Pubdate: Sat, 25 Jun 2016 Source: Ottawa Citizen (CN ON) Copyright: 2016 Postmedia Network Inc. Contact: http://www.ottawacitizen.com/ Details: http://www.mapinc.org/media/326 Author: Dr. Lewis Leikin. Page: D6 WHY OTTAWA'S BOARD OF HEALTH BACKS SUPERVISED INJECTION SITES Harm reduction allows drug use but improves addicts' health. The recent Ottawa Board of Health decision to support enhanced harm reduction, including supervised injection sites (SIS), for IV drug users was in the public interest. Harm-reduction strategies have been used in Ottawa for years, successfully, to reduce the spread of dangerous diseases associated with unclean needle use, to reduce teen drug use by 75 per cent, and to save lives using a naloxone peer overdose prevention program. While some argue that treatment should be the sole use of public funds, the evidence is unequivocal that harm reduction interventions are effective and essential in managing complicated, chronic and treatment-resistant illnesses such as drug addictions. Perhaps the greatest resistance to accepting SIS as a public health strategy stems from the notion that it is condoning an illegal activity and that it supports, perhaps even enables, individuals to engage in a behaviour that is self-destructive. On the surface, SIS seems to sanction an activity that is illegal, potentially lethal and flouts the rules of society. The idea of providing addicts a sanctioned place to "use" is turning a blind eye to breaking the law, and at worst, tantamount to helping them put a loaded gun to their head. Reconciling the apparent conflict between public health and public safety has proven difficult for some. One solution is to recognize that two opposing ideas can both be true at the same time. SIS would permit users to inject, legally, a substance that came from criminals somewhere. And, the drug addict would certainly be "using," meaning they will engage in an addictive, illness behaviour. At the same time, SIS users, who are suffering from a severe and chronic illness that has derailed their lives, are not shooting up in an alley or other public place, using a dirty or used syringe that is spreading communicable diseases. Instead, the individual is using in a medically supervised setting where disease spread is stopped, and where they are exposed to social and health influences, such as counsellors, housing and financial assistance supports, that may moderate their future behaviour. The SIS is not quite the same as a loaded gun, enabling the addict. Individuals injecting on-site are in a very different environment than normal - one that is health-rich and not "reinforcing," as some believe, of addiction. The presence of health and social service specialists enables change, and creates an opportunity to open a door to break the cycle of addiction. Yes, an SIS permits drug use, and it also enables health. Without the SIS, the addict uses and there is no impact on either of public safety or public health. With the SIS, the addict uses, and public safety may be improved, at least certainly not worsened. Public health is improved with reduced rates of communicable diseases and overdoses, and increased likelihood of healthier behaviour including seeking treatment. Perhaps no other element of SIS is more compelling, however, than the mortality argument. On average, 33 Ottawa residents die each year from unintentional drug overdoses, representing 72 per cent of all drug overdoses. The Ottawa coroner predicted that with current trends in opioid use, strength and availability, the number of overdose deaths in Ottawa is likely to increase. There are approximately 90 supervised injection sites in the world, and all have clearly demonstrated reduced rates of overdose deaths. They are equipped with health specialists and medicine to treat overdoses. Whether one is inclined to lean toward public safety or public health in the debate, it is equally relevant to know that in Ottawa, an SIS can prevent deaths and save lives. At the end of the day, that fact alone should be sufficient for anyone trying to reconcile public health with public safety, and to recognize that supporting SIS in Ottawa is in the public interest. Dr. Lewis Leikin, C. Psych., is a member of the Ottawa Board of Health. - --- MAP posted-by: Matt