A tale of two public health crises

Opioid crisis takes back seat to coronavirus

As one public health emergency sees policy-makers around the world turn to the best available science to stem its tide, another deadly crisis rages on while science remains noticeably absent.

In Canada and many other countries, the rapid scaling up of evidence-based responses to the outbreak of coronavirus has seen politicians standing alongside public health officials to deliver the latest updates on how governments are responding to limit the spread of the virus and minimize its harms. Contrast that to the ongoing opioid overdose crisis, where it seems politicians are too often seen standing next to the critics of those same public health officials. This is a concerning reality given that approximately 12 Canadians die every day of an opioid overdose.

Case in point: the stale debate that continues to surround supervised consumption sites, which have been conclusively proven effective in preventing overdoses and reducing other drug- related harms, while not undermining public safety objectives.

In these health facilities, people consume, usually by injection, pre-obtained drugs under the supervision of nurses and trained staff who are able to provide sterile needles and respond to overdoses when they occur. The scientific evidence derived from the evaluation of these facilities is both comprehensive and clear: they save lives. Yet despite the mountains of evidence that’s been compiled about their effectiveness, this health intervention continues to be controversial for those who don’t know, or willingly choose to ignore, the science.

As scientists who worked on the evaluation of Insite — North America’s first legal supervised injection facility, which is located in Vancouver — and have studied the scientific literature derived from similar facilities around the world, it is disheartening to see the science ignored by politicians who are eager to score partisan points and prevent safe consumption sites from opening in communities that desperately need them.

Here’s what the science tells us: not a single death has been reported in a supervised consumption site. Reviews of over 75 studies undertaken between 2014 and 2017 concluded such places promote safer injection conditions, reduce overdoses and increase access to health services. Supervised injection sites were associated with less outdoor drug use, and they did not appear to increase crime or substance abuse. In fact, our study of conditions around Insite showed there were fewer instances of public drug use, publicly discarded syringes and other injection-related litter in the area after the facility opened. Using crime statistics from the Vancouver Police Department, we also demonstrated that the opening of Insite did not result in increases in drug-related crimes.

Dozens of other peer- reviewed studies published in science and medical journals have also shown the benefits of Insite, including how fatal overdose rates sharply decreased in the area around the site. The science further demonstrates that people who use supervised consumption sites are less likely to engage in behaviours, such as syringe sharing, that would lead to HIV and hepatitis C infections. While some critics — offering no evidence — charge that having places like Insite reduces the number of people going into treatment for substance use, our evidence shows that Insite provides an open door into the medical system, promoting the uptake of evidence- based treatments for substance use disorders.

There are at least 100 supervised consumption sites operating around the world, mainly in Canada, Europe and Australia. This is a paltry number considering the tens of thousands of people who die of an overdose every year, with rates on the rise due to the prevalence of powerful opioids like fentanyl in the illicit drug supply, including more than 13,000 preventable deaths across Canada since the current crisis began.

In response to the rise in drug- related deaths, several cities around the world are considering opening similar sites. And yet, it in many cases, it is politicians, in contravention to the advice of public health officials, who are preventing them from opening, despite the staggering numbers of people who would surely benefit.

In Glasgow, attempts to open a supervised consumption site have been thwarted by the British Parliament. In Philadelphia, the opening of the first sanctioned site in the United States was scuttled at the last minute. In Canada, both the Alberta and Ontario governments have threatened to de- fund existing supervised consumption sites in campaigns fuelled by misinformation and bogus reports that have not been subject to conventional scientific review, despite the Supreme Court of Canada ruling that Insite has “proven to save lives with no discernible negative impact on the public safety and health objectives of Canada.”

Critics argue that supervised consumption sites encourage drug use and bring crime to surrounding communities. Politicians seem happy to listen to them, even as the science overwhelmingly says the opposite.

So why the difference in responses between the two health emergencies? Why listen to the scientists and public health experts in one case, but not the other? The coronavirus outbreak is certainly an acute concern, but we have been in the midst of an opioid crisis for years and we’re not going to lessen its impact on society unless our elected leaders are able to get over the stigma surrounding substance abuse and use the best available scientific evidence to help solve the crisis.

Thomas Kerr is a professor in the department of medicine at the University of British Columbia ( UBC) and a senior scientist at the British Columbia Centre on Substance Use. M- J Milloy is the Canopy Growth professor of cannabis science at UBC and a research scientist at the BC Centre on Substance Use.