By Chris Grinham
We started Safer Ottawa in 2007 to pick up discarded needles in the neighbourhood. The reason we started it was that a neighbour came by and told us that some of the kids in our neighbourhood were seen playing with a discarded needle and she asked me if I can go and pick it up. So, with a set of pliers and a Maxwell house coffee can, I walked over and picked up my first needle. Over the next three years, my wife and I picked up 7,000 more.
We worked really hard with the City, Ottawa Public Health and Ottawa police to get changes to how needles were both handed out and how they were picked up, and that was extremely effective. During that exercise, we realized that needles were not the problem – they were a symptom of the problem and the problem was addiction, so if we wanted to have the most positive effect possible we had to get to the root cause and not simply clean up the spillage.
We continue to check on the situation of discards in the city and we are still very pleased with the response time and the serious reduction of discards visible on the streets. That is not to say that needles do not end up discarded improperly, but it’s happening significantly less than it was in 2007. We will continue to monitor that situation and report our findings to the city.
Once again, there is a push for Supervised Injection services in the City of Ottawa, and once again we find it important to provide correct and accurate information to the public and decision makers.
There are three main arguments that proponents of Supervised Injection Services in Ottawa make for the need for Supervised Injection Site(s) in Ottawa: to prevent/reduce Infection of HIV and Hepatitis-C; to prevent/reduce overdose deaths from injection drug use; to connect people who use drugs with health services.
A closer look, however, shows that the facts and numbers do not support the claim that there is a need for supervised injection services in Ottawa, nor does the evidence support claims that they will be in any way effective.
Ottawa HIV Infections
There were a total of 50 HIV infections in Ottawa in 2015. That is a 6-year low, which continues a downward trend: from 72 infections in 2010 to 50 infections in 2015. The vast majority of HIV infections in Ottawa are not attributed to Injection Drug Use (IDU), but to unprotected sex. Only approximately 7% of HIV infections in Ottawa have been attributed to IDU. If we follow the numbers from the official studies of 2011 and 2013 and apply those ratios to 2015, that would suggest that of the 50 infections that occurred in 2015 in Ottawa, 3 or 4 infections might have occurred through injection drug use. It is important to note that infections rates associated to IDU are not confirmed to be caused by IDU, just considered likely, as such the numbers could be lower, however we feel it to be the responsible approach to quote the highest possible number based on these reports.
Ottawa Hepatitis-C (HCV) Infections
Ottawa tracks Acute (new) and Chronic (pre-existing) cases of Hepatitis-C (HCV) together; as such, it makes it difficult to track year to year new and pre-existing cases. In 2013, Ottawa Public Health (OPH) released a report titled Substance Misuse in Ottawa Technical Report which broke down these numbers. There were a total of 206 Acute (new) and chronic (pre-existing) cases of HCV in Ottawa in 2015. That is a 6 year low and continues a 3 year downward trend: from 230 in 2010 to 2016 in 2016.
The report found that, of the 2010 infections, 17 were potentially attributable to IDU; in 2011, that dropped to 9 infections that were potentially attributable to IDU. Once again, it is important to note that infections rates associated to IDU are not confirmed to be caused by IDU, just considered likely.
It is clear that Ottawa does not have the out of control or skyrocketing infection rates as some have claimed. In fact, Ottawa’s infection rates are considerably lower than most, if not all, other major cities within Canada. Below is a sample of the most recently available information from comparable and/or surrounding cities.
Overdose deaths in Ottawa
Each year there are approximately 40 drug overdose deaths in Ottawa. This number has been quoted very frequently in the media; however, in most cases, whether purposefully or not, it is quoted incorrectly and without proper context. That number includes both intentional (suicide) and unintentional overdoses, which in turn include accidental prescription medication misuse – such as dosage or combining with other medications.
To get the most accurate information possible regarding Injection Drug Use overdose death statistics, we contacted the Regional Supervising Coroner’s office and requested information on overdose deaths in Ottawa which occurred from an injection, both intentional and unintentional overdose. Based on the report form the coroner, there have been a total of 25 deaths from 2008 to 2014 from drug overdose by injection, giving Ottawa an average of 3.5 deaths per year from injection drug overdose. This makes it that, while every death is tragic, Ottawa does not have a large problem of overdose death from injection drug use.
Connect people who use drugs with health services
We have addressed this several times and our position has not changed. A supervised injection site is not required to connect people with health services. We have dozens of agencies and organizations within Ottawa that do just that every single day, including but not limited to Needle and Stem distribution and exchange locations, Community health Centres, Homeless Shelters, Ottawa Police, Ottawa inner city health, Ottawa Public health, religious organizations and many non-profit groups. To suggest that you need an SIS to provide access to health services or to perform outreach services is not only false but, in our opinion, a serious insult to those that work tirelessly in these services and vocations every single day.
We do not think that the supervised injection site in Vancouver has been very effective. There are many studies that show how effective InSite is – however, a good majority of those studies were written or co-authored by the very people that founded InSite in the first place. They attribute reductions in disease to the supervised injection site, while ignoring many other factors, including other organizations’ health initiatives and, of course, law-enforcement initiatives.
The situation in the downtown east side Vancouver is still terrifyingly deplorable. There is so much misery on those streets and it doesn’t seem to be getting any better. InSite has been in operation for 13 years and Vancouver still has the highest rates of HIV and hepatitis C in the country and the downtown side of Vancouver is still one of the worst neighbourhoods in Canada.
Based on the official numbers of infection and overdose death in Ottawa, the proposed Injection Site(s) would be established to attempt to reduce: 4 or less HIV infections per year; 9 or less HCV infections per year; and 4 or less IDU overdoses per year.
Since an SIS is not mandatory, meaning not all users would use its services and certainly not for all injections, and since we have no geographical data to link where these infections and overdose deaths occurred, we cannot be even remotely certain if an SIS in Sandy Hill/Lowertown area would even reach this very small target population. Therefore, it is impossible to claim that an SIS would have any positive impact at all on the rate of HIV/HCV or number of overdose deaths in Ottawa; it is more than plausible to say that it would not. Adding to that the obvious reality that Supervised Injection Services are not needed for outreach services, and we can see absolutely no justification for opening an SIS in Ottawa.
The numbers show quite clearly that the City of Ottawa has been doing a very good job at reducing infection rates and has done a fantastic job at keeping injection drug related overdose deaths extremely low. What we don’t have in Ottawa are enough resources to provide services to help people suffering from addiction; if someone asks today “please help me, I need to get clean” – the answer in most cases would be “we’d love to help, but no help is available” and that is truly tragic.
The truth is, and this is something that everyone from all sides of this issue agrees on, Ottawa needs more services for housing, detox, treatment and aftercare. The wait times for treatment are shockingly long, the availability of housing to get street-involved addicts out of the environment surrounding the shelters and street life is low, and again, wait times for a unit are far too long and aftercare services in most cases are all but non-existent.
If we are being truly honest, the only way to guarantee someone does not become infected or dies of an overdose because of injection drug use is to help them break free from addiction, to provide them the services and support necessary to stay free of addiction and help them return to a healthy lifestyle.
There’s a limited pot of money to help street-level addicts and we have to make sure that we get the best results we can with the funds we have available. Those results are best achieved through treatment programs, aftercare programs, housing initiatives and prevention programs. We should be at all times in the business of doing everything and anything we can to help people get off drugs – that is the only way that they can return to a healthy and safe standard of living.
Chris Grinham co-founded Safer Ottawa, a non-profit organization that promotes drug treatment, education and prevention. Safer Ottawa picked up thousands of needles and drug equipment discarded on Lowertown and Sandy Hill streets.