Right now, there’s an evolving conversation taking place at the federal, provincial and local level about how we approach substance misuse in our communities. This conversation has the potential to broaden the way in which our community delivers services to address drug addiction – for the better.
Last month, Dr. David McKeown, Toronto’s Medical Officer of Health, released a report recommending an integrated supervised injection service (SIS) model in Toronto. Typically, clients of these services are marginalized and vulnerable members of our community who live with mental illness and serious medical issues. These members of our community often live without regular meals or stable housing.
The Sandy Hill Community Health Centre, one of Ottawa Public Health’s (OPH) community partner agencies, has launched public consultations on their plans for submitting a federal exemption application to Health Canada in order to provide SIS for people struggling with drug addiction.
The primary purpose of a SIS is to provide a hygienic environment where people affected by addictions can inject drugs under the supervision of trained staff, instead of doing so covertly, possibly in a high-risk environment. A SIS also serves as a bridge to other important health and social services including counseling, health teaching, medical treatment, referrals to drug treatment, housing and income support.
As a public health physician, I am especially interested in the discussion about substance misuse in our communities. Along with our many partner agencies, OPH’s approach to serving the needs of people at risk for living with addictions is based on four interrelated pillars: prevention; harm reduction; treatment and enforcement. None can succeed alone – all are needed. In recent years we have also emphasized community engagement to address underlying issues, promoting mental health and wellness in all sectors of our community.
With respect to the harm reduction pillar, nearly 20 local agencies work in partnership across the city to distribute harm reduction information and supplies with the aim to reduce preventable disease and death in the community. Last year, together with our community partners, the OPH Site Needle and Syringe Program recorded almost 20,000 service encounters, and distributed 775,000 needles, along with other harm reduction supplies.
OPH’s Site van travels daily across the city – from Orleans in the east, Kanata in the west, and Barrhaven in the southwest – to provide mobile nursing services to clients where they live. Services include testing for HIV and Hepatitis C, important education to increase awareness about the risks associated with needle sharing and other drug use behaviours, as well as training for people to help intervene in the event of a drug overdose and prevent death through the administration of naloxone. In the past four years, over 60 overdoses have been reported back to OPH as having been reversed due to quick action by a peer through our Peer Overdose Prevention Program.
However, the challenges related to substance misuse in our community persist. At OPH, we work with the Ottawa Police Services, Ottawa Paramedic Services, the local coroner, and emergency room professionals on the early identification and response to new trends in drug misuse. As many as 5,000 people in our community use injection drugs, in addition to the vast number of people who struggle with addiction to tobacco, alcohol and other substances. This is a significant number when you consider the impact on their quality of life, and the burden on the community and emergency and health services.
On average, about 40 Ottawa residents die from drug overdoses every year, many as a result of unintentional overdoses of drugs used illicitly. In our community, that’s in the same range as the number of annual homicides and traffic-related deaths combined. In many cases these overdose deaths are preventable and the problem isn’t going away. Emergency room visits for overdoses have increased by more than 80 percent in the last seven years in Ottawa. While the prevalence of HIV and Hepatitis C among people who use drugs have been relatively steady over the past decade in this city at approximately 10 percent and 70 percent, respectively – these are troubling numbers considering that these infections are preventable.
Evidence has shown that SIS save lives and offer other positive impacts for affected individuals, their loved ones, and the community at large. SIS, as a public health intervention, is well-established. They must be considered as part of any comprehensive approach in working with and treating people who inject drugs. SISs help reduce overdoses and transmission of bloodborne diseases and help to reduce community issues such as public drug use and discarded needles.
I am sensitive to, and take very seriously, the legitimate concerns expressed around public safety and the idea of supervised injection services in our city. We need to ensure that any SIS’s in Ottawa will use the right model for those accessing services in this city, and for the communities in which they live. Accordingly, OPH welcomes the opportunity to review any SIS proposal and to work with community and city partners to ensure that the broader public health perspective is considered.
I welcome the opportunity to join residents, partners and community leaders in a robust and comprehensive conversation about enhancing the ways in which we approach substance misuse in Ottawa.
Dr. Isra Levy
Medical Officer of Health
Ottawa Public Health