Ottawa Vending Machines, Success Plus Concern

By Scott Douglas Jacobsen

Ottawa’s program for harm reduction, which is a pilot, for needle and pipe vending machines as well as safe injection sites has been a success while make one resident feel unsafe in the neighbourhood now.

There have been more than 250 stems for drug smoking and 600 needles dispensed since the middle of September, according to Ottawa Public Health.

The point for the program was to reduce the number of infectious diseases spread including Hepatitis C and HIV  (CTV News, 2017). The infectious diseases can be spread through drug users’ needle and pipe exchanges with one another.

Ottawa Public Health’s communications, Donna Casey, said that the feedback from the ‘clients’ or the clientele was positive. The clients said that the access to the supplies is there when other potential providers are closed.

This is apparently during the night, according to John Becvar who is a harm reduction outreach worker. The most popular harm reduction vending machine is the one in Byward Market by the Ottawa Public Health’s Clarence Street facility.

Laura MacDonald, who is a long time resident of the community, is in support of the harm reduction movement, but finds the new drug users make the community less safe than before. It is a concern to her.

People have used drugs, at her doorstep. MacDonald said, “There’s more people who are dealing drugs. There’s more prostitution. There’s more … things you wouldn’t see on a regular basis, but they’re happening on a daily basis.”

In 2016, Public Health Ontario reported that there were 40 opioid-related deaths in Ottawa (2017).

References

CTV News. (2017, October 29).  Ottawa needle-vending machines called a success, but resident says area’s now unsafe. Retrieved from http://www.ctvnews.ca/health/ottawa-needle-vending-machines-called-a-success-but-resident-says-area-s-now-unsafe-1.3654205.

Public Health Ontario. (2017, September 19). Opioid-related morbidity and mortality in Ontario. Retrieved from http://www.publichealthontario.ca/en/dataandanalytics/pages/opioid.aspx?_ga=2.178827748.1539913755.1495651174-1137714540.1478537187.

Regina Harm Reduction Advocates Call for Safe Injection Sites

By Scott Douglas Jacobsen

Harm reduction advocates are looking to have safe injection sites in Regina (Knox, 2017). Many of them or make-shift in places such as homes and alleyways. Saskatchewan, as a province in Canada, has the highest per capita opioid overdose hospitalization rate.

The argument from the group making the calls is that the safe injection sites provide a space that is stigma free. Some have praised the efforts but state more data is needed on them.

In other words, it is a statement about the praiseworthy or laudable nature of the safe injection sites that are popping up in houses and alleyways because they help and afflicted minority population, such as youths or addicts

But the evidence is not necessarily in in terms of the benefits of pop up safe injection sites as opposed to stable ones.

Executive Director for Carmichael Outreach, Cora Gajari, said, “I really applaud the efforts of the people who set up in front of city hall. In terms of safe injection sites, though, I don’t know that we really have enough evidence to prove that we need them here in Regina.” (Ibid.)

“There’s always this tendency to be reactive and see what others are doing, bide our time. I think perhaps it’s the place of Regina to be a leader in the province to get something like this started,” Councillor Andrew Stevens said (CBC News, 2017).

The President and Co-Founder of the White Pony Lodge, Shawna Oochoo, estimates between 80 and 100 needles are picked up by volunteers per month by the White Pony Lodge.

Stevens continued, “I can’t just see us sitting around and waiting, I think we need to get ahead of this.”

In the past, in 2016, the freezes on harm reduction efforts have coincided – though correlation is not causation – with an increase of HIV rates (Fraser, 2016).

Reference

CBC News. (2017, October 9). Time to talk about supervised injection sites in Regina, councillor says. Retrieved from http://www.cbc.ca/news/canada/saskatchewan/supervised-injection-regina-1.4346191.

Fraser, D.C. (2016, June 16). Sask. HIV rate goes up as harm-reduction expansion remains on hold. Retrieved from http://leaderpost.com/news/politics/sask-hiv-rate-goes-up-as-harm-reduction-expansion-remains-on-hold.

Knox, J. (2017, October 9). Harm-reduction advocates call for safe injection sites in Regina. Retrieved from https://globalnews.ca/news/3793429/harm-reduction-advocates-call-for-safe-injection-sites-in-regina/.

Toronto Board of Health Considering New Measures

​By Scott Douglas Jacobsen

The Toronto Board of Health is considering a set of measures in order to push back against the crisis of overdoses. There was a plea from Ontario Premier Kathleen Wynne for immediate declaration of a health emergency in the public.

There has been a huge spike in overdoses and deaths related to opioids across the country, as well as Ontario. The Board of Health for Toronto met after a report was published by the Canadian Institute for Health Information (CIHI).

Five people were hospitalized every day between April, 2016, and March, 2017. Toronto had the highest opioid-related hospitalizations in the province. More than a year ago, British Columbia made a public declaration of a health emergency in the province.

Councillor Joe Cressy, Chair of the city’s Drug Strategy Implementation Panel, said, “If the province declares it an emergency, as a result of that, dollars can flow quickly to the people who need it and the organizations that are responding.”

There was collection of real-time data about overdoses. This is to identify areas of risk. Of course, unfortunately, the data comes with the assumption of deaths or overdoses. There was an open letter to the government of Ontario.

Harm reduction advocate, Zoe Dodd, said, “The province said to us when we asked for it few weeks ago that there was no end in sight, that they weren’t going to call [an emergency]. But that is exactly why you call a public health emergency, because there needs to be an end in sight.”

Subsequently, $222 million in funding is being provided for the next 2 1/2 years for the hiring of front-line harm-reduction workers. This is also in order to create addiction clinics with quick access as well as the supplies of Naloxone, which can help with the prevention of overdoses.

FDA Considering New Enforcement With Implicit Focus on Harm Reduction

​By Scott Douglas Jacobsen

According to the CSP Magazine’s Angel Abcede, the FDA is considering new enforcement policy, which would include harm reduction policy. One aspect of the policy is geared around nicotine addiction as one core strategy. The research will focus on electronic cigarettes as an alternative to combustible cigarettes

Many have been curious as to the new US FDA position and strategy with President Trump’s new administration. Gottlieb’s document provided some insight.

The new Commissioner of the FDA, Dr. Scott Gottlieb, issued a document on nicotine addiction and breaking it:

“Our approach to nicotine must be accompanied by a firm foundation of rules and standards for newly regulated products. To be successful, all of these steps must be done in concert and not in isolation.”

He argued for more research and public discussion with combustible and electronic cigarettes (as an alternative to combustible cigarettes, for example). The other option to combustible cigarettes was to argue for an engineering of the low-nicotine options of cigarettes, not simply e-cigarettes. This is to reduce the probability of youths becoming involved in addictions to cigarettes.

In response to this need, the FDA has, in the past, extended deadlines for new-product applications – for several years, apparently. There is a pronounced crisis in addiction that threatens American families.

As noted by Gottlieb, “Envisioning a world where cigarettes would no longer create or sustain addiction, and where adults who still need or want nicotine could get it from alternative and less-harmful sources, needs to be the cornerstone of our efforts.

This is of concern to the FDA generally. The focus on nicotine levels was found to be among the most unexpected announcements. In accordance with this, there will be the issuance of an Advance Notice of Proposed Rulemaking (ANPRM) for input on pluses and minuses for the introductive of lower-level cigarettes.

There will be public-commentary on lower-nicotine cigarettes as well as public-commentary on the dangers around various alternatives such as e-cigarette batteries, e-liquids for youths, and the potential for traditional cigarettes to be more harmful than easy e-cigarettes.

“A key piece of the FDA’s approach is demonstrating a greater awareness that nicotine—while highly addictive—is delivered through products that represent a continuum of risk and is most harmful when delivered through smoke particles in combustible cigarettes,” Gottlieb said.

Groups with traditional anti-tobacco stances, such as Campaign for Tobacco-free Kids in Washington, D.C., agreed with as well as having healthy scepticism against comments made by Gottlieb. These conversations incorporate harm reduction philosophy in a high-level organization with potential for positive impacts on the lives of North Americans.

​Nikki Sullivan, of the Cape Breton​ ​Post, on Harm Reduction

​By Scott Douglas Jacobsen

Nikki Sullivan, of the Cape Breton​ ​Post, reported on harm reduction. She described this as something possibly confusing for those were not more familiar with the philosophy, methodology, and the practice. It was a way to help people with substance abuse disorders. Part of it can include absence. Another part of it can include the reduction of the potential harm to people who happen to use substances, or drugs more colloquially.

The main aim is to reduce the harms associated over the long term with substance misuse, or abuse. Where the focus is the individual user, the problems boil down to the individual but incorporate community and societal consequences.

So, the reduction in overall harm of the individual can boil down to an overall reduction in harm to the community and society. There are many strategies. There is a tremendous amount of empirical support for this, according to the experts, and the Canadian Medical Association has intervened in the past to support harm reduction. The principles include, with a focus on the individual, the dignity of the individual.

The dignity and respect for their own choices plus helping with the reduction of harm. It is a realistic view incorporated into society, with the idea that drugs cannot be eliminated but their negative effects can be reduced.

There could be things like safe needle distribution sites and consumption sites, as well as therapy and treatment, and Naloxone programs that you can take home. Naloxone can help prevent overdoses of particular substances, which is important in the current context of the opioid overdose “epidemic” in British Columbia, Ontario, and elsewhere in the country.

Harm Reduction is a non-judgmental approach and less punitive one, too, to the traditional hard drug enforcement model. The traditional approach is mostly punitive, which, according to the evidence and experts, has contributed to an increase in the amount of drug use and abuse and, therefore, cost of the individual to the community and society.

Take, for example, the introduction of harm reduction to improve the lives of users. It has been proven to reduce the case of hepatitis C, HIV, and the levels of a drug overdose. In the words, it is effective in important domains for the health of citizens who have used drugs or substances. This is in stark contrast to the punitive approach. If you go punitive, the drug use and abuse go up; if you use harm reduction, the drug use goes down and abuse goes down.