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This article, written by Inderveer Mahal of the University of Toronto, was originally published in The Conversation and is republished here with permission:
Ontario is undoubtedly at the heart of an opioid overdose crisis. From January to September 2018, 1,031 incredible Ontarians died of an overdose.
The number of deaths in the province is second only to 1,155 deaths in British Columbia, dubbed the "zero point" of the overdose epidemic in North America.
Yet, in the absence of signs of slowing the crisis, the Ontario government announced in April that it would abruptly stop funding for several supervised injection sites – a step back unprecedented and dangerous to reduce the urgency of public health.
Opioids in the supply of illicit drugs
Opioid use disorder is one of the most difficult and dangerous forms of substance abuse for the Canadian health care system.
It is a chronic, life-long illness that causes severe withdrawal symptoms (vomiting, diarrhea, pain, anxiety, and cravings) when regular users suddenly stop taking opioids. As the symptoms are so intense, it creates a strong motivation to continue using opioids to prevent withdrawal.
During my training as a resident in family medicine, I distinctly remember a patient who had said to me, "No words can describe how withdrawn is unsustainable."
With an infiltration of very powerful and cheaper opioids, such as fentanyl and carfentanil, in the supply of illicit drugs, patients who use them are dying at an unprecedented rate across the board. from Canada. The most recent statistics are staggering: 10,300 Canadians lost their lives between January 2016 and September 2018.
Safe injection sites save lives
In 2003, the first federally-supervised and supervised supervised injection site (SIS) was opened in Vancouver. At the time, it was already well established that patients with UDU needed support for the duration of the illness, not just when they stopped taking the drug and were in remission.
Known as Insite, the facility was a controversial public health intervention aimed at reducing the number of deaths and harms – including the transmission of HIV and hepatitis C through shared needles. – among those who fought against drug addiction.
Insite allows users to access clean supplies and inject in a supervised environment with qualified professionals who can act immediately to reverse an overdose. Since it opened in 2003, 3.6 million patients have injected under surveillance at Insite only. There were 6,440 overdose interventions and zero deaths
In fact, in 2011, a landmark decision by the Supreme Court of Canada (9-0) ruled that prohibiting supervised injection sites was unconstitutional as it deprived Canadians of vital medical care. .
With robust data supporting the utility of SIS as an effective intervention in the prevention of overdose deaths, many provinces, including Ontario, have incorporated them as part of a overall harm reduction strategy.
Less dangerous disposal of syringes
However, for safe injection sites to work, they must be brought to and located in communities where injecting drug users live. After the opening of Insite, the number of deaths related to an overdose was reduced by 35%, but only within 500 meters of the facility. The fatal overdose rate in the rest of the city decreased by only 9.3%.
In cities such as Toronto, where many users live close to each other, several secure injection sites are needed in a small radius.
In light of this, Doug Ford's government is ill-advised to try to justify the elimination of funding simply because there are "four one-kilometer sites in a neighborhood". This argument runs counter to the latest best practices based on scientific evidence. prevent Canadians from dying.
Equally important is the fight against the deeply rooted stigma of SIS and support for the marginalized populations they serve. Misconceptions that they promote drug use and increase criminal activity in surrounding neighborhoods have long since been dispelled.
Drug users who visit secure injection sites also modify their injection behaviors. In one study, 71% of SIS users reported fewer injections in public spaces, while 56% reported less safe disposal of syringes – a vital change in preventing the transmission of infectious diseases like the HIV. Secure injection sites also provide direct access to mental health and addiction treatment resources, as well as access to housing and employment badistance.
Overall, this is one element – an important prevention of death – of an integrated approach to a complex disease.
Ontario's cruel and short-sighted approach
The sudden refusal to renew funding for safe injection sites will undoubtedly lead to the death of more Canadians.
I spoke to Dr. Eileen de Villa, Medical Officer of Health, Toronto. She was adamant that these are "preventable deaths," adding, "In fact, we need more of these evidence-based services that save lives, not less."
For communities to cope with the overdose crisis, it is necessary to maintain lifesaving services and open new ones as needed. The arbitrary caps on the number of SIS in Ontario, such as the 21 proposed by the Ford government, are at best short-sighted and cruel at worst.
In order to master the "defining health crisis of our time," public policy makers will need to understand the complexity of opioid use disorder and ongoing communication with front-line workers and patients trapped in HIV / AIDS. disease.
There is currently an isolated, one-sided and unsupported approach to harm reduction in Ontario. If this is not rectified, the consequences are clear: more preventable deaths and more devastation for Canadian families.
– Indulging Mahal, Family Physician and Global Journalism Researcher at the Munk School of Global Affairs & Public Policy, University of Toronto
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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