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Mark Tyndall, provincial executive director, British Columbia Centre for Disease Control.

To combat the mounting death toll from drug overdoses in Canada, the Health Ministry in British Columbia has determined that programs allowing witnessed drug injection must be considered part of the crisis response. The federal government has introduced Bill C-37, designed to streamline the process for supervised consumption site approval. These are welcome and important initiatives that recognize that we can't help people that we don't see.

While the introduction of street-level fentanyl has been blamed for the recent spike in deaths, this crisis has exposed the precarious lives of people who use drugs and their dependence on an unregulated network of illicit drug distributors who care little about their customers. Because of high demand for opioid drugs, even if the supply of fentanyl could be completely cut off, it would be replaced by something else.

While we know that drug overdoses are happening to people from all walks of life, the crisis is primarily affecting an underclass of highly vulnerable people who are already suffering from a history of trauma, physical pain, isolation, poverty and mental illness that fuels the demand for self-medicating drugs. Without a dramatic shift in policy, people using these drugs will continue to be dependent on the illicit market.

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The message to people using drugs is clear: The drugs you are buying on the street are dangerous and can kill you. However, if you insist on using these drugs, do not use alone; do not rush your injection; always use clean needles; and in the event that you do overdose have someone around who can administer naloxone and call 911.

While these are basic life-saving recommendations, we have made it virtually impossible for people to comply. By definition, these measures require a place where people can be supervised during their injection and this is technically illegal. Despite a Supreme Court of Canada decision in favour of supervised injection sites in 2011, the federal government subsequently passed Bill C-2, which imposed multiple barriers to opening new sites.

The Liberal government this week announced it would repeal that bill and replace it with five conditions outlined by the high court in that 2011 decision.

Instead of allowing the supervision of drug injection, we have trained a group of heroic people, mainly volunteers, who seek out those who have overdosed and hope that they can administer naloxone before it is too late. In shelters and low-barrier housing, people are found dead in their own rooms when it would have been quite simple to provide a designated area with the very things that are necessary to prevent these deaths through early intervention.

Even prior to this overdose crisis, the establishment of supervised injection sites was considered to be an essential harm-reduction intervention. These sites are widely recognized as an effective way to provide a safer place to use drugs and respond to overdoses. In 13 years of operation, Insite has not had a single overdose death.

This is a remarkable accomplishment on its own but the impact of Insite goes far beyond overdose prevention. Insite has successfully engaged with thousands of the most marginalized drug users and provided a tiny oasis of safety while connecting the willing with health care, addiction treatment services and housing. On many levels, the fact that these essential health facilities have not been opened beyond Insite and the Dr. Peter Centre in Vancouver is a failure to provide the most basic services to Canadians.

In response to the overdose crisis, we must redefine supervised injection sites and consistently offer a supervised environment for people who are using drugs. Supervision could be provided in a range of spaces including existing community health facilities, homeless shelters, a heated tent, in a housing complex, through a mobile van, or attached to hospitals. They must be placed in areas where people are using drugs and provide a respectful environment where people are unafraid of arrest or harassment. To address the current overdose crisis, they should be designed specifically to attract people who are injecting alone. In addition to responding to overdoses, these sites should provide information around the circulating drugs and how to use them in the safest way possible. Importantly, there should be opportunities to directly connect people to addiction, health and social services.

There remains an urgent need for low-barrier access to substitution treatment such as suboxone and methadone, better access to prescription opioids, low-threshold withdrawal management and recovery beds, more long-term addiction treatment programs, along with a list of early interventions that can help reduce the devastating impacts of drug addiction. However, as these more upstream interventions are being planned and scaled-up, we must not make life-saving interventions illegal.

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