Tories start to get it on in­jec­tion sites

Re­al­iza­tion that you can’t get clean if you’re dead

National Post (Latest Edition) - - CANADA - Chris sel­ley Na­tional Post csel­ley@na­tion­al­ Twit­­ley

One of the new-ish On­tario gov­ern­ment’s more sur­pris­ing de­ci­sions thus far has been its com­ing around to tol­er­at­ing safein­jec­tion sites for opi­oid users.

The chances didn’t look so hot when it launched a re­view of the ev­i­dence, which is over­whelm­ingly sup­port­ive of the harm re­duc­tion ap­proach. And when Health Min­is­ter Chris­tine El­liott can­didly ad­mit­ted that “what­ever I think is re­ally not the point,” the prospects seemed dire in­deed. The point is what Premier Doug Ford thinks, and he has al­ways de­scribed him­self as “dead against” the idea.

But last month, El­liott said the re­view had found what sup­port­ers said it would: Inas­much as safe in­jec­tion sites pre­vent fa­tal over­doses on their premises with roughly 100-per-cent ef­fi­ciency amid a hor­ri­fy­ing na­tion­wide epi­demic of over­dose deaths, they work re­ally, re­ally well.

You might wish they would do more than that. Some still in­dulge the fan­tasy dis­tinc­tion be­tween “let­ting them shoot up” and “send­ing them to treat­ment.”

But pre­vent­ing peo­ple from dy­ing is pretty damn im­pres­sive all by it­self.

“The ev­i­dence clearly demon­strated that th­ese sites were nec­es­sary,” El­liott said at a news con­fer­ence.

Now, how­ever, harm re­duc­tion pro­po­nents claim the sys­tem is un­der bu­reau­cratic at­tack. Un­der the new ban­ner of “con­sump­tion and treat­ment ser­vices” (CTS), the prov­ince will only ap­prove and fund sites that ex­ist in “in­cor­po­rated health care or com­mu­ni­ty­based or­ga­ni­za­tions that of­fer in­te­grated, wrap-around ser­vices.” That means no more “popup” over­dose-pre­ven­tion sites, which had pre­vi­ously been ap­proved on a six-month ba­sis.

Th­ese health care fa­cil­i­ties must pro­vide “on-site or de­fined path­ways to ad­dic­tions treat­ment ser­vices” and other so­cial sup­ports; must have “a des­ig­nated health pro­fes­sional … present at all times” (i.e., not just vol­un­teers trained in over­dose re­sponse); must have a “foot wash sta­tion” in­stalled for some rea­son; must be more than 600 me­tres from any other CTS fa­cil­ity, and ideally not within 200 me­tres of a li­censed child care fa­cil­ity, park or school (which seems to threaten at least two ex­ist­ing sites in Toronto); must of­fer “cul­tur­ally, de­mo­graph­i­cally and gen­der-ap­pro­pri­ate” ser­vices; and must be com­pli­ant with the Ac­ces­si­bil­ity for On­tar­i­ans with Dis­abil­i­ties Act.

Fa­cil­i­ties can con­tinue to op­er­ate while they nav­i­gate the reapplication process, which pro­po­nents claim is far too la­bo­ri­ous. It in­cludes sub­mit­ting a re­port of con­sul­ta­tion ac­tiv­i­ties with neigh­bour­hood stake­hold­ers, po­lice and city of­fi­cials, as well as a “com­mu­nity en­gage­ment and li­ai­son plan” for on­go­ing con­sul­ta­tion. Fa­cil­i­ties must re­port on a monthly ba­sis ev­ery­thing, from the num­ber of over­doses, to the num­ber of clients re­ferred, to treat­ment, to the num­ber of times po­lice were called to the fa­cil­ity.

The process was hardly greased light­ning be­fore­hand. Com­pre­hen­sive re­port­ing is a good idea. And of­fi­cially task­ing th­ese fa­cil­i­ties with clean­ing up nee­dles and other drug para­pher­na­lia in their neigh­bour­hoods is also a good idea, if only to main­tain com­mu­nity sup­port. Safe in­jec­tion sites are sup­posed to help with such prob­lems, but there is no ques­tion they have wors­ened in some parts of Toronto. (Harm re­duc­tion fa­cil­i­ties may at­tract drug users to a given neigh­bour­hood, but they have lim­ited hours.)

Still, all this red tape is a bit off-brand for Ford’s open­for-busi­ness gov­ern­ment. Once con­ser­va­tives get past the ide­o­log­i­cal hur­dle of harm re­duc­tion, they ought to be im­pressed by its sim­plic­ity: Two vol­un­teers in a tent with a bunch of nalox­one kits and $200 in sup­plies from any phar­macy can pro­vide the most ba­sic ser­vice, which is en­sur­ing that peo­ple do not die. Those two vol­un­teers are most likely to erect their tent where the need to stop peo­ple from dy­ing is great­est, and there is no good rea­son we should want to stop them from do­ing so — even if it’s within 200 me­tres of a play­ground.

Would we rather they shoot up in the play­ground? Would we rather they die un­no­ticed in an al­ley?

Strangest of all, the gov­ern­ment has capped the num­ber of fa­cil­i­ties at 21. As it stands, fed­er­ally ap­proved fa­cil­i­ties ex­ist only in Toronto, Ot­tawa and Lon­don; there are pend­ing ap­pli­ca­tions in Guelph, Hamil­ton, Kingston and Thun­der Bay. Even if they were all ap­proved, that leaves a lot of On­tario ci­ties with big-time opi­oid prob­lems with no harm re­duc­tion ser­vices on of­fer. Toronto boasts the high­est death toll, but its mor­tal­ity rate of 10.4 per 100,000 pales in com­par­i­son to the health units con­tain­ing Thun­der Bay (20.1), Sault Ste. Marie (19.1), Sud­bury (17), Brant­ford 16.9), Ni­a­gara Falls and St. Catharines (16.1).

Some of those com­mu­ni­ties re­main dead-set against safe-in­jec­tion sites. But why on Earth would we pre-emp­tively shut the door on those that come around? Once you ac­cept the ba­sic, blunt premise of harm re­duc­tion — that you can’t get clean if you’re dead — slap­ping ar­bi­trary re­stric­tions on it be­comes in­de­fen­si­ble. Or it ought to, any­way.



Once you ac­cept the ba­sic, blunt premise of harm re­duc­tion — that you can’t get clean if you’re dead — slap­ping ar­bi­trary re­stric­tions on it be­comes in­de­fen­si­ble. Or it ought to, any­way.


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