As many as 18 per cent of addicts admit to reusing needles that have been used by someone else. Register file photo

The moral debate around safe injection drug sites

  • April 21, 2012

TORONTO - There are 9,000 injection drug users in Toronto and another 3,000 in Ottawa. They face arrest all the time. Many addicts live in neighbourhoods with a concentration of counselling and detox facilities. The federal government has launched anti-drug subway posters to combat the problem.

Chances are there will still be 12,000 injection drug users in Ontario’s two biggest cities next year and the year after that.

The Toronto and Ottawa Supervised Consumption Assessment Study released April 12 by scientists at Toronto’s St. Michael’s Hospital and the University of Toronto has stirred up moral consternation, political fidgeting and coffee shop outrage by calling for safe, medically supervised injection sites aimed at reducing the harm drugs cause and providing a way into treatment.

The effects of sticking needles full of doubtful substances in your arm are bad. People who inject drugs are at high risk to get the virus that causes AIDS. In Ottawa 11 per cent of injection drug users currently have HIV, in Toronto four per cent. More than half of Toronto and Ottawa addicts currently have hepatitis C.

As many as 18 per cent of addicts admit to reusing needles that have been used by someone else. One in five addicts still alive told researchers they had overdosed in the previous six months. More than half of addicts say they shoot up in public places.

The epidemiological facts say nothing about the heartache of families who have lost husbands, wives, daughters and sons to injectable cocaine, heroin and bizarre concoctions called crank. It says nothing about the poverty clearly visible in drug-affected neighbourhoods.

Safe injection sites could save lives by reducing infections, preventing overdoses and steering addicts to treatment, concludes the TOSCA report.

“We clearly came at this through a harm reduction perspective, which doesn’t advocate for drug use,” said co-principal investigator Ahmed Bayoumi of St. Mike’s. “It says there are harms associated with drug use and people are going to use drugs. It searches for ways to minimize the harms both to individuals and to communities that are associated with drug use.”

Bayoumi’s scientific premise often meets with moral doubts.

In 1999 the Sisters of Charity in Sydney, Australia, wanted to run a safe injection site, but a group of disturbed Catholics wanted the Congregation for the Doctrine of the Faith in Rome to rule on the proposal. The CDF concluded giving people a safe place to shoot up did not constitute formal co-operation in evil, but worried that it was an “extremely proximate” kind of material co-operation in drug use and advised against it. Cardinal George Pell quashed the plan.

Having spent time as a theology student counselling and advising in a St. Michael’s Hospital detox clinic, Canadian Catholic Bioethics Institute executive director Moira McQueen believes the good of saving lives outweighs the hazards.

“I can’t see that a site that is actually aimed at reducing risk — that is its aim — that that in itself is wrong,” she told The Catholic Register.

A paper published in The Lancet at the same time as the TOSCA study was released revealed overdose deaths in Vancouver’s Downtown Eastside have dropped 35 per cent since the Insite safe injection site opened there in 2003.

“To say we wouldn’t do it because of property values is to say the least disproportionate from a Christian perspective,” McQueen said.

McQueen can foresee a role for pastoral care in a safe injection site delivered by the same kind of frontline religious and lay counsellors who currently work in jails, shelters and detox clinics. The aim is always to get addicts included again in society and in God’s love and mercy.

“The other side says ‘You’re promoting drug use.’ The short answer is no. We’re acknowledging that it’s terrible what it does to people,” she said. “It’s a common sense approach.”

The science alone can’t settle the debate between harm reduction and unequivocal moral and legal condemnation, said Bayoumi.

“We’ve said all along that there’s a values dimension to this,” he said.

The TOSCA study, first requested by Toronto City Council in 2005, is there to answer questions science can address — everything from property values and crime statistics to morbidity and mortality.

“The answer comes from the discussion of how that science integrates with people’s views and values,” said Bayoumi.

Bayoumi believes people are ready to have a discussion about what are the best options.

“Clearly there’s a need for addiction services. There’s a need for opiate substitution therapy like methadone maintenance therapy. There’s a need for counselling and social work and services for housing and employment and all those things,” he said. “This is not a substitute for any of those things.”

Police chiefs have been doubtful. They told the TOSCA researchers the sites would increase the likelihood of addicts committing crimes to buy the drugs and provide a sort of institutional wink legitimizing drug use.

“I don’t know of any place in Toronto where (a safe injection site) couldn’t have a significant negative impact on the communities,” Toronto Police Chief Bill Blair told reporters after the report came out.

Toronto City Council is still some ways off moving on the TOSCA recommendations.

“There has not been enough research done on the topic in Toronto,” said Councillor John Filion, chair of the city’s board of health, after the more than 300-page report was released.

At Queen’s Park provincial politicians are being cautious.

“I have a responsibility at all times to be alive to the best advice,” Premier Dalton McGuinty told a press scrum.

“Experts continue to be divided on the value of the sites,” said Health Minister Deb Matthews in a press release. “We have no plans to pursue supervised sites at this time.”

Federally, the Conservative government fought a losing battle against Vancouver’s Insite all the way to the Supreme Court of Canada.

Last October the top court ruled closing down Insite would contravene addicts’ right to life, liberty and security of person. Health Minister Leona Aglukkak must issue an exemption to the Controlled Drugs and Substance Act for safe injection sites if they are demonstrably, medically necessary, said the court.

“What’s clear to almost anybody who works in this area is that there is still an unmet need, even with all the services that are there,” said Bayoumi. “Something additional has to be done.”

McQueen emphasizes that her openness to safe injection sites doesn’t come without conditions.

“If it’s not aimed at promoting a false idea, if it’s not aimed at promoting something that’s immoral, if it’s actually aimed at helping people with things from the medical community, that’s OK,” she said.

The scientist also has a moral scale to weigh safe injection sites.

“There are lots of ways to approach this,” said Bayoumi. “One is to value people’s health and to want everybody to have the best health possible, no matter what choices they may have made or what circumstances they find themselves in.”

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