"There's a health crisis in Ottawa."
Chris Dalton's pronouncement contains not a trace of drama, but it's hard to reconcile with the city I see at the moment. It's springtime in the national capital, and it's beautiful -- the bike paths along the canal and rivers are getting busy, trees are flourishing in greens and reds, and the historical architecture in the core of the city glints beneath the sunlight.
But even in a well-groomed capital city, social inequities are playing out with detrimental health consequences. If you’re paying attention, they’re apparent. As a social worker, Dalton is paying attention.
"It started when I worked at the Shepherds of Good Hope, which is a shelter in Ottawa, back in 2010. That's kind of the last-chance shelter in Ottawa," he says, explaining that people end up there after they've been kicked out of the other shelters. Despite different policies towards drug use among shelters, people continue to bring drugs inside.
"We've made it as hard as possible to use drugs, and people are still doing it. Shutting doors and pushing people out into the streets is not deterring people from using drugs."
Ottawa is one of the leading cities in Canada when it comes to HIV and hepatitis C infections among drug users, and last year there were at least 36 overdose deaths.
As part of the Campaign for Safer Consumption Sites (CSCS) in Ottawa, Dalton is working to change ineffectual approaches to drug use, "by bringing people inside and treating them as human beings with health problems instead of criminals committing illegal activity."
The people behind CSCS want to see a facility modeled on Insite, Vancouver's supervised injection facility. The benefits of Insite for not only people who use drugs, but also the wider community, have been extensively documented: reductions in public drug use, needle sharing, neighbourhood litter, and long-term health expenditures; increases in use of counselling, detoxification, and addiction treatment services; and prevention of HIV and hepatitis transmission as well as overdose deaths.
In Vancouver, support for Insite has grown since its inception. Now, the police department, current and former mayors, and local business associations are in favour of it. Such is the magnitude of the positive community change created by the facility.
CSCS already has support from health professionals, including nurses and community health centre staff; Dr. Mark Tyndall, head of infectious diseases at the Ottawa Hospital; and Dr. Lynne Leonard, an epidemiologist at the University of Ottawa. Members of the Drug User Advocacy League and other groups of people who use drugs stand behind the proposal. Recently some members of the police force have even vocalized support, according to Dalton.
Focused on Ottawa's ByWard Market and Lowertown area, where three of the city's biggest shelters are located, CSCS organizers are now striving to build and demonstrate community support for the establishment of a safe consumption site. A few weeks ago, they hit the streets, knocking on doors and talking to residents.
"We surveyed people in the neighbourhood as well as gave information," says Dalton, who admits that the response from residents was better than expected. Of the people spoken to, most were not knowledgeable about the impact of safer consumption sites. Some people became supportive when they learned more about it. Others maintained their opposition to the idea, citing concerns such as increasing numbers of drug users and littered needles -- concerns that Insite has shown to be unfounded, as the facility has actually helped decrease public drug use and litter. Overall, according to Dalton, among surveyed residents there was "about 78 per cent support for a site in Ottawa" and "65 per cent support for a site in the ByWard Market."
The need to gain community support for a health initiative with clear benefits may seem bizarre. After all, clinics and hospitals are opened without so much grumbling and groundwork.
But the Supreme Court ruling that allowed for the continued operation of Insite in 2011 was double-edged.
It meant that the life-saving and life-dignifying work of Insite could go on. The judges ordered the federal government to grant the needed exemption to the Controlled Drugs and Substances Act (CDSA) that would allow drug users to safely access the facility. It was a slapdown to the federal government's intransigence in the face of mountains of evidence demonstrating the beneficial outcomes of Insite for the community.
At the same time, the ruling didn't open the floodgates to more safe injection sites. The court affirmed that the decision was not "an invitation for anyone who so chooses to open a facility for drug use under the banner of a 'safe injection facility.'"
The court stipulated that the health minister must weigh any decision to grant an exemption to the CDSA by considering the "evidence, if any, on the impact of such a facility on crime rates, the local conditions indicating a need for such a supervised injection site, the regulatory structure in place to support the facility, the resources available to support its maintenance, and expressions of community support or opposition."
This leaves health advocates in the unenviable position of having to garner support for each proposed facility, for a project that has been exhaustively shown to be effective and necessary.
In a sense, the court decision has determined that an enormous amount of energy will be put into proving something that's already been proven, over and over.
If this reality discourages Dalton, he hides it well. There's a more worrisome reality that drives him.
"People are dying on the streets and HIV is spreading," he says. "By treating people like human beings, by treating them with dignity and giving them options, they will be a lot more likely to live productive lives and possibly go to treatment."
"With the amount of commitment and progress that's been made through Insite and globally for safe injection sites, and with the already existing support in Ottawa, we can push through."
Photo: fieldtripp / Flickr
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