Excellent response by Liz Evans to the Kopala column

Liz Evans' special column in response to M. Kopala's column in the preceeding post.
[all links added]

The dead can't kick drugs

Vancouver's safe injection site isn't the whole solution to the drug problem in the Downtown Eastside -- but it has done a great deal of good

Liz Evans, Citizen Special
Published: Thursday, December 20, 2007

I was saddened by Margret Kopala's recent column, "Revoke this licence to enable" (Dec. 8). Like Ms. Kopala, I remember my first experiences in the Downtown Eastside as shocking, and I too was naive about the problems there when I left the hospital as a nurse to work in the community. It's now been almost 17 years working in the very neighbourhood Ms. Kopala describes. Addiction is clearly dreadful and tragic, but those who offer simplistic solutions offer false hope. Clearly if it were as simple as Ms. Kopala believes, there would be no debate.

Meanwhile, people suffer and die living with addictions.

Ms. Kopala's one sensible point regarding a young girl facing the tragic consequences of addiction is that she could have been her sister. Indeed, those suffering with addiction across Canada, including those helped by InSite, Vancouver's supervised injection site, are someone's sister, or brother, or son, or daughter.

I have called the parents of addicts who had overdosed to tell them their child was dead. I met one mother, at the airport, who had flown across the country to visit her dying son. She arrived too late and fell to the floor screaming in grief when she heard the news.

I was a young, inexperienced nurse. What comfort could I really offer in this tragedy? She wanted her addict son alive, addicted or not. There are things we can do. Harm reduction is one. It can keep people alive, so one day, they can enter treatment.

Harm reduction strategies buy time because not everyone is ready to enter treatment. Clean needles and condom distribution prevent the spread of disease. These are basic health interventions that are accepted across the world, from the United Nations to the medical health officers of every single jurisdiction of this
country.

InSite is neither the problem nor the solution. It is one measure designed to prevent drug overdose deaths, which it has done; reduce public disorder, which it has done; reduce the spread of HIV, which it has done; provide a doorway into the health system and into treatment, which it has also done.

Twenty-five academic papers have now been published in the world's most renowned medical journals including The Lancet, the New England Journal of Medicine, the British Medical Journal, and the Canadian Medical Association Journal. To date there has not been one single independently peer-reviewed article disputing the scientific evidence, which Health Canada paid close to $2 million to compile.

The most recent piece of research indicates that there has been a 30-per-cent increase in the number of people entering detox and methadone therapy as a result of using the injection site -- which strengthens further the argument that harm reduction is a necessary part of the health-care continuum. Making this link from the chaos of the streets to the path of recovery even stronger, OnSite opened above InSite this September, offering 30 beds to addicts wanting to detox, and escape the cycle of addiction.

The public is aware that addiction is a complex issue that requires a comprehensive strategy - one that incorporates improved enforcement, comprehensive prevention programs, and flexible and accessible detox and treatment interventions. But it also needs to include harm reduction - so people don't die unnecessarily, and parents don't continue to lose their children.

Other jurisdictions now also involve harm reduction strategies as part of their overall plans to tackle addiction. Sweden, as was mentioned by Ms. Kopala in her column, has now established needle-exchange programs in order to stop the spread of disease and comply with UN expectations, while conforming to international efforts to limit the global AIDS pandemic. Britain, where a heroin prescription maintenance
program has been in place for many years, has now expanded its addiction treatment program to include stimulant maintenance for cocaine addicts.

In no place where harm reduction approaches have been used have advocates argued they be implemented exclusive of prevention, treatment and enforcement. In every jurisdiction where harm reduction is practised, it is done so in collaboration with local police, business and residents to ensure both the individual users and the broader community equally benefit.

Since InSite opened in 2003, there has been a dramatic decrease in the number of public injections and injection-related litter. As a resident of the neighbourhood, I have witnessed a stark contrast in the livability of the Downtown Eastside since InSite opened its doors. Over the past four years of operation, InSite nurses have now supervised more than one million injections, each of which would have otherwise occurred outside, in the public view, and with a much higher risk of drug overdose death, or spreading HIV and hepatits C.

While I welcome the significant improvement to my neighbourhood for both myself and my children, the primary reason I continue to support InSite is its ongoing life-saving work. More than 900 overdose interventions have happened at InSite - each someone's child who would not be with us today if InSite nurses had not been there to take immediate action.

Like Ms. Kopala, I hope politicians like Stephen Harper [write to him here] and Health Minister Tony Clement [write to him here] think about the children when they consider public health policy relating to drug addiction. I hope desperately that resources are finally put into prevention efforts to stop kids from using drugs in the first place. But I also hope to never again explain to a crying mother why her child died from a drug overdose that could have been prevented, in a civilized country like Canada.

Liz Evans is a nurse and the executive director of the PHS Community Services Society, which operates InSite, Vancouver's supervised injection site.
© The Ottawa Citizen 2007