A health economist’s dream come true? A political vote-winner? Something our health care administrators should be falling over themselves in a rush to implement? An obvious yes to all three. Except for intravenous drug users in Victoria. They don’t qualify for proven and humane therapy.
Twenty per cent of Canadians will have substance-abuse issues in their lifetimes. The total yearly medical cost for drug abuse in Canada is $1.8 billion. For alcohol, it is $3.3 billion, and smoking costs us $3.7 billion.
IV drug users have an astounding 60 per cent chance of acquiring hepatitis C. The lifetime cost of this infection is more than $100,000 per person. HIV rates are high (30 per cent), with costs exceeding $150,000 per person. These two infections are acquired mainly from the re-use of needles and syringes.
The overall death rate for IV drug users is greater than for many types of cancer and is 10 to 14 times greater than non-users. Fifteen per cent of all Vancouver ER visits used to be drug-abuse-related.
Because of these crisis numbers, which earned Vancouver the title of being the IV drug capital of Canada, a comprehensive care facility — Insite — was set up in 2003, the first (and still only) such facility in North America.
It provides a safe injection site, sterile injection supplies (excluding drugs), counselling, addiction and detoxification programs and facilitates referrals to various health programs. The facility is extensively monitored and researched, leading to many scientific publications.
The results have been dramatic. HIV and HCV infection rates have plummeted. Up to 12 fatal overdoses per year have been prevented. Insite users are 30 per cent more likely to engage in addiction-treatment programs than non-Insite users. The homeless rate for Insite users has dropped from 45 to 10 per cent. Reports of recent incarceration have dropped from 30 per cent to seven per cent.
Every dollar spent on this facility saves the taxpayer between $1.50 and $5 in health-care costs. This type of analysis does not include non-medical benefits, including better quality of life and, of course, life itself.
And on Vancouver Island, in spite of our police and several councillors being in favour of such a program, our own health authorities refuse to follow suit.
How can that be? Our island has one of the highest HCV infection rates in Canada — 11 fatal overdoses occurred in Victoria in 2011.
Opponents to the Vancouver Insite claimed that having such a facility would legitimize IV drug use, leading to higher numbers of such users. Research has shown repeatedly that this is not the case.
It was felt that crime and general public disorder would gravitate around the facility. The opposite has occurred and the immediate area around the facility is now free of needles and other supplies. There are no reports of increased crime in the area.
The Vancouver Police Department, the Canadian Medical Association, Canadian Nursing Association, Vancouver city council, Vancouver Coastal Health Authority and the Vancouver public strongly support this facility. Why are we so different?
Some of our health authorities might be sticking to the outdated view that to supply these illegal drugs is against the law. The Harper government, in its rampage through socially beneficial programs, attempted to remove Insite’s exemption from this law. The Supreme Court threw out the petition, giving a clear message to our own health authority that there would be no legal challenges to opening up a similar facility in Victoria.
Given the extraordinary success of Insite and taxpayer money saved, it can safely be said that the Vancouver Island Health Authority is not acting in the public’s best interest in this regard. This is not acceptable.
In fairness, the apathy of Victorians might have to share some of the blame. I recently encountered evidence of this. A church that I attended ran a workshop on this very topic immediately following Sunday service (to provide information on the need for such a facility in Victoria). The session had been widely advertised in the church, even announced twice from the pulpit. Only three members of the church attended.
Nevertheless, harm reduction is one of the pillars on which our health-care system is based. Access to safe and dignified health care is a right for all people, regardless of financial, housing or health status. We offer health care to smokers with lung cancer and to hopeless alcoholics with cirrhosis. It is discriminatory not to offer effective care for IV drug users. It is unethical.
Dr. Adrian Fine is a retired medical specialist. He works with YES2SCS, a Victoria group raising public awareness of IV drug issues. His views do not necessarily represent the views of that organization.