Pubdate: Mon, 30 Nov 2015
Source: Toronto Star (CN ON)
Copyright: 2015 The Toronto Star
Contact:  http://www.thestar.com/
Details: http://www.mapinc.org/media/456
Author: Theresa Boyle
Page: A2

STUDY BOLSTERS CASE FOR SAFE INJECTION SITES

Three Supervised Facilities in Toronto, Two in Ottawa Would Be Worth the Money

A new study bolsters the case for opening five safe injection sites 
in Ontario, including three in Toronto, by showing they would be more 
cost effective than previous research has projected.

Because of a recent surge in the cost of treating hepatitis C, there 
is now a better economic case to be made for preventing the spread of 
the potentially deadly virus through the sharing of needles, 
according to a paper published today in the journal Addiction.

Advocates of safe injection sites hope the findings put the issue 
back on the front burner and nudge the federal Liberals into making 
good on a commitment to expanding supervised injection services 
across the country.

The study points out that new drugs on the market are highly 
effective in treating hep C, but come at a steep price.

"Because hepatitis C treatment is so expensive now, preventing a very 
costly infection becomes much more attractive," said lead author Dr. 
Ahmed Bayoumi, a physician at St. Michael's Hospital and a researcher 
in its Centre for Research on Inner City Health.

The study builds on findings of a 2012 report that showed that 
opening three supervised injection facilities in Toronto and two in 
Ottawa - Ontario's two largest cities - would be good value for the 
money. They would reduce public drug use and prevent new hep C and 
HIV infections.

Since that report's release, new hep C drugs, with astounding cure 
rates in excess of 94 per cent, have become available. Two were 
approved earlier this year under the Ontario Drug Benefit exceptional 
access program - Holkira Pak and Harvoni.

Prior to that, they were out of reach for most patients because they 
came with a price tag of up to $60,000.

The new study shows that a Toronto safe injection site has an 
incremental cost-effectiveness ratio of $10,763 per quality adjusted 
life year, compared to $31,781 in the 2012 report. This is a 
technical measurement that assesses the dollar value of a medical 
intervention, taking into account life expectancy and quality of life.

"Another way to say that in plain English is that if you look at the 
return on investment, it's more favourable now than it was in our 
initial report," said Bayoumi, who also contributed to the 2012 report.

The new analysis shows there is an 86-per-cent chance that one or 
more supervised injection facilities would be cost-effective in 
Toronto. It takes into account the number of people who use drugs, 
how frequently they would use an injection site, the cost of the 
facility, and the cost and availability of hep C treatment.

Bayoumi said the conclusion is conservative and that the cost would 
be much lower if the services were incorporated into existing health 
facilities.

The annual cost of operating a freestanding facility is pegged at 
$1.5 million for rent, insurance, cleaning and maintenance, and $130 
per patient for equipment and personnel.

A 2013 report from Toronto Public Health suggested the city should 
create supervised injection sites for drug users, integrating them 
into existing health services.

It is estimated that 10,000 people in Toronto use injection drugs, 
including heroin, cocaine and crystal methamphetamine.

Richard Elliott, executive director of the Canadian HIV/AIDS Legal 
Network, said the future of safe injection sites in Canada looks good.

"We have more evidence that there is a benefit . . . and a new 
government that has expressed its support for supervised consumption 
services," he said.

Asked whether her office would support opening safe injection sites 
in Ontario, Health Minister Jane Philpott issued the following statement:

"Our government believes in evidence-based decision making. When 
properly established and managed, supervised consumption sites have 
the potential to reduce the harms associated with drug abuse on 
individual users and communities.

"Decisions regarding applications for safe injection sites are 
evaluated carefully by Health Canada to ensure health and safety 
requirements are met," the statement read. The Canadian HIV/AIDS 
Legal Network sent a briefing paper to all MPs on Monday, the eve of 
World AIDS Day, calling on the federal government to move forward on 
a number of HIV-related issues, including the scrapping of Bill C-2, 
which forces proposed injection sites to meet a lengthy list of 
requirements before opening.

The bill, passed by the House of Commons earlier this year, has 
widely been viewed as an attempt by the previous Conservative 
government to impede the operation of Vancouver's Insite safe 
injection site and to thwart the opening of new sites.

It requires applicants to consult with police, community members and 
public health officials and to gather crime statistics before getting 
an exemption from federal drug laws.

The Conservative government introduced the legislation after the 
Supreme Court blocked its attempt to close the Insite centre, ruling 
that health services could not be denied to addicts.

"It would seem like a fairly straightforward, no-brainer kind of move 
that the government should repeal Bill C-2 and actually get on with 
issuing the appropriate exemptions to the applications it has 
received," Elliott said.

He was referring to applications for a federal health act exemption 
from a community group in Montreal and from Vancouver's Dr. Peter Centre.
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MAP posted-by: Jay Bergstrom