of visitors to the clinic
reported they were less likely to share a syringe. It facilitates a
more comprehensive healthcare approach: a study by the New England
Journal of Medicine found that the rates of enrollment in addiction
treatment and alcohol detox programs increased with the opening of
the clinic, as a direct result of their referrals. Finally, a study
by the British Journal of Medicine found that the clinic has not lead
to an increase in relapse among former users, nor has it proven to
negatively effect the habits of current users, such as shooting up
more often. Of the over 500 overdoses that have occurred there, none
resulted in fatalities. From a medical perspective, that seems like
successful healthcare.