Pubdate: Sat, 19 Mar 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Jeff Gray
Page: M1

TORONTO'S SUPERVISED INJECTION SITES OFFER START TO REDUCING OVERDOSE
DEATHS

Frank Coburn, 70, says he overdosed on the drug fentanyl last year
while furtively shooting up in Seaton House, one of the downtown's
largest homeless shelters. He says he blacked out and his heart
stopped. The next thing he knew, he woke up on a stretcher, looking up
at the paramedics who revived him.

"In a safe-injection site, it would never have gotten that far," said
Mr. Coburn, who is no longer homeless but still uses drugs and the
services of the Works, a harm-reduction clinic for drug users near
Yonge-Dundas Square where he also serves as a "peer outreach worker."

Instead of dying of overdoses alone in alleyways, addicts using a
supervised injection site can be tended to by a nurse right away. And,
in Mr. Coburn's case, he says he would also have been able to mix his
drugs himself, instead of needing to quickly and clandestinely inject
a "premixed" hit inside a homeless shelter, making an overdose less
likely.

Toronto Public health officials had Mr. Coburn on hand this week as
they announced a proposal to open small-scale supervised injection
sites for users of heroin or other injectable drugs at three health
clinics across the city. The Board of Health (which meets on Monday),
City Council, the provincial government and the federal government
must all still approve the plan. Consultations with the affected
neighbourhoods and the police are also mandatory.

The three sites under consideration are Toronto Public Health's the
Works needle-exchange clinic on Victoria Street near Yonge-Dundas
Square, the Queen West Central Toronto Community Health Centre near
Queen Street West and Bathurst Street, and the South Riverdale
Community Health Centre on Queen Street East near Carlaw Avenue.

Toronto's top health official, Medical Officer of Health David
McKeown, and a downtown city councillor who heads the city drug
strategy panel, Joe Cressy, have been championing the cause, citing
numbers that show a 41-per-cent increase in overdose deaths over a
decade in the city, with 206 reported in 2013. Supervised injections
sites, they say, will save lives and reduce that number.

But Jurgen Rehm, a scientist at the Centre for Addiction and Mental
Health (CAMH) and a leading expert on harm reduction, cautions that
winning acceptance of these sites with pledges that overdose deaths
will plummet right away could end in disappointment.

There is no question a "clear consensus" exists among health experts
that supervised injection sites - of which more than 90 now operate
around the world - are beneficial, Dr. Rehm says, and addicts who use
them are much less likely to die of an overdose. But drug addiction is
far from an easy problem to solve. And Dr. Rehm fears that the
ideological battle lines drawn around supervised injection sites can
make it harder to appreciate the benefits that they do offer, as
forces pro and con debate the issue in black and white, instead of
grey.

"Once such a decision is made, it is oversold. It is hyped up. It's
seen as a panacea," said Dr. Rehm, who is the director of CAMH's
social and epidemiological research department and also holds posts at
the University of Toronto and the Dresden University of Technology.

Any notion that three small-scale sites could quickly lead Toronto's
overdose death numbers to dwindle in the first few years is "rubbish,"
he says. In fact, overdose numbers could rise, he said, even if
Toronto goes ahead with the three clinics.

Take Insite, Vancouver's 13-year-old supervised injection site. Inside
the facility, studies say, no one has ever died of an overdose. And
overdose deaths near the Downtown Eastside injection site are also
down dramatically. But overdose deaths in Vancouver as a whole remain
high, Dr. Rehm says, because less than 10 per cent of all of
Vancouver's drug injections take place within Insite, even with the
centre's large size and profile. And in Toronto, an even smaller
fraction of drug injections would take place in the proposed three new
supervised centres, if they are approved.

That is partly due to their small size: Toronto Public Health says
each clinic will have just three spots for addicts to shoot up at a
time, in a small room, limiting the numbers that can be accommodated.
It is also partly due to the fact that, especially at first, many drug
users will choose to stay away, distrusting the public-health system
and fearing that police are lying in wait outside a supervised
injection site in order to arrest addicts, Dr. Rehm said.

Still, he said, harm-reduction policies, including supervised
injection sites but also the distribution of "overdose kits"
containing the anti-overdose drug naloxone, do reduce overdose deaths.
But it takes time.

Getting hard-core drug users to kick heroin or other opioids is
extremely difficult. But offering a supervised injection site does get
addicts in the door, Dr. Rehm and other proponents say, establishing a
relationship with health workers that could see some drug users get
into treatment and emerge drug free.

And there is no question, Dr. Rehm says, that operating supervised
injection sites is more cost efficient for the health system than the
status quo, as they will at least somewhat reduce the need for
emergency-room visits and ambulance and police time that street-drug
overdoses now cause.

While supervised injection sites sound radical to many in Toronto,
some other countries go farther: For more than 20 years now in
Switzerland, the health system actually hands out heroin to addicts,
particularly those that have trouble taking methadone, a drug commonly
used to replace heroin.

This ensures users are getting drugs from a "safe" source, negating
the need to scrounge up money to pay for their habit as they
transition into treatment programs. Programs in Vancouver and Montreal
briefly experimented with giving addicts heroin, but the exemptions
were cancelled by Health Canada in 2009 under the previous
Conservative government.

Experts say there is no evidence that harm-reduction policies actually
increase drug use. They also say safe injection sites do not attract
large numbers of drug users from other parts of the city, as addicts
tend to use drugs in their own neighbourhoods.

One of the advocates that spoke with reporters this week about the
need for supervised injection sites said she has no intention of
stopping her own habit of injecting cocaine.

"I never wanted to stop using so that wasn't my case," said Cindy
Reardon, 47, a "peer outreach worker" at the Works, the city's central
needle exchange clinic. A member of its client advisory board, she
says she has been using the service since 1989, and strongly supports
expanding it to include a supervised injection site. But she said only
drug users who want to quit will ever quit.

"I have a job, I went to school, I have a home, so for me it wasn't as
chaotic as for some. But if you are street-involved, it is very hard
to find a place to use. So [a supervised injection site] gets people
in the door, and if you so choose, there is room for that
conversation. But if they don't want to, harm reduction dictates that
we approach people where they are at."

Ms. Reardon, who says she is HIV-positive and asked reporters to refer
to her as "a user, not an addict," says she used to shoot up in the
unsanitary bathrooms of fast-food restaurants when she was a student
at the University of Toronto's Scarborough campus, a practice that saw
her catch a serious infection that put her in wheelchair. This, she
said, could have been avoided in a supervised injection site: "If you
were an injection drug user, you would want this service."

Mr. Coburn, the overdose survivor, says his life spiralled into
depression, homelessness and drug use after a personal crisis about 20
years ago. Now 70, he says he is feeling better about himself.

Allowing drug users into a supervised injection site not only reduces
the risks of overdosing alone in a dark alley. Mr. Coburn said it also
brings people addicted to drugs out of the shadows and helps restore
some of their dignity, as he gestured out the window of the Works
clinic, opposite Yonge-Dundas Square.

"Across the street, that alleyway there, a guy ODed and was passed out
in the snow and was run over by a dump truck," he said. "These stories
occur all the time, over and over again. =C2=85 You are running around,
hiding in corners. You don't want anyone to see you."
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MAP posted-by: Matt