research – Page 8 – Matters of Substance

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

Harm Reduction is a public health response to substance use that minimizes death, disease, and injury from drug use by promoting safer drug use practices. However, the media regularly publishes articles about harm reduction in a negative light – we hear controversies about harm reduction services in the political arena, and passionately discuss the topic around the dinner table. But are we, the public, really that spilt in our opinions about harm reduction? A recent public attitudes study found the majority of the public in BC supports harm reduction services.

In December 2013, the BC Centre for Disease Control published a research article on the attitudes of British Columbian’s towards harm reduction strategies and services in the Journal of Substance Abuse Treatment Prevention and Policy. The study found over three quarters of British Columbians surveyed support harm reduction. Of those surveyed 72% support needle distribution and 65% support needle distribution in their own community. These results are encouraging for those working in harm reduction roles, whose work supports and promotes harm reduction activities in BC, and for those whose lives depend on harm reduction services.

The BC survey found that people who were younger, female and had completed at least a high school education were more likely to support harm reduction. Those who resided in the Fraser Health region were less likely to support harm reduction but even here 69% supported it. Targeting messages towards segments of the population who may have misconceptions about harm reduction may help gain further support for services that improve the health of, and reduce stigma towards, people who use drugs. Messages should inform the public that harm reduction has economic and health benefits and helps individuals, families and communities to be safer and healthier. Studies and experience has repeatedly found harm reduction programs do not promote illegal drug use but, in fact, decrease use and increase access to drug treatment programs. Platforms such as the media, city council meetings, and community forums should be utilized to share this information and bring awareness of the benefits of harm reduction services to all British Columbians.

It is important to note that regardless of some vocal media and local municipality opposition, British Columbians care about people with substance use issues and support harm reduction services. This brings into question why some policies are in place in BC that contradicts the benefits of harm reduction services and the public’s support. Are city councillors being swayed by a vocal minority? Or, are decisions being made for reasons that are not evidence-based? In the light of BC’s recent public attitudes survey, we encourage all policy-makers to re-evaluate their harm reduction policies in order to meet best practice recommendations, save people’s lives, and represent the public’s support for harm reduction services across the province.

Authors: Despina Tzemis (left), Harm Reduction, Health Promoter, and Jane Buxton, Harm Reduction Lead, BC Centre for Disease Control (right)

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Tag: research

Safer Consumption Services: Controversy Still Dogs a Life Saving Service

Do British Columbians Support Harm Reduction?