1

Master of Arts – Integrated Studies

SUPERVISED INJECTION SITE IN : REFORMING THE MODEL.

BY

ANNYX DAY

Integrated Studies Final Project (MAIS 701)

submitted to Dr. Angela Specht in partial fulfillment of the requirements for the degree of

Master of Arts – Integrated Studies

Athabasca, Alberta

February, 2017

2

Abstract:

Illicit drugs are a long-standing problem affecting drug users, governments, judicial systems, medical fields, police services, and communities. Arguments in support of Supervised Injection Sites (SISs) differ greatly from contentions against SISs.

Therefore, this research analysis explores the political, medical, moral, and legal dichotomies surrounding the SIS debates, lists Canadian legislation pertaining to SISs, describes supporting and opposing arguments in relation to the overall ideology of SISs, and highlights the call for a harm reduction model reform before housing a SIS in

Ottawa, Ontario, .

3

Table of Contents:

Background Information ……………………………………………………………. 4

Introduction …………………………………………………………………………. 5

Purpose of SISs ……………………………………………………………………... 8

Morality issues surroundings SISs ………………………………………………… 13

Legality issues surrounding SISs ………………………………………………….. 14

Canadian Legislations regarding SISs ………………………………...... 16

Advantages of SISs …………………………………………………………………20

Medical Arguments in Support of SISs …………………………………………… 22

Disadvantages of SISs …………………………………………………………….. 24

Police Services’ Arguments Against SISs ………………………………………… 27

My Recommendations for Ottawa ..……………………………………………….. 29

Conclusion ………………………………………………………………………… 35

Appendix 1 ………………………………………………………………………… 37

Appendix 2 ………………………………………………………………………… 39

Appendix 3 ………………………………………………………………………… 40

Works Cited ……………………………………………………………………….. 42

4

Supervised Injection Site in Ottawa: Reforming the Harm Reduction Model.

Background Information:

My particular interest in Supervised Injection Sites (SISs) stems from my professional experience in the policing environment firstly as a front-line police officer and now as a civilian member. In 2003-2004, I was a police officer with the Kativik

Regional Police Force (KRPF), in a small Inuit community called Inukjuak, before I was unfortunately injured on the job rendering me physically unfit for front-line police work due to permanent knee damage. During my short career as a police officer, I responded to and investigated drug calls where I helped drug and substance users after mild overdoses. I was exposed to the devastating effects of drug use and abuse, I interviewed drug users to understand the physical and psychological effects drugs had on them, and I interviewed drug users to understand the reasons for and consequences to addictions. I worked in conjunction with Inukjuak’s Youth Protection, Social Services, and the

Rehabilitation Centre in which conflict resolution practices were applied and rectified many situations. However, there were no locally established drug detoxification programs at that time.

In 2010, I returned to the policing environment as a civilian member with the

Royal Canadian Mounted Police (RCMP) and I worked as a dispatcher in the National

Capital Region before fulfilling my current Supervisory role in the RCMP National

Operations Centre. My current duties and responsibilities do not necessarily pertain to illicit drugs or illegal substances; however, I still remain invested in that particular aspect 5

of policing. Over the years, I have watched many television documentaries and videos

relating to drug use highlighting the negative consequences of addictions but also programs relating to the positive outcomes of interventions, detoxifications, and rehabilitation processes; therefore, with my personal and professional experiences I feel I can effectively contribute to the SIS debates. Also, I was born, raised, and currently live in Ottawa; therefore, my contributions to the SIS debates are as a result of my vested interest in current and future generations living in Ottawa.

Introduction:

Illicit drug use is an age-old problem that affects drug users in irreversible ways,

involves various levels of governments, influences the way our judicial system enacts

legislation, shapes the way our medical fields react, concerns the way our police services

operate, and impinges on the innocence of a community and its law abiding citizens.

Drug use happens anywhere the opportunity presents itself to drug users; in other words,

drug use may happen around the corner from your home, in your home, or near places

you regularly frequent. Drug use affects strangers, acquaintances, and even loved ones.

Community members need to recognize there exists a bigger picture to drug use, abuse,

and addictions; consequently, they should aim to mitigate risks associated to drug use and

the functionality of SISs. In other words, aside from allowing drug use in SISs, providing

resuscitation practices in the event of overdoses, and decreasing the spread of diseases

additional solutions in helping drug users and addicts exist and will be discussed

throughout this research project.

Ottawa, Ontario, Canada wants to house its first SIS in the near future. According 6

to Reevely, writer for a newspaper in Ottawa, the Sandy Hill, Centretown, Somerset

West, and Carlington Community Health Centres located in Ottawa are planning to open

“micro” SISs in addition to already housing medical clinics and running harm reduction

needle exchange programs (5). Stakeholders such as public health medical professionals

and some city officials have approved the notion of building an injection site whereas

policy, the Canadian judiciary, and other city officials including Ottawa’s Mayor Jim

Watson, Ottawa Police Services’ Chief Charles Bordeleau, and former Prime Minister

Stephen Harper reject most SIS components. Each bring forth valid arguments; thus, a

detailed analysis will ensue to determine what is best for Ottawa and which steps

targeting interventions best serve the public’s interest.

The harm reduction concept, over a century old now, was defined as “the public health movement aimed at protecting the entire community from harm” (Erickson et al.

1) which encompasses “any policy or program designed to reduce drug-related harm without requiring the cessation of drug use” (Erickson et al. 1), but also aims to “reduce the problematic effects of behaviors” (Logan and Marlatt 1). According to “Harm

Reduction: Alternative Therapies”, a variety of services can include (1):

• Psychiatric treatments

• Psychosocial treatments

• Acupuncture, message, herbals, etc.

• Pharmaceutical treatments

• Substitution therapy

• Medications that discourage use by inducing unpleasant consequences when abused drug is used 7

• Medication used to treat pre-existing psychiatric conditions that may have initiated drug use

Essentially, SISs are built on the premise of the harm reduction concept/model.

Moreover, it is at the discretion of SISs, detoxification centres, rehabilitation facilities, or

any treatment clinics to enforce alternative therapies chosen by the experts within those

facilities.

My main contention throughout this research analysis is -based Insite’s

– ’s first SIS – existing harm reduction model benchmark does not reach

above and beyond in addition to its accomplishments; in other words, even though Insite

has its merits and academic research praises its medical staff members for meeting its purpose and objectives since its inception, my overall contention calls for a harm reduction model reform by prioritizing the goal of targeting current and future physical and mental health and overall wellbeing of people with addictions that results in addressing the root causes of drug abuse and addictions enabled by integrating appropriate steps toward mandating detoxification and rehabilitation as alternative solutions to targeting safe drug use and supporting Insite’s current premise by building a

SIS in Ottawa upholding that exact premise. Even though other Canadian cities want to house SISs – modeled after Insite and other SISs around the world – and have commenced installing these processes, my focus will only be on the city of Ottawa’s endeavour in order to focus this research project.

Illicit drug use may lead to addiction and addictions can come in many forms such as addictions to substances, impulse control disorders, and behavioral addictions (Healthy

Place: America’s Mental Health Channel). However, I will not address addictions to 8 prescription medications, alcohol, tobacco, gambling, food, shopping etc., to which I will reserve similar realms and/or variables of addictions for other academic projects. My focus for this research project encompasses the actions of injecting illicit drugs and substances coinciding with the set norms of SISs. Therefore, I will describe the purpose of SISs while citing Vancouver’s Insite, I will explore moral and legal issues surrounding the premise of SISs, I will list Canadian legislation pertaining to SISs, I will address the advantages of SISs, as well as include medical arguments in support of SISs.

Conversely, I will explain the disadvantages of SISs and incorporate police services’ arguments against SISs. Finally, I will explicate my recommendations for Ottawa in reforming the harm reduction model.

Purpose of SISs:

In signing the Vancouver Agreement towards urban renewal in 2000, all levels of government prioritized harm reduction followed by prevention, treatment/rehabilitation, and enforcement in addressing the “Four pillars drug strategy” (Dooling and Rachlis 2).

In an effort to address this newly adopted harm reduction initiative and in “response to devastating twin epidemics of HIV (Patrick et al.) and drug overdoses (Tyndall et al.)”

(qtd. in Zlotorzynska et al. 1303), Insite – the first SIS in North America – was created in

Vancouver in 2003 (Insite – Supervised Injection Site; Bayoumi n. pag.); therefore, this section of my project includes research findings generated by Insite. Butler and Philips refer to the Canadian Centre on Substance Abuse in explaining the purposes of SISs,

Safer or supervised injection sites are specialized facilities that provide

injection drug users with a clean, safe, unhurried environment. Sterile 9

injection equipment is provided and health care and social service

professionals are available to deal with health issues, provide counseling,

and facilitate access to detoxification and treatment programs [available

on site or elsewhere]. Supervision is provided by health professionals

trained in low-risk injection techniques and overdose intervention. (1)

To date, Insite is the only Canadian SIS providing safe injection environments

offering primary health care services and voluntary admittance to addiction counseling

and treatments but also affording drug users and addicts housing and community supports

(Insite – Supervised Injection Site). Insite’s front line team includes “nurses, counselors, mental health workers and peer support workers” where Insite’s mandate is to operate

“on a harm-reduction model, which means it strives to decrease the adverse health, social and economic consequences of drug use without requiring abstinence from drug use”; moreover, “Vancouver Coastal Health operates, and provides all the funding senior administrative and health care workers for the facility” (Insite – Supervised Injection

Site). According to its website, Insite’s purposes are listed below (Insite – Supervised

Injection Site):

1. It keeps people from transmitting infectious diseases.

2. It provides the opportunity to form relationships and encourage people with addictions to access health care services, including primary care and addiction treatment.

3. It brings stability to the community by improving public order and reducing the number of injections taking place on the street.

4. It stabilizes people’s health.

I take issue with the overall portrayal that the common denominators behind the existence 10 of Insite being the injection of illicit drugs, drug habits, and addictions seem to be inevitable for people with addictions; furthermore, emphasis placed on accepted drug use in this facility overshadows the cruciality of recognizing root problems of drug use, abuse, and addictions. Aiding people with addictions in the recovery process by prioritizing the importance of detoxification and rehabilitation in achieving overall health and wellbeing are paramount over the allowance of illicit drug use in a SIS. It is one thing to accept that people with addictions visiting Insite have drug issues and addiction problems and to respond by creating an environment where illicit drug use is accepted and allowed, where staff members want to stabilize people’s health against the occurrence of overdoses and infectious diseases, where access to health care services and addiction treatments are voluntary, and where the containment of drug paraphernalia is facilitated (as per Insite’s purposes listed above) but it is another to prevent perpetual and debilitating drug abuse by recognizing and treating the root problems of drug use and addictions enabled by prioritizing detoxification and rehabilitation processes.

I agree Insite’s premise helps in the containment of infectious diseases and drug paraphernalia, assists people with addictions to seek treatments, as well as provides them with first aid practices which all aid people with addictions on a reactive level; however, I argue these practices are not proactive to the point of addressing the root causes of drug use and addictions and going above and beyond in ending the vicious cycle of drug abuse and drug addictions affecting people visiting Insite. By not reaching above and beyond in prioritizing detoxification and rehabilitation processes, Insite’s set norms based on the current harm reduction model create an environment encouraging unhealthy and illegal drug habits by allowing drug use in its facility, ultimately justifying people’s drug use 11

and decreasing incentives of seeking long-term treatment. According to Insite, the accessibility of treatment is available and encouraged by staff members (Insite –

Supervised Injection Site) but voluntary enrollment in available treatment options is not reaching above and beyond when the act of continuing drug use in a safe and controlled environment may be more appealing to people with addictions and may set them up for failure.

In support of Insite, research studies have been conducted in determining its benefits and effectiveness. According to Butler and Phillips, three years after its opening an Expert Advisory Committee, appointed by the federal Health Minister, conducted analyses and evaluations of Insite’s purposes previously listed on page 6 and its consequential impacts; moreover, the Expert Advisory Committee’s research included other jurisdictions in Australia and Europe (Wood et al.) (3). Please refer to Table 1,

Appendix 1 for the Expert Advisory Committee’s report. Additional studies supporting

Insite have also shown results relating to detoxification treatment, averted overdoses, needle-sharing, and drug related crimes listed in Table 1, Appendix 2. Therefore, Insite definitely has its merits for reducing elements of harm but my overall contention, however, supports the ideology that we should be targeting current and future physical and mental health and the overall wellbeing of people with addictions that result in addressing the root causes of drug abuse and addictions enabled by mandating detoxification and rehabilitation as opposed to targeting safe drug use and supporting

Insite’s current premise by building more SISs upholding the status quo. Mandating detoxification and rehabilitation processes are not easy sells but well worth careful attention. 12

In 2012, Insite saw 376,149 visits with an average of 1,028 visits per day, 3,418

clinical treatment interventions, and 497 overdose incidents (Insite – Supervised Injection

Site). Insite houses 13 injection booths and “supplies clean injection equipment such as syringes, cookers, filters, water and tourniquets. If an overdose occurs, the team, led by a nurse, are available to intervene immediately” (Insite – Supervised Injection Site). I

believe there is fault in this reasoning. The fault lies within the actions taken to remedy

drug use and addiction problems: supporting proactive measures underlined in addressing root causes of drug abuse and in mandating detoxification and rehabilitation processes dismantle Insite’s status quo. This generation of drug users and abusers may not all

achieve full recovery and sobriety but adopting a tougher proactive approach to drug

abuse and addiction may curb tomorrow’s youth and may decrease the number of addicts

in the future.

I acknowledge my perception would differ if employed in the medical field and I

understand that Insite’s methodology of providing first aid intervention instantly

remediates the overdose problem instead of having people overdose in alleyways and

overcrowd emergency hospital rooms; however, my police officer’s perspective says the

actions of offering drug paraphernalia as well as immediate assistance in preventing

accidental overdose only encourage drug use which suggest Insite staff members’ acceptance of the inevitable behavioural consequences affecting drug users. By creating

a safe zone injection site, it leads drug users to believe their actions are morally accepted

and free of legal consequences, which subsequently leads community members to

question the premise and benefits of SISs. The morality and legality issues surrounding

SISs follow. 13

Morality issues surrounding SISs:

Morality contentions usually speak to human injustices. Most arguments either

aim to protect people affected by addictions from themselves or aim to protect them from

others. Reinarman argues, “value neutrality in this sense has undoubtedly been useful or politically expedient, allowing for some common ground that benefits drug users by sidestepping ideological disputes” (qtd. in Hathaway and Tousaw 14). Hathaway and

Tousaw state, “harm reduction and enforcement may be reconciled, some argue, by

making human rights the main foundation of drug policy” (13).

I do not believe drug users, abusers, and addicts are immoral people nor do I

believe medical experts treating drug users, abusers, and addicts are acting immorally. I

believe it is immoral and irresponsible to build a facility allowing and supporting

supervised illicit drug use in which the premise of this facility invites drug abuse,

perpetuates addiction, and contributes to health deterioration while not prioritizing the

healing that needs to happen when addressing root causes of drug abuse and addictions

by mandating detoxification and rehabilitation processes within a SIS environment for

people affected by addictions. Mandated detoxification and rehabilitation are at the crux

of my harm reduction model reform and will be explicated in my recommendations

section. Knowing the devastating, negative, and irreversible biological, physiological,

psychological, and emotional effects illicit drugs have on a person and then allowing the injection of these harmful substances by providing clean drug paraphernalia and a safe environment highlight my biggest morality issues. I believe it is immoral to allow these acts to happen without prioritizing detoxification and rehabilitation processes, which 14

address the vicious cycle of drug use. , former Minister of Health, states, a

SIS “undercuts the ethic of medical practice” (qtd. in Bayoumi n. pag.).

Dr. Isra Levy, Ottawa’s health medical officer, makes a shortsighted statement by saying, “the alternative is to turn a blind eye and to have these people leave our care, and go off alone into the night and struggle alone” (Supervised injection site up for debate

Monday at health board meeting 2). Turning a blind eye is not the alternative to building a SIS nor is it to confine them to the limits of a SIS’s current premise of enabling drug use and making rehabilitation voluntary. It is to recognize and acknowledge that effective solutions entail mandating treatment enabling healing which then gives them a much better chance at life.

Legality issues surrounding SISs:

Essentially, illicit drugs and substances listed in the Controlled Drugs and

Substances Act (CDSA) Schedule I – VIII (Justice Laws Website) are illegal; in addition, any person engaged in any act surrounding the possession of these drugs and substances are subject to punishment and legal repercussions as per the Criminal Code of Canada

(CCC) (Justice Laws Website) and the CDSA (Justice Laws Website). In accordance

with my policing background, I am of the opinion that any act relating to illegal drugs

and substances should remain illegal in Canada regardless of the circumstances

surrounding these acts. However, my professional experience leads me to believe

punishing and implementing legal repercussions against drug users and addicts do not

resolve drug use and addiction problems in our society. In other words, incarceration is

not a viable solution in addressing root causes of drug use and abuse: mandating 15 detoxification and rehabilitation treatments within the SIS environment are better solutions.

Police officers can exercise discretion in drug related situations and in my experience most police officers have referred and brought people with addictions to local social services and related facilities instead of arresting and charging them with drug related legislation. I also believe that most police officers share my beliefs that punishing and implementing legal repercussions defeat the purpose and chances of rehabilitating people with addictions. Therefore, I am suggesting police officers continue applying their discretionary powers and bring people with addictions to local social services and related facilities. Conversely, I believe strict punishment should be reserved for illicit drug producers, dealers, and sellers; however, this is beyond the scope of this project and will be kept for another research project.

Insite has received exemptions with regards to acts surrounding illicit drugs and substances in order to offer its services to people affected by addictions. Our Supreme

Court Chief Justice McLachlin explains,

During its eight years of operation, Insite has been proven to save lives

with no discernable negative impact on the public safety and health

objectives of Canada. The effect of denying the services of Insite to the

population it serves and the correlative increase in the risk of death and

disease to injection drug users is grossly disproportionate to any benefit

that Canada might derive from presenting a uniform stance on the

possession of narcotics. (qtd. in Ling 3) 16

In other words, Insite’s “successes” do not make the possession of illicit drugs and

substances valid and acceptable in Canadian culture. Despite its successes in helping

people with addictions, Insite’s concept should not override current CCC and CDSA

legislations. In arguing against SISs, Kopala – an Ottawa resident who has written

extensively on drugs, SISs, and related issues – requests that we “preserve the moral and

legal coherence of our laws and the integrity of our medical and pharmaceutical

communities” (n. pag.). In other words, SISs’ premise and purpose should not override

Canadian legislations making illicit drugs illegal nor should the integrity on which the

medical community prides itself be put into disrepute.

To reiterate my legal stance surrounding visitors of SISs, legal punishment should

not prevail in assisting people affected by addictions achieve better health, wellbeing, and

sobriety. However, the following should be taken into consideration as a potential multi-

pronged approach to SISs. Kevin Hague MP, spokesperson for the Green Party of

Aotearoa New Zealand, called for a “drug law reform policy – towards a harm reduction

model” (n. pag.), which would address current drug legislations, policies, and procedures

in his country and reform them to mirror modern day norms. Canadian drug legislations

can be re-visited as a multi-pronged approach in order to coincide with my call for harm reduction model reform. Now let us explore the intricacies of Canadian legislation pertaining to SISs.

Canadian Legislation Pertaining to SISs:

In 2011, Insite received an extended exemption by the ,

“Insite saves lives… its benefits have been proven (Canada (Attorney General) v. PHS 17

Community Services Society)” (qtd. in Zlotorzynska et al.1303). According to Butler

and Phillips, the Legislative Summary of Bill C-2 explains,

The Court said that in determining whether to grant an exemption for a

supervised injection site, the Minister should also consider evidence

related to the impact of such a facility on crime rates, the local need for a

facility, the regulatory structure in place to support the facility, the

resources to support its maintenance, and expressions of community

support or opposition. In response to the Supreme Court of Canada’s

decision, the Government of Canada introduced Bill C-65, the Respect for

Communities Act, which seeks to define the criteria that the Minister must

consider when assessing whether to grant an exemption under the CDSA

(). (5)

Essentially, the Minister must conduct an extensive analysis – determined by necessity, utility, funding, expenses, maintenance, crime rates, opposition, support, and anything impacting the public’s interest – before a city decides to house a SIS. According to

Zlotorzynska et al., support from local police services and the affected communities must also be met (1303). The prerequisites of community and police support are important in the application of Rodal and Mulder’s theoretical framework addressed in my recommendations section. Another attribute of Bill C-65 is the protection from legal prosecution for people with addictions visiting SISs (Zlotorzynska et al.1303).

However, even though the Minister has discretionary powers whether to grant exemptions to existing SISs, “new restrictions under Bill C-2 could thwart plans for other 18

supervised injection sites” (Ling 2). Bill C-2’s stipulations include more than 25

requirements which some must accompany a letter from “the mayor, the police chief, the

chief medical officer and the relevant provincial minister” whereas other requirements

include providing execution plans supported by scientific evidence and conducting

security background checks on SISs’ staff (Egan n. pag.).

So, how should our current government respond to the requests of SISs?

Canadian citizens have their own opinions, concerns, and suggestions as to how the issue

should be addressed. Graham, former chief of the Vancouver Police Department from

2002 to 2007, facetiously explains, having accepted that drug use is inevitable, the

government has simply “enable[d] them to do so in a safe medical environment” (2). In

other words, instead of upholding the CCC and the CDSA legislations enacted by them

and prioritizing their “get tough-on-drugs” approach, the then government chose a

counter-productive goal, running a SIS enabling and encouraging illicit drug use. Former

Prime Minister saw fault in this reasoning as well; in fact, he vowed to stay true to his government’s tough-on-drugs agenda and explained, “Canadians do not want them in their neighbourhood because such a site ‘flows the entire drug trade into that community’” (Church and Stevenson n. pag.).

This introduces a whole new thread of arguments because it begs the question,

who supplies the drugs and what measures do drug addicts take to fund their addictions?

Do drug dealers purposely seek out the addicts and do the addicts commit crimes to fund

their drug habits? Money that buys drugs comes from criminal activity, which then funds

organized crime (Egan n. pag.). Kopala explains, 19

According to the latest Vancouver Police Department Crime Incident

Statistics report, this [property crime] also increased in 2016 by 24 per

cent over the same period in 2015… the addict typically takes his ill-

gotten gains (women typically prostitute themselves) and, because of an

exemption from the provision of the CDSA extended to Insite by the

Supreme Court in 2011, police officers stand aside as he purchases his

illegal substance from the local crime syndicate. In turn, the syndicate

uses its proceeds to buy guns and even more exotic drugs for addicts to

use in the city’s supervised injection site. (n. pag.)

Essentially, police officers are told to turn a blind eye to any drug deal that occurs within the vicinity of Insite because of this exemption. These off-limits zones blatantly prevent police officers from serving citizens of their community and protecting them from criminal activity. Moreover, purchasing illegal substances from crime syndicates only encourage them to grow their business of organized crime. Not only does Insite limit local authorities from doing their jobs, it gives crime syndicates the opportunity to gain more territory. Essentially, this creates a vicious cycle of victims; drug suppliers use drug dealers to push their illicit and harmful substances onto drug users, often addicted to those substances, who in turn often revert to committing crimes to fund their drug habits, which then proceeds of crime fund organized crime and allow the purchase or more illicit drugs and substances.

The Vancouver Police Department (VPD) was aware of crimes relating to illicit drugs that according to Mike McCormack, president of the Police Association, and Tom Stamatakis, President of the Vancouver Police Union and the Canadian Police 20

Association, the VPD deployed an additional ninety police officers within Insite’s

vicinity; therefore, a decrease in crime rates did ensue (Agar n. pag.). Naturally,

additional police presence would deter criminal activity and lower crime rates in any

particular area. As a result, Wood et al. explain that Vancouver research demonstrates a

decline regarding disorder in conjunction with public injecting (qtd. in Zlotorzynska et al.

1303).

At the outset, many people in the policing environment consequently feel the

exemption under section 56.1 (Butler and Phillips 7) only justifies and supports drug

trafficking, drug possession, drug use, and any drug related crime. Upholding section

56.1 undermines the very existence of our CCC, our CDSA, our legislative process, the

ideal that our society is based on law and order, the government’s tough-on-drugs

approach, the importance of police officers’ oath, police officers’ authority and

investigative skills, and even our claimed efforts in caring for and rehabilitating drug

addicts.

Advantages of SISs:

There is a “widespread agreement among health authorities, including the World

Health Organization, that such programs [harm reduction programs and SISs] are

essential to [in] the fight against HIV/AIDS and other drug-related harms” which

“have helped reduce illicit drug use and improve public health: fewer people are injecting drugs; more are accessing addiction treatment; and HIV transmission related to injection drug use has plummeted” (Insite – Supervised Injection Site). According to Wood et al.,

additional peer-reviewed research demonstrate reductions of syringe sharing, decreases of 21 fatal overdoses, and increases of addiction treatment (qtd. in Zlotorzynska et al. 1303;

Bayoumi n. pag.).

According to Insite, specific research examined its impact regarding four areas: 1) overdoses; 2) health; 3) appropriate use of health and social services; and 4) costs for health, social, legal, and incarceration associated with injection drug use, which resulted in Insite demonstrating a reduction in disease transmission, lives and health care dollars saved, no increase in crime or perpetual drug use, and the promotion of addiction treatment enrollment (Insite – Supervised Injection Site). Consequently, its website illustrates,

The program now has the support of leading national health organizations

such as the Canadian Medical Association, the Canadian Association of

Nurses, and the Canadian Public Health Association. Health organizations

in other parts of Canada are now advocating for similar programs in their

jurisdictions. (Insite – Supervised Injection Site)

At the outset, Insite seems to be meeting its objectives after receiving commendations from various medical authorities as well as organizations and will likely remain open since “the Supreme Court of Canada unanimously determined that it should remain open to protect public health” (Insite – Supervised Injection Site). It is comprehensible why medical authorities highly support Insite’s premise because in addition to its achievements, it reduces the number of people using hospital emergency rooms for drug related treatment and it reduces the overall number of people affected by HIV and other blood borne disease transmissions. 22

Another advantage is its Vancouver’s Eastside location where more than one-third of 12,000 injection drug users live (Insite – Supervised Injection Site). Insite’s accessibility and in-house drug use permit the containment of needles and other drug paraphernalia protecting the general public from coming in contact with used needles and minimizing the exposure to drug use. It gives staff members the opportunity to monitor drug users’ actions and behaviours as well as recommend rehabilitation treatment.

Lastly, staff members administer first aid and medical treatment in the event of drug overdoses. Overall, Insite gets an A if we limit its efforts to its benchmark. However, my main contention deals with aiming higher, going above and beyond its current premise, and calling for a harm reduction model reform by prioritizing the overall wellbeing of people affected by addictions.

Medical Arguments in Support of SISs:

Doctors, nurses, and medical authorities have the responsibility of providing life

to all citizens regardless of where they come from, what lifestyles they choose, or what

their beliefs are. According to Ling, Executive Director Maxine Davis wrote a letter to

the Vancouver Courier stating,

As an employer, we are upholding provincial law – the B.C. Health

Professions Act – by allowing nurses to practice according to

determinations made by their governing body. We are also observing

federal law: nurses do not provide, possess, or assist with the injection of

illegal drugs. (3) 23

At the outset, SISs are extensions of emergency hospital rooms designed with drug users,

drug abusers, and drug addicts in mind because they are encouraged to inject drugs in

close proximity to SIS medical staff in the event of overdoses instead of having to visit

the local emergency rooms or worse dying in deserted alley ways. A 2011 study showing

“overdose deaths around Insite had declined by 35 per cent” was published in

(Insite – Supervised Injection Site). Furthermore, Dr. Beyrer, a professor at Johns

Hopkins School of Public Health, advocates SISs “should be expanded to other affected sites… on the basis of the life-saving effects” (Insite – Supervised Injection Site). Dr.

Bayoumi of Toronto’s St. Michael’s Hospital agrees with research findings demonstrating SISs reduce the transmission of HIV and hepatitis C diseases (CBC News

1).

With regards to other benefits SISs offer, Leikin explains,

Individuals injecting on-site are in a very different environment than

normal, one that is health-rich, and not ‘reinforcing’ as some believe, of

addiction. The presence of health and social service specialists enable

[enables] change, and creates an opportunity to open a door to break the

cycle of addiction. (n. pag.)

I somewhat agree that a SIS is a “health-rich” environment because it does resolve secondary effects of drug use (e.g., needles are discarded in a safe manner, overdose deaths decrease, diseases are less likely to spread, and exposure to drug use) are minimized; however, primary effects of drug use (e.g., irreparable physiological deterioration as well as psychological damage resulting from every injection/intoxication 24

episode) only increase. The option of voluntary detoxification is not enough to break the

cycle of addiction nor does the presence alone of health and social service specialists

entice drug addicts enough to seek treatment; therefore, reforming the harm reduction

model to include mandated detoxification and rehabilitation treatments are realistic

components to breaking the cycle of addictions.

Disadvantages of SISs:

SISs supporters argue the containment of needles and drug paraphernalia in these

sites protects the general public from exposure from those needles and the drug use to

which Rados counter-argues SISs cannot guarantee that all intravenous drug users will

use such facilities for those purposes nor will SISs eliminate the littering and the loitering

e.g., drug users “passing out” on public property (2). I echo this sentiment in that public

health and safety cannot be guaranteed every time drug users want to inject; moreover,

SISs cannot prevent drug users from loitering in public areas because SISs are not

equipped with “pass out rooms” only injection booths. Garth Davies, a criminology

professor at Simon Fraser University, and Colin Mangham, research director for the Drug

Prevention Network of Canada, are authors of a report in which “Mangham faulted the

research into Insite for failing to discuss the fact that ‘only a small percentage of IV drug

users use Insite for even a majority of their injections’” (Geddes 4).

Location becomes a disadvantage for law-abiding citizens living in the vicinity of

SISs because they constantly have to be vigilant and be on the lookout for behaviours

they want to avoid which may make them feel unsafe and in danger of being victims of

criminal activity. Leikin believes that with SISs, “public safety may be improved, at least 25 certainly not worsened” (n. pag.) to which I completely disagree because organized crime tends to monopolize these areas, drug dealers tend to congregate in these areas, and the dangerous measures drug addicts take to fund their drug habits tend to increase. Most importantly, addiction is not just about an isolated, one-time drug use; consequently, it is crucial to recognize that addiction is about feeding that need multiple times a day usually throughout the drug addict’s life span until either the drug addict successfully rehabilitates long-term or dies from the effects of drugs. Therefore, I argue public safety is challenged every time each drug user seeks to feed his/her addiction need.

Another disadvantage for SISs is the widespread agreement among many law enforcement members that Insite should close its doors and similar facilities should never exist. When sworn-in, police officers take an oath to serve citizens of their community and protect them from any criminal activity while upholding the CCC, Federal Statutes,

CDSA, Provincial Offences, and Municipal laws. In the wake of SISs, police officers are concerned with: 1) the promotion of current drug cultures in allowing facilities such as

Insite to exist; 2) the perpetuation of criminal activities deriving from drug use; 3) the acceptance of drug possession and drug use in housing future facilities such as Insite; 4) the notion of SISs undermining drug possession legislations listed in the CCC and

CDSA; 5) trivializing addictions by providing resuscitation practices in the event of overdoses which in turn serve as reactive solutions; 6) underplaying the importance of detoxification and rehabilitation by Insite’s policy against mandatory treatment; 7) the lack of promoting alternative solutions to Insite’s existing premise; 8) establishing proactive solutions toward sobriety; and finally, police officers are concerned with 9) setting precedence that criminal and deviant behaviours relating to SISs are permissible 26

and in the public’s best interest. Therefore, the logic behind the widespread agreement

among law enforcement members against facilities such as Insite is valid and justifiable.

Having taken the oath twice, I take my policing careers, related duties, and responsibilities very seriously; thus, I am of the opinion that Insite’s current premise only perpetuates drug use and addictions, reinforces short-term solutions against overdose death, promotes criminal activity, and does not make use of long-term solutions towards rehabilitation, sobriety, and wellbeing to its full advantage. Reforming the harm reduction model and mandating detoxification and rehabilitation will instill a higher level of encouragement towards utilizing Ottawa resources upholding the logic that detoxification protects drug users from perpetual drug abuse and that rehabilitation programs support addicts toward a life of sobriety. These alternative solutions enhance

Insite’s current premise and entice multiple community resources and stakeholders to work together to uphold what is best for people with addictions as well as what is in the public’s best interest.

In listing another disadvantage, Insite and similar facilities limit themselves to being categorized as reactive environments by allowing avid drug use in providing 13 injection booths and by promoting the use of medical treatment for overdoses over the importance of detoxification and rehabilitation processes which are proactive solutions in achieving sobriety. Catering to drug addicts by allowing drug use in a controlled environment is a disadvantage many people argue. Simply put, SISs’ status quo makes drug use that much more appealing to drug users and addicts.

Another alarming disadvantage is as follows. Fifty percent of people who use 27

Insite “are homeless or living in shelters or have significant mental health issues” and are long-time drug users (Insite – Supervised Injection Site). Establishing mandated detoxification and rehabilitation treatments might help in addressing mental health issues and in turn homelessness.

The last disadvantage of my non-exhaustive list presents itself as a warning.

Recent statistics show that,

According to the Coroners Service of , illicit drug

overdose deaths have increased from 200 in 2007 to a projected 800 in

2016. The introduction of the designer drug fentanyl isn’t solely to blame.

Heroin overdoses – on their own or laced with fentanyl – are a major

factor. (Kopala n. pag.)

Due to the popularity of the drug and the declaration of a fentanyl crisis in Vancouver and other Canadian cities, overdose death projections are grim.

Police Services' Arguments Against SISs:

As one can imagine, the SIS ideology does not appeal to everyone especially members of police services. Dooling and Rachlis report the VPD and the RCMP have declared their opposition to SISs (3). Graham’s professional experiences as Chief of the

VPD and his implications surrounding Insite led him to explain,

The Vancouver Police Department (VPD) supported the opening of the

supervised injection site in 2002 as a research project, not as a concept, 28

and that support continues to this day. The Vancouver Police letter of

support to the federal health minister has been inaccurately used by harm

reduction proponents as a blanket endorsement for a wide variety of

initiatives and projects surrounding the supervised injection site (SIS). (1)

The issues that VPD had with Insite were: firstly, Insite’s misapprehension regarding

VPD’s support in its research project phase and not VPD’s support in its conception; and

secondly, the timeline and duration of the initial research project. Essentially, the VPD

only agreed to support the temporary supervised injection site as a research project;

however, fourteen years later it is still in existence. Graham believes abstinence from drugs is the first solution whereas mandatory and compulsory drug treatment for addicts should be the second solution (2). Education is the third (Graham 2). I address mandatory treatment in the following section.

With regards to possessing illegal drugs, it is understandable why the VPD’s

“position was straightforward – follow the law” (Graham 1) and why the VPD is against the existence of Insite as well as the foundation on which it was built. We should uphold existing legislation relating to the CCC and the CDSA. The Drug Prevention Network of

Canada (DPNC) along with the RCMP oppose Insite’s premise (Insite – Supervised

Injection Site) which should be expected from both organizations to stand against Insite’s

validity because the DPNC and the RCMP’s main objectives are to protect all Canadian

citizens against harmful, illegal substances. They would not meet their mandates,

objectives, and purposes if they argued anything less; moreover, they would disappoint

the majority of Canadian citizens and receive harsh criticism if they failed to uphold any

enacted legislation pertaining to illicit drugs and substances. 29

Mayor Jim Watson and Police Chief Charles Bordeleau not only oppose building

a SIS located in Ottawa but also oppose the application for an exemption by Ottawa’s

Oasis, Sandy Hill Health Services harm-reduction program (Church and Stevenson n.

pag.) because Mayor Watson believes “the focus should be on providing additional

treatment options for drug users” and Chief Bordeleau expresses “concerns about public

safety” (Ottawa Board of Health votes in favour of supervised injection sites 2;

Supervised injection site up for debate Monday at health board meeting 2). Letellier,

chairman of the Cactus board of directors in Montreal, has voiced his willingness to open

a SIS before they are granted legal approval (Church and Stevenson n. pag.). In essence,

it is of the utmost importance that the Nation’s Capital set precedence and demonstrate

leadership setting the example for other Canadian cities like “Toronto, Montreal, and

Edmonton” (Supervised injection site up for debate Monday at health board meeting 1) wanting to establish SISs.

My Recommendations for Ottawa:

Due to the scope of this research project, I will explicate one solution directly

involving SISs’ harm reduction model. However, other proactive solutions such as the

continuation of delivering early education and drug prevention programs in schools,

establishing the practice of early mental health issues and addictions diagnoses,

encouraging family support throughout the rehabilitation process, assisting recovering

addicts and connecting them with available community resources and housing, guiding

the employment search for recovering addicts, as well as supporting the necessity of

financial and long-term planning for their future are indispensable in a multi-pronged 30 approach against drug addictions.

Any new proposed injection site must be upheld by an approved amount of positive scientific and medical evidence, relevant additional research, consultations, and community impact assessments (Ling 2). If Ottawa’s decision is to house a SIS then in reaching above and beyond Insite’s current premise, a long-term agreement should be made and a commitment contract should be drawn up between the SIS and local detoxification and rehabilitation centres detailing drug users and addicts willing to get professional help will be guided to enter one of Ottawa’s sixty-three centres listed in

Table 1, Appendix 3 all ranging from outpatient rehabilitation services, withdrawal management and detoxification centres, private practice addiction clinics, methadone clinics, support group services, which all serve groups differentiated by age, gender, as well as life circumstance (Existing Addictions Treatment Options in Ottawa compiled by

Annyx Day, 2017 based on the Sunshine Coast Health Centre: A Non 12-Step Program website). These centres equipped with highly trained professionals treat addictions by guiding and encouraging drug users and addicts to follow successful paths in achieving detoxification and long-term recovery; therefore, treatment enrollment and recovery success rates may increase if what I propose is followed.

McCormack, president of the Toronto Police Association, states, “you have to have some realistic measures to get people off drugs, not to condone the use of drugs”

(Agar n. pag.). Furthermore, Agar explains, “we don’t cure alcoholism by inviting alcoholics to the bar” (n. pag.). I absolutely agree you cannot expect to cure a disease by subjecting addicts to the very environment that condones the use of what made them sick in the first place. The whole point of detoxification and rehabilitation is to isolate the 31

person from what is endangering them, to treat underlying factors of addiction, to teach

them coping skills, and to present them with healthy options. Ottawa has sixty-three

healthy options. Dr. Baker believes “support, treatment, abstinence, and counseling are

all part of the solution” to curing drug addictions (Graham 2). Widespread prevention

and treatment programs are necessary solutions (Kopala n. pag.).

Bayoumi recommends a SIS “should have clearly established rules” (n. pag.).

Therefore, the following is what my harm reduction model reform entails: by prioritizing

the goal of targeting current and future physical and mental health and the overall

wellbeing of people affected by addictions resulting in addressing the root causes of drug

abuse and addictions, the following SIS*5*STEPS enable enrollment in mandated

detoxification and rehabilitation programs. Essentially, every time a person with an

addiction visits the SIS located in Ottawa, he/she is given an equal opportunity to apply

all the steps listed below in attaining recovery from drug use, abuse, and addiction.

However, the steps are done before he/she injects the drugs in order to encourage a

clearer and of sound mind decision process.

SIS*5*STEPS

Step 1 – Initial consultation with a health and social service specialist to determine if the person with an addiction wants help to quit drug use and receive professional guidance to ending the addiction cycle; if so, determine what type of help is required. If not, person with an addiction leaves the consultation area and is free to use the drugs within the SIS.

Step 2 – Ottawa’s SIS health and social service specialist refers the person with the addiction, who voluntarily requested help, to an Ottawa detoxification and/or rehabilitation centre appropriate for the person’s needs and goals.

Step 3 – Mandate the treatment by signing a non-binding agreement/contract (the person with the addiction keeps a copy of the contract for the purpose of a visual 32 reminder of the verbal commitment made between staff and the person with the addiction). The drugs are taken away and discarded by SIS staff.

Step 4 – Person with the addiction enters appropriate detoxification and/or rehabilitation program determined by the previous consultation.

Step 5 – Follow-up done by SIS staff with detoxification and/or rehabilitation staff to retrieve progress report regarding the referred person with the addiction.

Created by Annyx Day, 2017

These five steps may decrease the chances of people with addictions from falling through the cracks as the steps are repeated every time they visit Ottawa’s SIS even if they have previously relapsed from a detoxification and/or rehabilitation program. Essentially, the repetitious nature in the application of the SIS*5*STEPS for every person that utilizes the SIS is what may be the turning point and even the catalyst towards recovery.

Therefore, equal opportunity, consultation with a specialist, visual reminder of the agreement, mandated detoxification and rehabilitation requested by the person with the addiction, and repetition of the process may influence detoxification and rehabilitation success rates.

At the outset, my harm reduction model reform necessitates members of

Parliament, various community stakeholders, and health and social service specialists work together to enact my SIS*5*STEPS and to meet specific stipulations outlined in

Bill C-2 in addition to respecting existing Canadian legislations before housing a SIS in

Ottawa. SIS*5*STEPS should also set precedence for other Canadian cities wanting to house SISs. The following demonstrates how my harm reduction model reform coinciding with Rodal and Mulder’s theoretical framework appropriate for this context are attainable. Rodal and Mulder’s definitions of the 1990s concepts 1) consultation, 2) 33

partnership, and 3) devolution are as follow (27-8):

1) Consultation – is ‘an interactive and iterative process’ that seriously elicits and considers the ideas of clients and other stakeholders, and encourages their input in decision-making, policy development, issues resolution, and the design and delivery of programs and services (Environment Canada).

2) Partnership – is an arrangement between two or more parties who have agreed to work cooperatively toward shared and/or compatible objectives and in which there are shared authority and responsibility, joint investment of resources, shared liability or risk-taking, and mutual benefits.

3) Devolution – denotes the transfer of functions or responsibility for the delivery of programs and services from the federal government to another entity.

Consultations will appease concerns stakeholders and community members may have while encouraging the input of their perspectives in order to collectively design relevant policy in conjunction with service delivery logistics. Future Ottawa Public

Health surveys and stakeholder sessions will address service delivery logistics (Ottawa

Board of Health votes in favour of supervised injection sites 2).

Partnership will determine which detoxification and rehabilitation centres listed in Table 1 Appendix 3 want to work cooperatively with Ottawa’s SIS to apply

SIS*5*STEPS while being directly implicated in the recovery processes of people with addictions. An agreement by way of a contract between local detoxification and rehabilitation experts and Ottawa’s SIS needs to happen to halt the following: local statistics demonstrate an alarming trend,

On average, 33 Ottawa residents die each year from unintentional drug

overdoses, representing 72 per cent of all drug overdoses. The Ottawa

coroner predicted that with current trends in opioid use, strength and 34

availability, the number of overdose deaths in Ottawa is likely to increase.

(Leikin n. pag.)

In the prevention of such overdoses, the Sandy Hill Community Health Centre has been pushing for a SIS for a while now with or without the government’s approval; in fact, there have been three more Ottawa Health Centres – Centretown, Somerset West, and Carlington Community Health Centres – following suit (Reevely 5). Jack McCarthy, executive director at the Somerset West centre, believes multiple SISs in Ottawa are justified due to wide-spread drug users in our city (Reevely 5); furthermore, Cameron

MacLeod, board executive director at the Carlington centre, supports future SISs in

Ottawa based on some of the centres’ existing needle-exchange programs (Reevely 5).

Other statistics conducted by the Forum Research demonstrate a 58 per cent approval rate of a SIS located in Ottawa (Crawford n. pag.).

North American statistics illustrate in 2003, 2.6 million received rehabilitation treatment of more than 24 million suffering from substance abuse (Innovative Drug &

Alcohol Rehab n. pag.) and the Sunshine Coast Health Centre reports in 2006, approximately 50 per cent achieved abstinence, 20 per cent relapsed short-term, and 30 per cent were in various stages of relapse (n. pag.). According to the Drug Addiction

Recovery Statistics – Treatment Center Statistics, flawless recoveries are seldom (n. pag.). I also attempted to get statistical information from a spokesperson for Insite but to no avail, she never returned my call. Consequently, the whole purpose of SIS*5*STEPS is to increase accessibility to and success rates of detoxification and rehabilitation processes. 35

Finally, the transfer of responsibilities from the federal government to the

municipal government will define the devolution process. This process encompasses the

logistics of a SIS; moreover, Jozaghi et al.’s research revealed the cost-effectiveness of a

SIS in Ottawa is dependent on the prevention of both human immunodeficiency virus

(HIV) and hepatitis C virus (HCV) (2). For a complete research analysis and explanation

of their findings, government officials, community stakeholders, as well as health and

social service specialists involved in this endeavour can refer to their study.

Conclusion:

The decision to house a SIS in Ottawa is much more complicated than what it may seem on the surface in that numerous components illustrated in this research project need to be taken into account. SISs currently reflect the existing harm reduction model.

However, my main contention throughout this research analysis has been the existing harm reduction model benchmark does not reach above and beyond in addition to Insite’s accomplishments. Even though Insite has its merits and academic research commends its

medical staff members for meeting its purpose and objectives, my overall contention

called for a harm reduction model reform by prioritizing the goal of targeting current and

future physical and mental health and overall wellbeing of people with addictions that

results in addressing the root causes of drug abuse and addictions enabled by integrating

appropriate steps toward mandating detoxification and rehabilitation as alternative

solutions to targeting safe drug use and supporting Insite’s status quo.

I described the purpose of SISs while citing Vancouver’s Insite, I explored the

moral and legal issues surrounding the premise of SISs, I listed Canadian legislation 36

pertaining to SISs, I addressed the advantages of SISs, as well as included medical

arguments in support of SISs. Conversely, I explained the disadvantages of SISs and

spoke to police services’ arguments against SISs. Finally, I explicated my recommendations for Ottawa in reforming the harm reduction model and enacting

SIS*5*STEPS before housing a SIS.

I also argued the city of Ottawa’s endeavour needs to be innovative and represent leadership for other Canadian cities wanting to house SISs. I believe SIS*5*STEPS highlight simple yet effective solutions, which target current and future overall wellbeing of people affected by addictions. Furthermore, SIS*5*STEPS connect people with addictions with local long-term recovery specialists giving them a chance at a better life.

Therefore, it is imperative the government, community stakeholders, and health and social service specialists enact and establish SIS*5*STEPS before housing a SIS in

Ottawa, Ontario, Canada in the best interest of people with addictions as well as in the

public’s best interest. 37

Appendix 1

Table 1 – Findings of the Expert Advisory Committee Examining Research on Supervised Injection Sites quoted in Butler and Phillips (3):

Formally Stated Objective Findings of the Expert Advisory Committee of Insite Increasing access to health • Insite encourages users to seek counseling, and addiction care detoxification and treatment, which results in an increased use of detoxification services and increase engagement in treatment. • Insite facilitated the immunization of injection drug users in Vancouver’s downtown East Side during an outbreak of pneumococcal pneumonia in 2006. Determining impact on • Insite staff have successfully intervened in over overdose fatalities 336 overdose events since 2006 and no overdose deaths have occurred at the service. • Mathematical modeling suggests that Insite saved about one life a year as a result of intervening in overdose events, though the committee suggested that the validity of these findings should be treated with caution. Reducing the transmission of • Self-reports from users of Insite’s services and blood-borne viral infections users of supervised injection sites in other and other injection-related countries indicate that needle sharing decreases infections with increased use of these sites. • However, no direct evidence exists that supervised injection sites reduce the rates of HIV infection. Determining impact on • Self-reports indicate that there was a reduction in public order the number of people injecting in public in the downtown East Side, as well as in the vicinities of supervised injection sites located in other jurisdictions. However, the committee cautioned that these sites do not have the capacity to accommodate all or most injections that might otherwise take place in public. • There was no evidence of increases in drug- related loitering, drug dealing or petty crime in areas around Insite, or other supervised injection sites located in other jurisdictions. One supervised injection site was closed in Europe due to littering and loitering. • There were no changes in rates of crime recorded 38

by police during the first three years of Insite’s operations. • There is no evidence that supervised injection sites influence rates of drug use in the community or increase relapse rates among injection drug users. Determining cost- • Cost-benefits studies showed that one dollar spent benefits/effectiveness on Insite provided a savings of between $0.97 and $2.90 to the health care system, reflecting potential cost savings associated with preventing HIV infections and overdoses. • However, the committee noted that these results should be treated with a degree of caution because of limitations in the validity of the data used in the analysis. Table prepared by the authors using data obtained from Health Canada, “Vancouver’s INSITE service and other Supervised injection sites: What has been learned from research? Final report of the Expert Advisory Committee,” Reports & Publications, 31 March 2008.

Butler and Phillips 3

39

Appendix 2

Table 1 – Insite’s effectiveness quoted in Dooling and Rachlis (3):

• A study published in 2006 showed that there was an increase in uptake of detoxification services and addiction treatment (Wood et al.).

• Another study published in 2006 showed that Insite did not result in increased relapse among former drug users, nor was it a negative influence on those seeking to stop drug use (Kerr et al.).

• Results of studies using mathematical modeling showed that about one death from overdose was averted per year by Insite (Expert Advisory Committee).

• A subsequent study estimated 2-12 deaths averted per year (Milloy et al.)

• Although these studies did not have sufficient power to detect any difference in incidence of blood-borne infections, Kerr and colleagues did find that Insite users were 70% less likely to report needle-sharing than those who did not use the facility (Kerr et al.).

• Wood and colleagues found that there was no increase in crime following the opening of the facility (Wood et al.).

• There had been statistically significant decreases in vehicle break-ins and theft, as well as decreases in injecting in public places and injection-related litter (Wood et al).

• In 2008, an economic analysis concluded that Insite provided incremental benefits beyond more traditional harm programs such as needle exchange (Bayoumi and Zaric).

• The investigators considered Insite’s impact on needle-sharing behaviour, safe injections practices and increased referral to methadone maintenance treatment and concluded that there were incremental net savings of $18 million and 1175 life-years over 10 years of facility operation (Dooling and Rachlis).

Dooling and Rachlis 3

40

Appendix 3

Table 1 – Google search for Drug Rehabilitation Centres in Ottawa. Existing Addictions Treatment Options, Professionals, and Organizations in Ottawa compiled by Annyx Day, 2017 based on the Sunshine Coast Health Centre: A Non 12-Step Program website.

Ottawa – Outpatient Services

• Sandy Hill Community Centre, Inc. (for youth and adults)

• Amethyst Women’s Addiction Centre (for women)

• Centretown Community Health Centre (ages 55 and older)

• Decision Canada (male federal offenders, ages 18 to 99)

• Maison Fraternité – Fraternity House (ages 14 to 99)

• Ottawa Booth Centre (for men)

• Rideauwood Addiction and Family Services

• Serenity House

• Sobriety House (for men)

• OATC Vanier Clinic

Ottawa Outpatient Services – Private Practice Addiction Therapists

• Andrea Allevato – BSc, MA, CCC

• Carole Alphonso – R. Psych

• Morry Appelle – Ph.D.

• Conny Barry – MA, M.Ed

• Rory Batchilder – Med, CCC

• There are 38 other qualified therapists listed

41

Ottawa Withdrawal Management Services (Detox)

• Montfort Renaissance Inc. Ottawa Withdrawal Management Centre

• Royal Ottawa Mental Health Centre

Ottawa Methadone Maintenance Therapy

• Ontario Addiction Treatment Centres (two locations)

Ottawa Medical Monitoring Services

• Health at Work Services

Finally, there are five locations for Mutual Support Meetings in Ottawa. There are sixty- three facilities in total located in Ottawa.

Existing Addictions Treatment Options, Professionals, and Organizations in Ottawa compiled by Annyx Day, 2017 based on the Sunshine Coast Health Centre: A Non 12-Step Program website.

42

Works Cited

Agar, Jerry. “Not so safe injection site.” Toronto Sun 8 July 2013: n. pag. Web. 20

Aug. 2016. Print.

Bayoumi, A. M., and G. S. Zaric. “The cost-effectiveness of Vancouver’s supervised

injection facility.” CMAJ 179 (2008): 1143-51.

Bayoumi, Ahmed. “Evidence, values, and ideology in public health decision-making:

The debate over supervised injection facilities.” PHO Grand Rounds. Centre for

Research on Inner City Health St. Michael’s. Public Health Ontario. 26 Nov. 2013.

Lecture.

Butler, Martha, and Karin Philips. “Legislative Summary: Bill C-2: An Act to amend the

CDSA.” Library of Parliament 41-2-C2-E (2013, Revised 2015): 1-13. Print.

Canadian Centre on Substances Abuse. “Harm Reduction: What’s in a Name?” Jul.

2008. Web. 14 Dec. 2016.

CBC News. “Safe-injection sites make financial sense for Ontario, study says: Health-

care system could be spared high cost of new hepatitis C treatments.” CBC News.

Web. 4 Apr. 2016. Print.

Canada (Attorney General) v. PHS Community Services Society. SCC 44, 3 S.C.R. 134,

2011.

Church, Elizabeth, and Verity Stevenson. “Supervised injection site proponents push on

despite Harper’s opposition.” 14 Aug. 2015: n. pag. Web. 19

Apr. 2016. Print.

Crawford, Blair. “Support grows for Ottawa safe injection site: poll.” Ottawa Citizen

26 Jul. 2016: n. pag. Web. 20 Aug. 2016. Print. 43

Dooling, Kathleen, and Michael Rachlis. “Vancouver’s supervised injection facility

challenges Canada’s drug laws.” CMAJ 182.13 (2010): 1440-1444. I printed 1-9.

Print.

Drug Addiction Recovery Statistics – Treatment Center Statistics. “What are the Most

Recent Drug Addiction Recovery Statistics?” Luxury Rehabs. Web. 1 Jan. 2017.

Drug Prevention Network of Canada. Home Page. Web. 12 Dec. 2016.

Egan, Kelly. “Egan: New law could kill any hope for safe-injection site in Ottawa.”

Ottawa Citizen 7 Apr. 2015: n. pag. Web. 19 Apr. 2016. Print.

Environment Canada. Environment Canada in Transition, Consultations and

Partnerships: Working Together with Canadians. Environment Canada, Internal

Publication Prepared for the Transition Team Steering Committee on Consultations

and Partnerships. Jun. 1992.

Erickson, Patricia, et al. “CAMH and Harm Reduction: A Background Paper on its

Meaning and Application for Substance Use Issues.” CAMH Centre for Addiction

and Mental Health May 2002: 1-8. Print.

Expert Advisory Committee. “Vancouver’s INSITE service and other supervised

injection sites: What has been learned from research?” Health Canada. 31 Mar. 2008.

Web 14 Nov. 2016.

Forum Research: The Forum Poll. Web. 14 Nov. 2016.

“Four pillars drug strategy.” Vancouver (BC): City of Vancouver. 2008. Web. 14

Nov. 2016.

Geddes, John. “RCMP and the truth about safe injection sites.” Macleans (20 Aug.

2010): 1-7. Web. 7 Nov. 2016. Print. 44

Google. Search for “drug rehabilitation centers in Ottawa.” Web. 3 May 2016.

Graham, Jamie. “Supervised injection sites – a view from law enforcement.” BCMJ 50.3

Apr. 2008: 132-4. I printed 1-2. Print.

Green Party of Aotearoa New Zealand. “Drug Law Reform Policy – Towards a Harm

Reduction Model.” Home Page. 2011. Web. 26 Jan. 2017.

“Harm Reduction: Alternative Therapies.” Street Works. 1-2. Web. 13 Nov. 2016. Print.

Hathaway, Andrew D., and Kirk I. Tousaw. “Harm reduction headway and continuing

resistance: Insights from safe injection in the city of Vancouver.” International

Journal of Drug Policy 19.1 Feb. 2008: 11-16. Print.

Health Canada. “New Legislation for Supervised Consumption Sites.” Backgrounder,

Jun. 2013.

Health Canada. “Vancouver’s INSITE service and other supervised injection sites: What

has been learned from research? Final report of the Expert Advisory Committee.”

Reports & Publications 31 Mar. 2008.

Healthy Place: America’s Mental Health Channel. “Types of Addictions: List of

Addictions.” Healthy Place Home Page. Web. 19 Jan. 2017.

Innovative Drug & Alcohol Rehab. “Drug Rehab Statistics, Cost, Process, Success

Rates.” Sober College Rehab Redefined. 21 Jan. 2015. Web. 1 Jan. 2017.

“Insite – Supervised Injection Site.” Insite Home Page. Web. 19 Apr. 2016. Print.

Jozaghi, Ehsan, et al. “A cost-benefit/cost-effectiveness analysis of proposed

supervised injection facilities in Ottawa, Canada.” BioMed Central (2014):

9-31. I printed 1-25. Print.

Justice Laws Website. “CDSA (S.C., 1996, c. 19).” Government of Canada. 27 Jan. 45

2017. Web. 31 Jan. 2017.

Justice Laws Website. “Criminal Code (R.S.C., 1985, c. C-46).” Government of Canada.

27 Jan. 2017. Web. 31 Jan. 2017.

Kerr, T., et al. “Safer injecting facility use and syringe sharing among injection drug

users.” Lancet 366 (2005): 316-8.

Kerr, T., et al. “Impact of a medically supervised safer injection facility on community

drug use patterns: a before and after study.” BMJ 332 (2006): 220-2.

Kopala, Margret. “The harm in ‘harm reduction.’” The Ottawa Citizen 17 May 2008:

n. pag. Web. 2 Jul. 2016. Print.

Kopala, Margret. “Kopala: Why safe injection sites won’t cut it.” 9 Aug. 2016: n. pag.

Web. 20 Aug. 2016.

Leikin, Lewis. “Leikin: Why the Ottawa board of health supported supervised

injection sites.” Ottawa Citizen 24 Jun. 2016: n. pag. Web. 20 Aug. 2016. Print.

Ling, Justin. “Safe injection sites in Montreal.” CBC National Magazine Jun. 2015:

1-4. Print.

Logan, Diane, E., and G. Alan Marlatt. “Harm Reduction Therapy: A Practice-Friendly

Review of Research.” J Clin Psychol. 66.2 Feb. 2010: 201-14. I printed 1-12. Print.

Milloy, M., et al. “Estimated deaths averted by North America’s first

medically-supervised safer injection facility.” PLoS One 3 (2008): e3351.

“Ottawa Board of Health votes in favour of supervised drug injection sites.’’ CBC News

21 Jun. 2016: 1-2. Web. 7 Nov. 2016. Print.

Patrick, D.M., et al. “Determinants of HIV seroconversion in injection drug users during

a period of rising prevalence in Vancouver.” Int J STD AIDS 8 (1997): 437-45. 46

Rados, R. “Safe Injection Is A Fallacy. Poletical 1 Aug. 2013: 1-3. Print.

Reevely, David. “Groups may take poke at ‘micro’ injection sites.” The Ottawa Sun

17 Jun. 2016: 5. Print.

Reinarman, C. “Public health and human rights: The virtues of ambiguity.” International

Journal of Drug Policy 15 (2004): 239-241.

Rodal, Alti, and Nick Mulder. “Partnerships, Devolution and Power-sharing: Issues and

Implications for Management.” Optimum: The Journal of Public Sector

Management 24.3: 27-45. 1993. Print.

Sunshine Coast Health Centre. “Success Rates in Addiction Treatment Centres.” Home

Page. Web. 1 Jan. 2017.

Sunshine Coast Health Centre: A Non 12-Step Program. “Directory of Alcohol and Drug

Rehab Programs.” Home Page. Web. 24 Feb. 2017.

“Supervised injection site up for debate Monday at health board meeting.” CBC News

20 Jun. 2016: 1-2. Web. 7 Nov. 2016. Print.

Tyndall, M., et al. “HIV incidence and mortality among injection drug users in

Vancouver – 1996-2000 [abstract].” Can J Infect Dis Med Microbiol 12 (2001):

69 B.

Wood, E., et al. “Changes in public order after the opening of a medically supervised

safer injection facility for injection drug users.” CMAJ 171 (2004): 731-4.

Wood, E., et al. “Attendance at supervised injecting facilities and use of detoxification

services.” N Engl J Med 354 (2006): 2512-4.

Wood, E., et al. “Impact of a medically supervised safer injecting facility on drug

dealing and other drug-related crime.” Subst Abuse Treat Prev Policy 1 (2006): 13.

Wood, E., et al. “Summary of findings from the evaluation of a pilot medically 47

supervised safer injection facility.” CMAJ 175.11 Nov. 2006: 1399-404.

Zlotorzynska, Maria, et al. “Supervised injection sites: Prejudice should not

trump evidence of benefit.” CMAJ 185.15 Oct. 2013: 1303-4. Print.