Pubdate: Thu, 8 Nov 2007 Source: Argosy, The (CN NK Edu) Copyright: 2007 Argosy Publications, Inc. Contact: http://argosy.ca/ Details: http://www.mapinc.org/media/2655 Author: Sarah Alden Cited: British Columbia Centre for Excellence in HIV/AIDS http://www.cfenet.ubc.ca Bookmark: http://www.mapinc.org/topic/Insite (Insite) Bookmark: http://www.mapinc.org/topic/Downtown+Eastside Bookmark: http://www.mapinc.org/topic/Four+Pillars Bookmark: http://www.mapinc.org/coke.htm (Cocaine) Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction) Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) Bookmark: http://www.mapinc.org/find?142 (Supervised Injection Sites) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) 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. - --- MAP posted-by: Richard Lake