Pubdate: Fri, 20 Oct 2017
Source: Prince Albert Daily Herald (CN SN)
Copyright: 2017 Prince Albert Daily Herald
Author: Arthur White-Crummey
Page: A1


Clinical coordinator at Vancouver's largest supervised injection site
says P.A. should open similar facility

Prince Albert should open a safe injection site before a bad situation
gets worse, says a senior staff member from Canada's first legal
facility for injecting drugs.

Tim Gauthier, clinical coordinator at Vancouver's Insite, was the
keynote speaker at the Prince Albert Parkland Health Region's HIV
Education for Change event on Wednesday. He said he was shocked when
he heard how many drug users in the Prince Albert area are contracting
HIV through needles. The numbers convinced him that the city needs to
expand its harm reduction programs.

"For me it's not even a question," Gauthier said. "When I heard about
the 70 per cent of people who are HIV positive and are injection drug
users, I just couldn't believe that more hadn't been done."

The Prince Albert Parkland Health Region recorded 56 new HIV
infections in 2016, according to preliminary data. That's 73 per cent
higher than the average for the ten years prior. The majority of new
cases come from injection drug use.

Gauthier shared statistics from Vancouver's Downtown Eastside, where
Insite helped reduce the proportion of injection drug users testing
HIV positive from 35 to 17 per cent. He also pointed out that
Vancouver is dealing with a massive increase in overdoses, but no one
has ever died of an overdose at Insite.

Prince Albert isn't Vancouver, of course. Vancouver has far more drug
users, and far more resources. But Gauthier said that any community
can run a supervised site. It doesn't take much to prevent drug users
from overdosing.

"It's a simple thing to do," he said. "If something happens, I'm here.
I can either intervene or call for help. Already, your chance of
surviving this event is so much higher than it was before."

He acknowledged that Prince Albert has not yet faced the kind of
crisis Vancouver is dealing with, an epidemic triggered by the easy
availability of the powerful opiate fentanyl on the city's streets.
But he said it makes no sense to wait for tragedy to strike.

"It hit us really hard, really fast," he said. "And it's really
unfortunate that we were reactionary to that."

When asked directly whether Prince Albert should move to open a safe
injection site, his answer was clear: "a big fat yes."

Gauthier spoke shortly after a presentation from Patrick McDougall of
Vancouver's Dr. Peter Centre. The Dr. Peter Centre actually started a
safe injection site before Insite opened its doors, but without a
federal exemption from the Controlled Drugs and Substances Act. In
other words, it was illegal.

McDougall told the conference how the centre provides a full range of
services to people living with HIV and AIDS. It offers art therapy,
music therapy, acupuncture, supportive housing and an extremely
popular food program. It's unlikely Prince Albert could support
something quite so ambitious, but McDougall said there are plenty of
models that work for smaller communities.

"If the community interest and the community compassion are there, the
models will follow," he told reporters after his speech. "Prince
Albert is going to get something that's right for Prince Albert."

He agreed with Gauthier that Prince Albert clearly has an infectious
disease problem, and suggested that harm reduction can help. McDougall
said it's important to reflect on what could work best - but not to
overstudy the issue. He said the solutions are already out there.

"We don't need to wait until an overdose crisis hits," he

Councillor Evert Botha sat at the back of the hall at Plaza 88,
listening to both men tout their centres. He has long been calling for
an expansion of harm reduction services in Prince Albert, including a
supervised injection site, and recently pushed a motion of support
through council.

He said he found the turnout at Wednesday's event "encouraging." About
120 people showed up, from as far as Melfort, Muskoday and Pelican
Narrows. They came from health centres, nursing programs and prisons.
Botha said he feels like more people are warming to the idea of harm

"I think a lot of people are slowly but surely getting onto the same
page," he said. "We are very different in our needs from Vancouver or
Montreal, but this same approach to harm reduction applies here."

Botha said the plan to bring a safe injection site to Prince Albert is
still slowly inching forward. At this point, proponents are waiting to
secure a letter from Saskatchewan's minister of health.

The proposal has drawn the opposition of Mayor Greg Dionne, who
rejects arguments that a site will clean up needles or help "cure"
drug users. He said he would prefer to see more addiction treatment
centres in Prince Albert, not a safe injection site.

But McDougall and Gauthier explained that safe injection sites can
work in concert with other strategies.

"It's not either-or," Gauthier said. "Harm reduction doesn't exist in
and of itself and neither should addiction treatment or the
abstinence-based models. It needs to be a continuum of care."

They said that safe injection sites are designed for people who aren't
yet ready to stop using drugs. Insite and Dr. Peter keep people alive
and disease-free until the day they opt for treatment. McDougall said
the centres let addictions workers spend more time with heavy users
that otherwise wouldn't seek help, building trust that could set them
on the path to recovery.

"For us, providing supervised injection services was one way we were
able to have a brand new conversation with our clients," McDougall
said. "We found that post-injection was one of those times we could
really engage with our clients, talk about what was going on."

Gauthier pointed to research showing that Insite users are more likely
to enter treatment. In fact, the centre's onsite detox program doesn't
have enough spots to meet demand. He challenged the idea that
supervised injection encourages drug addiction, a view he says misses
the point of harm reduction.

"That's not what it's about at all," he said "There's no cheering
party cheering people on to do more drugs.

"What we are doing is accepting that people are doing things... that
maybe aren't the safest things to do, but there are ways that this
doesn't have to be as dangerous as it is."

During his speech, Gauthier kept busting myths. He said that it's
almost unheard of for someone to show up at Insite to inject drugs for
the first time. It's happened on maybe 10 occasions, in his
recollection, and all of those people were hardened drug users who'd
already snorted lines or popped pills.

"We have never, ever, ever had anybody who was new to drug use and
just trying drugs for the first time," he said. "They've been using it
for years in different ways."

Safe injection sites also don't increase trafficking, which Gauthier
said is strictly prohibited at the facility. Users can't even pass
someone a pencil, he told the conference. He said that studies point
to a cleaner neighbourhood, with less discarded needles and less
public drug use.

"People aren't injecting outside, because they're injecting inside,"
Gauthier said. "So they're not injecting in the parks, on the
playgrounds or on the sidewalks."

He said that the facility has driven an obvious reduction in the
number of discarded needles around the neighbourhood, a phenomenon
backed up by research. "It gets better, not worse," Gauthier stressed.

Insite also saves money. Studies suggest the facility has prevented
dozens, perhaps hundreds, of new HIV infections - infections that
would have required a fortune of public spending on antiretrovirals
and medical treatment.

"That's a lot of people who aren't experiencing a lifelong, chronic
condition, and then, of course, the cost that goes along with it,"
Gauthier said.

Steve Mah, director of the Prince Albert Parkland Health Region's
Access Place harm reduction centre, served as MC for the conference.
He stressed that the event isn't part of some healthregion sponsored
drive to bring a safe injection site to Prince Albert. He just thinks
the city should learn from what's happening elsewhere.

"I think there are aspects of the presentations that could be
applied," he said. "We would have our own unique spin on what harm
reduction looks like, but in order to learn we need to go to the
experts in these fields, take what they've done and make it successful
for us."

Mah seemed particularly enthusiastic about Saskatoon's Sanctum. One of
their nurses told the conference how the facility helps keep
street-entrenched people with HIV out of hospital, offering them a
safe and supportive place to live. Residents don't get kicked out for
using, so they don't end up cycling back to the streets. Our health
region struggles with similar patients, Mah said, people don't
complete treatment for infectious diseases because of addiction. They
wind up back on the streets, get sicker and then return to hospital
through a never-ending revolving door. With a place like Sanctum, they
could get care where they live, presumably at a lower cost to taxpayers.

"I believe a transitional care facility such as Sanctum could benefit
this particular region," Mah said. "To have a champion like Sanctum
come in and show us currently what's underway in that region, we can
learn a lot."

Like Gauthier and McDougall, Mah said there are still a lot of
misconceptions around harm reduction. That's a shame, because opening
new harm reduction facilities is a debate for the whole community -
not just health officials. Mah hopes the conference will spread the
information people need to make an informed discussion.

Guathier hopes it also spreads empathy. He said the public needs to
realize that people with drugs in their veins aren't less worthy for
that. He said society regularly accepts dangerous behaviours, and
tries to find ways to make them safer. He drew an analogy with
horseback riding, which risk analysis shows is more dangerous than
party drugs like MDMA.

"We don't have this prohibition around horseback riding. We don't
judge each other for it. We're not like, 'you did it to yourself,'" he
told the conference.

"We say 'wear a helmet, use a saddle, maybe don't ride the horse by
yourself at night time.'"

He said staff at Insite, and some of the 17 other sites already
approved, are on hand to help guide Prince Albert's plan forward.

"Everybody wants to help each other get their site up and going,
because we all want people who are injecting drugs to have access to a
program like this," he said.

For Botha, the conference only reinforced his commitment to the plan,
both for a safe injection site and a Sanctumtype home in Prince
Albert. He said he's "100 per cent behind" those ideas. The research,
he stressed, is on their side.

"There's a lot of noise on the wrong side of the argument, but if we
look at the science... the practice works, the numbers work," he said.

"Every dollar we're investing in harm reduction is going to save
multiple dollars down the line."
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MAP posted-by: Matt