Pubdate: Sat, 10 Jun 2017
Source: Telegram, The (CN NF)
Copyright: 2017 The Telegram
Contact:  http://www.thetelegram.com/
Details: http://www.mapinc.org/media/303
Author: Kenn Oliver

IF YOU BUILD IT, THEY MIGHT COME

Advocates support idea of supervised injection and consumption site in
St. John's, but unsure if drug users would use it

Advocates endorse supervised injection and consumption site in St.
John's The number of supervised injection and consumption facilities -
often referred to as safe-injection sites - in Canada will soon grow
exponentially.

Over the last month, a new facility opened in Surrey, B.C., two were
approved for Montreal, three more were approved for Toronto and
there's one on the way for Ottawa. There's also talk in the addiction
treatment and outreach community of Halifax having its own.

Which begs the question: should St. John's explore the possibility of
establishing a place where drug users can administer substances to
themselves in a safe, controlled environment under the supervision of
health professionals?

"Setting up here, you've got some logistic challenges, but it's not
out of the realm of possibility," says Christopher Smith, St. John's
site co-ordinator for the Canadian Community Epidemiology Network on
Drug Use (CCENDU).

"For a small community, it's a tricky one because folks don't want to
be identified as drug users and there's always a perception of what's
called in the academic literature 'the honey pot effect.' If you build
a service like this, basically you'll be attracting junkies or drug
users to that particular neighbourhood."

Smith, however, insists the data culled from Vancouver Coastal
Health's Insite, North America's first legal supervised injection site
in the British Columbia city's downtown eastside, actually points to
the contrary.

"There are tons of stats about the number of referrals made to
methadone, the decreases in petty crime in the area because people no
longer necessarily need to commit crimes," he says.

If St. John's were to have its own such facility, Smith believes it
could be modelled after Insite, which is also home to a detox centre -
Onsite- and an assisted living centre.

He says the facilities act as contact points and are ideal for
reaching those drug users who are hardest to reach, including homeless
people who are reticent to interact with the system.

"There's a certain faction of the homeless population that just
absolutely hate any kind of institutional quality, so they'll stay
away from hospitals, shelters," Smith says.

"Over time the idea is that as people get more and more comfortable
with facilities and the staff there, they would then say, 'I'm tired
of being sick and tired and spending all my money on this.'"

Tree Walsh, co-ordinator of the Safe Works Access Program (SWAP)
needle exchange, says it's hard to say whether or not drug users in
the St. John's metro region would avail of the service.

"Stigma is so much more an issue here because of the size of the town.
In a big city like Vancouver, it's easy to be anonymous, not so much
here in Newfoundland," she says, noting that having it happen in
tandem with SWAP might make it more appealing to the people who
already avail of the needle exchange.

Walsh says a more important first step in any harm-reduction strategy
is making safe use equipment more readily available to people around
the island. Currently, intravenous drug users only have access to new
equipment at the St. John's and Corner Brook SWAP sites.

Though she admits it's not likely to happen, in her mind both that
service and supervised injection and consumption could happen in the
same place at the same time.

"If we could have one, my contention is we can have a place where
people can get new equipment in every community pretty much, at least
everywhere there's a public health nurse," says Walsh.

"Why not? It is public health. And if the person could inject while
sitting there, that would be very helpful, too, because naloxone is on
hand if it's needed."

At the recent launch of the St. John's Community Action Group on
Fentanyl, when asked about a safe-injection site in the province,
Minister of Health and Community Services Dr. John Haggie noted the
success of the sites in acting as conduits to other rehabilitative
services, but suggested the problem in determining a need here comes
down to geography and numbers.

"It's actually very difficult to get a handle on how many people we
have using intravenous drugs," he told reporters. "We have estimates
and surveys that put the figures somewhere between 800 and 1,000, but
those are prone to error. If it turns out that we have some evidence
that it might work, then we'll certainly look into it."

Walsh and Smith are working to get a better handle on that number 
through a project called "Pushing the Point: Collaborative Needs 
Assessment Addressing People Who Inject Drugs in St. John's."

"That will give us a certain amount of information, but the true
number of people who use is always significantly higher than those who
will have the courage to come forward and, again, it's stigma for most
folks."

As for the geography issue, through his work with various needs
assessments and surveys, Smith says, the evidence suggests that how
far a user is willing to travel sometimes depends on their drug of
choice.

"Crack is a very sort of immediate thing. You get it and you're going
to do your hit right there, right then, if you have to duck into an
alley or a doorway it doesn't matter, but nobody's going to go across
town with a piece of rock in their pocket.

"Junk is a little more premeditated and requires a little more calmer
conditions to prepare it properly, so opioid injectors will typically
travel a little bit longer."
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MAP posted-by: Matt