The bells tolling opioid deaths in Canada incessantly ring. They toll for the nearly 14,000 individuals who have died from opioid overdoses from January 2016 to June 2019. The federal government’s response to this ongoing tragedy has been to authorize the establishment of even more supervised drug injection sites (SIS). This will not solve the problem.
The government’s response is based on the well-orchestrated public relations campaign which claims that these sites are beneficial for drug addicts as they allegedly save their lives. However, evidence supporting this proposition is unreliable.
The establishment of safe injection sites is based on the concept that addicts cannot change and therefore must be provided with clean facilities and medical supervision to inject their drugs as needed. This assumption is contradicted by the thousands of former drug addicts who have sought treatment and now lead healthy, productive lives. In fact, the fundamental solution for a drug addict is abstinence-based treatment rather than easy access to facilities to continue to inject drugs.
Effect of Drug Injection Sites on Addicts
The problem with the supervised consumption approach is that it deepens the addiction. Well-off individuals can afford to obtain treatment for their addictions, but it is the addicts without money or support who are shuffled off to a SIS, where they inject themselves with street drugs. Their addiction continues and leads to their further degradation and eventually a difficult death.
Advocates of supervised drug-use sites argue that these facilities provide opportunities for the addict to seek treatment. The latter is not the priority for such facilities, however, as very few addicts take advantage of treatment offered them. SIS staff don’t exert pressure on addicts to seek other treatment since they believe the addicts must make their own independent decisions. But a drug addict, without support, is unable to do so.
In contrast, Sweden, a very liberal country, has a drug policy based on zero tolerance and mandatory treatment for addicts. Treatment facilities are also widely available there. As a result, Sweden has the lowest rate of drug use in Europe. It is noteworthy that the effectiveness of treatment is the same whether it is voluntary or mandatory.
Regretfully, advocates for safe injection sites have justified their use based on research provided in approximately 30 studies on Insite, the drug injection site established in Vancouver in 2003—North America’s first SIS. These studies, however, have been criticized by experts for their flawed evaluations, reporting and interpretation of findings that give the overall impression that the facility is successful. Some examples of these flawed studies include one which purports to show that Insite effectively controls injection drug behaviour; another study purports to show positive impact on the community, but the data collected was not adequate in scope to warrant its positive claims; a study attempted to show that Insite reduces the prevalence of Hepatitis C infections among users; and another study purports to indicate that Insite reduced drug dealing and other drug-related crimes. All these studies purported to show that Insite has curtailed crime and disease and led to a 35 percent reduction in deaths caused by drug overdose. The studies concluded, without exception, that Insite’s operation has produced exemplary results.
These studies, however, were conducted by the same individuals who lobbied for the establishment of Insite in the first place. As a result, they had a personal interest, as well as a conflict of interest, in ensuring that Insite be regarded as successful. Their research papers violated prime directives of evaluation in that they intermingled activism with positions of public and professional responsibility, without acknowledging their efforts as activists. Their research, in effect, was carried out for the purpose of supporting the political objective of continuing the operation of Insite, establishing that it was “successful” in treating addicts. The studies were peer reviewed only by supporters of the facility.
One such study on Insite was published in the British medical journal The Lancet on April 18, 2011. This study was pivotal in the decision by the Supreme Court of Canada, handed down on Sept. 20, 2011, to prevent the federal minister of health from closing Insite. The study purported to show there was a 35 percent reduction in overdoses in the 500-metre radius around Insite, while in the rest of Vancouver, the rate decreased only by 9 percent.
The B.C. Vital Statistics reports from the years 2002-2005, however, indicated that overdoses actually increased in that specific area by 14 percent, or 11 percent when population-adjusted, between 2002, the year before Insite opened, and 2005, the final year of the study period. In addition, in a letter to the editor published in The Lancet on Jan. 14, 2012, an international medical team of drug experts exposed the egregious error of the original 2011 study’s assertion that overdoses had decreased around Insite. The letter referenced an extended analysis of the errors in the study.
Increased Crime, Public Disorder
In March 2008, the federal government’s Expert Advisory Committee (EAC) produced a report on safe injection sites which found that there is no proof that the facilities decrease the spread of HIV and blood-borne diseases.
Nor is there any proof that the facilities decrease crime in the area. The EAC report estimated that each addict causes $350,000 worth of crime each year through stealing, break-ins, and auto theft in order to support a $100-day-habit. The addict obtains illicit drugs, usually heroin or cocaine, of questionable purity, from a drug trafficker, which the addict brings into the site for injection purposes. The site becomes a “honey pot” or meeting point for drug traffickers.
The report also criticized the claim that public order improved in the area around Vancouver’s Insite, noting that other studies have shown that deterioration in public order at such injections sites was the norm. In fact, drug injection sites are destructive for the communities in which they are established, including making it unsafe for passersby and harming local businesses.
A February 2012 position paper by the Ontario Association of Chiefs of Police stated that the OACP did not support the introduction of supervised injection sites in Ontario on the grounds that “such facilities will encourage, not reduce, the consumption of illicit drugs among users.”
“The consumption of illicit drugs at supervised injection sites will inevitably lead to a general degradation of the social and economic life of communities in which these facilities are situated,” the paper said.
Since three drug injection sites opened in the Moss Park area of Toronto in 2017, residents say they’re seeing more used needles in the street, dealers openly selling drugs, and people yelling abuse at passersby, the Toronto Star recently reported.
According to the OACP’s paper, “supervised injection sites around the world have focused on the individual without adequately addressing the treatment component.” In fact, addicts urgently need abstinence-based treatment.
A compassionate society must not further undermine addicts by enabling their addiction by way of drug consumption sites. A far more effective approach would be to provide them with well-rounded treatment at abstinence-based facilities as well as other community support systems to deal with their myriad problems—social, economic, mental and/or physical health—in order to break their destructive addiction.
This is something that supervised injection sites, with their primary focus being “safe” drug use, have no way to achieve.