Scitech  Support for safe injection sites

Positive studies might not be enough to get Quebec on board

A public health organization has voiced support for supervised injection sites in Quebec in a recent publication drawing from studies that examined Insite Vancouver, North America’s first supervised injection site.

The 2009 report from the Institut national de santé publique du Quebec (INSPQ) pointed to positive benefits such as minimizing disease transmission and overdose-related deaths, as well as providing injection drug users with access to health care as reasons for the recommendation.

This is only the first step in implementing the still-controversial supervised injection sites in Quebec, but places like Insite, established less than seven years ago, have demonstrated that there are surprisingly few drawbacks compared to the benefits.

Clientele at safe injection sites are given clean syringes and other necessary equipment to decrease the transmission of HIV and Hepatitis C, which can be spread through sharing needles. According to a summary of findings published in the Canadian Medical Association Journal in 2006, there have been drug overdoses at Insite, but no overdose-related deaths, thanks to the medical care immediately available.

The benefits of supervised injection sites don’t stop after users walk out the facility’s doors. This was explained by Jean-François Mary, client representative of Cactus – a community organization in Montreal which provides a needle exchange program as well as social support for at-risk populations including intravenous drug users and sex-trade workers.

“[The sites] promote safer habits for injection…even if the person doesn’t do all of his [or her] injections in the safe injection site. There is a lot of education going on there on the practices of injection,” Mary said. “The nurses have the ability to teach people how to inject safely and properly.”

Sarina Isenberg, student director of the McGill Global AIDS Coalition, voices support for resources such as addiction treatment services and Insite’s social benefits.

“Not only do they train people on how to inject safely with the supervision of nurses and trained staff but they also have kind of a support group there, and there’s counselling available. It functions as a community centre of sorts,” Isenberg said.

Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, pointed out a cost-saving aspect of supervised injection sites.

“There is the benefit of saving public funds by actually getting health services to people in need of them in a preventive, expense-saving kind of way rather than high expenses of ambulance responses to overdoses, hospitalization costs associated with those, all of the costs of treating people for untreated infection, whether it is with HIV or [Hepatitis-C] or other kinds of sepsis from abscess sites that get infected,” said Elliott.

Despite the proven benefits of supervised injection sites, the federal government recently appealed to shut down Insite. With the appeal dismissed in January, Insite was allowed to remain open on both jurisdictional and constitutional grounds, meaning that the provincial, rather than the federal government, held precedence in the matter. More importantly, the site was determined to have a sound constitutional basis.

According to Elliott, this legal case is important. “There are some very significant implications for what might happen in other provinces,” he said. But what does this mean for supervised injection sites in Quebec?
“The ministry of health doesn’t have much to hide behind now…. It’s time…to take a position on this matter. Whether it is a positive or negative response, we need to be aware of what the position is,” said Mary.

“I think the time has well passed for continuing to wonder about whether or not these sites are a good idea. The evidence is certainly in,” said Elliott.

According to Elliott, the publication from the INSPQ should be “an encouragement for the Quebec government to actually get on with looking at where those sites might be needed and useful in Quebec and working with community organizations that work with the communities most affected.”

Mary commented on Cactus’s possible future in implementing supervised injection sites.

“We’ve been running a needle exchange program for more than 20 years so we know that we would be able to offer, in the premises of Cactus, a place for people to inject safely and I think this is the position of other exchange programs in Montreal,” he said.

Mary noted, however, that Insite runs on funding provided by the British Columbia Ministry of Health, and so far there has been no indication of the Quebec Ministry of Health’s opinion on the sites.

A supervised injection site in Quebec would also require a federal waiver of criminal liability, like Insite Vancouver obtained in 2003 during the Martin administration. Mark Wainberg, director of the McGill AIDS Centre, was not optimistic that such a waiver could be obtained from the current Harper administration.

“It’s one thing to challenge the existence of a site or to challenge the government for wanting to shut it down once it’s open already. It’s a much more difficult thing to start a new site from scratch,” said Wainberg. “I’m not aware of any serious efforts being made here to open such a site, although I think it’s fair to say that the vast majority of HIV researchers in Quebec would endorse the idea.”

While there may be a long way to go before opening a supervised injection site in Quebec, the dismissal of the appeal against Insite in Vancouver indicates that these types of health care centres could eventually take root in other Canadian cities.

While the public generally tends to look at the big picture of supervised injection sites, Elliott notes that we must remember these sites are helping individuals. “The potential for protecting individuals’ health is one of the benefits, particularly individuals who are some of the most marginalized and least connected to necessary health services.”