WHY OTTAWA NEEDS SOME INSITE

A comprehensive harm reduction program would reduce drug use and make
Ottawa safer, writes Dr. Mark Tyndall.

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.