Supervised injection not a panacea

After 14 years of operating in legal purgatory, the Dr. Peter’s supervised injection facility was finally granted an exemption under section 56 of Canada’s Controlled Drugs and Substances Act, the same exemption that allows people to possess illicit drugs at Insite.

Minister of Health Jane Philpott recently visited Insite, a clear sign that the Liberal government is embracing a proven public health intervention.

Plans to open supervised injection facilities in other Canadian municipalities are being initiated. With Canada’s new federal government, the public health benefits of supervised injection will no longer be limited to Vancouver’s downtown east side.

But the conversation cannot end with supervised injection.

Right outside the doors of Insite or the Dr. Peter’s Centre, drug possession is still a criminal offence. Having a place to use safely without fear of death, HIV contraction, or incarceration is an incredible first step. But what happens before someone walks into a supervised injection site?

How were they able to score?

Buying off the street is expensive. Prohibition inflates drug prices. Users turn to property theft, panhandling, and sex work to afford drugs. The small minority of people caught up in this cycle account for a large majority of the societal costs associated with illicit heroin use.

Many encounter violent, traumatic situations that further a drive to self-medicate as a protective response. Which trauma will they relive after they leave Insite?

Sex work can mean getting into a car you’ve never seen before to earn enough drug money for a morning that you might never see again. Some are abused. Some workers disappear. Some contract HIV.

What are they injecting?

Fentanyl, under the mistaken impression that it’s heroin. In the last month of 2015, British Columbia suffered a staggering amount of overdose deaths. Sixty-two to be exact. The deadliest month for overdose deaths in British Columbia since recordkeeping began in 2003.

Use of fentanyl, and chemically similar drugs were detected in one-third of these deaths. Fentanyl is approximately 50 to 100 times stronger then heroin.

With an anticipated tightening of the province’s prescription-monitoring program (PMP), it seems likely that some prescription opioid users will lose their only legal source of medication. Research shows that PMPs act as a barrier to prescription access for patients with legitimate medical needs.

This issue is especially serious when people buy a street drug of unknown potency instead. To some, these consequences of drug use should be placed entirely on the shoulders of the person using them. But we should know better. It’s too frequent that policy and legislative decisions serve as a barrier to public health and safety.

Providence Health’s Heroin-Assisted Treatment (HAT) program is an example of what the future could look like if the law wasn’t a barrier to treatment. For HAT’s patients, getting the next high is no longer the existential threat that it was on the street. Patients entering the program receive pure medical grade diacetylmorphine (heroin) or hydromorphone (dilaudid) twice a day.

As a result, rates of illegal activity among HAT’s patients is reduced, providing large benefits to the patient but also to community and public health. In one survey of injection drug users, 62% of sex workers indicated a willingness to leave the trade, but remained active due to the financial cost of buying street drugs.

HAT reduces the need to work a risky, unregulated trade by providing a prescription instead of the abuse, stigma, and unpredictable drugs that come with working in an alleyway.

It’s an exciting time to be alive.

Just a year ago, it seemed unthinkable that supervised injection would become an accepted public health intervention. We can’t let the conversation die now.

If we do, it will take a lot of people with it.

Jordan Westfall

About Jordan Westfall

Jordan Westfall, a recent graduate from Simon Fraser University's School of Public Policy, wrote his graduate thesis on drug overdose prevention. The title of his thesis is "Life Won't Wait: Naloxone and Drug Overdose Prevention in British Columbia".

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