A new study is backing up the idea that safe injection sites in Ontario are not only a good idea for public health, but that they would save money in the strained healthcare system.
Canada has North America's first and only safe injection site, in Vancouver, British Columbia, called Insite. It opened in 2003 and since then, mortality rates from overdoses and the spread of infectious diseases have dropped dramatically in the metro Vancouver area.
A 2012 study suggested that a total of five new injection sites in the province of Ontario would help reduce the rates of new infections among individuals using illicit substances but that it came at a cost of $31,781 per year, per patient.
But now, an update to that same study out of Toronto's St. Michael's Hospital argues that safe injection sites would cost a fraction of that, about $10,763 per head, and cites an estimated 86 percent success rate in new facilities remaining cost-effective. The study bases this on a number of factors, ranging from the cost of equipment and rent, to the current and future price of Hep C drugs.
The study notes that breakthrough drugs such as sofosbuvir-velpatasvir, which has been shown to be 99 percent effective in curing five of the six main genotypes of Hep C, are ideal but far too expensive to consistently provide, with the drugs sometimes costing up to $60,000 per patient before it can eradicate the virus.
The main argument put forward in favor of safe injection sites is that it can help reduce the spread of infectious diseases, including HIV/AIDS, through the reusing or exchange of contaminated needles. The study estimates that a single site in Toronto could prevent 164 new cases of HIV and 469 cases of Hep C. It also notes that the costs saved in preventing Hep C infections is much greater than it is of HIV.
In 2013, Toronto Public Health released a report supporting the idea of combining existing programs such as The Works, Toronto's needle exchange program, with the creation of safe injection sites. The sites would serve the city's estimated 10,000 injectable drug users, and according to the original St. Michael's study, about one in five of those users report overdosing every six months.
According to Dr. Philip Berger, medical director of the Inner City Health Program at St. Michael's Hospital, much of the apprehension to safe injection sites comes from the same stigma against drugs that exists in many other harm reduction programs, and that it has come at a heavy cost.
"People can't get their head around the idea of watching people inject drugs, even if it's way safer for them to do it that way," he said, adding that, despite initiatives such as methadone maintenance treatment and needle exchange programs that cities like Toronto and Vancouver have in abundance, many addicts will still end up going back to using injectables.
"There are a subset of people who will not stop injecting drugs no matter what treatment facilities are available. For that subset, it's a lot more effective to offer them a safe and secure place to use those drugs."
Despite the results of Insite, government opposition to safe injection has been significant in Canada: earlier this year, the former Conservative government introduced a bill that clamped down on a number of harm reduction initiatives, including the development new safe injection sites. Officially titled The Respect for Communities Act, Bill C-2 made it so that safe injection sites had to pass a myriad of checks and balances before being approved for operation, including consultations with the police and a swath of public health officials. Still, the city of Montreal has vowed to open up a number of locations in its jurisdiction.
Cecile Kazatchkine, spokesperson for the Canadian HIV/AIDS Legal Network, told VICE News her hope is that Justin Trudeau's new Liberal government will repeal the legislation. In the most recent election, the Liberal Party ran on a platform of expanding harm reduction programs, which included taking another look safe injection sites.
"One of our asks to the new government is to both repeal this legislation and, instead of creating barriers to supervised consumption services, implement policy that would bring in new services and initiative for [harm reduction]," she said.
On Monday, prior to World AIDS Day, the HIV/AIDS Legal Network wrote a letter to all sitting members of Canada's parliament that highlighted five requests for the current government to address, the second of which was to "promote harm reduction drug safety policy".
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