Safer Consumption Services: Controversy Still Dogs a Life Saving Service

Despite the pragmatic nature of harm reduction programs, and their demonstrated ability to save lives, controversy still dogs efforts to scale-up harm reduction. One of the most misunderstood and controversial initiatives are safer consumption services (SCS).

In the last 20 years, SCS services (sometimes also known as safer injection services (SIS) have been integrated into drug treatment and harm reduction programs in Western Europe, Australia, and Canada. The focus of these services is facilitating people to safely consume pre-obtained drugs with sterile equipment. These services can be offered using a number of models including under the supervision of health professionals or as autonomous services operated by groups of people who use drugs.

The objectives of SCS include preventing the transmission of blood-borne infections such as HIV and hepatitis C; improving access to health care services for the most marginalized groups of people who use drugs; improving basic health and well-being; contributing to the safety and quality of communities; and reducing the impact of open drug scenes on communities.

Safer consumption services grew out of the recognition that low-threshold, easily accessible programs to reduce the incidence of blood-borne pathogens were effective and cost-effective. This was the conclusion of over 30 research studies on Vancouver’s own supervised injection site known as Insite.

Research has found that SIS services:

  • are actively used by people who inject drugs including people at higher risk of harm;
  • reduce overdose deaths — no deaths have occurred at Insite since its inception;
  • reduce behaviours such as the use of shared needles which can lead to HIV and Hep C infection;
  • reduce other unsafe injection practices and encourage the use of sterile swabs, water and safe needle disposal. Users of these services are more likely to report changes to their injecting practices such as less rushed injecting;
  • increase the use of detox and other treatment services. For example, the opening of Insite in Vancouver was associated with a 30% increase in the use of detoxification services and in Sydney, Australia, more than 9500 referrals to health and social services have been made since the service opened, half of which were for addiction treatment;
  • are cost-effective. Insite prevents 35 new cases of HIV and 3 deaths a year providing a societal benefit of approximately $6 million per year. Research estimates that in Sydney, Australia, only 0.8 of a life per year would need to be saved for the service to be cost-neutral;
  • reduce public drug use; and reduce the amount of publically discarded injection equipment; and
  • do not cause an increase in crime.

Professional groups such as the Canadian Medical Association, the Canadian Nurses Association, the Public Health Physicians of Canada, the Registered Nurses Association of Ontario, and the Urban Public Health Network have expressed their support for SCS.

Sounds like it’s time to move beyond controversy and get on with creating more of these life-saving programs!

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC



Author: Connie Carter, Senior Policy Analyst, Canadian Drug Policy Coalition

21st century drinking in BC: more convenience, more government revenue and reduced harms?

On Friday January 31, 2014 the BC government endorsed all 73 recommendations contained in John Yap’s landmark review of liquor laws with the stated goal of modernizing BC’s approach to managing alcohol. Modern drinking in British Columbia will mean consumers are able to purchase and consume more types of alcohol and in more places. Bars, nightclubs and restaurants will be able to compete aggressively on price by offering happy hours; Canucks fans will be able to consume hard liquor while watching a game; festivalgoers will be able to purchase alcohol and wander freely as they drink it; shoppers will be able to buy alcohol with their groceries and parents will be allowed to bring their children into pubs.

The government heralds these and other measures as a way to free businesses and charities from cumbersome, out of date regulations. Interestingly, the media release is relatively silent on an encouraging swathe of other recommendations in the report that, while less politically appealing, make BC’s approach to alcohol also more responsive to health concerns. Mr Yap clearly heard the messages delivered during the review by individuals and groups concerned with health and safety, including those summarised in the CARBC submission.

We congratulate Mr Yap on his acknowledgement that alcohol is a major health issue and not just a matter for the economy, for tourism and government revenue. His very first recommendations concern the need to communicate the serious health effects of alcohol more effectively to British Columbians along with active promotion of the national drinking guidelines. The report even mentions the word “cancer”. This is critically important: at the present time the BC Liquor Distribution Branch has absolutely no mandate to acknowledge, address or monitor the health and safety consequences of the product it so efficiently distributes across our province. It will now be required to collaborate with health experts to design educational materials and, more importantly, consider how to price the many thousands of its alcoholic products so that: a) they are not too cheap and b) their price reflects their degree of potential harmfulness i.e. alcoholic strength.

Perhaps wisely, the government press release has not trumpeted the recommendations on alcohol pricing. It has used only cautious language stating rather timidly that the BC Liquor Distribution Branch should “consider” setting minimum prices according to the ethanol content of drinks and whether they are at “an appropriate level”. Such policies, while possibly the most effective available to government to reduce alcohol-related harm, are undoubtedly not quite as popular as the introduction of happy hours and less red tape for small business.

For the past eight years CARBC has been collecting and reporting indicators of alcohol consumption and related harms across 89 local areas of the province as part of the Alcohol and Other Drug (AOD) Monitoring Project. When Mr Yap’s report asserts that in 2011 there were 20,542 alcohol-related hospital admissions and 1191 alcohol-related deaths, those estimates were calculated by the AOD project team. They were also the basis of research published in the American Journal of Public Health identifying the significant positive impacts of minimum alcohol prices on BC hospital admissions. This same paper also identified negative but smaller impacts on hospital admissions from the increased availability of alcohol associated with the large increase in private liquor outlets that occurred between 2002 and 2006.

On the basis both of local and international research, if the government proceeds with only the more popular recommendations in the report, the net effect will be upward pressure on levels of alcohol consumption and increased harms. If the key recommendations for higher minimum prices based on ethanol content are fully implemented, the net effect will be reduced alcohol-related harms and increased government revenues. Maybe this is what 21st century drinking should be: more choices, more responsibility, more convenience and more financial incentives to produce, promote and consume less harmful products. Perhaps also more funds for treatment and prevention. We at CARBC will continue to watch and hope that the easier and popular policy changes will not be implemented in advance of those which are less popular but more effective in terms of protecting health and safety. Either way, we will observe and report the outcomes as they unfold.

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Authors (left to right): Tim Stockwell, Dan Reist, Kara Thompson, Gerald Thomas, & Kate Vallance