Pubdate: Tue, 15 Mar 2016
Source: Toronto Star (CN ON)
Copyright: 2016 The Toronto Star
Author: Howard Ovens
Note: Howard Ovens is chief of the Department of Emergency Medicine 
at Mount Sinai Hospital, and Toronto Central Local Health Integration 
Network and Ontario Expert Lead for Emergency Medicine.
Page: A11
Bookmark: (Supervised Injection Sites)


I've been an emergency physician in downtown Toronto for more than 30 
years, and I regularly see patients with health problems related to 
the injection of illicit drugs. The problems might be caused by the 
drug itself, such as an overdose, but often the woes I see are caused 
by the use of dirty or shared needles. These include abscesses, heart 
damage, and viral infections such as hepatitis C or HIV.

These complications not only make users ill, they also cost a lot of 
money and health-care resources to treat; and they pose a danger to 
others by furthering the spread of infectious diseases.

These issues make injection drug use a public-health problem that 
affects us all. And they are why we as a community should support the 
development of supervised injection services in Toronto, as our 
city's medical officer of health recommended this week.

For years, many people have worried about how best to deal with 
illicit drug use. Criminalizing drugs to prevent their distribution 
has failed. Increasing the policing of areas where drug users 
congregate has been unsuccessful in reducing drug use and its 
resultant ills. It became clear that other strategies were needed to 
reduce the social and economic consequences of drug use, regardless 
of whether we were reducing drug use itself.

Providing clean needles was the first step. Many cities have needle 
exchange programs where intravenous drug users can get clean needles, 
no questions asked. Toronto has such a program, and it gives out 1.9 
million clean needles every year.

Other cities have gone further. In Vancouver, a supervised injection 
service called Insite was established a dozen years ago. It does not 
provide drugs; it simply provides a safe place for those who are 
injecting to do so.

The experience in Vancouver is similar to that of dozens of other 
cities - mostly in Europe - where supervised injection services 
exist. There is no increase in drug use or crime. The societal 
problems of drug use - needles discarded in parks, apartment 
stairwells and public washrooms - are substantially reduced. The 
injection of drugs in public spaces is reduced. Emergency department 
visits made by injection drug users are reduced, too.

Individuals who use supervised injection services are less likely to 
suffer from the diseases experienced by other drug users. As well, 
they are offered support and the opportunity to try to end their 
addiction, and some have taken that route. Supervised injection 
services not only do no harm, they are also proven to do good.

These sites have proven to be a cost-effective way to reduce diseases 
associated with drug use. As a physician, I am very much against 
intravenous drug use, and I counsel my patients against it. My hope 
for those who don't take my advice is that they use clean needles and 
inject in a safe location where help is available if they overdose.

Establishing supervised injection services in Toronto is the best 
help we can offer intravenous drug users who won't stop, which is why 
I and many of my colleagues support the applications to permit 
supervised injection services in this city.

Given the proven health, social and economic benefits of these 
services (which even the Supreme Court of Canada recognizes), why 
don't we have more such sites? Somehow this issue has become a moral 
and political concern rather than a public-health one, and to those 
who framed it that way, evidence is irrelevant.

To those who object to supervised injection sites on moral grounds, 
or simply want them in someone else's neighbourhood, let me share a 
few observations from my experience:injection drug users are 
vulnerable and often desperate people, but they are people. They can 
be your brother, sister, child, neighbour, friend or co-worker; you 
probably encounter some every day. Without help they can become sick 
and a drain on society. With just a little help at the right time and 
place, they can survive, be healthy and lead meaningful lives.

To me the moral case for supervised injection services is just as 
compelling as the health and economic ones. As Pearl S. Buck wrote, 
"the test of a civilization is in the way that it cares for its 
helpless members." Supporting the development of supervised injection 
services is an opportunity for Toronto to show it cares for all its citizens.
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MAP posted-by: Jay Bergstrom