Harm reduction at home
When Dr. Mark Tyndall moved to Ottawa from Vancouver earlier this year to take up the post of head of infectious diseases at the Ottawa Hospital, he was surprised at what he saw. The overdose rate among injection drug users seemed to be high, although it was difficult to find stats to confirm that, and the rate of HIV transmission was among the highest in the country. In Vancouver, those kinds of issues helped inspire the community to support a safe injection site, Insite, which the Supreme Court of Canada has just ruled should stay open. In Ottawa, few seemed to be talking about, or even aware of, the issue.
Tyndall, who was co-lead investigator when Insite opened in 2003, hopes to change that. The Supreme Court ruling on Insite has opened the door a crack for other communities to build similar facilities, and Tyndall is willing to push through, leading the charge to get one opened in Ottawa. There is a need, he says.
The kind of facility he envisions for Ottawa would be a full medical establishment that includes a place where addicts could get HIV testing, access to anti-viral medicines and access to detox and drug treatment facilities – a “point of contact” for people with the health system.
“I would be keen to try to spearhead something and try to get things going,” he said.
“I feel strongly that this is an important harm reduction intervention for Ottawa and have every reason to think we could have an impact. There are enough people using drugs in this city to warrant a supervised site.”
Tyndall said the unanimous Supreme Court ruling on Insite “clears up some of the legal questions. Beyond the legal questions,” he added “it is just a matter of finding a facility and getting people to rally around it.”
Tyndall said he has approached LHIN “about what they could do to improve health care for this population.” But it is clear there will be hurdles to overcome before a facility is opened in Ottawa. On Friday, both Mayor Jim Watson and police Chief Vern White said they oppose a safe injection site in the city.
But Tyndall says there is a need. “There are gaps in the system right now. We are not meeting the needs of some of the most marginalized patients … this would be an important intervention to bring together.”
He added that it is unlikely there will be unanimous support from the community. Still, he said, there are real benefits to the community from harm reduction and research in Vancouver has demonstrated that many of the fears about negative impact on the community have not come to fruition. Tyndall also points out that harm reduction saves millions in health costs – and lives.
“Sometimes we just look like fools arguing about this when Germany dealt with this 20 years ago. It seems like this is leading edge stuff, but it’s been done over and over.”
Stayed tuned for the issue to heat up this fall when a paper looking at whether Ottawa and Toronto would be good locations for harm reduction programs is due to be released.