Food for thought

This post started life as a response to ernurse and her post, The Usual Suspects, about prevention and health promotion reducing numbers in the ER. It's a great post and you should read it.

Hey there ernurse,

ERnurse journal is a great blog. I haven't been by in a while, but I really liked this post [The Usual Suspects] I agree that prevention and health promotion could go a long way to reducing numbers in the ER. I wish there was a quick fix way to turn the system on it's head and make public health and primary care the driving force rather than the secondary & tertiary care in the hospitals.

Anyways, re: your quote "For the drunks and drug users that we have to cater to every night, I really don't know what to say" I just wanted to offer a couple of suggestions to help you formulate what you might want to say (knowing full well you may come down against, which, of course, is fine too). Below are some prevention & promotion ideas & resources for this segment of the population.

Harm reduction is a big, scary idea for a lot of people, which is [kinda] understandable given how addiction in our society is seen as an issue of criminality rather than of mental health/ illness.

It's funny though, when I've talked to the average Joe/Jane and asked well, what do you think about seat belt programs, bike helmet programs, smoking/drinking cessation programs that don't require you to go cold turkey, condom & safer sex programs, even needle exchange programs, people are all for those.

Change from those programs though to a program for drug addicts to use their drugs safely and people are dead set against it. Even after you explain that a harm reduction program such as Insite doesn't exist in a vacuum but with programs for prevention of addiction, treatment, and enforcement. Even after you explain that it treats & prevents disease spread & abscesses & sepsis and thereby prevents long hospital stays and ultimately saves the system money. Even after you explain that at Insite there have been nearly 1000 overdoses prevented. Even after you explain that despite those overdoses there has not been one single fatality. Even in the face of all of these arguments, some people just see the addicted as the disease, not the addiction.

My own blog is all about a harm reduction approach in Vancouver, Canada, the Insite Safe Injection Site. Here's an intro.

Here's a link to a similar program for street living alcohol users in Ottawa. The Shepherds of Good Hope is a church run ministry that makes it's own wine and gives it out in a controlled manner to prevent binge drinking, drinking of unsafe substances, etc.

Lastly though, if you only do one thing, I would recommend reading the book "In the Realm of Hungary Ghosts" by Dr. Gabor Mate. Mate looks at legal addictions of affluence (shopping, gambling, work) and contrasts them to addictions of poverty (drinking, smoking, illegal drugs) in a unique way. He asks many excellent questions for reflection of your own beliefs (which I am working on as a future post).

Cheers, Jen

Link Love

Here's a long overdue link to a great essay on Insite by Mark Rabnett, hospital librarian extrodinare.

Injecting doubt: the rhetoric of harm reduction and the fate of Insite

Attention people in/around Ottawa, Montreal & Toronto: PUBLIC FORUMS

So, 3 posts in 2 days, pretty good, pretty good...

So thanks to Friends of Insite (a Facebook group reachable here), word on the social networking sites is that there are 3 upcoming forums (fora?) in Ontario and Quebec. Speakers will be:

• Liz Evans, founder and executive director of the Portland Hotel Society, which operates InSite
• Tony Trimingham, an Australian advocate for supervised injection sites whose own son died of an overdose.

Please let people know about, and please attend at the following locations and times:

• Ottawa: Monday July 14, 6:30pm Ottawa Public Library, Main Library Branch
• Montreal: Tuesday July 15, 7:00pm Leacock Building, McGill Campus
• Toronto: Thursday July 17, 7:00pm City Hall

Here to is a video (also courtesy of Friends of Insite) featuring Tony Trimingham and discussing the importance of supervised injection sites.

Dr. Brian Day (Pres. Cdn Med. Assoc) on Insite

Missed an article in yesterday's round up. This appeared in the Toronto Star and is by Brian Day, President of the Canadian Medical Association (CMA).

Ottawa's bad prescription on addiction

Jun 08, 2008 04:30 AM
Brian Day

When the federal government announced it would appeal the B.C. Supreme Court's decision on Vancouver's safe injection site, it chose to dismiss growing scientific evidence of the positive role harm-reduction programs can play in society.

It is hardly a surprise, however, that the Conservatives would favour a "law-and-order" approach. They made their position pretty clear when they rejected harm-reduction programs in the new national drug strategy.

While the federal government rejects scientific evidence that harm- reduction programs are successful, health-care professionals and public-health experts know they are an important part of the puzzle in addressing illegal drug use. Harm reduction, along with treatment, policing and prevention are cornerstones of a comprehensive, integrated public-health strategy.

Conservatives contend that money could be diverted away from Insite into treatment and rehabilitation programs for addicts. Money does need to be diverted, but it's not from facilities like Insite.

Of all the money that Canada spends to combat illegal drug use, less than 10 per cent is spent on treatment and rehabilitation. The vast majority of the money goes to interdiction and law enforcement. While law enforcement has an important role to play, it is obvious we need a rebalancing of resources and focus.

Not unlike mental illness, there exists a negative view and stigma around addiction, that these members of society are somehow weaker than others, that it is acceptable for us to turn a blind eye to their suffering. It's time to clear the air – addiction is a disease and those who suffer with it need medical assistance just as those who suffer from heart disease or cancer.

We know that stigma prevents individuals with an addiction from seeking help. We are now concerned that this stigma may also be affecting the development of appropriate public policy in this area.

Evaluation of safe injection sites show that they help prevent overdose fatalities. They help reduce needle-sharing, which is an important contributor to the spread of HIV and other infectious diseases. They encourage users to seek counselling and treatment. They do not increase the rate of injection drug use or crime in surrounding neighbourhoods. In fact, the government's own Expert Advisory Committee confirmed many of these facts.

Programs such as Insite are often the first and only contact people have with mainstream health and social services. It can also act as an important door into other areas of the health-care system for those who likely wouldn't or couldn't access the care they need.

Instead of closing down this site, the federal government should be working with public-health officials to see if such sites might work in other areas.

Health Minister Tony Clement has stated that "science is one of the issues that must be taken into account when it comes to a public policy decision." In this matter, the science is clear: Harm reduction is a proven and effective tool.

Marginalizing an already vulnerable population and leaving them at even greater risk of disease and death is bad medicine and, as the polls show, even worse politics. And with the B.C. government's plans to intervene on behalf of Insite, Canadians should rightly wonder why their tax dollars are going to be financing both sides of this argument.

They also should wonder why the federal government seems to be opposed to safe injection sites in British Columbia, but is willing to consider them in Quebec. Clement's public hedging on Quebec's proposal is further proof that his decision appears to be based on political science and not the real thing.

When it comes to safe injection sites, Conservatives need to consider the health of all Canadians, not just those who agree with the government's ideological bias against drug-addicted patients.

Dr. Brian Day is president of the Canadian Medical Association.

An eventful 6 weeks

Well, I've gotten behind on blogging and it's been about the most eventful 6 weeks possible (for InSite and my private life, so bad timing there). Anyways, here's a timeline of the most recent events at InSite:

On May 28th the B.C. Supreme Court ruled that it would be unconstitutional for the Federal Govt to close InSite and further exempted InSite from federal drug laws until June 30, 2009. (CTV story here).

In a May 29th speech to the Parliamentary Health Committee, Tony Clement, Minister for Health, in a mind boggling political spin on addiction, hope, dying and palliative care

"called Insite "a failure of public policy... [and] ethical judgment." More focus should be on prevention and treatment and not on "palliative care," he said, referring to Mayor Sullivan's description of Insite's purpose. "Palliative care is what you give someone when there is no hope," Clement said. "It is end-stage treatment when every other solution has failed and we just wait for people to die. But injection drug users are not dying. There is still hope for them." (Vancouver Courier article here)

[Rant: There is so much wrong with his quote, I don't know where to begin (luckily others are more knowledgable and suscinct than I). My $0.02: That the Health Minister is unaware that Palliative Care extends beyond the dying and thinks it is devoid of hope (for either the dying or the ill) is shameful. That someone who still claims to have hope for those with addictions would take away life-saving resources is atrocious. Anyways, he also said that more treatment beds were needed. No kidding. No one (at InSite or otherwise) thinks differently. Harm Reduction works WITH treatment. It facillitates and leads to treatment. Four Pillars not one. More on that below...]

June 3rd : The Attorney General of Canada filed an appeal of the Supreme Court of BC ruling (Vancouver Courier article here).

June 3rd to 5th: Ipsos Reid conducts a national poll asking Canadians if safe injection sites were a "good thing", a "bad thing" or if they weren't sure. A majority of Canadians (55%) said they were a good thing. Province by province a majority voted "good" except in in Ontario (49%)Saskatchewan and Manitoba (both at 45%). A majority (57%) of urban dwellers went with good (no surprise there), as did a half of the rural dwellers polled. The second question asked Canadians if they thought InSite should be expanded to other Canadian cities. 49% said yes, 46% no and 5% didn't know. (Montreal Gazette article here).

June 4th: In that Ipsos-Reid poll, Quebeckers were the most favourable to safe injection sites (66%). No shock then when they announce that they are considering a safe injection site(s) also. (Canada.com article here, Montreal Gazette article here).

June 5th: Demonstration on Parliament Hill with the planting of crosses on the lawn to represent the 868 overdose interventions to date at Insite. (Georgia Straight article here, Rabble.ca articleby Libby Davies (MP in whose riding Insite sits) here). [Jen's excuse for not having a picture/participating here, it was at the exact same time as the ceremony]

June 8th: An interview with Liz Evans on Worldpress.org (here) in which she discusses the private member's bill in the BC legislature to designate InSite a provincial responsibility and the rally where the government and opposition gave the attending Downtown Eastside residents a standing ovation. She also comments on how governments heel-dragging over InSite has obscured debate and movement on the other 3 pillars of the Four Pillars Approach

July 2nd: Although the Vancouver police chief is known to support InSite, the official word from the VPD on whether InSite is a "good thing" or "bad thing" is "we're not sure; we'll sit on the fence" (Canada.com story here).

And lastly, the most recent news item deals with the likely next step: the appeal of the BC Supreme court ruling in the Supreme court of Canada:

[Vancouver] safe-injection site case headed for Supreme Court of [Canada], lawyer predicts (from The Canadian Press here)

VANCOUVER — The future of Vancouver's controversial supervised-injection site is likely headed for the Supreme Court of Canada, says the lawyer representing a group fighting to keep the facility open.

Ottawa has filed its appeal of a B.C. Supreme Court decision that struck down sections of federal drug laws and ensures Insite will remain open as a constitutionally protected health-care service.

But lawyer Monique Pongracic-Speier predicts the case won't be settled at the B.C. Court of Appeal, regardless of the outcome.

"I think there is a realistic chance that this will go up to the Supreme Court of Canada," Pongracic-Speier said in an interview Wednesday.

"It's an extremely important constitutional issue and it is an issue that I believe the Supreme Court of Canada would find has a national interest."

Insite opened in the city's troubled Downtown Eastside as a pilot project in 2003 under a special exemption from federal drug laws, but Ottawa had refused to say whether it would extend the exemption after it expired at the end of last month.

In a May 27 decision, B.C. Supreme Court Justice Ian Pitfield ruled that federal drug laws prohibiting drug trafficking and possession are unconstitutional and gave the federal government a year to rewrite them.

Pitfield said laws that prevent people suffering from the disease of addiction from accessing such a service infringe on their right to life, liberty and security of the person.

Within days of the decision, federal Health Minister Tony Clement announced his intention to appeal and made it clear Ottawa wants the facility shut down.

Documents filed with the B.C. Court of Appeal last month don't list the government's specific reasons for seeking to overturn the decision, but ask that the Supreme Court ruling be set aside.

In the meantime, Pongracic-Speier said the facility will remain open.

"Insite's operations will not be affected unless and until the decision of the B.C. Supreme Court is overturned by a higher court," she said.

The two groups who initially launched the court challenged filed their own appeal of the decision.

While Pitfield ruled that it would be unconstitutional to force Insite to close, he rejected the plaintiffs' arguments that the facility should be exclusively under provincial jurisdiction because it is a health-care facility.

The site, which sees an average of 600 users each day, allows addicts to bring their own drugs to inject under the supervision of medical staff.

The site has a long list of supporters, including the city's mayor and police chief, but opponents claim the site promotes drug use by facilitating addiction.

New Democrat MP Libby Davies, whose riding includes Insite, said the federal government's appeal is purely political.

"It's not based on any evidence or any public policy issue, so I think that it's a colossal waste of time," Davies said.

"Insite is part of the solution, it's not part of the problem. Why would the federal government spend all of this time and money to fight a battle they're going to lose
anyway?"

Thanks for joining me for the news; stay tuned for sports and weather.