Supervised injection sites are places where people can safely inject drugs under medical supervision. Understandably, there are many questions and concerns regarding the existence and creation of more such sites in Canada. As a taxpayer, health-system user and family physician, I share many of these concerns. But first, I'd like you to meet John.
Every three months, John walks into my office and refills his medications. He is a middle-class working citizen with three children. He has high blood pressure and high cholesterol, is 15 pounds overweight and was recently diagnosed with prediabetes. At each visit, we discuss the need for 30 minutes of daily exercise and better eating habits.
John and I both realize that his health, finances, family, quality of life and mortality are all at stake. But changing behaviour can be difficult. There are numerous hurdles to overcome, including current and past circumstances, genetics and his individual choice, all of which contribute to his state of health.
As John tackles these hurdles, I write his prescriptions and work with him to find ways to reduce the risks. After all, they will affect his life, his family and, probably, other Canadians. The national cost of heart disease and stroke is upward of $20-billion a year.
So how does his situation relate to injection drug use? Much like John's lifestyle, injection drug use has been repeatedly shown to be a product of current and past circumstances, genetics and individual choice. Injection drug use affects the individual, families and other Canadians.
I'm concerned about the harms associated with users injecting in public spaces, stray needles, crime rates, health complications, health-care spending and the morality of funding supervised drug use. But I'm also relieved by what I have learned.
The majority of studies published in medical journals have shown that government-established supervised injection sites and needle exchanges do not increase drug use or drug users. They do not increase drug-related criminal activity, according to Vancouver Police Department statistics. Rather, multiple studies have shown that there is less injection drug use in public spaces, fewer stray needles and a corresponding increase in the number of needles discarded in neighbourhood safe disposal boxes.
In regards to health concerns, supervised injection sites have been associated with safer injection practices. By accessing the appropriate addiction, social, and preventative health services through these sites, there is less need for delayed, complicated and significantly more expensive medical treatments. While the yearly operating cost of Canada's first supervised injection site is about $3-million, the prevention of the spread of HIV alone is estimated to save Canadians more than $5-million a year in health-care costs.
Finally, is it moral to fund a site for the supervision of drug use? Each of us will have to find his or her own answer. Speaking for myself, I refuse to pick and choose which patients deserve compassionate care and which deserve righteous judgment.
At the end of the day, I will advocate for supervised injection sites the same way that I advocate for John and all my patients' health: using the best available evidence to provide the best available care, regardless of my biases toward each patient's current or past experiences, genetics or decisions.
It's our health. They're our taxes. Let's take care of them together.
Dr. Thomas Man is a family physician in Toronto.