Injection facilities needed to combat infection crisis, AIDS network says

A nationwide project to provide safe injection facilities is needed to help protect the 125 000 Canadians who inject illegal drugs, the Canadian HIV/AIDS Legal Network says.

“Canada is in the midst of a public health crisis concerning HIV/AIDS, hepatitis C, and injection drug use,” network Executive Director Ralf Jürgens said during the April release of a 70-page report, Establishing Safe Injection Facilities in Canada: Legal and Ethical Issues.

It says overdoses involving illicit drugs have been the leading cause of death in British Columbia residents aged 30–49 for the last 5 years. In 1999, 34% of the estimated 4190 new cases of HIV infection in Canada involved injection drug users; over 60% of the more than 5000 new cases of hepatitis C infection reported in Canada each year are related to injection drug use (see CMAJ 2001;165 [4]:436-7.)

Anne Livingstone, project coordinator for the Vancouver Area Network of Drug Users, says a “human tragedy” is unfolding in Vancouver's Downtown Eastside, which is home to many of the province's drug users. “In 1997, Vancouver recorded the highest increase of HIV infection ever observed in the developed world.”

The report makes 6 recommendations, including a call for government financing to launch pilot injection facilities that would provide free equipment and a safe place to inject. Each site would have several rooms and would also provide primary health care, information about safe injection practices, supervision of injections, resuscitation in the event of an overdose, and counselling. Illicit drugs would not be provided.

Benedikt Fischer, an assistant professor in the Department of Public Health Sciences and Centre of Criminology at the University of Toronto, said these facilities have been shown to reduce drug-related crime, blood-borne infections and the burden on public health in Germany, the Netherlands, Switzerland and Austria. The total number of drug users has also decreased. “This is not about condoning drug use,” said Jürgens. “This is about doing something for everyone in our community.”

Although British Columbia's provincial coroner called for the introduction of safe injection sites in 1994, nothing has been done, partly because of obstacles created by existing laws.

(When Sydney, Australia, opened a safe injection site last year [CMAJ 2001;165(10):1375], 800 users registered during its first 3 months.)

Most urgently needed in Vancouver is an exemption to allow the use of illegal drugs at such sites. East Vancouver MP Libby Davies urged the government to grant the exemption because “we cannot wait any longer.”

Jürgens concurs. “Canada has a legal and moral obligation to try these sites. Logic, compassion, and basic decency require us to act.” — Debra Martens, Ottawa