It’s time to approach addiction as a medical issue

The City of Hamilton needs a safe injection site in order to deal with a problem that is very real, a problem that is only going to get worse. North America is in the throes of an unprecedented opioid addiction crisis. Added to that, the introduction of fentanyl has helped create a death by overdose epidemic. A recent study showed Hamilton was the epicenter of this problem in Southern Ontario. EMT workers refer to the burden of responding to ever increasing calls to overdose situations, saying they are ‘rammed’, overwhelmed by the number of calls to which they attend.

We don’t need a study that takes two years to complete-we simply need to determine the best place to establish such a site and do it. The evidence of the value of safe injection sites is well documented throughout the world. Harm reduction is at the root of the concept, but there are many benefits that any city would realize by opening such places.

On a recent visit to Australia, I had the chance to speak with Miranda St Hill, Service Operations Manager of the Uniting Medically Supervised Injection Centre (MSIC) in the Kings Cross area of Sydney.

The Kings Cross site opened in May 2001. The initiative came from the recommendation of a Drug Summit created by then New South Wales premier Bob Carr: the Summit heard from a wide range of community members including users, police, family, counselors, EMT workers and many other groups. In December of 1999, the government of New South Wales invited the Uniting Church to apply for a license to open a safe injecting site. After months of community consultation, a site was chosen. However, a local BIA held up the opening, going to court in an attempt to stop the site. In April of 2001, the Supreme Court ruled the site was well thought through, and it opened on May 6, 2001. They see approximately 200 visitors per day, far fewer than their ‘sister site” in Vancouver. By any measuring stick, it has been a huge success and serves as a fine example of the positive effects such a place has in society.Injection Quote

“We can only change the world one conversation at a time, but by looking within, behind fear and misinformation, we hope you will see the Centre for what it is; a practical and compassionate service for marginalized people.” Dr. Marianne Jauncey, Medical Director, MSIC.

The challenge to choose a location was helped by the court order, which insisted the facility be located where users bought and used their drugs. St Hill showed me a plot graph that identified EMT calls for overdoses over a period of time. The King’s-Cross area was the obvious choice, as it exhibited the highest number of red dots by far. Users can legally use within the clinic, and local police have a discretion to not charge someone for possession if they are in the immediate vicinity of the clinic.

Of course, the decision to open in Kings Cross met with objections. Not everyone wants a safe injecting site in their neighbourhood. It’s not always something people see as a positive. Of course, neither are needle strewn alleys and parks. The simple reality is that people are using in public, and this is not a positive for any area. The changes in Kings Cross happened quickly. Far fewer people were using outdoors. St Hill told me of a local pastor who would collect 100-200 needles on his parish property per day. Now, it’s a bad day if he finds even two discarded needles. “In the two years since Superintendent Darcy and his team have been working at Kings Cross with the injecting centre, reported crime is down 50%. Every death we can save through the injecting centre, every addict we can get off the street so it doesn’t affect the amenity of the residents and people who live in the area, we applaud. And
we certainly support the injecting centre.” Dick Adams, NSW Senior Assistant Police Commissioner (1998-2005).

Moving forward with an injecting site requires political support. “You need the politicians willing to take on the cause while they’re in office,” St Hill told me. Given that both Mayor Eisenberger and Councillor Green have publically declared their support for a safe site in Hamilton, I think we have that necessary piece of the puzzle.

Since its opening, the centre has been under intense scrutiny, subject to countless governmental evaluations. The original Medical Director of the clinic, Dr. Ingrid van Beek resigned in 2008, frustrated that the centre was still operating on a ‘conditional’ license. It was granted permanent status in 2010.

Through evaluation after evaluation, the centre proved it was successful in meeting the five criteria for success as set out by the government. First and foremost, it was to prevent death by overdose. In fact, no one has died from overdosing in any safe injection site in the world. Another expectation of the site is that it would reduce the spread of blood born viruses like
hepatitis and HIV. As St Hill told me, “another box ticked.” A third expectation would be the improvement of the community. A dramatic decrease in discarded needles combined with far fewer people injecting in public is another check mark.

The last major expectation is that the centre will serve as a place where people can get referrals to counseling, drug treatment, medical treatment, etc. St Hill identified the clientele of the site as hard-to-reach people often dealing with mental health issues, being homeless and marginalized. She said are careful when attempting to persuade clients to seek outside help. “We don’t push treatment, but the minute there’s a chink of interest, we’ll pick it up and flow with it.” Hence, hope for a healthier future.

When the question of funding and the concern that a place like this would drain money from an already stressed health care system, St Hill smiled. She told me the site was 99% funded through money and resources confiscated by the legal system that was deemed ‘proceeds of crime.” Brilliant!! However, she was also quick to point out that even if the site were fully funded by public health care money, it would measurably save money in the system. How? Most significantly, by the drastic reduction in EMS calls to overdoses. If our EMT are telling us there are ‘slammed’ by such calls, the savings are clear. In addition, a huge reduction in hospital time for those who OD, be it in emergency, critical care or ward. Fewer deaths mean fewer autopsies. And not even factored into these benefits is the reality that people who OD potentially suffer from permanent brain injury. The sooner the overdose victim is treated, the less likely they are to suffer such an injury. So, this means huge savings to the health care system over the period of that person’s life.

St Hill talked about the range of positions people take on the issue. “At first blast, the idea of it (the site) seems counter-intuitive. You need people to sit and listen and do look at the evidence, and they’re totally convinced on the value of the site. But if you’re just going to go by your emotions and not take in the information that is available, that’s where you get your intractable position.” Her position was clear throughout our discussion: if people examine the evidence, they will agree that safe injection sites are helpful to society.

We must also accept that this whole issue needs to be “looked at through a health care lens,” said St Hill. Providing health care to people who are ill is part of the fabric of our identity. We don’t question programs to help cancer victims, even if they smoked. We shouldn’t question this. The longer the decision-making process takes the more lives that will be lost. It’s really that simple. And safe injection sites can be a great help in this crisis.

Of course providing marginalized users some basic human dignity is another benefit, one that shouldn’t be ignored.

“Each time people come to MSIC, they are treated with dignity and respect. This should be essential in any service, but it’s even more important for our clients who are already stigmatized, often homeless, often mentally ill, and have been treated poorly most of their lives. It’s the thing clients most frequently say to us; thank you for treating me like a human being.”

All quotes from anyone other than St Hill are from:
(Cross Currents, UnitingCare NSW.ACT. ISBN: 978-0-9806889-1-7)