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.
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MAP posted-by: Matt