Last friday, Ontario’s new Minister of Health and Long-term Care, Christine Elliott, announced the Ford government’s decision to put a hold on approving any new overdose prevention sites until more evidence is reviewed. This move came less than a month before August 31, International Overdose Awareness Day – a day dedicated to remembering all of those who were lost too early to a drug overdose. This day should act as a reminder to all levels of government that we are living through an epidemic of preventable deaths. If the loss of 4000 Canadians in 2017 alone wasn’t enough, this day should prompt government reflection on what political action is needed to turn this crisis around. We strongly urge the Ford government to take this chance to reconsider its decision to freeze the overdose prevention site approval process – a move that, if not reversed, experts say will directly contribute to rising overdose deaths throughout the province.
Thanks to an in-depth scientific evaluation of Insite, Vancouver’s supervised injection facility (SIF), the evidence has been clear for more than a decade: SIFs have been shown to prevent infectious disease transmission and injection-related injury and infection, connect clients with health resources including mental health and addiction treatment, reduce public disorder, and even save taxpayers an estimated $18 million over 10 years (what right-leaning voter can’t appreciate that?). On top of this – and most relevant to the current opioid and overdose crisis across Canada – using a SIF significantly reduces the risk of fatal overdose, so much so that the results can be seen at the population-level. The opening of Insite, which oversees up to 12 injections at a time, was shown to contribute to a 35% decline in the fatal overdose rate within the Downtown Eastside community within its first 2 years of operation. In fact, since opening its doors in 2004, Insite has seen over 8000 overdoses but not one death. This is because staff are on-hand to make sure that if a client overdoses, naloxone is administered and emergency responders are called. However, SIFs are operated by health authorities in a somewhat medicalized setting. For this reason, they may be avoided by some of the most marginalized members of the community who tend to be at highest risk of overdose but less willing to interact with the health care system due to experiences of stigma and discrimination.
This is where overdose prevention sites come in. Overdose prevention sites are low-threshold supervised consumption service settings in which trained drug-using peers and other community volunteers are on-hand to respond to an overdose. Overdose prevention sites are less expensive than SIFs to operate, and can be set up quickly to respond to a spike in overdoses within a community. The Ontario Minister of Health says she needs to review the evidence to see if overdose prevention sites “have merit” before approving any more sites. Although her comments suggest the “evidence” she is looking for will be opinions of the surrounding community, if she were referring to formal peer-reviewed research specific to overdose prevention sites, we might be waiting for a while. There is very little published research on these sites because they were implemented very recently as an emergency response to a public health crisis, and a proper scientific evaluation takes time. However, a rapid qualitative evaluation of these sites is expected to be published in the near future by research scientists in Vancouver. Based on this research, the lead investigator Dr. Ryan McNeil has publicly voiced support for the sites in response to the Ontario government’s decision.
Even without peer-reviewed research evaluating overdose prevention sites, a basic review of overdose trends within the population should tell us all we need to know about the importance of a low-threshold supervised consumption model. In BC, the first province to implement and quickly expand overdose prevention sites, there have been over 2000 overdoses at these sites, yet not one death. What would have happened to these individuals had they been forced to inject alone or away from trained responders? A simple review of overdose data in BC suggests that many of these overdoses could have been fatal, since the majority of overdose deaths occurred among individuals who used alone and/or in a private setting away from the public.
Our organization has many wishes on this Overdose Awareness Day, but reversing the freeze on approvals for new overdose prevention sites in Ontario is at the top of our list. This move would immediately start saving lives.
Here’s what else we are advocating for on International Overdose Awareness Day and every day:
- Immediate decriminalization of drugs at all levels of government, and other recommendations set out by the Canadian Association of People who Use Drugs.
- Expansion of harm reduction on post-secondary campuses, including large-scale naloxone training and distribution and drug checking.
- Good samaritan policies around drug-related emergencies implemented and publicized on campus, and written into the student code of conduct.
Stephanie is a doctoral student in population and public health at the University of British Columbia, where she is currently undertaking research to better understand the links between cannabis, opioids, and drug-related morbidity. Specifically, she is interested in understanding the potential role of cannabis in harm reduction among people who use illicit drugs in Vancouver’s Downtown Eastside neighbourhood. Her other research interests include the therapeutic use of cannabis among people living with HIV/AIDS. Stephanie has also served as staff writer for the UBC Medical Journal (2014-2016) and as an intern at the Canadian Drug Policy Coalition (2014), and is currently working with other students to revive the CSSDP’s Vancouver chapter. In addition to her academic writing, Stephanie has published numerous letters and articles on cannabis in local newspapers including the Vancouver Sun and The Province. She joined the CSSDP in in 2016, and is looking forward to working with other students across Canada to push for a drug policy that is guided by evidence and human rights.