Safe injection sites

[ssiguy]

Canada's opioid crisis and generally drug abuse problems have become endemic and cause deaths, misery, and a sense of hopelessness.

One of the ways "professionals" think we can help deal with these problems is thru safe injection sites and I am dead set against them. I agree with their premise that the sites can offer counselling, ensure clean needles, and be there in case of a medical emergency and all of that makes sense to me. To me addiction is a health issue not a criminal one.

What I strongly disagree with is the "sites" part of the equation. Right now London has a real homeless and drug issue problem in their downtown like every other city but the city wants to build a safe-injection site right downtown. If I were a business or resident of the area I would be jumping I be so mad. They are magnets for criminal behavior. As they leave their injection they are fried and uncontrollable or maybe tired and so set up on the nearest sidewalk. If they are women their pimps wait for them at the front door.

I strongly believe that as a health issue it should be dealt with where every other health issue is.............the hospital with special out clinic.

Thoughts?

[J.OT13]

My opinions have changed on this over the years. I used to think that drug addiction was a "choice" and that addicts should be treated as criminals. That if someone O.Ds. well that's there problem and they asked for it.

Today, I'm much more sensitive to the subject. I understand that it's a mental health issue and that we need to help whomever is willing to get help, get clean and back in active society. Law enforcement should tackle the root of the problem, that is producers, distributers and dealers.

That said, a few years ago in Ottawa, before the safe injection sites were legalized, an illegal safe injection tent was set-up in a park near downtown. The number of used needles increased significantly in the area with this site. Neither the City or the police did anything about it, both saying it was the other's responsibility. Pass the buck.

I don't have anything against safe injections sites, but I want to see results. A reduction in used needles on the street and our parks, fewer overdoses, more addicts ultimately getting better. Safe injection sites or any other reform to de-criminalize drug use should not put the rest of the population in danger.

Not quite the same, but we had (have?) another program for alcohol addiction. They would live in this facility and be served alcohol at certain times of the day. Each addict would get a prescribed amount and that amount would go down week after week. Some got clean, others didn't, but the program seemed to yield some positive results. I'm not sure if it's still around.

Safe injection sites are one tool to try and reduce harm. Traditional clinics can help those who want to get help. Other solutions exist or could be developed, but the system often reverts back to the old ways that have mixed results.

[biguc]

Originally Posted by ssiguy

I am dead set against them.

I strongly believe that as a health issue it should be dealt with where every other health issue is.............the hospital with special out clinic.

Sound like you're actually in favour of them, but you want them to be at hospitals.

I'm no expert but that seems like a reasonable take. It makes me wonder if other social services like homeless shelters would also benefit from being near or at hospitals.




As a related topic, I'd like to hear forumers' observations about drug use in COVID days.

I know that overdose deaths roughly doubled in Vancouver. Anecdotally it seems like people's drug habits changed in a lot of places when quarantine measures came through. I live in a city with a rave scene. Drug use is a part of that, but people taking speed to dance for 24 hours is not a social problem. With clubs shut, people tweaking around the city is a social problem. Also, since party drugs are uppers there didn't seem to be much opiate use relative to other European cities (Copenhagen is the worst I've seen anywhere). Post-quarantine, heroin caught on. Mostly people smoking it, so at least there's no needle problem yet.

So, less outlets for fun + desperate times = more opiate use


On a broader perspective, homelessness also seems worse, or at least more visible, than pre-quarantine. It could be that a lot of people scraping by couldn't keep it together when their jobs evaporated. It could be that a lot of marginally homeless--couch surfers and so on--found their usual hosts less accommodating when they became afraid of getting sick. Whatever the case may be, with businesses all closed, every doorway became a viable camping spot, and a lot of areas that were usually busy with tourists are became camp sites.

[bolognium]

London has had a temporary safe injection site downtown for years now (I live about 100 meters away from it). The current plan is for a permanent site, 5 blocks away from this one on the other side of downtown (literally across the street from a mission).

My main criticism here is that the city is going with a single-site model. Whether people like to admit it or not, the areas around these sites turn into complete zoos and are filthy with litter, waste, needles, and people squatting. People congregate there and spend time there 24 hours a day. Also, criminals prey on the already disadvantaged people, since they are all meeting, waiting, and hanging out in the same place.

I think safe injection sites are necessary, but having a single one serving a large area turns the site into a very unsavory place. So the city just shoves the site into the already least-pleasant location and crosses its fingers that the surrounding residents and businesses can survive. I'd wager having a larger number of smaller sites would help break up this congregating effect, and would have a smaller impact on the businesses are residents around them. Instead of having one extremely undesirable area with increased crime, litter, and homelessness we would see the problem spread out over numerous smaller sites. Still not an ideal situation, but better than laser-focusing all the issues into one corner of our downtown.

[MonctonRad]

Good points, but I wonder if there doesn't have to be a certain "critical mass" to make an injection site viable. Is security necessary to keep the staff safe? I imagine so. If you are going to have ancillary services on site like counselling and social work, then the site would also have to be a certain size.

The injection sites should be located where the need is. For example, in Vancouver it would obviously have to be in the downtown east end. Here in Moncton, it should be on or near St George Street (although this would be at odds with the city's attempt to gentrify the area).

[ssiguy]

The people that make these decisions are well paid and probably live no where near one for many of them it's out of sight out of mind and to hell with the local residents.

It is a health issue so why isn't it treated like every other health issue and dealt with at the nearest hospital as an out clinic? You'd have the space, the health/social/rehab workers already in place and a full emergency dept in case of an overdose, and security in case of a problem. What's more, treating it at the hospital would take away the stigma as drug use being a criminal issue and not a health one.

Drug abuse is not a problem relegated to our downtowns as it effects everyone from all socio-economic backgrounds but the downtown residents are forced to deal with all the problems and makes developing the area more difficult.

[ssiguy]

[QUOTE=biguc;9062546]Sound like you're actually in favour of them, but you want them to be at hospitals.

I'm no expert but that seems like a reasonable take. It makes me wonder if other social services like homeless shelters would also benefit from being near or at hospitals.

As a related topic, I'd like to hear forumers' observations about drug use in COVID days.

I know that overdose deaths roughly doubled in Vancouver. Anecdotally it seems like people's drug habits changed in a lot of places when quarantine measures came through./QUOTE]

Apparently, that is a bit of a misconception. My nephew's car broke down and the cop there was kind of enough to give him a lift home and they talked about precisely this.

The cop said that the opioid crisis is rising but not appreciably faster than before the pandemic. The difference is that deaths and medical emergencies have soared because due to the pandemic and restricted trade and personal travel, the dealers are finding it harder to get their "product". Hence they are lacing the drugs with other very dangerous substances from rat poison to industrial chemicals.

[theman23]

Originally Posted by ssiguy

The people that make these decisions are well paid and probably live no where near one for many of them it's out of sight out of mind and to hell with the local residents.

It is a health issue so why isn't it treated like every other health issue and dealt with at the nearest hospital as an out clinic? You'd have the space, the health/social/rehab workers already in place and a full emergency dept in case of an overdose, and security in case of a problem. What's more, treating it at the areas more difficuhospital would take away the stigma as drug use being a criminal and not a health one.

Drug abuse is not a problem relegated to our downtowns as it effects everyone from all socio-economic backgrounds but the downtown residents are forced to deal with all the problems and makes developing the area more difficult.

Most dope fiends don’t particularly like the hospital or the staff.

There’s an increasing push to improve accessibility to health care by providing it I the community. If you want to treat it like every other health issue, it makes no sense to move these sites to the hospital.

[jigglysquishy]

They are an important tool to fighting opioid addiction. They need to either be in hospitals or in the immediate surroundings though.

The plain reality is that they kill life around them and are a crime magnet. In a hospital setting these problems are minimized.

[ssiguy]

Originally Posted by theman23

Most dope fiends don’t particularly like the hospital or the staff.

There’s an increasing push to improve accessibility to health care by providing it I the community. If you want to treat it like every other health issue, it makes no sense to move these sites to the hospital.

I am not saying that the patients should be going thru emerg or general admittance but rather an out-clinic connected to it. They can keep the same staff but just move facility.

I am sure there are people who wouldn't like going to the hospital but conversely I think there are a lot of users who also don't use safe injection sites because everyone in the area knows where they are and using it is an embarrassment............"hi everybody, I'm a crack addict".

This is particularly acute for addicts who don't fit the universal stereotype of being being dirty, living on the streets, criminals, or being prostitutes to support their addiction. Many users are just your average people next door in the suburbs and they will avoid such injection sites lest they be seen walking into it but such is not the case if they are seen walking into a hospital. The out-clinic can have both a separate entrance from outside and one connecting to the main hospital building so anyone can avoid the stigma of entering the clinic.

If these so called professionals want to change the conversation and get the message out that addiction is a health issue and not a criminal one, they should be the first to advocate for providing the healthcare needed for these people at the local hospital like everything else.

[wg_flamip]

Originally Posted by jigglysquishy

They are an important tool to fighting opioid addiction. They need to either be in hospitals or in the immediate surroundings though.

The plain reality is that they kill life around them and are a crime magnet. In a hospital setting these problems are minimized.

It's important to remember that safe injection sites are a tool in the fight against multiple public health crises in addition to opioid addiction. Importantly, they help to prevent the spread of HIV, Hepatitis C and other bloodborne illnesses—something that we all benefit from.

Additionally, safe injection sites can be really useful in identifying and tracking drugs adulterated with especially dangerous substances, which may allow the organization to put out a warning to other users or alert law enforcement to a malicious supplier. Several safe injection sites now offer drug checking as part of their services, which is especially important today with the fentanyl issue.

Further, preventing overdose deaths on-site lifts the burden off of the often underpaid workers that usually have to deal with it when other options aren't available. It's not the job of a barista, bartender or mall janitor to provide care when a member of the public is ODing on the washroom floor—they're not trained for that, they're not paid for that and the whole ordeal can be extremely distressing, even traumatizing. And that's when the person is discovered alive; I've known a fair few who've found the body too late.

[ssiguy]

I totally agree with the concept of harm reduction and I have no problem with safe injections but rather the "sites" part of the equation.

As you correctly state, burn-out and low wages don't help and again this could solved by having the services at a hospital. The workers would enjoy hospital workers wages and benefits and if they suffer from burn-out they can be temporarily assigned to other work in the hospital. They could also benefit from a work-share with current hospital workers who may want to work at the clinic but not full time/permanently due to the issues you raised of burn-out, lower wages, or having to change your work location.

Out-clinics can also be provided at numerous hospitals all over the city while injection sites are always downtown forcing the users to live in more expensive and unavailable downtown housing prices to be closer to the service they require.

Hospitals are more accessible, offer a safer environment, have the immediate emergency care if needed, don't have the stigma of an injection which keeps many non-downtown users away, greatly reduces staff burn-out issues and lower pay, and wouldn't have to deal with the politics of where the health service should be provided.

[theman23]

Originally Posted by ssiguy

I am not saying that the patients should be going thru emerg or general admittance but rather an out-clinic connected to it. They can keep the same staff but just move facility.

I am sure there are people who wouldn't like going to the hospital but conversely I think there are a lot of users who also don't use safe injection sites because everyone in the area knows where they are and using it is an embarrassment............"hi everybody, I'm a crack addict".

This is particularly acute for addicts who don't fit the universal stereotype of being being dirty, living on the streets, criminals, or being prostitutes to support their addiction. Many users are just your average people next door in the suburbs and they will avoid such injection sites lest they be seen walking into it but such is not the case if they are seen walking into a hospital. The out-clinic can have both a separate entrance from outside and one connecting to the main hospital building so anyone can avoid the stigma of entering the clinic.

If these so called professionals want to change the conversation and get the message out that addiction is a health issue and not a criminal one, they should be the first to advocate for providing the healthcare needed for these people at the local hospital like everything else.

Most health care in the community is not provided in the hospital. Accessibility becomes an issue when you start moving care to hospitals. Not sure why this has to be an exception.

[wg_flamip]

Originally Posted by ssiguy

Hospitals are more accessible, offer a safer environment, have the immediate emergency care if needed, don't have the stigma of an injection which keeps many non-downtown users away, greatly reduces staff burn-out issues and lower pay, and wouldn't have to deal with the politics of where the health service should be provided.

As we're seeing with COVID and saw with SARS, hospitals are not always safe places. Furthermore, as hospitals become increasingly centralized, many of the neighbourhoods and communities in which opioid users tend to live find themselves far away from any hospitals, and the hospitals near to them aren't necessarily the ones that can best accommodate them. In Toronto, for example, St. Mike's is really the only hospital close to a safe injection site, and it's already bursting at the seems trying to provide all of the services hospitals are already responsible for.

Additionally, from a bureaucratic perspective, having the sites directly under the authority of public health agencies rather than hospitals allows for a more co-ordinated approach to larger prevention strategies, somewhat similar to STI testing sites.

I agree that having several sites scattered around is a better model than having a single facility or jamming multiple facilities in one neighbourhood. There are safe injection sites in Leslieville and Queen West, for example, that are pretty inconspicuous: Most people passing through don't even know they're there.

[WarrenC12]

From 1st and 2nd hand experience at St. Paul's (hospital of choice for DTES residents in Vancouver), those patients cause quite a disturbance in the hospital itself and can represent a health and safety concern to staff and other patients.

Refusal to wear masks while coughing everywhere is a common occurrence these days. Outreach via a few brave workers in appropriate PPE in the community might be better for all involved.

[WhipperSnapper]

Toronto is beyond safe injection sites. We can't provide adequate shelter to Canadians. Ramshackle tent cities are sprouting up everywhere. Out of control real estate investment has a role to play in it. It's more Trudeau's open borders that is gobbling up municipal budgets around the nation for sheltering Canadians with mental and addiction issues.

[WarrenC12]

Originally Posted by WhipperSnapper

Toronto is beyond safe injection sites. We can't provide adequate shelter to Canadians. Ramshackle tent cities are sprouting up everywhere. Out of control real estate investment has a role to play in it. It's more Trudeau's open borders that is gobbling up municipal budgets around the nation for sheltering Canadians with mental and addiction issues.

Uhhhh.. I assume you have evidence for this specific cause and effect?

[VantageHD]

I am opposed. They do nothing to fix the problem and only ruin the neighbourhoods and property values that bureaucrats decide to locate them in. It's long time to admit defeat on this tactic and try something else. These have come into my community and I've only seen the problem get worse.

[kwoldtimer]

Kitchener opened its first safe injection site earlier this year in a building just across the street from City Hall. Afaik, it has been operating successfully, without any particular problems.

[SignalHillHiker]

As far as I am aware, we have yet to establish a safe injection site here but there is definitely a need. There has been lots of media coverage, especially in May, profiling healthcare workers attempts to establish one for heroin and cocaine.

The pressure now is because illegal drugs are harder to get into the province, and what’s arriving is far more often laced with other substances (fentanyl, etc) than is normally the case here.