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Comment: The case for supervised injection, treatment

Drug addiction remains a major public health challenge in many settings throughout the world, including in Victoria.

Drug addiction remains a major public health challenge in many settings throughout the world, including in Victoria. Too often, policy-makers have failed to respond quickly to drug-related harm with interventions that have been found to be effective through carefully conducted research.

This failure of public policy typically leads to immense preventable suffering and health-care costs.

The lack of appropriate and informed response is often perpetuated by those who cling to overly simple solutions and ignore scientific evidence.

Recently, some have argued that supervised injection sites are not needed in Victoria (“Treatment is the answer, not safe-injection sites,” letter, Jan. 6) despite ongoing problems of overdose and other harms, and that what should be implemented instead are more abstinence-based treatment programs.

Often accompanying such recommendations are claims that supervised injection sites, such as Insite in Vancouver, have failed to promote entry into addiction treatment and that the science supporting such sites is somehow flawed. However, a close look at decades of research on high-risk drug use shows that such claims are baseless.

Regarding Insite, the evidence is clear. Peer-reviewed scientific studies have found that Insite has led to increased admissions to detoxification services, with regular users of the facility being twice as likely to enter detox. Interestingly, a followup study showed that rates of entry into detox programs among Insite users increased by more than 30 per cent in the year after Insite opened. This increase occurred even before a detox program opened above Insite.

Further, studies have shown that regular Insite users are also more likely to enrol in other types of abstinence-based addiction treatment, including residential-treatment centres and peer-support programs such as Narcotics Anonymous.

Far from being “sham reports,” the aforementioned research has been published in some of the world’s top addiction and medical journals, including The New England Journal of Medicine and Addiction. Suggesting that Insite has done nothing to promote entry into addiction treatment is not only false, it’s also an insult to the many nurses, social workers and counsellors who have succeeded in supporting Insite users in taking that first step toward abstinence.

It’s also sad that critics of harm-reduction programs fail to recognize that, in order to effectively tackle high-risk drug use, we need a continuum of services. But why not just have the abstinence-based treatments and skip harm reduction, one might ask? Research has shown that abstinence-based approaches alone do not constitute an effective public health strategy.

Even when abstinence-based addiction programs are widely available, only 10 to 20 per cent of people who use drugs are reached by these services, and the majority of these individuals will relapse upon leaving treatment.

The problem of relapse and the limited impact of abstinence-based treatments have led the American Society of Addiction Medicine to describe drug addiction as a chronic disease, typically involving cycles of relapse and remission. Given the chronic nature of drug addiction, and given that so many people cycle in and out of active drug use, we need programs that protect people actively using drugs from harms such as overdose and infectious diseases.

We also need programs that reach active drug users and connect them with addiction treatment. For the entire system to work optimally, we need a comprehensive continuum of care, ranging from low-threshold harm-reduction services to abstinence-based treatment programs.

When the Supreme Court of Canada was asked to determine whether Insite should be allowed to stay open, it heard from many organizations that stood behind the evidence supporting the facility. Included were the Canadian Medical Association, the Canadian Association of Nurses and the Canadian Public Health Association. We are hopeful, as policy-makers in Victoria consider the merits of establishing supervised injection sites, that they will manage to drown out the voices of those who misrepresent science and offer overly simple solutions, and instead listen to the country’s leading medical and public health experts.

It turns out that these experts agree — supervised injection sites are evidence-based interventions that save lives and health-care costs. However, they are most effective when part of a comprehensive system of care that includes not only harm reduction, but also a range of evidence-based addiction-treatment programs.

Mary Clare Kennedy is a doctoral student in the School of Population and Public Health at the University of British Columbia. Dr. Thomas Kerr is a professor in the department of medicine at UBC and the director of the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS.