Pubdate: Thu, 12 Apr 2012
Source: Ottawa Citizen (CN ON)
Copyright: 2012 The Ottawa Citizen
Contact: http://www.canada.com/ottawacitizen/letters.html
Website: http://www.canada.com/ottawacitizen/
Details: http://www.mapinc.org/media/326
Author: Don Butler

MAYOR, POLICE OPPOSE INJECTION SITE PLAN

Report Recommends Creation Of Two Drug Facilities

Ottawa's mayor and police chief served notice Wednesday that they will
oppose any effort to open supervised facilities in the city where
addicts can go to inject illegal drugs.

Within hours of the release of a much-anticipated report that
recommended the creation of two supervised drug injection sites in
Ottawa and three in Toronto, Mayor Jim Watson said that if extra money
is available, it should go to drug rehabilitation and treatment programs.

"It's better use of tax dollars to put it into these kinds of
treatment centres as opposed to safe injection sites," Watson told
reporters.

Ottawa police Chief Charles Bordeleau said the report's findings have
not changed his view that supervised injection sites are
undesirable.

"As long as the criminal element is there, we will have issues around
the current form of safe injection sites," Bordeleau told reporters.
"As long as addicts are forced to commit crimes to supply themselves
with the drugs and the money to buy their drugs, that is a problem,
that is a public safety concern."

He added that he would not be opposed to a different model, such as
one where clients were injecting methadone rather than illegal drugs.

Before a supervised injection facility could open in Ottawa or
Toronto, Federal Health Minister Leona Aglukkak would have to grant an
exemption under Section 56 of the Controlled Drugs and Substance Act.

That could prove to be a considerable hurdle. The federal government
persistently tried to close Canada's only existing supervised
injection facility, Vancouver's Insite, by refusing to renew its exemption.

But last fall, the Supreme Court of Canada ruled that Aglukkak could
not deny an exemption if there was a demonstrated need.

In an email, Aglukkak said applications to open new supervised
injection sites "will be reviewed based on merit." But she said
prevention and treatment were key pillars of the government's
anti-drug strategy.

"Our government believes that the system should be focused on
preventing people from becoming drug addicts," Aglukkak wrote.

Given Watson's opposition, the initiative to open supervised injection
facilities here and in Toronto would likely have to come from the
Ontario government. Premier Dalton Mcguinty didn't close the door on
that possibility Wednesday.

Though he made no commitments, Mcguinty said he'd study the report and
did not repeat statements he made last fall opposing supervised
injection sites. "I have a responsibility at all times to be alive to
the best advice," the premier told reporters in Toronto.

Deb Matthews, Ontario's minister of health and longterm care, noted
that experts continue to be divided on the value of the sites, adding:
"We have no plans to pursue supervised sites at this time."

Wednesday's report, known as the Toronto and Ottawa Supervised
Consumption Assessment and billed as the most comprehensive of its
type ever undertaken, was the work of a team of researchers led by the
University of Toronto's Carol Strike and Dr. Ahmed Bayoumi of St.
Michael's Hospital in Toronto.

Four years in the making, it concluded that Ottawa and Toronto would
both benefit from the creation of multiple supervised injection
facilities, which could improve the health and reduce harm among drug
users.

It recommends the creation of supervised sites for injection drug
users only, saying there is insufficient evidence to recommend the
creation of supervised facilities for those who smoke drugs such as
crack cocaine.

Providing drug users with a safe and supervised place to inject drugs
would reduce the incidence of HIV and hepatitis C infections among
addicts, the report says.

The reductions would be fairly modest, however. Each of the two
clinics in Ottawa would reduce the number of HIV infections by between
six and 10 per year, while the reduction at the Toronto clinics is
projected to be two or three per facility.

As well, the Ottawa facilities would prevent 20 to 35 hepatitis C
virus infections per clinic per year, while the Toronto clinics would
each prevent 15 to 20 hepatitis C infections annually, the researchers
say.

Bayoumi said the report's modelling was "fairly conservative" and
didn't look at the impact on overdose rates or hepatitis B infections.
"So the potential benefits might be considerably greater than what we
estimated."

Coincidentally, a study published Wednesday in The Lancet found that
overdose deaths from illicit drug use dropped by 35 per cent in
Vancouver's Downtown Eastside after the Insite clinic opened there in
2003.

The findings "clearly show facilities such as Insite could literally
be the difference between life and death for many people," said Dr.
Thomas Kerr, co-director of the Urban Health Research Initiative,
which did the study.

While supervised injection clinics would result in some savings in
treatment costs, "those savings are not as great as the cost of
operating the facilities," Bayoumi said in an interview.

"That doesn't mean it's not worth doing. There are lots of things we
do in health care that don't save money." Two sites in Ottawa, he
said, "would still represent good value for money."

The cost of operating each facility would depend on use. Insite, which
supervises more than 500 injections on an average day, has an annual
operating budget of about $3 million.

Though Insite is the only supervised injection facility in North
America, about 90 such clinics exist worldwide, mostly in Europe and
Australia. The report paints a comprehensive picture of hard-core drug
users in Ottawa and Toronto. Between them, the two cities are home to
about half the people who inject drugs in Ontario.

It estimates that Ottawa has about 3,000 injection drug users and
Toronto has about 9,000.

Ottawa users were more likely to inject cocaine, while Toronto addicts
were more likely to use opiates.

About 30 per cent of adult drug users in Ottawa reported injecting at
least once a day, with more than one in four doing so in a public
place. Fourteen per cent in Ottawa and 18 per cent in Toronto said
they'd injected drugs with needles that had already been used by
someone else. One in five in both cities reported they had overdosed
in the past six months.

Among people who inject drugs, Ottawa has the highest new rate of HIV
infections in the province. HIV prevalence is 11 per cent in Ottawa
and four per cent in Toronto. As well, 60 per cent of drug users in
Ottawa and 52 per cent in Toronto have hepatitis C, the study says.

Drug use in Toronto is widely distributed throughout the city, while
in Ottawa it is concentrated in a few distinct neighbourhoods, the
report said.

According to Lynne Leonard, a University of Ottawa professor who was a
study coinvestigator, half of Ottawa's injection drug users live in
the downtown core, about 25 per cent live in Hintonburg and another 25
per cent live in Vanier.

While the study says two supervised injection facilities would be
appropriate for Ottawa, Leonard thinks there should be at least three
- - one in or near each of the three districts where most injection drug
users live.

Bayoumi said it was important to locate the facilities nearby because
addicts won't travel long distances to inject their drugs. In Ottawa,
the study found that 40 per cent of users were willing to walk 10
minutes or less to use a supervised injection facility, and another 36
per cent said they would walk more than 20 minutes.

Overall, 75 per cent of people who use drugs said they would use a
supervised injection facility if one was available.

The report found surprising levels of public support for supervised
injection sites. In Ottawa, more than half of those surveyed said they
would strongly support such a facility if it reduced neighbourhood
problems related to injection drug use, increased contact with health
and social service workers or reduced disease transmission and
overdose. Levels of support were even higher in Toronto.

Support for supervised injection facilities fell sharply, however, if
their purpose was simply to encourage safe drug use. In that case,
just 38 per cent of Ottawans expressed strong support, compared to 31
who were strongly opposed.

Community opposition was a major theme in discussions with stakeholder
groups.

"Even residents and business owners who were supportive of supervised
consumption facility implementation did not necessarily want to see a
facility in their own residential neighbourhoods or near their
businesses," the report says.

To ease concerns, the report recommends that supervised injection
facilities should, if possible, be integrated into a hospital, clinic
or other existing organizations that work with drug users.

Though there will always be some who oppose the creation of supervised
injection sites, Strike said their views should not be given more
weight than those who are supportive.

"In other places in the world there is opposition to these facilities,
but they've been moved forward," she said.

The report also says supervised injection facilities should have
clearly established rules as well as a strong evaluation plan to
assess whether they're meeting their objectives.

Such facilities should also be part of a comprehensive drug strategy
that includes prevention, treatment, enforcement and harm reduction,
it says. 
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