Doug Ford and Toronto Sun doctor need an education in harm reduction and injection sites

An op-ed published in the right-wing newspaper presents a total misunderstanding of harm-reduction programs like Vancouver's Insite facility

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      "Is it such an immoral and unethical crime to hang drug dealers?"

      That's the question that Dr. W. Gifford-Jones posed in the Toronto Sun over the weekend (June 14).

      In an op-ed titled, "Doug Ford is dead right, injection sites are dead wrong," Gifford-Jones presents a total misunderstanding of the goals and functions of supervised-injection facilities like Vancouver's Insite.

      "Some readers may think drug injection sites work," he writes. "If that’s the case, why are 42,000 addicts, just in one Canadian province, lining up every week for methadone treatment, costing tens of millions of dollars to overburdened taxpayers?"

      Supervised-injection facilities fall under an umbrella of health-care programs called harm reduction.

      The primary goals of harm reduction do not include ending an individual's addiction to drugs such as heroin and fentanyl. Many people do find detox and treatment options through harm-reduction programs like Insite. But that's not one of the facility's primary goals. Harm reduction's stated function is to reduce harms associated with problematic drug use and to reduce harms caused by the prohibition of illicit narcotics and the war on drugs. Not to end drug use itself.

      An example: Cocaine does not spread the infectious disease hepatitis C. Hepatitis C is often spread among drug-users via shared needles. A needle-exchange program therefore seeks to reduce harm by making clean syringes available to minimize the risk and spread of hepatitis C.

      At Insite, injection-drug users are supplied with clean needles and encouraged to inject drugs under the watchful care of a registered nurse.

      The result is a minimized risk of infection and a reduced likelihood that a drug overdose becomes a fatal drug overdose. Those are Insite's primary goals and intended outcomes.

      The idea of harm reduction is to keep people alive long enough for them to get into treatment, if treatment is what they want. Not to push people into treatment from the start. Insite does also offer connections to detox and treatment. But that's a secondary benefit of the facility.

      Thus, the paragraph by Gifford-Jones quoted above is a non sequitur. The first sentence regarding drug-injection sites is not directly related to the conclusion regarding methadone that immediately follows.

      Here's a correctly structured argument of the sort that Gifford-Jones was going for:

      "Some readers may think that applying the death penalty to drug dealers works. If that's the case, why are there more than 1.88 million people addicted to opioids in Iran, where they actually do execute drug dealers?"

      Illicit-drug overdose deaths across British Columbia declined after Vancouver began implementing harm-reduction programs in the late-1990s.
      Travis Lupick / B.C. Coroners Service

      Insite saves lives.

      The building at 139 East Hastings Street is quite possibly the most-studied health intervention in North American history. And here's how Dr. Sanjay Gupta summarized that research in a segment aired on CNN last October: "Over 14 years, there have been over three million visits there [to Insite] and not one single death. The rates of overdose in the surrounding downtown area dropped by 35 percent. And Insite users were 30 percent more likely to get addiction treatment."

      Opioids killed nearly 4,000 people across Canada in 2017. If Insite's success is any indication, new supervised-injection facilities recently established in Ontario will save lives. But opponents of harm reduction like Gifford-Jones are presenting false conclusions that are plainly contradicted by a mountain of scientific research.

      "History shows that more money, more social workers, and injections sites will end in failure," Gifford-Jones—whose website states he also goes by the name Ken Walker—writes in the Toronto Sun.

      "It’s my hope that Ford’s efforts to fight this cancerous growth of illegal drugs and more injections sites will receive overwhelming public support."

      B.C.'s chief coroner, Lisa Lapointe, has made a very different assessment. Last November, for example, she told CBC News that if it were not for our province's various harm-reduction programs, B.C. would not have seen the more than 1,400 fatal overdoses that it did in 2017. Without harm reduction, Lapointe maintained, B.C. would have seen a number of overdose deaths closer to 4,500 that year.

      When Ontario residents elected Doug Ford earlier this month, they knew his positions on harm reduction.

      "I don't believe in safe-injection areas, as I call them," Ford said in April 2018. "I ask anyone out there, if your son, daughter or loved one ever had an addiction, would you want them to go in a little area and do more drugs? I'm dead against that." (Vancouver's Insite was actually established with strong support from parents groups.) So it's no surprise that opinions like that of Gifford-Jones are finding space in the pages of the right-wing Toronto Sun.

      But the opinions of both Gifford-Jones and Ford on this matter are at odds with Toronto's medical health officer, Dr. Eileen de Villa, among so many others.

      “Our belief, based on the evidence, is that the criminalization of people who take drugs actually is contributing to this opioid-overdose emergency in our city, because it forces people into unsafe drug practices and actually presents a barrier to those who might be interested in seeking help for addressing opioid-use disorders,”  she told the Globe and Mail earlier this month.

      Amid an epidemic of drug-overdose deaths, politicians, including Ontario's new premier, should listen to their experts' advice.