U.S. Should Follow Canada’s Lead on Heroin Treatment

The Opinion Pages | Op-Ed Contributor
U.S. Should Follow Canada’s Lead on Heroin Treatment
http://www.nytimes.com/2016/03/23/opinion/us-should-follow-canadas-lead-on-heroin-treatment.html

By PATRICIA DALY MARCH 23, 2016


VANCOUVER, BRITISH COLUMBIA — The crisis that led officials in Ithaca, N.Y., to consider opening a supervised-injection center for heroin users, part of what the United States Centers for Disease Control and Prevention has called a national epidemic of overdose deaths, is sadly familiar to us here.

Overdose deaths and H.I.V. infection among injection drug users were so high nearly 20 years ago that Vancouver declared a public health emergency. With open drug use and needles discarded in the streets of downtown Vancouver, we responded in 2003 by opening North America’s first supervised-injection center for heroin and other injection drugs.

Clients come to the center, called Insite, with drugs they’ve obtained. Using clean equipment, including syringes, that the center provides, they can inject themselves in one of 13 booths under the supervision of nurses. Those nurses can help them immediately if they overdose.

This model has been a demonstrable success, preventing overdose deaths and reducing rates of H.I.V. infection, while helping some of the most marginalized members of our community get addiction treatment and other important health services.

But despite these achievements, no other city in Canada or the United States has followed Vancouver’s lead. Political ideology, the illicit nature of injection drugs and a profound misunderstanding of addiction have resulted in thousands of preventable deaths every year in both countries.

Addiction is a chronic, relapsing medical condition, not a lifestyle choice. Those disproportionately affected by it include people with mental illness, brain injury and histories of physical and sexual abuse. In the United States, inappropriate prescribing of opioid painkillers set many on the path to heroin addiction, a cheaper and more accessible alternative. Despite vast investments, law enforcement has failed to keep heroin and other illicit drugs out of the hands of vulnerable addicts.

Those opposed to harm-reduction services like Insite worry that providing a place for safe injection drug use will make it more socially acceptable and lead to more addicts. But research shows the opposite to be true in Vancouver; illicit drug use here has declined since the center opened, and use of alcohol and marijuana among high school students is also down.

Others argue that public funding should be spent on addiction treatment, not harm-reduction services. The truth is that both are needed — addiction is a complex condition, with no easy cure. In Vancouver we invest at least 10 times more resources in addiction treatment than harm reduction, and research on new approaches to treatment is always underway. Harm reduction — helping people even as they use drugs — is needed to keep users alive long enough to give them the chance to be treated. Prevention is also important, but again, there is no simple solution.

While we continue to develop strategies to prevent and treat addiction, what is clear is that opioid and heroin overdose deaths are preventable. The drug Naloxone, which blocks the effects of heroin, is a safe, inexpensive antidote when someone is available to administer it, as is the case at Insite.

Over the last 13 years, millions of injections have occurred at Insite and there have been no deaths. The United States would be wise to make this service available to all who need it.

Patricia Daly is the vice president for public health and the chief medical health officer of Vancouver Coastal Health, a publicly funded regional health authority, which runs Insite.