Welcome to our blog about Opioids!

Over the course of the next few weeks, this blog will cover several areas of interest regarding Opioids. Please click on any of the links below to check out the information regarding these topics, and how they relate to Opioid systems!


Endogenous Opioid Neurotransmitters

Heroin

Chronic Pain

Morphine Derivatives

Safe Injection Sites

Safe Injection Sites

Welcome back to Team Opioid’s blog! Today’s blog, which is about safe injection sites (SIS), will be the final post adding to our discussion about Opioids. Hopefully from this blog you’ll be able to understand more about SISs, and be able to make a better informed decision as to whether or not SISs are a good system implementation to promote harm reduction within the community of intravenous drug users.


Courtesy of Kan (2009)

Introduction
From sharing needles to being improperly informed about drug use methods, many drug users end up being infected with diseases like HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and the development of abscesses (which is the swelling of some parts of tissue from a bacterial infection - occasionally resulting in pus forming)(Koester, Glanz, & Baron, 2005). Because of these infectious diseases and harmful drug use behaviour, there is a current need to find a way to reduce the harmful effects of drug abuse.

One ‘new’ method in helping prevent the spread of diseases from drug use is by using a Safe injection site (SIS), also known as a safer injection facility (SIF)(Strathdee, 2007). There are many controversial policies which work in favour of, as well as against, the use of safe injection sites (SISs). However, it will be through time and pilot programmes that will allow for the proper diagnosis of the efficacy of SISs. One of the many pilot SISs is here in Vancouver, B.C, located within the downtown east side of Vancouver. Even though this injection site has not been in Vancouver for very long, there seem to be many ideas on whether this injection site is helpful or harmful to drug users, and also whether this site should be kept open. Hopefully from this blog, there will be more insight shed upon both sides of what SISs are about, and as the reader, you’ll be able to make your own decision on whether or not these injection sites are helpful.

Arguments Against the Use of Safe Injection Sites(SISs)
One main argument against the use of SISs is that SISs promote the use of drugs. By creating a clean sterile environment and providing the drug users with syringes, bandages, ‘cookers’, and other drug use paraphernalia, some individuals believe that this promotes the use of drugs and is creating an extreme liberal attitude (Skretting, 2006). Individuals against the use of SISs may believe that the money used for SISs could be used to promote drug prevention programs instead of the harm reduction program that the SISs are used for and that the use of SISs is a waste of money and human resources (Skretting, 2006). Others may believe that SISs are a nuisance to the neighbourhood that they are housed in and promote more problems than it solves. However, even though there might seem to be disadvantages of having SISs, there may be some advantages too.

Arguments Supporting the Use of Safe Injection Sites (SISs)

One benefit of having SISs is allowing relationships to form between health care workers and drug users. Within these relationships, there is an opportunity to counsel drug users that need help with their drug taking habits and hopefully in time suggest that the individuals attend detox programs. When drug taking individuals come to use the SIS, they are offered new needles, bandages, alcohol wipes, ‘cookers’, as well as a clean sterile environment, that is closely monitored by nurses and counsellors, to engage in their drug taking behaviour. Offering proper drug injection methods and observing individuals after they administer their drug will allow for less opportunities of overdosing during the time of drug taking. This also allows for decreased opportunities to spread HIV, HBV, HCV, or other diseases (Koester, Glanz, & Baron, 2005). Preventing situations where drug overdosing can occur can help save an individual’s life and give them back their dignity in letting them know that they are cared for (Skretting, 2006). Another benefit of having an SIS is allowing drug users to attend one consistent safe environment to use their drugs rather than going to many different public places like coffee shops and creating problems with other individuals. This also prevents drug using individuals from using public washrooms to ‘shoot up’ or littering the public areas with drug paraphernalia. Having a central environment for drug users to go will allow for proper disposal of drug needles that will prevent less disease spreading to the general public. As we see the benefits of SISs, we realize that there is also a SIS that is within our very own city.

Vancouver's Very Own Safe Injection Site (SIS) - Insite

According to Insite’s Website (http://supervisedinjection.vch.ca/), Insite is the first safe injection site to run in Canada and in North America under the Controlled Drugs and Substances Act. This safe injection site first opened in 2003 and is currently used as a pilot study to understand the benefits and the effects of having a safe injection site for intravenous drug users. This injection site is open 18 hours a day, seven days a week for drug users to use the facilities. Insite is a part of Vancouver Coastal Health and works alongside with the Vancouver Police Department, Portland Hotel Society Community Services (PHS), and more (http://supervisedinjection.vch.ca/). There have been over 7500+ individuals who have registered to use Insite in Vancouver. Insite is currently about to attend trial to decide whether they should continue on as a SIS or to be closed down.

For an opportunity to read some personal stories from drug users and how Insite has helped them (Click on the link to download from Insite’s Website): http://supervisedinjection.vch.ca/docs/insite_stories.pdf

Some facts about SISs:

• SISs are a drug prevention program using the method of ‘harm reduction’. Harm reduction tries to ensure that individuals that do high risk behaviours will be able to minimize the consequences of their behaviours (i.e. – reduce the amounts disease spread among drug users, or the amount of people that overdose) (http://www.soros.org/initiatives/health/focus/ihrd/articles_publications/articles/what_20010101). Harm reduction is part of a four pillars drug approach in Vancouver alongside prevention, treatment, and enforcement.


• Although the argument against SISs (like Insite) is that they promote drug use in individuals, this is not necessarily true. According to Substance Abuse Treatment, Prevention, and Policy research from Insite’s website (http://supervisedinjection.vch.ca/research.htm), Insite has not increased the amount of individuals seeking drug use behaviour or other at risk-behaviours that may be associated to drug use.
  


• Individuals need to register before being able to use SISs.

More Media Coverage Regarding Safe Injection Sites:

Insite: Vancouver's Own Safe Injection Site Website

The Fifth Estate: “Staying Alive” Video (Studer, 2009)

The Fifth Estate (2009): Timeline: Insite

The Canadian Encyclopedia: Vancouver's Safe-Injection Sites Controversy (MacQueen, 2003)

CTV News: Federal lawyers in court to shutter B.C. injection site (The Canadian Press, 2009)

CTV News: 'Safe' crack rooms could cut HIV rate: B.C. study (The Canadian Press, 2009)

References