Wednesday, August 20, 2008

supervised injection sites

I can't find the first article, but I really wanted to talk about this: safe injection sites. This is a big deal right now in Vancouver, and I want to follow the issue and see what happens.

Basically, right now in Vancouver there's a place where people can go to inject drugs (heroin mostly I would think) with clean needles and medical staff. This is actually against the law in Canada, but they've been able to get out of it for now. Things are catching up with them though, and people are saying that this is a really bad practice and is just enabling people.

Very honestly, I'm not sure what I think. I often struggle with whether the things I do are enabling or helpful. This would be classified harm reduction, and I'm all for harm reduction. Also, is it really that different then just handing out clean needles? I don't know about other countries, or even other cities really, but where I live, it's really easy to get clean needles; they'll even bring them to your house.

The argument in favour of this, is that people are going to use drugs anyway. No matter what we do, they'll find a way to get those drugs into their blood stream. By giving people medical supervision, they're less likely to die. This gives them more time to make changes in their life, and it helps prevent the spread of disease which costs our health care system tons of money anyway. Why treat disease when you can prevent it?

Against supervised injection sites is the enabling argument. Giving people a safe place to do it encourages drug use. It's saying "as Canadians we think this is okay", do we want to send that message? This is medical professionals harming people. They're looking at people using illegal drugs, watching them inject themselves, and letting them do it. How can this be ethical?

I'm definitely not on the against side, I'm just not quite sure I'm on the for side. What's great about this place in Vancouver is that it has detox and transitional housing in the same building. That makes it a great place of outreach where medical staff can talk to people about quitting and getting clean. Seeing someone everyday also gives medical staff an opportunity to notice if people are getting sick and maybe catch things like TB earlier. It also gives access to referrals to things like methadone clinics.

I talked to a couple of my clients about needles, but no one was interested in saying to much. Most of the ones I work with are snorting and smoking cocaine/crack, we really don't see a lot of heroin users. Heroin users go to the medical detox at the hospital and get on methadone programs. People inject Ts and Rs, (twalin and ritalin) though, but apparently clean needles are pretty easy to get, so it seems to be a bit of a non issue.

Intersting thing to think about, and something I'm hoping to talk more to my clients about in the future.


Lee said...

hmm I don't really understand. What would be the reason to do this as opposed to just giving out needles?
So that if they OD they get medical attention right there?
I can't picture really a lot of drug users wanting to be supervised while using.

antiSWer said...

The site runs at full capacity and there has never been an overdose death there. They get clean needles, clean paraphernalia and a clean, safe place to inject with medical supervision.

The best thing about this site is that it is a place that pulls in the most vulnerable users and provides a point of first contact.

There was a big court decision that allowed the SIS to continue operations without the federal government exemption. This has opened the door to more sites being opened across the country. Quebec is looking at opening a few. Some of the research is fascinating. You can find it here:

Oh, and the term "safe" injection site is a little bit dated. It's admitted that injecting drugs, especially street drugs that consist of who knows what is not "safe". It's called (much more properly) "supervised injection sites".

Anonymous said...

Admittedly, substance abuse is not my primary area of practice. But what you're describing makes me really uncomfortable. To me, I think it's a question of resource allocation. It's true that these sites do seem to reduce harm. I would rather see the vast majority of resource go toward preventing it all together. Mitigating the negative consequences of drug use seems to have a place in what we do, but at some point natural consequences do have a role in reversing poor choices. And what about the idea of creating a culture around this drug use? It may be safer, but it's still sort of creating a community around drug use. I'm not sure I like that. Thanks for raising the issue, though. It's challenging for sure.

antiSWer said...

Insite does create a community, but the thing about it is that the community is focused on bettering lives. There are nurses, counselors, advocates, social workers and other support staff on site that help the people go to where they want to go.

I've done a lot of research on this and needle exchanges lately, so I'm a big advocate of them...

I will say, though, I would also like to see more money put into prevention. In Vancouver, we have what is called the four pillars approach to addiction. The pillars are: prevention, treatment, harm reduction and enforcement. About 90% of the money spent towards this is on enforcement. A balance between the four would make a significant difference.

Still Dreaming said...

thanks for your comments. It's given me a lot to think about. I too get frustrated when we focus so much on the enforcement pillar. It's an interesting balance...