The opioid crisis in Canada gets a lot of media attention these days, and with more than ten thousand deaths due to overdose in the last three years, it is easy to see why. The Government of Canada has introduced Safe Injection Sites that work alongside public health facilities to help battle this issue.
Safe Injection Sites are harm reduction facilities where intravenous drug users can legally use illegal drugs. The idea behind them is that by allowing drug users to administer their drugs in a medically supervised facility there is less likelihood of death from overdose. These sites have a lot of controversy around them, and public awareness on how they actually work is very low. By discussing what they are and how they work, we can begin to understand why they could be considered vital in the fight against opioid overdose and other drug-related fatalities.
What are Safe Injection Sites?
Safe Injection Sites (SIS) are medically supervised facilities that allow for the safe consumption of intravenous drugs. In other words, addicts are able to come to these facilities and use their drugs without worrying about prosecution from the law. These sites provide medical supervision to the drug users to reduce overdoses, and to help prevent the spread of disease through shared needles.
The first of these sites was created in Vancouver in 2003, when the city was seeing the use of morphine and heroin rise dramatically. Safe Injection Sites, also known as Safe Consumption Sites, can be a way of battling violence and other illicit behaviour. The idea is that with an SIS, those who are going to be using illegal injectable drugs regardless of the laws around them, will be able to use them in a safe environment, as they are protected against harassment by other drug users and law enforcement officials. So along with providing safety to the individual, they promote a safer community.
Safe Injection Sites are located in communities where the need is high. They often provide care to the homeless or people with precarious living situations. Upon entering a site, the addict, who already has the drugs in their possession, will be assessed by the nurse and then taken to a room to administer the drugs. Before administering the drug, staff are now able to check for any alterations that may affect the strength of the drug. The most prime example of this is heroin laced with fentanyl, which is lethal even in very small doses. The client is given a clean needle, self-administers the drug and is then monitored for signs of adverse reactions. The patient is then moved to a waiting room where monitoring is continued, and where information is provided about other social and health services they might qualify for.
According to Public Health Canada, Safe Consumption Sites are to also provide:
- Education on harms of drug use, safer consumption practices and safe sex
- Referrals to drug treatment and rehabilitation, housing services, health services, mental health services and needle exchange programs
Though the main goal of Safe Consumption Sites is to reduce the likelihood of overdose, a lot of work is done by staff to connect clients with other services. These sites, which allow health care workers to have direct contact with people who do not have regular care providers, can be an important part of community health.
Overdose Prevention Sites
Along with safe injection facilities, there are also Overdoes Prevention Sites, which are similar to SIS but are more temporary. These sites are normally run by volunteers in the medical community, but do not have the connection with other social and health services. Their main goal is to provide a safe environment for people to use their drugs, and the emphasis is on overdose prevention.
Unlike Safe Injection Sites, these temporary sites do not have the ability to test drugs for trace amounts of fentanyl. Instead, addicts are given access to Naloxone, which is used to reverse the effects of fentanyl. These sites are considered more mobile as they operate with limited structure, and are often placed in areas where there is urgent need.
Overdose Prevention Sites can also be run by groups who are awaiting government approval for a permanent Safe Consumption Site. They are a great addition to the battle against the overwhelming opioid crisis.
Do Safe Injection Sites work?
There has been a lot of controversy over Safe Injection Sites since the first one in North America was established in 2003. The immediate reaction to these sites tends to be concern that they promote drug use rather than reduce it.
Not long after Insite (the Vancouver based safe injection facility) was established, the Canadian Government began work on closing the site altogether, saying that it was promoting harm and questioning the research that pointed to its success. The Conservative Government at the time was concerned that Insite would cause more drug-related crime in the neighbourhood surrounding it, and that it would not do anything to help the number of people falling victim to overdose deaths.
The organizers of Insite took the argument to the federal court, where they fought the Governments claims of Safe Injection Sites not helping. The fight went all the way to the Supreme Court, where it was unanimously decided that Insite had already demonstrated its ability to improve the quality of life of their clients, and that closing such a facility would be unlawful. After this ruling, more safe injection facilities started appearing across the country, all having similar results as Insite.
Even with the ruling that closing Safe Injection Sites would be unlawful, it is still up to the individual provinces to open and fund these facilities. That means that when governments change hands, funding is often on precarious grounds.
That was seen more recently in Ontario when the newly elected Ford Government decreased funding for Safe Injection Sites significantly. In fact, some of the Safe Injection Sites in Ontario will be closed down if they are unable to find other sources for funding. This hurdle has caused a lot of outrage in the health care community, as there is a very real risk of overdose deaths increasing.
An example of this can be seen in the city of Ottawa, which has four sites within a few kilometers of each other. In 2018, all four sites had a total of 72,015 patients coming through the doors, and they had to administer Naloxone over 500 times. If some of these sites were shut down due to close proximity, the facilities would not be able to keep up with demand, and inevitably, deaths would happen.
On the other side of the coin, British Columbia has been increasing the number of safe injection facilities, which has decreased the number of overdose deaths. There are now over 60 facilities in British Columbia, some of them located in homeless shelters. Since the population most served by Safe Injection Sites tends to be homeless, this was a useful strategy to implement. When looking at where the Safe Injection Sites were located, the public health officials in British Columbia realized that people were not going to travel far in order to use the facility.
Part of the reason for British Columbia’s advanced thinking when it comes to Safe Injection Sites is due to the positive results they have seen since 2003. In just two years, Insite was able to reduce the number of overdose deaths in the surrounding area by 35%. When comparing that same time period for the rest of Vancouver, it was seen that there was only a 9% decline in deaths due to overdose. That is a huge success rate, and as other Safe Injection Sites started to open across Canada, they have seen similar results.
According to a study done by The College of Family Physicians of Canada, the results look like this:
- 88 fewer overdose deaths for every 100,000 people
- 67% fewer ambulance calls for drug-related emergencies
- Reduction in HIV infections
These numbers not only prove that Safe Injection Sites decrease the number of deaths due to overdose, but also have a positive effect on the health care system. With fewer ambulance calls and a decrease in HIV infections, the health care system is less strained, which means resources can be used for other health care issues.
Death due to overdose is not the only thing that Safe Injection Sites have a positive impact on. Since the Government of Canada has also made education a goal of Safe Consumption Sites, a lot of improvement in the overall health of the clients has been seen. People who attend the SIS are given access to health care and other social services that they may not have known about previously. Attendees are given treatments such as wound care, and information on housing and rehabilitation centres.
This all allows for the quality of life of the patients to improve, as they have fewer overall health concerns, and are able to participate in services that are meant to help their life situations.
Many people worry that these sites cause more public nuisance, violence and crime in surrounding neighbourhoods. When looking at the research, however, this public opinion is not valid. According to a study done in the surrounding area of Insite, it was seen that the numbers for drug trafficking and assaults did not increase, and that vehicle break-ins and thefts actually went down. Safe Injection Sites are placed in neighbourhoods with the most need, and so the correlation between them and crime has more to do with the actual neighbourhoods themselves, rather than with the introduction of these facilities to the area.
These facilities also help reduce harm done to the general public, as users are able to discard their used needles in a safe manner, and are even given more information on other places in which they can safely exchange used syringes for clean ones. This means that there are fewer dirty syringes and needles discarded in public areas where anyone can get their hands on them.
All of that being said, the one thing that Safe Injection Sites cannot do is help the overall drug problem. Even with SIS popping up across the country, the opioid crisis has continued to grow. Though Safe Injection Sites do educate clients on rehab and detox facilities, there is nothing they can do to get people to attend such programs. And even if a client does agree to attend a rehabilitation or detoxification centre, once the program is done, little to no help is given to them afterwards. Unfortunately, since the people who use the facilities are usually homeless or have precarious living circumstances, aftercare is oftentimes inaccessible.
Safe Injection Sites are often seen by the drug rehabilitation community as a band-aid solution- it helps only one aspect of the overall problem. Battling the opioid crisis in Canada has not been an easy task and so far, it seems as though we do not have an actual solution. Safe injection facilities have been around for more than fifteen years, and yet the rate of overdose deaths continues to rise.
That being said, the evidence shows that Safe Injection Sites not only save lives, but help the communities in which they are placed. By giving users a safe place to take their drugs, SIS do decrease the amount of violence and crime in the areas surrounding them. They also improve the quality of life for those attending the facility, as they are able to gain referrals to much needed health care and social services.
These facilities should be seen as an asset to the fight against drug deaths as they are able to save lives every day. Clearly, a lot more needs to be done to help the overall opioid crisis in Canada, but Safe Injection Sites are needed, as they serve the most vulnerable members of our society.
By implementing Safe Injection Sites across Canada, the government is taking the first step in the right direction when it comes to fighting the addiction problem in our society.
Photo credit: Zaldylmg. This picture has a Creative Commons attribution license.