Pubdate: Tue, 16 Oct 2012
Source: Excalibur (CN ON Edu)
Copyright: 2012 Excalibur
Contact:  http://www.excal.on.ca/
Details: http://www.mapinc.org/media/3147
Author: Melissa Leone

CAN SAFE INJECTION SITES WORK IN TORONTO?

Insite, a safe injection site in Vancouver, has contributed to
reducing overdose deaths and the spread of HIV through medical supervision

Vancouver's Downtown Eastside has long been known as a hotbed for
drugs and disease, with average life expectancy of its residents in
1996 a full nine years below the provincial average. At one point,
AIDS was spreading so fast among intravenous drug users, and overdose
death rates were so high, that the local health board had to declare a
public health emergency.

That's why recent statistics from Vancouver Coastal Health, which say
that life expectancy in the area has jumped to just two years under
the provincial average, are simply astounding. At the core of this
incredible development is the harm reduction work of one unique
organization.

Located in the Downtown Eastside neighborhood, Insite has been
providing a safe and health-focused space for intravenous drug use
since 2003.

The protocol at Insite is simple: addicts bring their own drugs, and
use them in one of 12 injection booths. This takes place under medical
supervision, every day of the year from 10 a.m. to 4 a.m.

The site is full of clean needles, sterile water, cookers, filters,
tourniquets, alcohol swabs, and condoms. Patients are in and out of
Insite in 15 minutes or less, and the wait time averages between 20-30
minutes.

At the site, patients are exempt from the criminal code, and cannot be
arrested as long as they are using drugs inside the building.

Carol Strike, associate professor of public health at the University
of Toronto, has done extensive research on harm reduction. Stike says
there is an informal agreement between the workers at Insite and drug
dealers that dealers can sell drugs within a one-mile radius of the
building.

There are always staff on duty at Insite. Two nurses stand by with
oxygen masks and syringes of the overdose drug, naloxone. To date,
1,500 overdoses have been reported at the site, but because of quick
intervention by Insite's medical staff, there has not been a single
casualty.

Insite also has addiction counselors, mental health workers, and peer
staff that connect clients to community resources such as housing,
rehabilitation, and other support services.

Insite has over 12,000 registered drug users and sees an average of
850 visits a day. All patient information is kept confidential, as
patients use code names to enter and exit the building. Most patients
are homeless or barely housed, and have legitimate mental health issues.

Strike found that 70 per cent of Insite's patients are males in their
late 40s. An average patient at Insite has been using for over 16 years.

The philosophy of Insite is simple: If intravenous drug use is going
to occur, a space that alleviates its dangers is a must. The risks of
unsupervised injection are high, as drug users are often hurried, and
are less likely to have hygienic equipment.

For example, addicts are known to mix their drugs with puddle water,
or doing "shake and bake," which is mixing the drugs in the syringe
without first cooking out their impurities. Such techniques can cause
gangrenous abscesses and endocarditis, a bacterial infection of the
heart valves.

At Insite, this danger is eliminated as users are given a tray of
instruments upon entering, which contains clean syringes, adhesive
bandages, and antiseptic pads. All products are tossed out after one
use, and nothing is recycled.

Since opening, Insite has taken drug users off city streets, and
reduced the spread of transferable disease in Vancouver, including
HIV. In 2008, Vancouver's overdose deaths were the lowest in 30 years,
and the rate of new HIV infection among injection drug users was the
lowest since record-keeping began in Canada over 30 years ago.

Insite currently costs just three million dollars a year to run out of
Vancouver's 44-million dollar budget for addiction services.

When the Conservative government came into power, harm reduction was
taken out of its national drug strategy. Prime Minister Steven Harper
was on a mission to close down the facility, believing it to foster
addiction and relapse. He was also fundamentally opposed to the idea
of the site's funding coming from taxpayers, a criticism echoed by
many Canadians.

Fortunately for Insite, the Supreme Court of Canada ruled that closing
the site would violate the Charter of Rights and Freedoms. The
facility was allowed to stay open, sparking interest in several other
Canadian cities, including Victoria, Ottawa, Toronto, and Quebec City,
to open safe-injection clinics of their own.

But support for a Toronto version of Insite is far from unanimous,
even among drug users.

A group of young men sitting in the lobby of Vita Nova, a non-profit
organization located in Vaughan that provides support for different
forms of addiction, collectively agree that opening such a site in
Toronto is a bad idea.

Luciano, an ex-heroin addict, says the idea is too
tempting.

"I've been here more times than I'd like to admit. I was sober for
years, and then you get a craving, the smallest craving in the world,
and before you know it, you're using again," he says. "To me, Insite
sounds like a wonderful place to relapse at, and I don't want to
relapse again." The other men nod in agreement.

"I understand why people think this is helpful, and trust me," says
one of the men. "It sounds really appealing to me, almost too
appealing, and that's why they shouldn't go through with it."

Franca Carella, founder and executive director of the Vita Nova
Foundation, passionately opposes the idea of introducing a safe
injection site to the city.

"It makes me sick. I would never support a site like this opening in
Toronto. Allowing addicts to use in a place like this is basically an
open invitation for death," says Carella. "I will not help people die."

She mentions that a recent University of Toronto study proved
addiction has an 82 per cent curable success rate, and that this
success rate is achievable for any addict. Sites like Insite will only
worsen the possibility for recovery, she says.

"The money used to fund this clinic should really be put towards
prevention, treatment, enforcement, and harm reduction," says Carella.
"We need to help addicts heal, help them discover their dreams and
their goals, allow them to transition from a life of pain and sorrow
to happiness and hope."

On the other hand, Strike, who has been studying the possibility of a
similar site in Toronto, says the sites themselves would be tools in
harm reduction.

She recommends building up to three safe injection sites in Toronto,
and two in Ottawa. To minimize attention drawn to them, and to ensure
privacy and confidentiality, she reccommends integrating them into
rehabilitation establishments already existing in the city.

Through her study, Strike found that over 50 per cent of Ontarians
agree Toronto and Ottawa need these sites.

However, there is no guarantee that a safe injection site will have
the same effect in Toronto.

Anna Marie D'Angelo, senior media relations officer at Insite, says
the culture around drugs in Vancouver is different from that of Toronto.

"We never advise others what to do. All we can say is that Insite
works in Vancouver because it is set up in a location with a history
of intravenous drug users," says D'Angelo.

Many people believe overcoming drug addiction is simply a matter of
willpower and dedication. Most experts agree addiction is a brain
disease, and though recovery is challenging, it is certainly possible.

Unfortunately, recovery is not an option for everyone. Countless
addicts refuse or fail to complete treatment.

Insite has approached what it sees as an inevitable problem, and is
working towards mitigating it instead of trying to eliminate it.
Perhaps it's time Toronto started thinking the same way.