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. - --- MAP posted-by: Jo-D