As opioid use spikes during pandemic, consumption sites should be ‘a no-brainer’

Over the course of 2020, COVID-19 has rippled around the globe at a relentless pace. Exactly where and how all this ends remain unanswered questions at this juncture.

In Canada, the onslaught of the virus and the attendant response have pervaded virtually every corner of society and transformed much of how we conduct day-to-day affairs, whether in the public or private spheres.  

Manitoba — like many other provinces — is in the midst of a terrifying surge that threatens to extend deep into the new year. 

Unsurprisingly, impacts have been far-reaching.

Virtually no one in the country has remained unaffected. And so it is true for many people who use drugs and alcohol.

A report released recently by the Public Health Agency of Canada (PHAC) found an increase in overdose deaths since the emergence of COVID-19. 

In Manitoba, the Winnipeg Police Service has also noted a significant escalation in calls related to overdose incidents.

Additionally, the Winnipeg Police Service reports an increase in the use of opiates — street drugs such as heroin and fentanyl, as well as prescription painkillers — a shift we have also observed at Klinic Community Health.

The PHAC study adds strength to concerned voices speaking for diverse segments of the population, from health-care workers to those who use drugs, all of whom have warned that substance use is increasing, as the COVID-19 pandemic unfolds.  

Pushed to the margins

We are now witnessing particularly unsafe behavioural patterns (use of unclean supplies, consuming substances alone and so on) that typically emerge when users are pushed farther toward the margins — a predictable, if unintended, consequence of public policies promoting social isolation.  

We believe that the shift to the red, or critical, level of the pandemic response system in Winnipeg will only exacerbate the situation.

Researchers, front-line workers, advocates and those who use drugs themselves are renewing calls for further measures to be taken to reduce harm. 

‘There is no singular antidote,’ to addiction and substance use, say the authors, but supervised consumption sites should be ‘a no-brainer.’ Dr. Andrew Lodge, left, is medical director at Klinic Community Health, where Jenny Ewasiuk, centre, works as a registered nurse. Brianne Goertzen, right, is the provincial director of the non-partisan Manitoba Health Coalition. (Submtited by Dr. Andrew Lodge, Jenny Ewasiuk and Brianne Goertzen)

While opposition from certain segments of the community remains, there is now broad-based consensus among the scientific, medical and broader community regarding the benefits of harm-reduction policies.

This includes the establishment of supervised consumption facilities, where people who use drugs are able to access clean supplies and use substances with assistance close at hand.  

Indeed, a draft version of a provincial report — the Manitoba Mental Health and Addictions Strategy, Improving Access and Co-ordination of Mental Health and Addiction Services — sent to the media in 2018 contained a recommendation for developing supervised consumption facilities in the province.

But the final version did not contain this recommendation and left questions surrounding its elimination. 

An established concept

Public opinion appears to mirror the research.  

A survey done last year by the Angus Reid Institute revealed strong public support; more than 66 per cent of those questioned favoured the adoption of supervised sites.

Supervised injection sites are no longer a new concept.

Europe has been operating such facilities for more than three decades and counts more than 100 sites across the region. Here in Canada, Insite — based in the heart of Vancouver’s notorious Downtown Eastside—has been subject to rigorous scrutiny since opening its doors in 2003. 

Studies have repeatedly shown that overdose frequency is reduced in the setting of supervised consumption facilities like Insite, based in the heart of Vancouver’s Downtown Eastside, the authors say. (CBC)

The evidence of benefit over a range of metrics remains consistent over time. Studies have repeatedly shown that overdose frequency is reduced in the supervised consumption facilities setting. Likewise — due to the accessibility of clean injection gear — transmission of devastating infections such as HIV and hepatitis C decreased among those who regularly used drugs in supervised injection sites. 

The result? A reduction in emergency department visits and hospitalization

Ultimately, the above benefits translate into cost savings for the system. In other words, supervised injection sites hold the potential to reduce taxpayer burden.

Even a cursory glance at the current situation reveals addiction and substance use are complex processes that require a multi-pronged approach. There is no singular antidote in all of this.  

Instead, there is great potential for different moving parts — principles established through evidence-based research — to work together, to alleviate the crisis we now find ourselves in.  

Supervised injection sites are an important component of this strategy and can work synergistically with other public health measures to tackle a society-wide epidemic.

‘Injection sites save lives’

With renewed public interest and acknowledgement of the important role public health measures play in nurturing healthier communities — a thin silver lining granted by COVID-19 — now is the time to push the envelope.  

Simply put, this tragedy is not going anywhere without concerted and meaningful action.

As we have seen over time and in different contexts, supervised injection sites save lives and prevent the transmission of deadly and debilitating diseases.  

And they save money.

No matter what one’s political leaning may be, this one should be a no-brainer.

This column is part of CBC’s Opinion section. For more information about this section, please read this editor’s blog and our FAQ.


ABOUT THE AUTHORS

Dr. Andrew Lodge is medical director at Klinic Community Health and a clinical assistant professor at the University of Manitoba. Jenny Ewasiuk is a registered nurse at Klinic Community Health. Brianne Goertzen is the provincial director of the non-partisan Manitoba Health Coalition and serves as a school trustee for Ward 3 of the River East Transcona School Division.

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