UBC Reports | Vol. 49 | No. 1 | Jan.
2, 2003
Research indicates lives and money will be saved
By Hilary Thomson
There are few issues in Vancouver more controversial than
the creation of safe injection sites for the addicts in the
city’s Downtown Eastside. In a recent municipal election,
this issue played a major role in the upset of an entire slate
of city councillors.
Medical experts at UBC have not hesitated to wade into the
debate.
Dr. Michael O’Shaughnessy, director of the B.C. Centre
for Excellence in HIV/AIDS, says safe injection sites would
improve what many health-care professionals are calling a
public health crisis.
“These sites are not a perfect solution, nor will all
addicts use them,” he says. “But it is clear that
if there is a group of individuals who regularly use the safe
site, the number of overdoses will decline.”
There are about 125,000 intravenous drug users in Canada
according to the Canadian HIV/AIDS Legal Network. The network
has cited a 1998 study that estimated the direct and indirect
costs of HIV and AIDS attributed to intravenous drug use in
Canada would mount to $8.7 billion by 2004 if current trends
continue.
Also, intravenous drug users incur costs for doctor visits,
emergency services, hospital admissions and medications to
treat bacterial infections and other illnesses. In addition,
there are policing and legal costs to enforce drug laws.
Health Canada is currently accepting proposals from cities
interested in establishing safe injection sites and a federally
approved site could be established sometime this year. It
is not yet known how sites will be funded. The cost of establishing
and monitoring a single facility in its first year could cost
between $500,000 and $800,000, according to network officials.
With more than 2,000 overdose deaths since 1992, Vancouver’s
Downtown Eastside has the country’s most visible drug
addiction problem, says O’Shaughnessy. In addition, approximately
30 per cent of addicts are HIV positive and more than 90 per
cent have hepatitis C virus.
Researchers and health-care practitioners in Vancouver have
led the academic debate in Canada on the topic of safe injection
sites, he says, and opinions are divided about the value of
such sites.
Often confused with shooting galleries — areas run by drug
dealers where addicts can inject — safe injection sites are
health facilities. There, people who have purchased the drug
can inject safely, using clean needles and equipment under
the supervision of trained staff. Users have access to medical
and social support services at the facility and can be referred
to detox centres and drug treatment programs.
O’Shaughnessy is confident that users would participate
in the sites, based on results from the Vancouver Injection
Drug User study conducted by local researchers in 2001. Users
were specifically asked if they would use such a site and
the majority indicated they would. In addition, users stated
that they continued to share needles despite the availability
of a large needle exchange program.
“We have learned what not having a site leads to,”
says O’Shaughnessy. “It is time for us to approach
this epidemic with a view to reducing the incidence of overdoses
and disease.”
In addition to health benefits, approximately 45 sites in
a dozen cities in Europe and Australia are credited with limiting
violence associated with drug use, reducing the public nuisance
of people injecting on the street and the health risk of needles
discarded in public places.
A key benefit of safe injection sites is the opportunity
to establish relationships with addicted individuals to help
them stabilize their lives, says Edward Kruk, associate professor
of Social Work and an expert in addiction counselling.
In Europe, social workers staff the sites along with users
or former users who serve as peer counsellors. Users can determine
their own goals that may or may not include abstinence but
might include finding housing and meaningful employment, seeing
a doctor, improving nutrition, and obtaining social supports.
Kruk counters the argument that money for sites could be
better spent on treatment facilities by pointing out that
traditional treatment methods don’t work that well. In
Frankfurt, Germany, the rate of recovery for those using safe
injection sites is more than four times higher than for North
Americans using traditional treatment therapies, he reports.
“We need to examine the whole issue of addiction treatment
from the perspective of drug users and former users,”
he says. “There’s been a huge shift in public and
political sentiment here over the last three years and I think
Vancouver is ready for safe injection sites.”
