Pubdate: Wed, 15 Jun 2016
Source: Ottawa Citizen (CN ON)
Page: A1
Copyright: 2016 Postmedia Network Inc.
Author: David Reevely


Health Unit Cites Looming Overdose Crisis

The capital is on the brink of an injection-drug crisis, the city's 
top public-health doctor believes, and now is the time to open a safe 
drug-injection site to try to head it off.

"In Ottawa, we are on the cusp of this larger trend, and we have 
dodged it because we have been lucky so far," says Dr. Isra Levy, the 
city's medical officer of health.

Monday night, after years of equivocating, his health unit released a 
report saying the city should have at least one supervised facility 
aimed at chronic users of injection drugs, where they can shoot up 
with clean needles and have nurses on hand to help if they overdose.

Such facilities "may be a useful part of the spectrum of clinical 
health services in communities that wish to have such services," Levy 
said lamely in 2014, when the idea first arose seriously here.

Now, he's come to believe they're a necessity.

Levy never had any doubt that providing a safe place for addicts to 
use drugs was good medicine - "I could have said that to you when I 
started my career 30 years ago," he says - but the rise in overdose 
deaths we've had here already, and sharp increases they've seen 
elsewhere in the country, have convinced him that a safe injection 
site is good public policy. "I have been skeptical, to be honest, 
about some of the overdose information that we have received," Levy 
says. But now he believes he's standing on firm ground, since 
health-unit epidemiologists have spent the past two months studying 
Ottawa's drug use.

Between 30 and 40 Ottawans die of drug overdoses each year, he said, 
a number that jumped sharply in 2009. Opiates like morphine and 
heroin, which are often injected, cause a large and growing 
percentage of those deaths. Levy attributes the increase a few years 
ago to powdered fentanyl, a powerful opiate where the difference 
between a "normal" dose and a deadly one is tiny.

Since 2012, Ottawa's drug users have had growing access to a drug 
called naloxone, which can counteract opiate overdoses. Levy says the 
health unit's stats say naloxone has saved about 60 lives since then 
- - but the final number of overdose deaths hasn't fallen.

In other words, naloxone is holding opiate overdoses off. Otherwise, 
we'd have more and more.

In British Columbia, the provincial public-health authority declared 
an emergency in April over rising numbers of ODs.

Here, a couple of hundred people each year survive overdoses with 
emergency-room treatment. Emergency-room visits for drug overdoses 
are up 60 per cent. Paramedic calls are up, too.

Drug overdoses here are not a stable problem.

Safe injection sites in Vancouver and in Europe have cut overdoses, 
reduced the spread of blood-borne diseases, and given chronic addicts 
contact with the health system they might otherwise not have.

There's zero proof from Vancouver that its long-standing 
safe-injection site in the Downtown Eastside promotes crime there. 
InSite, as it's called, is in a poor, and troubled neighbourhood but 
one that has business owners and landlords and residents; research 
commissioned by the federal Conservatives, who wanted to shut the 
site down, could find no sign that crime got worse on or around East 
Hastings Street after InSite opened.

The argument that a safe-injection site promotes crime is not 
supported by evidence.

InSite is a comparatively expensive standalone facility, costing 
about $3 million a year, but the evidence is that it covers its costs 
in averted HIV cases alone. Not one person has died there of an overdose.

The argument that a safe-injection site costs money we could better 
spend some other way is not supported by evidence.

More drug users live in the Rideau-Vanier ward than anywhere else in 
Ottawa. It's why the Sandy Hill Community Health Centre wants to add 
a small safe-injection facility to its existing drug-treatment clinic.

The health unit sums its conclusion up in one epic three-breath sentence:

"Given the ongoing challenges outlined in this report, the evolving 
conversation about the expansion of harm reduction services in Ottawa 
and in other Canadian jurisdictions, and the evidence in support of 
SIS (supervised injection services) as part of the continuum of care 
for persons living with problematic drug use, staff is recommending 
that Ottawa's Board of Health declare that, from a public health 
perspective, SIS are an effective, well-researched and evidence-based 
treatment option that have a place in any comprehensive approach to 
working with people who inject drugs."

Levy also wants to look at the possibility of a mobile site, possibly 
a sort of minibus that could travel to drug users on demand. It 
sounds odd, but that's how needle-exchange vans work.

The health unit acknowledges that it knows of only three in the world 
- - in Berlin, Barcelona and Copenhagen. There's a lot less research on 
them than there is on fixed-location sites, and drug users themselves 
don't see the appeal. Also, nobody here has proposed one.

But the epidemiologists point out that while injection-drug problems 
are concentrated in a couple of downtown neighbourhoods, Ottawa's a 
big city and there's hardly any part of it that hasn't had overdoses. 
A mobile site could visit different places and keep odd hours. So we 
should be "exploring with partner agencies the benefits and 
considerations of implementing a mobile SIS in addition to fixed 
services," the health unit's report says.

For Levy, outreach is vital. Heavy drug users might not have the 
wherewithal, or the time, to travel a kilometre to get to a safe 
injection site, so if one could come to them, they could still be served.

"There are some practical considerations," he acknowledges. The 
health unit's existing needle-exchange van doesn't have the room for 
resuscitation equipment that would be an injection site's major 
reason for being. It could only be in one place at a time, with one 
user at a time. Levy's personally attached to the idea, but his own 
staff aren't sure it's workable. More study is the compromise.

He says he understands the argument that it's unethical to condone, 
or at least ignore, drug abuse. He's had long, long talks about it 
with police-chief-turned-senator Vern White in particular. How can 
Levy, as a doctor, let a person shoot up with poison while he looks on?

"I see an ethical problem with throwing that person out of my office 
because he's going to do something I don't agree with," Levy says. 
Doctors attend to patients all the time who've done harmful things to 
themselves. They set bones broken in stupid teenage stunts. They 
treat obese diabetics and sun-worshippers with skin cancer and 
smokers with emphysema. They urge patients to make healthier choices 
and do all they can to support them when they're ready to.

"As a physician, I'm here to help. That's my reason for being here," Levy says.

Next, the board of health he advises will decide what to do with his 
advice. It's a body set up explicitly to depoliticize decisions that 
should be based on science. It's to debate Levy's recommendation next 
Monday night.

The transformation puts the health unit in conflict with both Mayor 
Jim Watson and Chief Charles Bordeleau of the Ottawa police, who are 
both against a safe injection site here. Well, Watson doesn't quite 
say that - he says he'd prefer to spend the money on rehabilitation programs.

"I'm hopeful that we can find common ground," Levy says. "I think we 
have common ground already, in fact . ... This is about people who 
need help. It's our job to provide that help. These aren't 'those 
people,' these are Ottawans, these are part of our family."
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