Pubdate: Sat, 14 Jan 2017
Source: Toronto Star (CN ON)
Copyright: 2017 The Toronto Star
Contact:  http://www.thestar.com/
Details: http://www.mapinc.org/media/456
Author: Ellen Brait
Page: GT1

ADVOCATES VOUCH FOR INJECTION SITES

Supervision helps build community, create safer spaces, support worker
says

Raffi Balian remembers lying beside his wife at night, with his drug
injection equipment hidden below the bed. He remembers trying to
inject drugs into his arm in the dark, while his wife lay beside him,
unaware.

"When I started injecting, I did a lot of it secretly. I couldn't tell
my friends," 60-year-old Balian said. "Within a month, I had incurred
enough damage that should have taken years. In that respect, I hurt
myself needlessly. If there were injection sites, I could have gone
and done it in a much safer manner."

Now, Balian works at the South Riverdale Community Health Centre, one
of the three health centres in Toronto that was recently approved to
become a supervised injection site, along with the Toronto Public
Health-operated needle exchange and the Queen West Central Toronto
Community Health Centre.

Balian, who has used "almost every drug there is" for 23 years and
used fentanyl for the past 13 years, credits his job and safe places
to inject with turning his life around.

He has a steady income and money in the bank, he's had a credit card
for the past three or four years and he's repaired severed
relationships with relatives. Balian, who used to inject drugs every
day, now only does so every month or so.

"But this has taken a while to develop and that's what an injection
site does," Balian said. "It gives us the opportunity to work with
people to get them to where I've gotten myself."

Ontario Health Minister Eric Hoskins confirmed on Monday that the
province will pay to install and operate supervised injection sites at
three locations in Toronto where users will inject their own illegal
drugs under medical supervision. Toronto council voted to back the
sites in July.

Amy Wright, 40, who is a peer worker at Parkdale Community Health
Centre and a community support worker at the nonprofit Sistering,
believes these sites also foster a community.

Wright, whose struggle with drug use began in her teens, said she
experienced this at Insite, Canada's first legal supervised injection
site that was launched in Vancouver in 2003.

"The first time I ever felt fully supported and loved, it was because
of the safe injection site and Vancouver's approach to harm
reduction," she said. "It's how I was able to address the real reasons
I used opioids to cope and I could do that in a way that there was no
shame."

Wright said she built up a level of trust with the staff at Insite,
which for someone who was hesitant to visit doctors and hospitals, was
helpful for having other health issues addressed.

"I found a lot of comfort in being able to go to the staff of Insite
and get any medical issues looked at because before I wasn't going to
doctors, I wasn't going to hospitals, I wasn't getting anything
addressed," Wright said.

"I was terrified of doctors and hospitals but they would use the
nursing staff at the same injection sites and it just prevents a lot
of illnesses."

Wright has also experienced and seen the life-saving benefits of
supervised injection sites first hand.

While using, she had "a bad mix one day," and the nursing staff saw
this and monitored her before ensuring she got back to her shelter
safely.

Such facilities also saved her girlfriend from overdosing on seven
separate occasions.

"I was really grateful that the safe injection site was there because
I would have had another loss on my hands and I'm not sure how well I
would have been able to deal with that," she said.

Dr. David Juurlink, head of clinical pharmacology and toxicology at
the University of Toronto, said "there's always been an argument for
(supervised injection sites)."

But the opioid crisis sweeping the nation, particularly British
Columbia, has cast a spotlight on the issue.

"I think the sheer number of people affected and the sheer amount of
misery our society has experienced as a result of these drugs are
major factors," he said.

He said an influx of fentanyl and carfentanil is being "added to the
drug supply to increase profit margins and increase the potency of the
drugs."

When these opioids are added to other drugs, people aren't always sure
what they're taking, which can lead to overdoses.

"It's the most dangerous time in history to use drugs purchased on the
street," Juurlink said. "I also think there is recognition on the part
of public health officials and politicians that this problem isn't
going away anytime soon."

At least 253 people in Toronto fatally overdosed in 2015 and the
deaths involving fentanyl surged from 23 to 42 from 2014 to 2015,
according to data from the Ontario coroner's office.

Dr. Dirk Huyer, chief coroner for Ontario, previously told the Star
that despite not seeing "the spike that B.C. has seen" in opioid
overdoses, opioid-related deaths in Ontario are "absolutely an issue."

Juurlink argued that supervised injection sites are necessary because
those taking drugs will continue to take them "despite knowing that
they're playing Russian roulette," partly to avoid withdrawal.

But with these sites, health professionals can watch for signs of an
overdose, resuscitate people if necessary and call 911.

Marty Thompson, a 55-year-old harm reduction outreach worker at the
Street Health Agency who was a drug addict for 22 years and now uses
opioids approximately once a week, echoed this argument.

He said that these sites are "so necessary."

"Drug users do our drugs now, in the wintertime, summertime, it
doesn't matter," he said. "It could be 9 a.m., 2 a.m., it could be
three in the afternoon. They're going to do it whenever, however."

Supervised injection sites will also lead to less complications
because of unhygienic situations, according to Balian, who said he
doesn't "know if there is one injection drug user who hasn't used in
washrooms."

"When you're hurried all the time and you don't have a place to use,
you're using on the street or a washroom or even if you have your
home, you have to use really fast because you don't want others to
know you're using and it creates all kinds of problems," he said.

Though Thompson supports the funding of supervised injection sites, he
thinks better locations could have been selected, as some of the
locations, like the needle exchange near Yonge-Dundas Square, "don't
have users."

This echoes Councillor Giorgio Mammoliti's concerns, who voted against
the sites in July.

Despite supporting needle exchange, Mammoliti worries supervised
injection sites will create "drug districts" that will "encourage all
addicts from all over the province and even around Canada to come take
drugs in the district."

But Juurlink argued that "these aren't just people who made bad
decisions."

"They're people who got addicted through therapy or childhood trauma
or social circumstances that led them to addiction," he said.

"People need help. They do not need to die in alleyways and public
bathrooms for lack of a safe place to use drugs."
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