Pubdate: Fri, 25 Nov 2016
Source: Winnipeg Free Press (CN MB)
Copyright: 2016 Winnipeg Free Press
Author: Jen Zoratti
Page: A4


Opioid crisis draws attention to supervised drug-use sites, but
Manitoba's not interested - so far

A DECADE ago, fentanyl, the killer synthetic opioid that can be 100
times more potent than morphine, was a relatively unknown drug. Today,
it's everywhere - and it's at the heart of a national crisis claiming
the lives of hundreds of Canadians.

In Manitoba, at least two dozen people have died from opioid overdoses
in 2016, nine confirmed to be caused by or related to fentanyl. It's a
dangerous drug that many people don't even know they're taking: it's
often showing up in other illicit drugs such as cocaine and heroin.

As Canada grapples with how to combat fentanyl's rapid spread, the
debate about supervised drug-use sites has been renewed. The sites are
safe places where users can inject drugs they've already obtained with
clean supplies under the supervision of nurses and medical staff. They
are also highly controversial.

"For a lot of people, (illicit drug use) is a black-and-white issue -
it's wrong," says Anna Marie D'Angelo, the senior media relations
officer at Vancouver Coastal Health, which operates Insite, the
pioneering supervised injection facility in Vancouver's Downtown Eastside.

Since Insite became North America's first supervised injection site in
2003, there have been more than three million injections at the
facility - and no one has died.

"We have a more pragmatic approach because we're looking at it through
a health-care lens. When you're on the ground working with clients,
you know that they've tried everything all their lives.

"Quite often they have mental illness, they're disconnected from
communities, they're homeless, they have all kinds of other heath
issues. And we want them to just say no now? That's not going to work."

There are only two legal supervised injection sites in Canada, and
they are both in Vancouver.

Still, activists in Vancouver have in recent days resorted to opening
up illegal "pop-up" injection sites in back alleys to help keep people

 From Nov. 15 to 22, Insite saw 104 overdoses, which would likely have
been fatal if not for the intervention they are able to provide.
Fourteen happened on Sunday alone.

British Columbia has been one of the hardest-hit provinces in the
fentanyl crisis. There have been 332 overdose deaths linked to
fentanyl from Jan. 1 to Sept. 30 this year, almost triple the number
in 2015.

Manitoba Health Minister Kelvin Goertzen has said opening a supervised
drug-use site is not part of Manitoba's plan to respond to the opioid
crisis. But should it be?

Manitoba is no stranger to harm reduction in health care. In Winnipeg,
many places - from Klinic to the Winnipeg Regional Health Authority's
Street Connections program, which distributes everything from clean
needles to take-home kits of naloxone, an opioid antidote - operate
under a harm-reduction model, meaning they aim to mitigate the harmful
consequences of risky behaviour. Providing clean needles or condoms
are basic examples of harm reduction.

Insite operates under a harm reduction model. It's important to note
its supervised injection, not "safe injection."

Injecting illicit drugs is not, by nature, safe. But supervision means
that if someone overdoses, a nurse is there. It also means the safe
disposal of used needles.

Harm-reduction work is a lot more than providing people with clean
needles. It's about providing people an entry point into the
health-care system.

Drug users who choose to inject at Insite are able to build trust with
health-care and social workers, which means they are more likely to
pursue detox, counselling and other treatments.

People who are ready to go into detox will be accommodated at Onsite,
Insite's detox facility, immediately.

"That's really important for this client," D'Angelo says. "Before,
it'd be 'Come back at 10 a.m. and go into detox.' Well, they don't
have watches. They don't make appointments. They don't know what day
it is. And then they don't show up. This is one way to reach a very
hard-to-reach client group."

Insite also has the capability to test street drugs for fentanyl.
About 90 per cent of drugs tested there have been positive for fentanyl.

"We tell people to just assume that it's in there," D'Angelo

She adds that workers are also able to pick up on whether or not, say,
a bad batch of heroin is making the rounds. They are also able to
attach numbers to the overdose crisis.

"Some provinces don't even know what their OD stats are because
there's no way to track it," she says.

Supervised drug-use sites are not easy to establish, which may explain
why there are so few in Canada.

Insite operates under an exemption from the Controlled Drugs and
Substances Act.

The former Conservative goverment attempted to shut down Insite,
taking the fight to the Supreme Court of Canada, which ruled in 2011
that Insite could remain open.

And so, in 2015, the Conservative government responded by introducing
the Respect for Communities Act, an amendment to the Controlled Drugs
and Substances Act that essentially made the process for applying for
a supervised injection site so hard and frustrating no one would want
to go through it.

This month, the Liberal government announced it is working to change
the legislation.

"I think there's a place for (supervised injection)," says Dr. Mike
Dillon, medical director at Winnipeg's Klinic.

"Certainly because of the size of the scope, we're not in the same
league as Vancouver or Toronto. Everything could be better. It would
be a good part of a larger harm-reduction program, but we haven't been
jumping up and down begging for a supervised injection site. Right
now, we're trying to keep up doing what we do."

Dr. Cathy Cook, the vice-president of public and mental health at the
Winnipeg Regional Health Authority, says there would be a considerable
number of things to look into before embarking on the process.

"At this point, we have not seen evidence that a safe-injection site
would benefit those who use illicit drugs in Winnipeg. It is something
we continue to discuss and monitor, but we would need to do a thorough
evaluation of the needs of the population who use illicit drugs before
undertaking such a process. That process would need to be undertaken
with our partners at the province and with the City of Winnipeg."

In addition to saving lives, Dillon says harm reduction saves money,
pointing to the cost of treating hepatitis C versus preventing its
spread via dirty needles.

D'Angelo points out calling 911 in the event of an overdose is a huge
draw on first-responder resources. "If you're at Insite and inject and
overdose right there, there's a nurse right there who can do CPR, who
can administer naloxone, etc. You'll be going to emergency, but you'll
be going alert. There is a cost to doing nothing, and people need to
acknowledge that."

Supervised drug-use sites might be a long way off for Manitoba, but
there are ways to save lives now. Dillon would like to see more
compassionate care for those struggling with addiction, as well as
more discussion about the complex root causes of addiction. "There's
no one-size-fits-all," he says. "There's a whole spectrum of people
who have different reasons for doing what they do."

What doesn't work is punishing people for engaging in risky

"It saves money and it helps people if we can have the attitude that
says 'we're not going to vilify you for using drugs.' We all use
drugs. If I didn't have my coffee this morning, I'd have a headache
and withdrawal," he says.

"There are just some drugs that are socially accepted and encouraged
and that's why we pay $5 for a latte. We shouldn't make people feel
bad. It's not helpful. We need to show them we're on the same team."
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