Safe Injection Sites: Sometimes it Pays to Do the Right Thing

In this country, we too often take for granted that most sacred and coveted of human rights: the freedom to choose our own destiny.  But when we are allowed to elect our own leaders, there is an implicit responsibility invested in each of us to hold them accountable for their actions; especially when those actions are fundamentally wrong. The Ford Government’s recent decision to reconsider the “merit” of safe injection sites is the worst kind of partisan politics.  It is a move designed solely to appeal to a minority of base voters, regardless of the cost in both dollars and lives.  It is so rare that a policy is both morally just and cost effective, and yet at a time when the opioid crisis is spiraling out of control, Ontario is on the verge of reversing the few gains we have made.  If this action is allowed to continue then those dollars, and those lives we could have saved, will be on each of us.

Canadians hear a lot about this “Opioid Crisis”, yet many of us have likely never see its direct effects.  You may be asking, what is this so-called “crisis”?  Or perhaps more importantly, why should I care?  Essentially, the Opioid Crisis refers to the North America-wide (and global) problem of rapidly increasing opioid drug use and related fatalities.  The figures are staggering. Ontario alone suffers two or more overdose deaths (ODs) each day, quadruple the rate from just 25 years ago, and the numbers are continuing to climb.  On the other side of the country, BC’s rates are twice as high as those in Ontario.  Moreover, deaths due to opioid overdose are just the most visible consequence of a much larger systemic issue at play.

Our Local Context

Here in London, a public health emergency was declared in 2016 in an attempt to combat outbreaks of HIV and hepatitis C related to IV drug use. Cutaneous infections, endocarditis, and a wide range of other potentially dangerous health conditions are all linked to the use of needle drugs.  The roots of this issue are systemic, and while the rise of illicit fentanyl and heroin are certainly major contributors, prescription painkillers are the source of addiction for many.  The role of physicians in creating this situation cannot be overlooked, nor can the actions of pharmaceutical companies like Purdue, which made false claims to doctors and patients denying the addictive nature of oxycodone, a synthetic opioid marketed by the company.

Ok, so we can all agree now that the Opioid Crisis is a big deal, and as future physicians, our profession is at least partly at fault.  So what can we do about it?  A number of measures have been proposed and implemented in the hope of lowering mortality and reducing infectious diseases related to IV drug use.  Naloxone, for example, is a drug that can temporarily reverse the respiratory-depressive effects of an opioid drug overdose; essentially, it restores life to someone who has OD’d and stopped breathing, buying more time for them to receive proper medical attention. Health care workers have begun to carry naloxone kits with increasing frequency, and these have also started to be placed in public spaces more regularly.  For example, our own Schulich Political Advocacy group recently met with London’s local municipal government officials to discuss the inclusion of a Naloxone kit at every public AED machine in the city; and in May 2018, the measure was approved and taken into effect over the summer. This represents a huge success for harm reduction in Ontario, and early data has shown that the expanded availability of naloxone has reduced mortality while sparing potential medical expenses.

Perhaps the most valuable initiative, however, has been the development of supervised injection sites (SISs).  These are facilities where IV drug users can go to use drugs under direct medical supervision.  Such sites often involve a needle exchange program in parallel, where used needles can be traded in for fresh ones.  This is designed to reduce the transmission of infection diseases, most notably HIV and hepatitis C.  These sites also act as first points of contact for providing healthcare to people who use drugs, often offering them referrals for rehabilitation, counseling, and education on infectious disease control and safe drug use.  As a relatively new concept, the effectiveness of SISs is still being evaluated, but the early data have proven very positive.

Safe-Injection Site Efficacy

A study done in Vancouver showed that with the opening of a single injection site, a 33% drop in mortality was seen from pre-SIS levels. Furthermore, there was a reduction of 40% in cutaneous infections, average length of stay in hospital fell by 67%, and ambulance calls for suspected ODs were also reduced by two thirds.  A further study of this site published in the CMAJ, found that not only was there a significant drop in mortality, but that this was done at a significant cost reduction for the healthcare system as well.  Most relevant for this effect was the decrease in HIV transmission resulting from the needle exchange program.  The cost of preventing one case of HIV was calculated to be around $20 100; which is only one tenth of the lifetime cost of an HIV patient.  When we add up all of these benefits – the reduced hospital stays, the drop in infectious disease, the prevention of overdoses – the overall result is clear: not only are we saving lives, but we are saving money while we do it!

The Ford Government now wants to evaluate the “merit” of these safe injection sites, and while they do so, they will be pausing the development of further sites.  This will cost money.  It will cost lives.  The Premier made his position on this issue quite clear during his campaign, and his actions should not be surprising. Yet his actions are nonetheless wrong. The role of the medical professional in the coming discussion will be important, and as community turns to us for answers, we must ensure that our actions and responses are measured with facts and compassion.  It is rare to find an issue with such a clear answer, and for safe injection sites, one thing at least is clear: sometimes it pays to do the right thing.

 

Author: James Payne

With a last name tailor-made for a future doctor, James really couldn’t have wound up anywhere but Schulich!  A London native, he did his undergrad at Queen’s, where he majored in Chemistry and Economics; the latter of which was the focus of his work for the UWOMJ journal.  James loves sports (he can catch a football better than Tom Brady), music, and, as you may come to find out, semi-colons.

Photo Credits: Marco Verch, Creative Commons