Category: Supervised Consumption Services

Cheap, Easy, and Lifesaving—Naloxone Treatment for Overdose

How much does it cost to save a life? That question got a clear and striking answer this week in the case of overdose from heroin in the United States. A study published in the Annals of Internal Medicine found that distribution of the overdose antidote naloxone—a safe, non-abusable, and inexpensive medicine—to one in five heroin users in the United States could prevent as many as 43,000 deaths. The cost of distribution would be equivalent to some of the cheapest, most effective, and most accepted medical interventions, like checking blood pressure at a doctor’s office.

The study used mathematical modeling to assess whether giving out naloxone was “worth it”—that is, to determine how much naloxone distribution would cost per “quality-adjusted” year of life gained. This is the measure used by economists and policymakers to compare health interventions and decide which ones are affordable. The naloxone study also investigated assumptions that patient advocates would rather not acknowledge—like whether it would be cheaper to let illegal drug users die, or to put them in jail. Those are ugly questions, but ones that certainly run through the minds of opponents of health services for drug users worldwide. The answer was that naloxone saves lives with costs far below what health or prison systems pay. For example, screening for cancer with colonoscopy costs over $50,000 per quality adjusted life year gained in the United States, and screening for HIV costs around $40,000.

Naloxone distribution saves lives for as little as $400.

The other question, of course, is whose lives are deemed worth saving. Drug overdose now kills more adults a year in the United States than motor vehicle accidents, or deaths from choking or accidental falls. Most of us have seen safety messages related to driving, choking, or minding our step, but naloxone and other measures to prevent overdose remain unknown to many at risk. As noted in an editorial in the same journal, co-authored by officials from the National Institute on Drug Abuse and the FDA, making new and easy-to-use formulations of the medicine can help. However, action can be taken now to make the medicine available to heroin users—actions that will prevent thousands of needless deaths, and spare family and friends who may have to watch helplessly as their loved ones stop breathing.

– Daniel Wolfe

Daniel Wolfe is director of the International Harm Reduction Development Program at the Open Society Foundations. This blog post was originally published on the Open Society Foundations website.

January 29, 2013
The Insite Story: Transforming Health Care Services through Leadership, Risk Tolerance and Innovation

It has been said that “an essential aspect of creativity is not being afraid to fail.” A PricewaterhouseCoopers’ survey conducted among the Times 1000 leading companies found that one of the common characteristics among the most innovative companies is that they take a balanced view of risk-taking behaviours. But a recent Conference Board of Canada survey conducted among Canadian health care executives confirmed that Canadian health care leaders have low tolerance for risk. Boards are perceived to be more risk-averse than executive teams by a fairly wide margin. As seen in the chart below, 57 per cent of respondents agreed or strongly agreed that their executive teams are risk-tolerant, compared to the 37 per cent who agreed or strongly agreed that their boards are risk tolerant, a difference of 20 points.

At a recent meeting of the Centre for the Advancement of Health Innovations in Vancouver, Insite, North America’s first legal supervised injection site for drug users, exemplified the importance of adopting a balanced approach towards risks. Insite’s leaders have taken bold actions, many of which carried significant risks, to implement innovative and transformative health care services.

Insite was created to provide needed services to a population group that has suffered social stigma, abuse and social exclusion in Canada: drug-addicts. Before Insite, there were very few effective solutions to protect drug users from HIV and drug overdose but Insite has changed this reality.It offers clean injection supplies, withdrawal management support, detoxification areas and transitional recovery housing. A team of mental health workers, counsellors, nurses and physicians work with people with drug addiction to educate, intervene when necessary, plan a path to recovery and assist with re-integration in the wider community.

And the results are outstanding: thirty-three per cent of Insite users are more likely to go to detox if they use the site once a week; 70 per cent are less likely to report syringe sharing, thus reducing HIV risk behaviour; and fatal overdoses within 500 metres of Insite decreased by 35 per cent after the facility opened compared to a decrease of 9 per cent in the rest of Vancouver. The benefits also extend to the heath care system and society: it has been estimated that supervised injection can save $14 million and 920 life years over 10 years due to a reduction in HIV, hepatitis and other medical interventions.

Despite these proven benefits, Insite has had to fight legal battles to prove legitimacy. In 2006, the federal government deferred the decision to extend Insite’s special exemption from the Controlled Drugs and Substances Act, citing a lack of evidence to support the benefits of supervised injection. In a brave demonstration of leadership, Insite’s supporters took the matter to the Supreme Court of Canada, which in 2011, ruled unanimously to uphold Insite‘s exemption, allowing the facility to stay open indefinitely. Over the past nine years, more than one million injections have taken place at Insite under supervision and with clean equipment. It is the busiest supervised injection site in the world with over 1,200 visits every day.

Insite’s leaders did not run away or gave up on their vision when the many obstacles appeared; they relentlessly focused on implementing change and appropriately and effectively managing the risks associated with a program of this nature. And these efforts have paid off: by partnering with the local health authority, Insite has been able to effectively bringing innovative health care services to marginalized populations who were previously unreachable.

The program continues to work with low-income people to bring more opportunities for this hard-to-reach population to control their addictions and access effective, culturally appropriate chronic disease management and disease prevention programs. Insite’s daring leaders were not paralyzed by fear of failure. They are transforming health care services by demonstrating that the “best health care solution lies in treating all people humanely”.

– Jeannette Lye

Jeannette is a graduate of the School of Public Administration at Dalhousie University and in addition holds a Master of Science in Cultural Psychology from Brunel University and an undergraduate degree in psychology from Acadia University. This blog post was originally published on ConferenceBoard.ca

January 4, 2013
The Missing Link in Overdose Prevention

Long-established medical practice supports prescribing pre-loaded syringes of epinephrine to people having severe, life-threatening allergic reactions to allergens such as bee stings, nuts and shellfish. Patients, including children, are taught how to use them and carry them with them at all times in order to administer the drug without delay when they have a reaction. It “buys time” to allow the person to get to emergency medical care for monitoring and further treatment if needed. Epinephrine is considered an emergency drug and in most circumstances is administered by trained medical personnel in health care settings. However, the risk of death from a severe allergic reaction, when seconds count, outweighs the risks associated with dispensing the drug for unsupervised use by lay people in the community.

For about thirty years, the harm reduction approach has been advocated by some in Canada as a means of promoting health and preventing needless injury and death among people who use drugs. It accepts that, whatever one’s beliefs about drug use and the people who use drugs, at any given time some people will use drugs unsafely. It holds that preventing unnecessary morbidity and mortality is best accomplished by a continuum of strategies which include educating drug users about the drugs they use, the risks involved, ways to mediate those risks, and the availability of supports to reduce or cease risky use.

For example, research from Australia has shown that needle exchange programs prevented 32,000 HIV infections and almost 100,000 Hepatitis C infections in the first decade of the 21st century, saving over AU$1 billion – which represents a five-fold return on investment. Despite decades of robust evidence supporting the efficacy of harm reduction, in general health care providers have been “slow adopters” of harm reduction strategies.

In September 2010, the College of Physicians and Surgeons of Ontario (CPSO) described widespread addiction to strong painkillers, known as opiates, as a “public health crisis” in Ontario. Earlier this year, a potent long acting opiate known as OxyContin was removed from the Canadian market and replaced with a new formulation called OxyNeo, which is made with a time release coating which is more difficult to bypass, making it less accessible to people using it without a prescription. This has resulted in fewer people using the drug, but not fewer people addicted to opiates.

Research from the United States shows that many former Oxycontin users turned to more readily accessible opiates such as fentanyl and heroin after Oxycontin was taken off the market there.Reports from police and addiction workers suggest the same is now happening here in Canada. One of the problems with this is that people have had to change from opiates with a precisely known strength to others with variable potency. The risk of overdose has increased as a result. Recognizing this, Ontario Health Minister Deb Matthews announced in April 2012 that her government was increasing resources to address opiate addiction, including distribution of “emergency overdose kits across the province.”

Similar to the way in which we provide emergency epinephrine to people with life-threatening allergic reactions, distributing a drug called naloxone, which reverses opiate overdoses, has been saving the lives of people who have overdosed on opiates since 1995 in the UK and Germany. There are 150 such programs in 19 American states but so far only Toronto and Ottawa have naloxone distribution programs up and running in Ontario, eight months after the health minister’s announced support of the strategy.

Naloxone distribution involves providing opiate users with education on overdose prevention, first aid, CPR, as well as naloxone administration in an overdose situation, which “buys time” to get someone to emergency care. The OHRDP received Ministry of Health funding to create a detailed guidance document, which they have compiled building on the work of the Toronto and Ottawa pioneers. It is replete with supporting documentation, current statistics, training manuals, sample protocols and medical directives (required legally to prescribe and dispense this medication to lay people). The naloxone has been purchased and is ready to be used by trained lay people.

Few health care providers would argue that the opiate addiction crisis has gone away. Small communities are dealing with issues like heroin which they have never seen before. What is different in small communities is that the people using substances are much more dispersed and invisible (for more information, see “Below the Radar”). While it may be reasonable in large cities to focus overdose prevention in places where there are high concentrations of drug users, small towns need a more widespread system of interventions because the people affected are not to be found in a few highly visible areas.

For example, Peterborough ranks seventh highest in the province for opioid related deaths. Peterborough Police Chief Murray Rodd has warned that “already we are seeing an increase in heroin and fentanyl in our city,” which he is concerned will lead to “even more overdoses in the coming months”. A network of Peterborough agencies is poised to roll out an evidence-based overdose prevention program, which includes naloxone training – the first for an Ontario county which includes many rural communities where 911 response times are longer than is common in large cities. Supported by the local Medical Officer of Health, the police service and EMS, it will only reach the people it needs to if local health care providers get behind the initiative. One hopes that they will do so without delay, as the project will undoubtedly save lives and provide a model for other small and rural communities.

One of the reasons we study epidemiology (what is causing injury and death) is to use that information to plan programs which will prevent unnecessary injuries and deaths. Health providers have an obligation to understand evidence based interventions available around opioid addiction and to use them to reduce deaths. Some may ask “is this really needed?” but when overdose death rates are so well documented, the answer is obvious. Saving even one person from a needless overdose death should be considered important. She is someone’s daughter, maybe someone’s mom. While the needs of opiate users may not resonate with health care providers in the same way as the needs of people severely allergic to bee stings, when we have an evidence-proven lifesaving intervention, we are obligated to offer it widely and without delay.

-Kathy Hardill

Kathy Hardill is a Primary Care Nurse Practitioner at a clinic which includes patients whose health is made vulnerable through homelessness, poverty and other risk factors. This blog post was originally published on HealthyDebate.ca

January 2, 2013
L’échange de seringues en prison – une question de droits de la personne

Les gens ne renoncent pas à leurs droits de la personne lorsqu’ils entrent en prison. Ils comptent plutôt sur le système de justice pénale pour les respecter, y compris leur droit à la santé. La santé carcérale est la santé publique.

Ces énoncés peuvent sembler évidents pour certains, mais le droit à des services de santé adéquats est à la base d’une nouvelle poursuite intentée contre le gouvernement fédéral du Canada. Les programmes d’échange de seringues sont un élément essentiel d’une stratégie globale de prévention de la propagation des maladies infectieuses, mais le service correctionnel fédéral ne permet pas ce service de santé de survie dans les prisons fédérales canadiennes. Pour contester cette politique, le Réseau juridique canadien, Prisoners with HIV/AIDS Support Action Network (PASAN), CATIE, le Réseau canadien autochtone du sida (RCAS) et Steven Simons, un ex-détenu fédéral, ont intenté une poursuite contre le gouvernement du Canada aujourd’hui, au motif de son défaut de protéger la santé des personnes incarcérées par son refus permanent de mettre en œuvre des programmes de seringues et d’aiguilles stériles.

L’utilisation de drogues en prison est une réalité. Un sondage de 2007 mené par le Service correctionnel du Canada (SCC) a révélé que 17 % des hommes et 14 % des femmes s’étaient injecté des drogues tandis qu’ils étaient en prison. Des prisonniers ne sont pas disposés à prendre part au traitement, le traitement peut ne pas être disponible ou approprié. Malgré le fait que l’utilisation et la possession de drogues sont illégales en prison, et malgré les efforts des systèmes correctionnels pour empêcher les drogues d’entrer en prison, celles-ci demeurent largement disponibles. En fait, aucun système correctionnel dans le monde n’a été capable de maintenir les drogues complètement à l’extérieur des murs. Le partage des seringues est une façon très efficace de partager les maladies transmissibles par le sang. Les personnes incarcérées ont des taux de VIH et d’hépatite C qui sont au moins de 10 et 30 fois plus élevés que ceux de la population dans son ensemble, et une grande partie de ces infections se produit parce que les détenus n’ont pas accès à du matériel d’injection stérile.

Cette poursuite remet en question la croyance selon laquelle les gens révoquent leurs droits quand ils entrent en prison. En fait, les prisonniers conservent les mêmes droits de la personne dont jouissent les personnes en communauté, sauf ceux qui sont évidemment restreints par l’incarcération. Cela comprend le droit au meilleur état de santé susceptible d’être atteint, un droit enchâssé dans plusieurs Traités et conventions de l’ONU. Ce droit englobe des mesures comme l’échange de seringues qui a fait maintes fois ses preuves comme moyen de prévenir la transmission des maladies.

Il y a également de bonnes raisons de croire que les services d’échange de seringues en prison sont bénéfiques pour nous tous. Ces services sont offerts dans bien des parties du monde et on a constaté, par des évaluations, qu’ils réduisent le partage de seringues, qu’ils n’entraînent pas une utilisation ou injection accrue de drogues, qu’ils contribuent à réduire les surdoses, qu’ils facilitent les renvois des utilisateurs à des programmes de traitement de la toxicomanie, et qu’ils n’ont pas donné lieu à l’utilisation d’aiguilles ou de seringues comme armes contre le personnel. Lorsque ces services ont été instaurés dans les prisons suisses, les employés étaient réticents au départ, mais parce que l’échange de seringues réduisait la probabilité des blessures par piqûres d’aiguilles, ils se sont rendu compte que la distribution de matériel d’injection stérile était dans leur propre intérêt, et ils se sentaient plus en sécurité qu’avant que la distribution commence.

La vaste majorité des détenus retournent éventuellement dans la communauté, donc les maladies qui sont acquises en prison ne restent pas nécessairement en prison, ce qui signifie que lorsque nous protégeons la santé des détenus, nous protégeons la santé de chaque membre de la communauté. Les prisonniers font partie de notre vie aussi, ce sont des mères, des pères, des frères, des sœurs, des amis et des êtres chers. Vous ne pensez peut-être pas connaître un prisonnier, mais les chances sont que vous en connaîtrez, et vous vous soucierez de sa santé et de son bien-être.

October 1, 2012
Qu’est-ce que la naloxone?

La naloxone est un composé chimique sécuritaire et très efficace qui inverse les effets des opiacés comme l’héroïne. Depuis 40 ans, elle est utilisée dans des milieux cliniques comme traitement d’urgence contre les surdoses d’opiacés. Aux É.-U. et en Europe, les programmes « Take Home Naloxone » ont été associés à des réductions de jusqu’à 34 % des décès liés aux drogues[1]. L’utilisation de la naloxone au Canada est autorisée depuis plus de 40 ans, et elle figure à la Liste modèle de l’OMS des médicaments essentiels. La naloxone ne peut faire l’objet d’abus – en l’absence de narcotiques, elle ne présente essentiellement aucune activité pharmacologique. La naloxone ne fonctionne qu’avec les drogues de la famille des opiacés/opioïdes – elle n’est pas efficace pour les surdoses d’autres drogues comme la cocaïne.

Comment la naloxone peut-elle réduire le nombre de décès liés aux drogues?

La naloxone peut jouer un rôle majeur dans la prévention des décès – surtout si elle peut être administrée à une personne en surdose aussi tôt que possible. Afin de maximiser l’effet de la naloxone sur les décès liés aux drogues, il faut que la naloxone soit disponible sur les lieux de la surdose avant l’arrivée de l’aide spécialisée. Ce qui veut dire que la naloxone doit être disponible pour les membres de la communauté, aux fins d’utilisation d’urgence. Les programmes « Take Home Naloxone » ont été liés à des réductions de jusqu’à 34 % des décès liés aux drogues[2].

L’accès à la naloxone varie autour du monde, notamment les doses à apporter (take-home) pour les personnes qui utilisent des drogues illicites en Europe, en Australie, de même qu’à Edmonton et Toronto. L’Écosse a instauré une National Patient Group Directive en août 2010 pour faciliter le développement de programmes de naloxone pour apporter. Les Patient Group Directives (PGD) permettent que la naloxone soit prescrite par des infirmières et des pharmaciens compétents. En Écosse, chaque personne libérée d’une prison et à risque de surdose reçoit une formation et une trousse de naloxone[3]. La naloxone est en vente libre à Turin, en Italie. Il y a plus de 180 programmes réussis de naloxone pour apporter aux États-Unis, comme le Project Lazarus de Caroline du Nord, qui a contribué à distribuer de la naloxone aux personnes qui sont à risque à cause des opiacés prescrits[4].

Au Canada, la naloxone est contrôlée à titre de médicament sur ordonnance (MSO) en vertu de l’annexe F du Règlement de la Loi sur les aliments et drogues. Elle est prescrite par les médecins à des patients désignés nommément seulement, qui sont jugés à risque d’une surdose d’opiacés. La disponibilité de la naloxone est également soumise à la législation provinciale régissant les pharmacies ainsi qu’aux organisations professionnelles comme les collèges provinciaux de médecins et chirurgiens.

La recherche a constaté que la disponibilité de la naloxone n’augmente pas l’utilisation des opioïdes. Des programmes ont remarqué que former des gens à administrer un médicament qui sauve des vies est une expérience qui change une vie.

[1] Scottish Drugs Forum. Take-home Naloxone: Reducing Drug Deaths. À l’adresse :www.sdf.org.uk/index.php/download_file/view/132/108/

[2] Buxton, et al., 2012; Scottish Drugs Forum.

[3] National Services Scotland. 2012. National Naloxone Programme Scotland Monitoring Report – Naloxone Kits Issued in 2011/12. À l’adresse : http://naloxone.org.uk/index.php/allresearch/99-reseach14

[4] Dasgupta, N. et al. 2008. « Project Lazarus: Overdose Prevention and Responsible Pain Management ». North Carolina Board of Medicine: Forum, p. 8. À l’adresse :www.ncmedboard.org/images/uploads/publications_uploads/no108.pdf

August 30, 2012
Rapport du directeur

Les trois derniers mois ont foisonné d’activités comme nous établissons davantage notre présence comme CCPD et formons des liens avec des organisations et des personnes du pays et du monde entier. Il se produit véritablement quelque chose de grand, et un élan se dirige vers de nouvelles approches innovatrices pour aborder les problèmes de drogues.

En février, j’ai été invité à prendre la parole à un congrès international, à Mexico,Drogas : Un balance a un siglo de su prohibición, organisé par le groupe de prévention du crime Mexico Unido Contra la Delincuencia. Le forum a effectué un examen exhaustif des solutions de rechange possibles aux conséquences désastreuses de la guerre aux drogues du gouvernement mexicain. Des conférenciers sont venus du monde entier pour faire part de leurs innovations, de leurs changements législatifs et de leurs pratiques qui ont donné aux politiques des drogues une approche de santé publique et les ont éloignées du modèle de justice pénale raté.

Intégration de l’injection supervisée dans les services de santé et la communauté : un échange de connaissances national

En avril, la CCPD a organisé un forum sur les services d’injection supervisée en partenariat avec le centre du Dr Peter de Vancouver et Cactus Montréal, à titre de réunion connexe du congrès de l’Association canadienne de recherche sur le VIH, à Montréal. Le congrès avait lieu à la magnifique Bibliothèque et Archives nationales du Québec. C’était une occasion pour les organisations de partager leurs expériences et de vérifier l’état actuel des discussions dans leurs localités. La CCPD travaille avec un certain nombre d’organisations à faire avancer ces discussions tandis que différentes localités cherchent à mettre en œuvre ces services.

Rencontre de la stratégie nord-américaine sur les drogues – San Francisco, 12 et 13 avril

Dans le cadre du travail international de la CCPD, nous avons été l’hôte d’une rencontre conjointement avec la Drug Policy Alliance des États-Unis et CUPHID de Mexico afin d’explorer le développement d’un dialogue coordonné nord-américain à propos des politiques sur les drogues. La rencontre de San Francisco a été la première séance préliminaire dans le but de vérifier comment nous pouvons collaborer à proposer des solutions de rechange aux politiques sur les drogues actuelles en Amérique du Nord. Tentant de raffermir ses liens sur le continent, la CCPD recherche présentement des alliés canadiens intéressés à soutenir ses travaux au Mexique.

Visite dans les Maritimes

Conformément à notre projet de constituer une coalition nationale, j’ai visité le Canada atlantique en mai. J’ai assisté à des activités et des rencontres à Halifax, à Saint-Jean Nouveau-Brunswick et à Charlottetown. Le Réseau atlantique de recherche sur la réduction des méfaits a invité la CCPD à prendre part à sa séance publique – Les gens et les politiques : comment les politiques sur les drogues influencent-elles la santé de nos communautés? En outre, une séance d’un jour avec des prestataires de services et des chercheurs examinait aussi comment mieux intégrer les services de réduction des méfaits dans le contexte des refuges et des salles d’urgence.

À Saint-Jean NB, AIDS Saint John, l’institut des études urbaines et communautaires de l’Université du Nouveau-Brunswick et la CCPD ont co-organisé une activité, Les drogues et la ville, qui présentait une discussion d’experts en politiques sur les drogues avec Tim Christie, directeur de l’éthique, région sanitaire de Saint-Jean et Bill Reid, chef du service de police de Saint-Jean.

À Charlottetown, j’ai rencontré des parents inquiets de l’absence de traitements pour les jeunes dans l’île, qui sont intéressés à organiser un « mouvement des toxicomanies » provincial afin de stimuler la discussion, de partager des expériences et de faire participer le gouvernement provincial au dialogue sur l’amélioration des services pour les personnes aux prises avec des problèmes de drogue.

Stratégie municipale sur les drogues de Thunder Bay

Le 24 mai, Canadian Students for Sensible Drug Policy et la stratégie sur les drogues de Thunder Bay ont organisé l’activité Pot, Pills and Parties, qui portait sur l’effet du projet de loi C-10 sur les jeunes gens et comprenait une présentation de la CCPD :Changer le cadre : une nouvelle approche des politiques sur les drogues au Canada.

En joignant les gens à travers le pays, la CCPD trouve de nouvelles façons innovatrices de consolider et de constituer sa coalition afin d’améliorer l’approche du Canada relativement aux problèmes des drogues. Nous continuerons de mobiliser les Canadiens et de travailler à cette fin à l’échelle internationale.

Photo Credits:
Mexico – Steve Rolles
Montréal – Caroline Mousseau
San Fransisco – CC Flickr evoo73
Halifax – Wooden Shoe Photography

June 29, 2012
Groundbreaking EU study supports use of heroin-assisted treatment

On Friday, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA ) released a groundbreaking report examining heroin-assisted treatment for chronic heroin users, once thought to be untreatable.

Photo Credit: Jay Black

The report, New heroin-assisted treatment, provides the first state-of-the-art overview of research, examining the latest evidence and clinical experience on the topic in Europe and internationally. The findings show that for the small minority of entrenched opioid users who repeatedly fail to respond to prescriptions of other substitute drugs such as methadone, supervised use of medicinal heroin can be an effective second-line treatment.

The study’s findings show that Supervised Injectable Heroin (SIH) treatment can lead to: the ‘substantially improved’ health and well-being of this group; ‘major reductions’ in their continued use of illicit ‘street’ heroin; ‘major disengagement from criminal activities’, such as acquisitive crime to fund their drug use and ‘marked improvements in social functioning’ (e.g. stable housing, higher employment rate).

From the report:

‘New heroin-assisted treatment is an issue that has attracted much attention, controversy and often confusion’, says EMCDDA Director Wolfgang Götz. ‘With Europe at the forefront of investigating and implementing this novel approach, the EMCDDA is proud to present the findings of the major contemporary research studies on the topic and the clinical and policy experiences of countries providing it. Our purpose in doing this is not to advocate, but to inform. We hope that this report will help policymakers and practitioners draw their own conclusions about this type of treatment within their own national context’.

What do you think about expanding heroin-assisted treatment to communities in Canada? Do you think it’s time to scale up harm reduction and provide evidence-based treatment options for our most entrenched drug users? We want to hear from you.

April 25, 2012
Toronto Drug Strategy Consumption Room Feasibility study released

Dr. Carol Strike and Dr. Ahmed Bayoumi (photo by Yuri Markarov)

In 2005 when the Toronto Drug Strategy was approved by Toronto City Council one of the main recommendations was to complete a needs assessment and feasibility study on the implications of establishing supervised consumption sites in Toronto.

The independent research project – expanded to include Ottawa – was carried out over four years by Dr. Ahmed Bayoumi, a physician and research scientist at the Center for Research on Inner City Health at St. Michael’s Hospital, and Dr. Carol Strike, an associate professor in the Dalla Lana School of Public Health at the University of Toronto.

The study recommends establishing injection sites, three in Toronto, two in Ottawa, that are fixed sites and should be integrated within existing service settings.

Download Report

The study does not call for the establishment of consumption sites for people who smoke drugs but does call for more research on how best to provide supervised consumption through inhalation. Evaluation and the importance of a comprehensive approach to substance use is also noted.

On September 30, 2011, the Supreme Court of Canada upheld the right of Insite, currently Canada’s only supervised injection site located in Vancouver, to remain open.

Read the full research report here and let us know what you think.

April 12, 2012
NAOMI Research Survivors: Experiences and Recommendations
On March 31st, 2012 the NAOMI Patients Association (NPA) will celebrate the completion of their first research report, NAOMI Research Survivors: Experiences and Recommendations. To mark the occasion, they are having an open house on Saturday, March 31st at noon at the Vancouver Area Network of Drug Users (VANDU), 380 East Hastings Street, in the Downtown Eastside (DTES) of Vancouver, BC where they will be sharing their report and celebrating their achievement. All are welcome and snacks and copies of the report will be available.

The Background

Dave Murray

In January 2011, Dave Murray organized a group of former participants from the North American Opiate Medication Initiative (NAOMI) heroin-assisted treatment clinical trial in the Downtown Eastside of Vancouver, now known as the NAOMI Patients Association (NPA).

The NPA is an independent group that meets every Saturday at the Vancouver Area Network of Drug Users (VANDU) offices. The NPA has reached out to all former NAOMI participants in the heroin stream of the clinical trial and offers support, education, and advocacy to its members. Although attendance at weekly meetings varies, the highest attendance at a meeting was 44 members. On average, 15 members gather each week.

The NPA is also associated with the British Columbia Association of People On Methadone (BCAPOM).

Mission of the NPA

The mission of the NPA is stated as:
We are a unique group of former NAOMI research participants dedicated to:
- Support for each other;
- Advocacy;
- Educating peers and the public;
- Personal and political empowerment;
- Advising future studies (heroin and other drugs) and permanent programs;
- Improvements in consent and ethics;
- The right to a stable life and to improvement in quality of life.
The NPA’s goal is to see alternative and permanent public treatments and programs implemented in Canada, including heroin assistance programs.

The Research

In March of 2011 the NPA decided to undertake their own research project focused on their experiences as NAOMI research participants. They met with me, Susan Boyd, a drug policy researcher and activist, and decided to work together to conduct focus groups, brainstorming sessions, and writing workshops with NPA members. The NPA adopted the words below to further guide their own research project. They are written by long-time DTES activist Sandy Cameron who passed away last year, from his poem, Telling Stories.

Telling Stories
We need to tell our own stories.
If we don’t tell our stories,
people with power
will tell our stories for us.
It is from this place that the NPA began their own research, to tell their own story in their own words.

NPA Research Findings

Five primary themes emerged from the research:
- Beneficial outcomes of being a participant in NAOMI,
- Problematic outcomes of being a participant in NAOMI,
- Ethics and Consent,
- Creative writing/Everyday life, and
- Recommendations for other research projects and programs.
The NPA’s report, NAOMI Research Survivors: Experiences and Recommendations, expands on these themes and much more. The full report is available here.
March 21, 2012