Friday 2 November 2012

New Insite: The Benefits of Safe Injection Sites


Mohamed Sarraj

Imagine you are a child walking home from school in a cluttered downtown core. You trip in a heap of garbage and turn to realize there’s more to it. A woman who looks to be around 30 years old is buried beneath the trash. She is riddled with needle tracks; her body has just expunged all waste to try to flush out the toxins that have left an expression of terror frozen on her face. She’d died alone, stripped of her humanity, left to rot in the sun by the trash. But she isn’t trash. She is somebody’s daughter, somebody’s sister, somebody’s mother. She does not deserve that. 

In many areas, the sight of such extremely disadvantaged people is as common as it is wrong. The problem exists, but what can be done about it? 

Safe injection sites give intravenous drug users a supervised and legal environment to inject. Safe needles are provided, medical attention is at hand, and detoxification and rehab facilities are usually in the same building. Vancouver’s safe injection site, Insite, is an answer to the East Side’s drug pandemic. Needles were strewn over the streets, alleyways were a sure place to find a dead body, and public injection was rife. Proponents of safe injection sites in Vancouver and elsewhere have argued that they directly save lives, reduce addiction, and improve public order.



It is important to note that safe injection sites cater to the disadvantaged who would otherwise be injecting on the streets. Infectious diseases arising from needle sharing—such as HIV or hepatitis—are a fatal pronouncement for these people who would often rather die than approach the medical system. But the prevention of infectious disease in safe injection sites also saves the wider public from these diseases, which will inevitably spread. In fact, a study in the Canadian Medical Association journal showed that Insite could save the healthcare system $20 million and significantly increase life span in the next ten years by stemming the spread of infectious disease.

Infectious disease is not the only concern. Drug overdose kills, and kills frequently. It begins with slow respiratory failure that renders the user unable to respond and soon unable to effectively move. Nobody has ever died of drug overdose at Insite because medical staff is on hand to help. In fact, Insite has cut overall overdose deaths in the area by 35 percent according to a study in the Lancet Medical Journal.
 Beside dumpsters in dark alleyways, let’s just say medical staff is rare, at best.

Almost counter-intuitively, safe injection sites can help people overcome their addictions. Drug addiction is a terrifying reality that many of society’s disadvantaged live with. It’s a waking and sleeping horror. But what do addicts get on top of it? They’re labelled as criminals, scum, and trash. They’re shunned and confined to shooting up in terrible conditions. To give them this baseline respect puts them a step closer to even the most basic healthcare we guarantee for all citizens. 

In a clean and secure environment, addicts can develop a closer trust with staff that is essential for the physician-patient relationship. Many addicts stay away from rehabilitation or treatment facilities because of alienation, fear, and distrust. Bringing them into the heart of healthcare is a crucial step to treatment and care. In 2010, Insite made 5,000 referrals to other services including onsite rehabilitation, with record completion rates. The model has been successful. 

Others say, however, that to expand these facilities is to legitimize and encourage drug use. But I would argue that being treated as someone who is sick, surrounded by medical staff, and constantly monitored does not attract those who do not use drugs. They are seen as a blessing by those who are currently addicted, but first-time drug users never plan on being addicted and would hardly think about safe injection sites when considering drugs to start with.

Yet some may say that it is the very negative conditions surrounding drug use that discourage it, and safe injection sites only alleviate the deterrents of drug use. These deterrents include death, alienation, and legal troubles. But again, initial drug use is hardly rational, and even so, a life with drugs in Vancouver, or anywhere, is still obviously worse than one without. Even assuming that safe injection sites may encourage some drug use, the effect is minimal, and it is still for the greatest good to expand the sites. 

The issue of perception also plays a big part in safe injection sites. In Vancouver, Insite reduced the amount of discarded needles and public injections. Many argue that seeing this particular public disorder encourages and creates an environment in which crime thrives. However, others argued before that Insite would have led to a migration of drug trafficking into Vancouver. The data show little to no negative impact on crime.

Strict illegality should never take precedence over a policy that can help save citizens, improve general health, and reduce addiction. Insite has worked in Vancouver and it can work in other parts of the country. People deserve better, and stigma should not push us into shying away from real problems.



6 comments:

  1. This article has touched upon concerns of stigma, perception and addiction. I do agree with his underlying point that despite negative connotations with the safe injection sites they should be allowed as their positives greatly outweigh the negatives. Although, I feel the author has seemingly skimmed over a few main points to support their argument. First of all, these safe injection sites are a step towards helping addicts and apart of a wider cause. The list of how these injection sites help, is premature in my opinion. Having these areas does help, but more needs to be done. You can not expect that these sites will on their own reduce all the ills listed in this article from dead bodies and needles in the streets. Second the author talks about the labeling of addicts, again relating to my first point there needs to be some kind of socio-cultural discussion concerning this, and as to why these sites are being rejected by the public. There is no “why” or “how” within this article - just some illusions of bodies in the street and some observations that I could read within a wikipedia article.
    The author in my opinion, comes across with an air of ignorant innocence. The entire article does not touch on any key points, and looks at the issue from a very one dimensional, typical perspective.

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    Replies
    1. Hi Lindsay,

      While I do agree that there is stigma surrounding the issue that should be dealt with, I don't necessarily think that the author's perspective on safe injection sites is completely one-sided. Even though he is mostly pro-injection sites, he does present some negatives about them. This is an assumption on my part, but I would like to think that the author wrote this knowing that there is an underlying cause for these addictions. I think the author's argument here is as follows: safe injection sites help mitigate the dangers (most notably, contagious diseases) associated with injecting drugs on the streets. Along the way too, there are other bonuses, specifically reducing costs for the healthcare system, helping to alleviate addictions, and restore a little public order. So in summary, I think his argument is that safe injection sites do not get rid of the problem, but they do help to reduce it, with other pros as a result as well. At the very least, that is a start.

      I do agree with you on one major aspect though; there is a stigma associated with this topic, as well as many other topics (for eg: safe sex, mental health) and there should be more open dialogues about these issues.

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  2. This was a great piece that has provided perspective on the use of safe injection sites in Vancouver. A key point is the concept that simply because safe injection sites exist, does not mean that they are encouraging drug use and actually do the opposite. The rejection of this fact is a struggle that advocates of safe injection sites face in encouraging the creation of such sites. Advocacy efforts that use evidence and research to inform lawmakers and the public about such correlations are critical in encouraging the continuation of Insite and other similar efforts.

    The role of stigma is often looked over but as this article pointed out, it is crucial in the treatment of those with drug addiction as it is intersected with many of the issues that are faced. Insite is one step in the right direction towards reducing stigma. Insite is a model for many other cities and regions that experience problems with intravenous drug use and I hope that it is continued throughout Canada.

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