Travis Lupick is the author of Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction.
Elections matter. Ontario is experiencing an epidemic of drug overdose deaths, and the results of the province’s last election stand to leave drug users to die.
On the campaign trail in April 2018, Progressive Conservative leader Doug Ford said he was “dead against” supervised injection facilities. Then he was elected premier. Now, the new Minister of Health has placed a moratorium on the establishment of overdose prevention sites (stripped-down, theoretically temporary injection sites).
The province “will be reviewing the evidence and speaking to experts to ensure that any continuation of Supervised Consumption Services and Overdose Prevention Sites are going to introduce people into rehabilitation,” reads a memo sent to Ontario healthcare providers on August 10.
"Until this review is complete, these sites are requested not to open until further notice."
Perhaps a sensible idea, in theory. In practice, the Progressive Conservatives will sabotage overdose prevention sites across Ontario.
Many drug users simply will not visit a facility that forces people to listen to judgmental lectures on abstinence and hands out pamphlets for treatment centres that most cannot afford. Instead, many will return to the alleys, where they will inject drugs that possibly contain the dangerous synthetic-opioid fentanyl, and where they will have no nurse watching them should they suffer an overdose. Some of them will die.
How many? On August 14, Toronto police warned the public that seven people in the city’s downtown core had died of a drug overdose over the previous 12 days. The powerful opioids fentanyl and carfentanil are to blame. In 2016, there were 726 fatal opioid overdoses in Ontario. Another 1,125 in 2017. If B.C. – where fentanyl first appeared in Canada, and where the overdose death rate is the highest in the country – is any indication, 2018 will be worse.
Mr. Ford and the Progressive Conservatives know that the scientific evidence which Ontario Health Minister Christine Elliott claims is under review all-but-unanimously agrees that supervised injection facilities are life-saving health interventions with minimal negative side effects.
The PCs were voted into power in the middle of an overdose crisis. If they did not review the science around injection sites – a primary component of Canada’s response to the crisis thus far – before the election, they neglected the most pressing issue facing Ontario today and, in doing so, embraced a criminal level of ignorance. If they did review it, then they are aware that the evidence supports injection sites as an effective form of harm reduction, and their party’s opposition to injection sites is purely ideological.
Let’s look at just four numbers provided by Vancouver Coastal Health, the government partner to North America’s first supervised injection facility, Insite, as well as many of B.C.'s newer overdose prevention sites.
Overdose reversals at Insite: 8,317. Deaths: zero.
Overdose reversals at Vancouver’s handful of overdose prevention sites: 2,564. Deaths: zero.
Combined, more than 10,000 overdoses since Insite opened in 2003. Not one death.
When a citizen injects drugs at a healthcare facility, they do not die.
Every fatal drug overdose is a preventable death. If we can get drug users to visit the sort of injection sites that Ontario's Progressive Conservatives are moving against, we can save those people from a fatal overdose.
But, on August 13, Ontario’s Health Minister told reporters: “There are some who believe that they’re not as effective as perhaps other things could be, so I need to hear about that.”
According to the figures above, an injection site’s effectiveness in preventing a drug overdose from becoming a fatal drug overdose is 100 per cent. So what is Ms. Elliott talking about?
“Essentially, the contradictory evidence is that they’re not as effective as some people think that they are,” she explained, “not so much in terms of saving lives, but in terms of whether people can get into rehabilitation after that.”
It appears that the Progressive Conservatives' opposition to supervised injection facilities is rooted in a misunderstanding of the aim of these initiatives and of harm-reduction as a category of health care in general.
It is not the primary goal of an injection site or any harm-reduction measure to introduce a drug user to detox, rehab or treatment options. But a connection to treatment can be made inside a supervised-injection facility like Vancouver’s Insite, and such connections are made every day.
The immediate purpose of an overdose-prevention site is to keep people alive and to reduce other harms associated with illicit-drug use, such as the spread of infectious diseases like hepatitis C. Injection sites meet these goals with remarkable success.
For that, they must remain in operation and free of ideological interference. If the Ontario PC Party’s goal is to see people addicted to drugs enter treatment, they must help keep those people alive long enough to get there.