Let’s be honest about needle sites
Dead people don’t recover.
That’s the working principle behind harm reduction: Avoiding the ultimate harm that could befall drug addicts by facilitating lesser harms, primarily via aiding and abetting in the consumption of those drugs in a safer environment.
The idea is somewhat counterintuitive. It also puts the addict at the centre of a radical social policy that doesn’t always give sufficient consideration to the broader community that will be affected. Good intentions can lead to bad consequences.
One need look no further than the Slab, an area leading from the Oslo train station directly to the city’s main street.
Emaciated addicts gather in the area every day, every night, slumping against the walls of derelict warehouses around the docks, openly injecting heroin, knowing police won’t move in unless it becomes necessary to quell a significant public disturbance.
Oslo: Europe’s drug overdose capital, with the highest death tables on the Continent.
A compassionate metropolis that was among the first to open injection rooms, in 2005. And the death rates did drop afterwards, those due to heroin halved within a couple of years. However, at the same time, deaths from methadone — provided by the state as a legal and rehabilitative substance — have spiked since, to the point that the overall mortality rate is exactly where it stood a decade ago. Nor has the “healthy” option of clean needles and nurses on hand attending to overdose crises altered the outward reality of social outcasts congregating, shooting up along the Slab.
As a civic experiment that put the emphasis on harm reduction — where most health advocates agree the effort should be concentrated — it hasn’t actually worked out so well. Yet Oslo — Norway — is among the 90-plus supervised injection service sites worldwide cited in a Board of Health staff report that was released on Monday and which will eventually find its way to Toronto city council. Montreal and Ottawa are planning to set up safe-injection sites as well.
Vancouver has two such sites already, the only locations approved by the federal government to this point. Boston, attempting to tackle its heroin epidemic, last year opened a test facility along a stretch of road that has come to be known as “Methadone Mile.”
Better near death — the heroin high has often been described as a between-life-and-death sensation of nirvana — and simultaneously near access to emergency intervention when required — than dead in an alley.
As someone who’s done heroin — just enough to know that this was way too pleasurable an experience for my addictive nature — I make no moral judgment about junkies. The extent of heroin use in Toronto, as described by Dr. David McKeown, medical officer of health, is convincing in its scope and dangers. Latest available data shows the rate of fatal overdoses is increasing, the 206 in 2013 being an all-time high.
There are few legitimate objections to opening safe injection sites here — three locations, as proposed in the board of health report, attached to existing health facilities. The benefits are obvious: supervision for users (who would bring their own heroin), sterilized equipment, encouraging access to related health services, reducing the risky behaviour that results in high levels of hepatitis C and HIV (mostly through sharing needles) and restoring some of the dignity that the drug takes away from its chronic consumers.
But it can’t just be about them. And since the three health-care-provider locations have already made it clear they intend to proceed once the federal government approves their application — for exemption from the Controlled Drugs & Substances Act — there hardly seems any genuine purpose to the community consultation that has been promised.
The engagement sounds like window dressing to me for neighbourhoods already intimately familiar with discarded needles, overt drugdealing and substance-addled addicts.
Research mentioned by the report’s authors indicates that half of those surveyed said they would not travel more than 10 blocks to use a safe-injection site. This finding is used to assure residents that hordes of heroin addicts won’t suddenly descend on their little pocket of the city. But it also means the sites can’t be located in distant, sheltered areas. They cater to drug traffic zones; hence their proposed situation at three downtown spots already servicing a clientele with high levels of injection drug use and “associated high-risk behaviors,” including frequent injectors and public injection.
Will safe injection sites make the situation worse? I don’t know. In some places it has. In some places, such as Oslo, the existence of safe injection sites has neither encouraged users to take it off the streets nor significantly persuaded users to avail themselves of rehabilitation programs. Even in Oslo, so often presented as the harm-reduction model, health officials admit the impact is “difficult to evaluate,” according to the Norwegian Institute for Drug and Alcohol Research.
I agree harm reduction is the best that can be hoped for and it’s hard to quantify. I have no objections to the board of health’s proposals. Junkie lives matter too. But the health department needs to be more honest about realities. Rosie DiManno usually appears Monday, Wednesday, Friday and Saturday.