Pubdate: Thu, 15 Dec 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Mark Tyndall
Page: S1

PREVENTION OF OVERDOSES SAVES LIVES AND MUST NOT BE ILLEGAL

To combat the mounting death toll from drug overdoses in Canada, the
Health Ministry in British Columbia has determined that programs
allowing witnessed drug injection must be considered part of the
crisis response. The federal government has introduced Bill C-37,
designed to streamline the process for supervised consumption site
approval. These are welcome and important initiatives that recognize
that we can't help people that we don't see.

While the introduction of street-level fentanyl has been blamed for
the recent spike in deaths, this crisis has exposed the precarious
lives of people who use drugs and their dependence on an unregulated
network of illicit drug distributors who care little about their
customers. Because of high demand for opioid drugs, even if the supply
of fentanyl could be completely cut off, it would be replaced by
something else.

While we know that drug overdoses are happening to people from all
walks of life, the crisis is primarily affecting an underclass of
highly vulnerable people who are already suffering from a history of
trauma, physical pain, isolation, poverty and mental illness that
fuels the demand for self-medicating drugs. Without a dramatic shift
in policy, people using these drugs will continue to be dependent on
the illicit market.

The message to people using drugs is clear: The drugs you are buying
on the street are dangerous and can kill you. However, if you insist
on using these drugs, do not use alone; do not rush your injection;
always use clean needles; and in the event that you do overdose have
someone around who can administer naloxone and call 911.

While these are basic life-saving recommendations, we have made it
virtually impossible for people to comply. By definition, these
measures require a place where people can be supervised during their
injection and this is technically illegal. Despite a Supreme Court of
Canada decision in favour of supervised injection sites in 2011, the
federal government subsequently passed Bill C-2, which imposed
multiple barriers to opening new sites.

The Liberal government this week announced it would repeal that bill
and replace it with five conditions outlined by the high court in that
2011 decision.

Instead of allowing the supervision of drug injection, we have trained
a group of heroic people, mainly volunteers, who seek out those who
have overdosed and hope that they can administer naloxone before it is
too late. In shelters and low-barrier housing, people are found dead
in their own rooms when it would have been quite simple to provide a
designated area with the very things that are necessary to prevent
these deaths through early intervention.

Even prior to this overdose crisis, the establishment of supervised
injection sites was considered to be an essential harm-reduction
intervention. These sites are widely recognized as an effective way to
provide a safer place to use drugs and respond to overdoses. In 13
years of operation, Insite has not had a single overdose death.

This is a remarkable accomplishment on its own but the impact of
Insite goes far beyond overdose prevention. Insite has successfully
engaged with thousands of the most marginalized drug users and
provided a tiny oasis of safety while connecting the willing with
health care, addiction treatment services and housing. On many levels,
the fact that these essential health facilities have not been opened
beyond Insite and the Dr. Peter Centre in Vancouver is a failure to
provide the most basic services to Canadians.

In response to the overdose crisis, we must redefine supervised
injection sites and consistently offer a supervised environment for
people who are using drugs. Supervision could be provided in a range
of spaces including existing community health facilities, homeless
shelters, a heated tent, in a housing complex, through a mobile van,
or attached to hospitals. They must be placed in areas where people
are using drugs and provide a respectful environment where people are
unafraid of arrest or harassment. To address the current overdose
crisis, they should be designed specifically to attract people who are
injecting alone. In addition to responding to overdoses, these sites
should provide information around the circulating drugs and how to use
them in the safest way possible. Importantly, there should be
opportunities to directly connect people to addiction, health and
social services.

There remains an urgent need for low-barrier access to substitution
treatment such as suboxone and methadone, better access to
prescription opioids, low-threshold withdrawal management and recovery
beds, more long-term addiction treatment programs, along with a list
of early interventions that can help reduce the devastating impacts of
drug addiction. However, as these more upstream interventions are
being planned and scaled-up, we must not make life-saving
interventions illegal.

Mark Tyndall, provincial executive director, British Columbia Centre for 
Disease Control.
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MAP posted-by: Matt