Meeting People Where They Are

Harm reduction as the only ethical and sensible response to the overdose crisis plaguing Ontario

Vanessa Gruben, Marie-Eve Sylvestre, Kyle Kirkup

3 août 2018

Premier Doug Ford’s government is in the midst of reviewing whether to continue funding safe injection and overdose prevention sites in Ontario. During this review, the opening of three overdose prevention sites has been put on hold. The review, which is being conducted by Health Minister Christine Elliot, will consider whether there is evidence to support continuing the sites. Minister Elliot has said the review will examine both the program as a whole as well as the funding and approval of individual sites.

In 2017, more than three people died every day of an overdose in Ontario; totalling 1261 deaths across the province.

We urge the government to continue funding these sites as the evidence overwhelmingly provides that these sites are a critical tool in combatting the current overdose epidemic and in reducing the risk of harm to people who use drugs.

Harm reduction is a non-judgmental approach which seeks to reduce the negative consequences associated with certain high risk activities, including drug use. Harm reduction caregivers and activists not only provide and advocate for life-saving health care services, they also promote the rights and dignity of drug users who face criminalization and stigma and are denied access to health and social services in the province.

Safe injection sites or supervised drug consumption facilities are places where people can use illicit drugs safely, and which consequently reduce the harms associated with unsupervised drug use. Safe injection sites provide people with clean equipment and a safe place to use drugs. These sites are supervised by staff who are trained to respond to a drug overdose and they often provide other services as well.

Overdose prevention sites offer similar services but are temporary facilities which are established by the province for a short time period, usually three to six months. Most overdose prevention sites in Ontario arose from peer organizing and community activists. For example, Overdose Prevention Ottawa opened the first safe consumption site in Ottawa in August 2017. After Doug Ford announced that he would suspend funding, volunteers in Toronto defied the government’s authority and set up a new tent.

These sites save lives. They reduce the risks that result from unhygienic drug use, such as Hepatitis C or HIV infections. These sites also lower the risk of harms by reversing potentially life-threatening drug overdoses. Importantly, safe injection sites and other harm reduction provide low-barrier access points in the health care system. For some, this will result in a greater uptake of addiction treatment services. Because they are staffed with addiction treatment counsellors, individuals who use drugs may have an opportunity to obtain counselling about different addiction treatment services, such as the use of medications for opioid addiction or entry into a detoxification program. Access to these services ultimately leads to decreased drug use.

The evidence proves this strategy works: the presence of an addictions counsellor at a safe injection site results in greater uptake of detoxification services. A study by Wood et al published in the New England Journal of Medicine, one of the leading medical journals in the world, concluded that connecting people who use drugs with an addictions counselor at a safe injection site results in more rapid entry into a detoxification or withdrawal management program, and further research has linked use of a safe injection site with cessation of drug use altogether.

People who use drugs deserve high quality, accessible health care. These sites offer much-needed health care services that many would not otherwise be able to access. The possibility of meeting with an addiction treatment counsellor is just one component of a broader range of health care services that these sites offer. While addiction treatment is a possible option that some may choose, this choice should not hinder the quality of care they are entitled to.

Minister Elliot is in a position to save many lives that would otherwise be cut short by the current epidemic. We urge the provincial government to acknowledge the overwhelming evidence in support of safe injection sites and to continue funding these life-saving centres. They need and deserve our support.

Vanessa Gruben, Marie-Eve Sylvestre, and Kyle Kirkup are Professors of Law at the University of Ottawa.