Harm reduction on trial
Today, the Supreme Court of Canada will take the first step in deciding the fate of thousands of Canada’s most vulnerable citizens. Federal government lawyers will be in the court to present their case to shut down Insite, Vancouver’s supervised injection site for people who inject drugs.
Lives hang in the balance with this case. Research released last month shows that fatal overdoses dropped 35 per cent in the vicinity of Insite in the two years after it opened, and it’s estimated that Insite will save the health-care system $14 million and prevent more than 1,100 HIV infections over a 10-year period.
Residents of Vancouver’s Downtown Eastside area aren’t the only people who need this service. Thousands of other vulnerable citizens across Canada would benefit from such a service in their towns and cities. The need continues to be great.
Each year, more than 1,000 Ontarians test positive for HIV, an enormous financial burden for the province’s health-care system in addition to the human toll. Across Canada, 21 per cent of new HIV cases in 2009 were due to injection drug use. For women, the number was as high as 35 per cent and an alarming 60 per cent among Canadians of aboriginal ancestry. The fact that this epidemic continues to ravage our most vulnerable citizens is unconscionable, particularly when supervised injection services can help prevent these infections.
In December 2005, Toronto City Council requested a study to evaluate the feasibility of clinics where people could inject drugs in the city. A research team surveyed more than 1,000 Ontario residents and concluded that demonstrating that such sites improve health and reduce neighbourhood problems was key to establishing and maintaining community support for clinics that offer supervised injection services.
To Ontario residents, there is no doubt such sites do improve health while reducing the spread of disease in the community and improving public order in the neighbourhood. To citizens who say the money should be invested in treatment facilities instead of supervised injection services — we need both. Each is along the continuum of health-care responses to injection drug use.
A recent report by British Columbia’s Provincial Health Officer calls for the expansion of supervised injection by incorporating the service into public health clinics throughout the province. Supervised injection service and other harm reduction services are recommended as necessary pieces for the continued decline in HIV cases among injection drug users in British Columbia.
This isn’t just a “Left Coast” phenomenon. Opposing the federal government in the Supreme Court is a list of highly reputable health-care organizations across Canada, including the Registered Nurses’ Association of Ontario, the Canadian Medical Association, Canadian Public Health Association, the Canadian Nurses Association and the Association of Registered Nurses of British Columbia.
The Dr. Peter AIDS Foundation is also an intervener in today’s case. The Dr. Peter Centre, the HIV/AIDS health-care clinic the foundation operates in Vancouver, is the only other site in North America that offers supervised injection services. A published study showed that our integration of supervised injection into nursing practice within a broader range of health-care services helps reduce barriers to care for vulnerable people. The Dr. Peter Centre is nestled in a bustling neighbourhood in the city’s downtown core. Such a clinic could be blended into a Toronto neighbourhood.
The Lancet, one of the world’s leading medical journals, has characterized opposition to supervised injection services as “misplaced moral judgments (that) have underpinned the neglect of people who inject drugs.” In an online commentary, The Lancet states, “it is wholly immoral to let people become infected with HIV or die when evidence based interventions exist to prevent these outcomes.”
A bold and human response is needed from our various levels of government to address this preventable human tragedy in our country. Lives are at stake.
Maxine Davis is executive director of the Dr. Peter AIDS Foundation.