A new report in a respected medical journal says that supervised-injection sites have little or no impact on their most important objectives. These include reducing overdose deaths, discouraging needle-sharing and limiting the illicit use of heroin.
Those are troubling assertions, as supervised-injection sites are one of the principal weapons in the fight to roll back opioid deaths. In addition, some of the data in the report come from B.C., giving it local relevance.
But can this be true? Are supervised sites really ineffectual? In the simplest of terms, the answer is no.
The report discards numerous published studies that produced strongly favourable results, on the grounds that their methodology was inadequate. Technically speaking, that might be so. But from an on-the-ground perspective, the report’s findings are nonsense, and transparently so.
After the Insite supervised injection facility opened in Vancouver, overdose deaths near the clinic declined from 253 per 100,000 population to 165, a drop of 35 per cent. Likewise, needle-sharing dropped 69 per cent, and both HIV-positive and hepatitis-C rates fell among the 7,000 clients. These results are consistent with findings in other Organization for Economic Co-operation and Development countries.
In addition, since supervised injection sites began operating in B.C., there has not been a single overdose death on any of the premises.
The question is not whether sites such as these are effective, it’s why haven’t we expanded their reach?
Last year, more than 400 Insite clients were referred to an adjoining treatment facility. Since this is generally regarded as an important step toward rehabilitation, we need more of these detox centres that offer withdrawal-management services.
Steps are also required to put an end to an absurd situation. At present, clients who visit supervised sites bring their own drugs with them. Yet it’s known that almost all of these street drugs are contaminated with fentanyl. The only reason there have been no deaths on site is that staff stand ready with naloxone kits — a powerful antidote that is generally successful if delivered in time.
So why not provide those clients with a safe product, instead of letting them shoot up with a potentially lethal cocktail, then embarking on heroic rescue efforts?
The answer is that Health Canada bans the dispensing of narcotics such as heroin, except by a physician in a treatment setting. Yet when permission was gained in 2003 for a randomized control trial in Vancouver, the results were striking.
Long-term addicts who had a history of prior treatment failure were given heroin and counselling under supervised conditions. The majority improved their lifestyles significantly, and had better success with employment, housing, maintaining family relations and avoiding hospitalization.
Their spending on drugs also fell, from $1,400 per month to about $500. That almost certainly reduced local crime rates. This is similar to European programs that have used heroin maintenance for the past 25 years.
On that basis, Fraser Health Authority maintains a clinic where addicts can be given injectable narcotics under supervision, and some addiction-specialist physicians in Vancouver are helping broaden this effort.
As well, the provincial government plans further expansion of supervised sites and addiction-treatment facilities. More than $300 million has been allocated over three years for this purpose. And Ottawa is slowly relaxing its restrictions on supervised heroin injection.
There is, of course, another side to this. Many principled opponents point out that harm-reduction efforts perpetuate addiction. They worry that government-funded agencies are supporting what, by any standard, is a destructive lifestyle.
There is truth in this. The best solution would be to end addiction entirely.
Yet the opioid epidemic is killing 100 British Columbians every month — more than die in motor-vehicle crashes. This public-health emergency shows that the decades-long war on drugs has largely been a failure. What we are left with is a choice among various options, none of which is optimal.
Given this reality, no effective intervention should be discarded because it fails to meet some unattainable standard of perfection.
And as too many families know, there is no possibility of recovery when life has ended.
