Pubdate: Fri, 08 Jan 2016
Source: Victoria Times-Colonist (CN BC)
Copyright: 2016 Times Colonist
Contact:  http://www.timescolonist.com/
Details: http://www.mapinc.org/media/481

Authors: Mary Clare Kennedy and Thomas Kerr
Note: Mary Clare Kennedy is a doctoral student in the School of 
Population and Public Health at the University of British Columbia. 
Dr. Thomas Kerr is a professor in the department of medicine at UBC 
and the director of the Urban Health Research Initiative at the B.C. 
Centre for Excellence in HIV/AIDS.
Page: A13

THE CASE FOR SUPERVISED INJECTION, TREATMENT

Claims About Vancouver's Insite Facility Don't Stand Up to Scrutiny, 
Insult the Staff

Drug addiction remains a major public health challenge in many 
settings throughout the world, including in Victoria. Too often, 
policy-makers have failed to respond quickly to drug-related harm 
with interventions that have been found to be effective through 
carefully conducted research.

This failure of public policy typically leads to immense preventable 
suffering and healthcare costs.

The lack of appropriate and informed response is often perpetuated by 
those who cling to overly simple solutions and ignore scientific evidence.

Recently, some have argued that supervised injection sites are not 
needed in Victoria ("Treatment is the answer, not safe-injection 
sites," letter, Jan. 6) despite ongoing problems of overdose and 
other harms, and that what should be implemented instead are more 
abstinence-based treatment programs.

Often accompanying such recommendations are claims that supervised 
injection sites, such as Insite in Vancouver, have failed to promote 
entry into addiction treatment and that the science supporting such 
sites is somehow flawed. However, a close look at decades of research 
on high-risk drug use shows that such claims are baseless.

Regarding Insite, the evidence is clear. Peer-reviewed scientific 
studies have found that Insite has led to increased admissions to 
detoxification services, with regular users of the facility being 
twice as likely to enter detox. Interestingly, a followup study 
showed that rates of entry into detox programs among Insite users 
increased by more than 30 per cent in the year after Insite opened. 
This increase occurred even before a detox program opened above Insite.

Further, studies have shown that regular Insite users are also more 
likely to enrol in other types of abstinence-based addiction 
treatment, including residential-treatment centres and peer-support 
programs such as Narcotics Anonymous.

Far from being "sham reports," the aforementioned research has been 
published in some of the world's top addiction and medical journals, 
including The New England Journal of Medicine and Addiction. 
Suggesting that Insite has done nothing to promote entry into 
addiction treatment is not only false, it's also an insult to the 
many nurses, social workers and counsellors who have succeeded in 
supporting Insite users in taking that first step toward abstinence.

It's also sad that critics of harm-reduction programs fail to 
recognize that, in order to effectively tackle high-risk drug use, we 
need a continuum of services. But why not just have the 
abstinence-based treatments and skip harm reduction, one might ask? 
Research has shown that abstinence-based approaches alone do not 
constitute an effective public health strategy.

Even when abstinence-based addiction programs are widely available, 
only 10 to 20 per cent of people who use drugs are reached by these 
services, and the majority of these individuals will relapse upon 
leaving treatment.

The problem of relapse and the limited impact of abstinence-based 
treatments have led the American Society of Addiction Medicine to 
describe drug addiction as a chronic disease, typically involving 
cycles of relapse and remission. Given the chronic nature of drug 
addiction, and given that so many people cycle in and out of active 
drug use, we need programs that protect people actively using drugs 
from harms such as overdose and infectious diseases.

We also need programs that reach active drug users and connect them 
with addiction treatment. For the entire system to work optimally, we 
need a comprehensive continuum of care, ranging from low-threshold 
harm-reduction services to abstinence-based treatment programs.

When the Supreme Court of Canada was asked to determine whether 
Insite should be allowed to stay open, it heard from many 
organizations that stood behind the evidence supporting the facility. 
Included were the Canadian Medical Association, the Canadian 
Association of Nurses and the Canadian Public Health Association. We 
are hopeful, as policymakers in Victoria consider the merits of 
establishing supervised injection sites, that they will manage to 
drown out the voices of those who misrepresent science and offer 
overly simple solutions, and instead listen to the country's leading 
medical and public health experts.

It turns out that these experts agree - supervised injection sites 
are evidence-based interventions that save lives and health-care 
costs. However, they are most effective when part of a comprehensive 
system of care that includes not only harm reduction, but also a 
range of evidence-based addiction-treatment programs.
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MAP posted-by: Jay Bergstrom