Pubdate: Tue, 19 Nov 2002
Source: Montreal Gazette (CN QU)
Copyright: 2002 The Gazette, a division of Southam Inc.
Contact:  http://www.canada.com/montreal/montrealgazette/
Details: http://www.mapinc.org/media/274
Author: Alana Hirsh

INJECTION SITES MAKE SENSE

Safe Injection Facilities In Europe And Australia Have Reduced HIV, Cut 
Drug Use In Public And Lowered Crime Rates

The drug users I worked with during my training as a family doctor in 
Vancouver were years ahead of the government in keeping up with 
evidence-based standards of treatment for addiction when they asked me to 
supervise in the safe-injection site they intended to open.

At that time, two years ago, the Canadian government opposed the idea of 
safe-injection facilities: legal centres that allow drug addicted 
individuals to inject their own, pre-obtained drugs in a hygienic, 
stress-free setting under the supervision of healthcare professionals. Not 
to be confused with illegal "shooting galleries," SIFs are comprehensive 
programs that offer sterile injecting equipment, condoms and information on 
safer sex and injecting practices, as well as counseling, medical care and 
referrals to detox, drug treatment and other health and social services.

Not wanting to jeopardize my medical license by "enabling" these drug 
users' illicit activities, I bought myself some time, suggesting: "Let me 
do some reading about it first."

After studying the literature, which attested to the success of SIFs in 
Europe and Australia; after dealing with the consequences of unclean needle 
use among my patients (HIV, hepatitis, severe skin infections, etc.); after 
seeing too many drug addicts with recovery potential overdose and die, I 
realized what the "junkies" already knew: it would be unethical not to 
provide this service for addicted people.

Last week, Health Minister Anne McLellan informed us that Canadian cities 
would soon be able to make proposals to open SIFs. Despite the fact that 
this life-saving measure is long overdue, it will likely evoke controversy. 
A Gazette editorial on Nov. 12, "Bad plan for drug addicts," argued that 
SIFs would encourage drug use and waste taxpayers' money. The evidence 
stands in stark contrast to these statements.

According to the Canadian National Task Force on HIV, AIDS and Injection 
Drug Use (1997): "Despite clear indications of an escalating problem since 
the mid-1980s and the use of a variety of approaches to address it, the 
spread of HIV among injectors is increasing, as is the incidence of 
hepatitis and tuberculosis." Twenty per cent of injection drug users in 
Montreal have HIV, and 70 per cent have Hepatitis C. One thousand Canadians 
die from drug overdoses each year. It's impossible to help these people 
recover from addiction when we can't keep them alive.

The real tragedy is that these deaths and this spread of disease are 100 
per cent preventable. Reducing the harm of injection drug use is not as 
daunting as many believe. Bustling urban centres around the globe have 
faced a threat similar to the one U.S. and Canadian cities grapple with 
today. In addition to public-health initiatives like the street outreach 
and needle exchange services we have in Montreal, 45 SIFs are currently in 
operation in the Netherlands, Switzerland, Germany, Spain and Australia.

Experience in Europe and Australia indicates that there has been 
considerable acceptance of the facilities by health-care professionals and 
injection-drug users. Statistics show that SIFs have resulted in the 
following: reduction in rates of HIV and number of deaths caused by 
overdoses; reduction in public drug use and discarded syringes in public 
areas; and reduction in crime. In spite of the oft-cited concern that 
establishing SIFs sends the wrong message, studies show that SIFs actually 
encourage addicts to quit: cities in Europe that have SIFs had a decrease 
in total number of drug users, likely related to their facilitating access 
to detox and drug treatment. Studies also reveal that SIFs are successful 
in reaching addicts recognized as the most difficult to reach through other 
programs.

As for the costs of setting up the SIFs, yes, taxpayers should pay for 
them. Given how our current approach to the drug use problem is consuming 
resources, we cannot afford not to. The astronomical health-care costs of 
injection drug use, estimated at $7 billion annually, are almost totally 
preventable if drugs are used in safe and sterile conditions. Prevent two 
cases of HIV, and your SIF is paid for.

SIFs have been demonstrated to be effective in other countries. As part of 
the international legal obligation to provide people with the highest 
standard of health possible, Canada cannot sit by while HIV, hepatitis and 
other preventable harms continue to befall drug users and cripple 
inner-city hospitals. A trial of SIFs, subject to rigourous scientific 
evaluation, is what is being proposed.

The drug users figured it out first. After initial opposition, the Canadian 
government has finally caught on. If we truly care about the health 
standards, safety and economic viability of our communities, we must not 
delay safe-injection facilities any longer.

Dr. Alana Hirsh went to McGill University medical school and trained in 
family practice in Vancouver.
- ---
MAP posted-by: Beth