Oped, Montreal Gazette, published 11/19/2002
The drug users I worked with during my training as a family doctor in
Vancouver were years ahead of the government in keeping up with
evidence-based standards of treatment for addiction when they asked me to
supervise in the safe-injection site they intended to open.
At that time, two years ago, the Canadian government opposed the idea of
safe-injection facilities: legal centres that allow drug addicted
individuals to inject their own, pre-obtained drugs in a hygienic,
stress-free setting under the supervision of healthcare professionals. Not
to be confused with illegal “shooting galleries,” SIFs are comprehensive
programs that offer sterile injecting equipment, condoms and information on
safer sex and injecting practices, as well as counseling, medical care and
referrals to detox, drug treatment and other health and social services.
Not wanting to jeopardize my medical license by “enabling” these drug
users’ illicit activities, I bought myself some time, suggesting: “Let me
do some reading about it first.”
After studying the literature, which attested to the success of SIFs in
Europe and Australia; after dealing with the consequences of unclean needle
use among my patients (HIV, hepatitis, severe skin infections, etc.); after
seeing too many drug addicts with recovery potential overdose and die, I
realized what the “junkies” already knew: it would be unethical not to
provide this service for addicted people.
Last week, Health Minister Anne McLellan informed us that Canadian cities
would soon be able to make proposals to open SIFs. Despite the fact that
this life-saving measure is long overdue, it will likely evoke controversy.
A Gazette editorial on Nov. 12, “Bad plan for drug addicts,” argued that
SIFs would encourage drug use and waste taxpayers’ money. The evidence
stands in stark contrast to these statements.
According to the Canadian National Task Force on HIV, AIDS and Injection
Drug Use (1997): “Despite clear indications of an escalating problem since
the mid-1980s and the use of a variety of approaches to address it, the
spread of HIV among injectors is increasing, as is the incidence of
hepatitis and tuberculosis.” Twenty per cent of injection drug users in
Montreal have HIV, and 70 per cent have Hepatitis C. One thousand Canadians
die from drug overdoses each year. It’s impossible to help these people
recover from addiction when we can’t keep them alive.
The real tragedy is that these deaths and this spread of disease are 100
per cent preventable. Reducing the harm of injection drug use is not as
daunting as many believe. Bustling urban centres around the globe have
faced a threat similar to the one U.S. and Canadian cities grapple with
today. In addition to public-health initiatives like the street outreach
and needle exchange services we have in Montreal, 45 SIFs are currently in
operation in the Netherlands, Switzerland, Germany, Spain and Australia.
Experience in Europe and Australia indicates that there has been
considerable acceptance of the facilities by health-care professionals and
injection-drug users. Statistics show that SIFs have resulted in the
following: reduction in rates of HIV and number of deaths caused by
overdoses; reduction in public drug use and discarded syringes in public
areas; and reduction in crime. In spite of the oft-cited concern that
establishing SIFs sends the wrong message, studies show that SIFs actually
encourage addicts to quit: cities in Europe that have SIFs had a decrease
in total number of drug users, likely related to their facilitating access
to detox and drug treatment. Studies also reveal that SIFs are successful
in reaching addicts recognized as the most difficult to reach through other
As for the costs of setting up the SIFs, yes, taxpayers should pay for
them. Given how our current approach to the drug use problem is consuming
resources, we cannot afford not to. The astronomical health-care costs of
injection drug use, estimated at $7 billion annually, are almost totally
preventable if drugs are used in safe and sterile conditions. Prevent two
cases of HIV, and your SIF is paid for.
SIFs have been demonstrated to be effective in other countries. As part of
the international legal obligation to provide people with the highest
standard of health possible, Canada cannot sit by while HIV, hepatitis and
other preventable harms continue to befall drug users and cripple
inner-city hospitals. A trial of SIFs, subject to rigourous scientific
evaluation, is what is being proposed.
The drug users figured it out first. After initial opposition, the Canadian
government has finally caught on. If we truly care about the health
standards, safety and economic viability of our communities, we must not
delay safe-injection facilities any longer.
Dr. Alana Hirsh went to McGill University medical school and trained in
family practice in Vancouver.