Safe injection facilities: compassionate or enabling?

By Dan Delmar on September 4, 2008

The ongoing debate over whether or not to provide Montreal drug addicts with clean syringes and a safe place to shoot up pits the tough love crowd against a more sympathetic, mothering approach; long-term solutions versus short-term relief.

Quebec’s new health minister, Dr. Yves Bolduc, scrapped a pilot project last month that would have seen a safe injection facility (SIF) created in the city, similar to Vancouver’s InSite centre. Injection drug users can walk into the centres, no questions asked, and get high in sterile cubicles as trained staff keep a watchful eye on them. Workers make sure there are no overdoses and that the addicts can leave on their own two feet.

InSite has been able to operate legally since 2003 because of an exemption granted to the organization by Health Canada. The project was in response to an out-of-control addiction problem in Vancouver’s Downtown Eastside, where an estimated 4,700 injection drug addicts live. Montreal is home to roughly 12,000 addicts island-wide, 25 per cent of which are HIV-positive.

“La prohibition et l’approche d’abstinence comme traitement pour les toxicomanes est un échec,” said Jean-Sébastien Fallu, the head of GRIP Montreal (Groupe de recherche et d'intervention psychosociale), at a recent press conference held to denounce Bolduc’s decision. “On a essayé d’autres solutions. Il y a des choses qui ne fonctionnent pas pour tout le monde…Il faut empêcher que ces gens là souffrent de problèmes de santé.”

There is no denying that clean needles will prevent the spread of HIV and Hepatitis C among drug users. Opponents of SIFs are arguing two main points: The first being a lack of research into the long-term effectiveness of the sites and the second is a more ideological standpoint against the tolerance of unhealthy, criminal behaviour.

“There’s something very wrong about it,” said Seychelle Harding, director of communications for Portage, a nonprofit group of treatment facilities that specializes in substance abuse problems. “I’m very happy the decision (by Bolduc) to have safe injection sites was dropped. These sites are a way to meet people and network to get drugs.”

Portage’s philosophy is incompatible with SIFs; a source higher up at the organization told The Métropolitain that it’s simply a stop-gap measure that enables a dangerous lifestyle and does not reduce the number of addicts on the street. Their treatment, on the other hand, is said to reduce criminality and drug use by 95 per cent.

Harding did concede that the sites “may be helpful for a highly marginalized population; a very small group that can’t be treated.”

Federal health minister Tony Clement used more polarizing language while addressing doctors at last month’s Canadian Medical Association conference in Montreal.

“Is it ethical for health-care professionals to support the administration of drugs that are of unknown substance, purity or potency; drugs that cannot otherwise be legally prescribed?” Clement said. “The supervised injection site undercuts the ethic of medical practice and sets a debilitating example for all physicians and nurses, both present and future in Canada.”

Clement’s critics have said that failing to intervene as addicts contract life-threatening infections could also be against a doctor’s code of ethics.

A combination of SIFs and treatment could be one possible solution that would bridge the gap between opposing forces in this debate. Research completed last year by the University of British Colombia, Vancouver’s St. Paul's Hospital and the B.C. Centre for Excellence in HIV/AIDS suggests that InSite has been “associated independently with a 30 per cent increase in detoxification service use, and this behaviour was associated with increased rates of long-term addiction treatment initiation and reduced injecting at the SIF.”

Bolduc’s reasoning for abandoning the project, initiated by his predecessor, was the lack of research available on the effectiveness of SIFs. No plans for the health ministry to conduct their own studies have been announced. Parti Québécois critics blasted Bolduc, calling it a Conservative-style lesson in civic morality and a failure to respond to the AIDS crisis. The PQ’s press conference last month was held at a Gay Village park that is notorious for neighbourhood children stumbling upon used syringes on the playground.

“On aimerait une société sans drogues,” said Fallu,  “mais peut-être ce n’est pas très réaliste.”



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