theglobeandmail.com, July 22, 2013
No link between supervised injection and Glee star’s death, health expert says
Glee star Cory Monteith’s death on July 13 in a downtown Vancouver hotel room from a lethal mix of heroin and alcohol has brought considerable attention to drug use in B.C. The day after the 31-year-old actor’s autopsy results were announced, police in Abbotsford warned the public about a surge of heroin overdoses there. Mr. Monteith’s death also resulted in a flurry of reports about addiction and drug abuse, with one columnist on Friday linking the actor’s death to easy access to drugs in Vancouver and the operations of Insite, a supervised-injection site in the city’s troubled Downtown Eastside.
Patricia Daly is the chief medical health officer for Vancouver Coastal Health, which – along with Vancouver’s PHS Community Services Society – operates Insite. The facility does not sell or provide drugs, but gives users a space to inject drugs using clean needles and under medical supervision. The clinic has had more than 1.8-million visits and no overdose deaths since it opened in 2003, when HIV rates were spiking in the neighbourhood.
What do you think of the opinion that Insite makes drugs such as heroin more easily accessible?
I think it’s ridiculous. It’s one of the things we evaluated after we opened Insite, because there were those concerns: If you open a supervised drug site, will that facilitate drug use? The studies have shown that’s not the case. In fact, over the last decade or more, we’ve seen a decrease in injection drug use.
Insite has a high profile. Does the association with drugs and dealers make it a magnet for drug users?
That’s not what we found. The users are local, mostly from Greater Vancouver. And these are chronic users. Injection drug use is a problem in all major North American cities. You don’t have to travel to Vancouver to find heroin or cocaine. You can find them in any big urban centre. The cost of heroin is about the same in Vancouver as it is anywhere else, which would leave you to believe that it is just as accessible in most places in North America as it is here. The people who live in those places know where to access drugs and they don’t have any problem accessing drugs. In fact, my colleagues in Montreal are very interested in opening a supervised injection facility. They are well aware of the drug problem there.
There have been anecdotal reports of people coming to Insite to try injecting drugs and then getting hooked. What can you tell us about Insite users?
One of the studies we did found the average Insite user had been injecting for 16 years. And only one person out of about 1,100 was performing their first injection at Insite. [Those figures come from a 2007 report in the American Journal of Public Health.]
Insite is part of Vancouver’s “four pillars” drug strategy, which incorporates harm reduction, prevention, treatment and enforcement. Some critics suggest there is too much emphasis on harm reduction measures, including Insite, and not enough on the other parts of the strategy. What do you say to that?
We [Vancouver Coastal Health] spend 10 times more money on addiction and mental health treatment than we do on harm reduction. We have far more methadone treatment care available, we have primary care available for drug users, detox residential treatment. We have expanded every kind of treatment since Insite was opened. The problem is that this is a very difficult problem to treat. We know addiction is very difficult to treat and many people relapse.
Are you concerned that this most recent controversy relating to Insite comes as other cities are looking into supervised injection sites of their own? [Insite opened with a temporary exemption to federal drug laws. Supporters went to court to seek changes that would allow the facility to remain open. In 2011, the Supreme Court of Canada ruled the site could continue, opening the door to similar operations in other cities.]
People had concerns when we first opened Insite. We have seen the data. We know that HIV rates are falling dramatically among injection drug users and harm reduction is one of the reasons for that. We [in Vancouver] are aware of the benefits. People aren’t in other cities. And if [supervised injection] is new to them, people are going to have some of the same questions we had here. All we can do is share the evidence we have and that’s what we have done. All we can do is present the facts, which show that clearly, some of the concerns are not warranted.
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