Why outsourcing the running of Ottawa’s safe injection sites works

By David Reevely - Published on Sep 20, 2016
In June, Ottawa's health board voted to support safe injection sites in principle. (Jonathan Hayward/ Canadian Press)

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While Canada has had one long-standing supervised injection site for hard-drug users in Vancouver since 2003 and Toronto has plans to fund three new ones next year, the key to opening such facilities in Ottawa, it seems, is to not follow either city’s model.

Ottawa Public Health is talking with more than 20 agencies that distribute clean needles to injection-drug users, including community health clinics, drop-in programs and shelters. They’ve all been identified as potential operators of supervised injection sites for Ottawa — where political necessity demands sites be run by outside agencies, not the health unit itself.

This consensus came about slowly, after years of opposition to the idea of supervised injection sites operating in Ottawa at all. Since Vancouver’s Insite opened in 2003, three Ottawa mayors have rejected the idea of bringing this harm-reduction model to the capital, all backed up by their respective police chiefs. A 2015 academic study, led by Ahmed Bayoumi at St. Michael's Hospital in Toronto, found Ottawa could prevent 360 HIV infections over 20 years with a single supervised injection site based on the Vancouver model.  But it attracted no real political support.

People who treat Ottawa’s drug users didn’t stop trying. After the Supreme Court ruled in 2011 that Insite could stay open, over the objections of the then-Conservative federal government, a community-health centre in Sandy Hill, on the east side of Ottawa’s downtown, forced the issue by making clear that it was going to apply for federal permission to open a site, no matter what.

While Ottawa Mayor Jim Watson isn’t a conservative, exactly, he is a stickler for personal propriety. It was wholly in character for him to say in response that he preferred to spend public money on treating drug addiction than on funding facilities where addicts could inject drugs with health-care supervision. He emphasized this while Sandy Hill began public consultations on its application to open a site in its facility this past spring, and has repeated this in conversations about supervised injection sites in the past

The city’s medical officer of health, Dr. Isra Levy, was unconvinced. As a doctor, he was certain a supervised injection site would keep severely addicted people alive —“I could have said that to you when I started my career 30 years ago,” he told me this past June — but as a health-policy official he wasn’t sure if it was the best use of public health care dollars. So earlier this year he assigned a team to marshal the evidence for and against, and the evidence his team found in favour of such sites was quite decisive.

They found that 30 to 40 people have been dying of drug overdoses in Ottawa each year. The number jumped in 2009, when powdered fentanyl hit the streets, and has stayed steady since despite the release of naloxone, which is used to reverse the effects of an opiate overdose. Paramedic calls and emergency-room visits for overdoses had both risen as well.

The overdose problem in Ottawa, and everywhere, is likely to get worse, both the study and Levy concluded.

So the health unit surveyed the people who treat addicts in and around Ottawa; a constellation of programs that focus on men, on women, on French-speakers, on people with dual diagnoses of addiction and mental illness. It found two important things.

First, most treatment programs in and around Ottawa have waiting lists of days, not weeks or months, suggesting there isn’t the vast unmet demand for the rehab Watson has suggested should take priority in public funding. Second, the people who do the treating were all but unanimous that the most important tool missing from their work was supervised injection facilities. They could help the addicts who came to them — but getting addicts to come to them was often the hardest part.

Presented with all this information, plus live testimony from treatment experts and addicts about people who’d picked up clean needles from health centres only to die of overdoses outside their doors, Ottawa’s health board voted 9-2 to support injection sites in principle last June.

This development shifted Watson’s position. His views were well-known, he said the day after the vote, but the health board “is the appropriate venue to hold an important medical debate into this complex and city-wide issue.” I disagree, in other words, but it’s not my call. So go do your thing.

The public health unit’s thing, for now, seems to be talking to already-existing health clinics that are willing and able to operate and foot the bill for supervised injection services. If multiple sites open at once (at least four large clinics — the one in Sandy Hill, two in Centretown in the heart of the city, and one in Carlington to the southwest are actively keen on the idea) it will spread use out over several neighbourhoods. None of them will have to be remotely as large as Vancouver’s InSite, and they’ll all be added to places where addicts already go for other services such as needle exchanges and rehabilitation treatment.

Most of them can add and run small injection sites for a fraction of Insite’s $3-million annual budget. The Sandy Hill centre’s working estimate is $250,000 to $300,000 a year — a small enough amount that they may be able to find the money by scrimping in other programs. The provincial government has also indicated it’s open to funding requests for federally approved sites if city councils are on board.

Over the summer, Ottawa’s health unit conducted a web survey to go along with its research. It’s not a poll, nor adjusted statistically to be representative of all public opinion, so its conclusions are limited. But it did draw a few thousand responses and registered very high support for injection sites in the downtown neighbourhoods most likely to get them.

One of the approaches that makes the politics of Ottawa’s diverse geographic regions work is that downtown councillors have mostly learned to defer to rural ones on things that are important to them, and vice-versa. This is a big issue, though. One of the dissenting two votes in the health board’s summer decision was cast by its chair, Coun. Shad Qadri, who represents far-west Kanata and a suburban village called Stittsville.

He could still be convinced, Qadri said at the time. But he just couldn’t see his way to voting yes, especially after visiting Vancouver and not being able to get a cabbie to take him all the way to Insite for a visit. (The other dissenter was also a suburban city councillor; all the health experts on the board voted in favour.)

Keeping that delicate accord intact on an issue such as supervised injection sites means not forcing hard stances. Don’t make the mayor say he’s in favour, because he isn’t. Certainly don’t ask for money from the city budget, because there won’t be any — Qadri was adamant about that.

But as long as the politicians aren’t asked to help directly, and as long as there’s no one location around which all the opposition can coalesce, they seem willing to stay out of the way.

David Reevely is a columnist for the Ottawa Citizen.

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