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Injection paraphernalia at the Dr. Peter Centre in Vancouver. (Laura Leyshon for The Globe and Mail)
Injection paraphernalia at the Dr. Peter Centre in Vancouver. (Laura Leyshon for The Globe and Mail)

MAXINE DAVIS

Integrating a supervised injection site into health care - and community Add to ...

The Toronto and Ottawa Supervised Consumption Assessment study, released on Wednesday, is noted as the most comprehensive study ever done before setting up such a service.

Vancouver’s Dr. Peter Centre, an HIV/AIDS health-care facility, was part of the study’s review.

Nestled in the city’s downtown West End neighbourhood, the building is an architecturally eye-catching merge of modern and heritage house, on a streetscape of heritage houses. It’s also a quiet icon of what can happen when a community extends itself to accommodate progressive health care – care that includes supervised injection service.

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Peter Jepson-Young was a young, gay Vancouver physician who died of AIDS 20 years ago, a time when one did not disclose being gay, let alone having HIV/AIDS. His was an act of courage – he appeared on the CBC’s supper-hour news once a week for two years to share with British Columbians his experience living and dying with AIDS. The public responded with compassion.

Today, the Dr. Peter Centre is responding to new challenges in HIV/AIDS care – care for individuals in the vortex of HIV/AIDS, hepatitis C, serious mental illness and addictions, recurring homelessness, and medical instability.

It’s no ordinary health clinic. It’s a therapeutic milieu of support, engaging individuals who generally steer clear of traditional health-care facilities. There are nutritious breakfasts and lunches, relaxing spaces, and a culture of respect and acceptance. Nurses assist with daily medication, wound care, and symptom management. Counsellors and music, art and recreation therapists respond to long-standing trauma, grief and loss, mental illness, suicidal thoughts, and the recurring problematic use of alcohol and drugs.

Adherence to HIV treatment can mean a near-normal lifespan, and recent research shows that individuals who maintain a regular HIV medication regime are 96 per cent less likely to transmit the virus. But medication adherence is an incredibly difficult challenge for the Dr. Peter Centre’s at-risk clients. Our integrated care model has helped many with adherence to HIV treatment and is recognized by leading HIV researchers, policy-makers and health-care providers for this success.

Many of the centre’s clients have been to detox and abstinence treatment numerous times. Their desire to achieve long-term abstinence still burns within. The clinical team is there to counsel and support individuals in managing their addictions day to day and longer term, including working on abstinence. When the person expresses a readiness to go to detox and abstinence-based treatment, clinicians are there to help make it happen.

It’s when abstinence is not the reality of a person’s life that supervised injection service can be a lifesaver. The Dr. Peter Centre integrated the service 10 years ago. Our galvanizing impetus was two overdoses at the centre – one in a bathroom and another in the laundry room – fortunately, neither fatal. There had never – and still hasn’t – been an overdose death in any of the supervised injection sites anywhere in the world.

The Dr. Peter Centre started the service after the College of Registered Nurses of British Columbia confirmed that it was within the scope of nursing practice to supervise injections for the purposes of preventing illness and promoting health.

Directly observing injections makes it possible for nurses to teach improved injection techniques to minimize harm to skin and veins, and to teach use of sterile equipment. This reduces repeated infections, which sometimes lead to hospitalization when infections spread to internal organs.

Supervised injection service has another benefit – we are good neighbours. Our clients do not need to leave the Dr. Peter Centre with clean needles to inject outside. Nobody wants the indignity of publicly injecting; nobody wants to witness it.

The centre shares a neighbourhood block with more than 300 residents. At the front of the centre is a neighbourhood park with a playground, dog park, community garden, and an elementary school. Partway down the block is a daycare, and another on a side street. On Saturdays, from late spring to early fall, a farmers’ market lines our street. And one street away is one of downtown Vancouver’s most prestigious hotel and condo residences.

We don’t just co-exist in the city – we thrive. The Dr. Peter Centre’s services are possible with nearly $1-million of annual donor support, to complement core government funding. The 100-plus volunteers include corporate staff who serve breakfast once a week. The gifts of kindness and generosity from individuals and businesses are boundless.

The Dr. Peter Centre experience reflects the best of humanity – an inclusive, compassionate community response to human suffering in our midst. As Toronto, Ottawa, Montreal, Victoria and other Canadian cities engage in conversations about integration of supervised injection service into their health care and communities, it may be helpful to remember the words of Nelson Mandela: “Many things seem impossible, until they’re done.”

Maxine Davis is executive director of the Vancouver-based Dr. Peter AIDS Foundation.

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