Safe injection sites save lives

The provincial government’s opposition to the sites is a poor response to the ongoing opioid crisis

Safe injection sites save lives

The first public health emergency of the twenty-first century was declared in March 2003, four months after the first outbreak of Severe Acute Respiratory Syndrome (SARS). There were 438 cases of SARS and 44 related deaths in Canada.

The World Health Organization declared a global pandemic from June 2009–2010, one month after the first outbreak of H1N1 in Canada. There were 33,509 cases of this virus and 428 related deaths in 2009.

Three decades after the opioid crisis was presumed to have started, British Columbia became the first province in Canada to declare a public health emergency in April 2016.

In 2017, there were 3,987 suspected deaths from opioid use in Canada — almost twice the number of motor vehicle fatalities in 2016 and eight times the number of SARS and H1N1 related deaths combined.

These staggering statistics demonstrate the necessity for an immediate, comprehensive, and detailed plan to approach the opioid epidemic. However, with Minister for Health and Long–Term Care Christine Elliot’s decision to halt the introduction of new supervised consumption sites in Ontario and to pause ongoing activities in some existing sites, the lives of many drug users are at stake.

Elliot, who became Minister at the end of June, stated in a press release that Premier Doug Ford needs to examine the evidence and hear from experts before coming fully onboard with supervised injection sites.

However, the evidence regarding Supervised Consumption Sites (SCS) and Temporary Overdose Prevention Sites (TOPS) as harm reduction tools has been well established since the first site opened in 1986 in Switzerland.

SCS and TOPS provide safe spaces and access to sterile drug use equipment for pre-obtained illegal drugs, emergency medical care in response to overdoses, basic health care, and support from health professionals with the aim of reducing communicable diseases and saving lives.

According to Dr. Eileen de Villa, City of Toronto Medical Officer of Health and Adjunct Professor in the Dalla Lana School of Public Health, “Experiences from other jurisdictions other than our own local ones have demonstrated that Supervised Injection Services and Overdose Prevention Sites provide many health benefits, including reversing overdoses and saving lives.”

“We believe that these health services continue to be part of a comprehensive approach to the overdose emergency, along with harm reduction, prevention and treatment services, in response to this very challenging and complex health issue affecting so many people in our community and beyond,” wrote de Villa.

In a 2006 study published in the Canadian Medical Association Journal, researchers found that the use of an SCS in Vancouver was associated with reduced syringe sharing, no significant increase in public drug dealing near the facility, and a reduction in public drug use.

In the three years that this study was carried out, there were no overdose-related deaths at the facility, and 60 per cent of overdoses were successfully managed by the facility without the need for external help. More than 2,400 referrals were made for addictions treatment between March 2004 and April 2005.

Similarly, a study published in the Journal of Public Health in 2007 found that SCS garnered positive changes in injecting practices, including less reuse of syringes, use of sterile water, swabbing injection sites, cooking or filtering drugs, less rushed injections, safe syringe disposal, and less public injecting.

“The people who claim that there is harm would claim that people are going to be more likely to inject drugs if they know that there is a safe place to do that,” said Barry Pakes, Professor of Public Health at U of T.

“In my personal opinion, I don’t think it’s very likely that [SCS and TOPS] increase drug use, but there are some people who would believe that the more society gives permission for this, the more prevalent it might be,” he continued.

“From a public health perspective, we don’t believe that’s the case and we prefer to reduce harm in those people.”

Despite Elliot’s insistence on evaluating the merit of SCS and TOPS, the evidence which suggests that these sites do not work or increase harm is unsubstantiated.

The potential fallout of this decision could be disastrous. Individuals from marginalized groups and those who have the least resources will be most affected by the withdrawal of services.

Cities across Canada can do little by themselves to aid drug users. For instance, Toronto Public Health operates a supervised injection service, but they can’t fund or approve funding for it or overdose prevention sites. Such decisions are made at the provincial level.

A recommendation from the Ontario Ministry of Health and Long-Term Care’s review on how to deal with overdoses is expected to be released in the coming months. Until actionable steps are taken, the fates of individuals and families of opioid users remain grim.

“There is no question that addictions care could be better… but improving care is a very small part of dealing with the opioid epidemic,” wrote Pakes in an email.

Residence dons cannot administer opioid antidote

Calls for opioid training on campus follow summer fentanyl crisis

Residence dons cannot administer opioid antidote

Residence dons at many, if not all, colleges on campus do not carry naloxone, the medication used to stop opioid overdoses, despite the spike in deaths and overdoses as a result of opioid drug use in the summer of 2017.

University College, Innis College, Trinity College, and New College confirmed their dons do not carry naloxone. As of publication time, Woodsworth College, St. Michael’s College, and Victoria College did not respond to The Varsity’s request for comment on their practices regarding naloxone.

Melinda Scott, Dean of Students at University College, explained in an email to The Varsity that dons have been instructed to “call 911 and then campus police if they suspect an overdose or other medical emergency” — a policy followed by Innis, Trinity, and New College.

Naloxone is unavailable to the Campus Police, and it is unavailable through the Health and Wellness Centre.

Dons at these four colleges do receive varying levels of first aid and CPR training. At Trinity, dons are given Emergency First Aid training, while Innis, New, and University dons receive Standard First Aid training.

The Emergency First Aid course is a basic one-day course offering lifesaving first aid and cardiopulmonary resuscitation (CPR) skills,” according to the Canadian Red Cross’ website.

By contrast, the Standard First Aid course offers more “comprehensive” training and deals with more types of emergencies, including head and spine injuries, bone, muscle, and joint injuries, sudden medical emergencies, environmental emergencies, and poisons.

Both levels of training meet “legislation requirements for provincial/territorial worker safety and insurance boards,” according to the Red Cross.

David Lowe of the U of T Health and Wellness Centre told The Varsity in August that opioid overdoses, especially from the drug fentanyl, were brought up in regular meetings between the university and the Ontario University & College Health Association.

Amra Das, Executive Director of the University of Toronto Emergency First Responders (UTEFR), previously told The Varsity that UTEFR was not equipped with naloxone, “but in light of growing public health concerns, this is something that we are seriously considering for the upcoming year.”

U of T professor Abhimanyu Sud, who specializes in safe opioid prescription, said that the biggest issue was educating students on the topic.

“We sometimes think that opioid overdoses happen with people who are addicted to opioids, but what’s particular about the moment right now is that we have a lot of opioid contamination of recreational drugs,” Sud said. “And those are potentially some of the more dangerous situations because you’re not expecting it at all. You’re not expecting there to be fentanyl or other opioids in the drug you’re using and you haven’t developed any kind of tolerance to it.”

This summer, the University of Ottawa’s student union had planned to give orientation leaders naloxone kits. However, after consultation with lawyers, they decided against it due to the possibility of being liable if the medication injections caused injury.

According to Sud, “It’s the same kind of ethical issues around administering CPR because you could potentially harm somebody by administering CPR but you’re also potentially saving their life. Naloxone shouldn’t be perceived any differently.”

In the first three months of 2017, there were over 1,300 emergency department visits related to opioids.