Opioid Use and Supervised Consumption Sites

The city of London suffers from a high rate of drug abuse. Recently, opioids have been gaining a lot of popularity among drug users. This has led the city officials to consider the implementation of supervised consumption sites.

Reflecting on my knowledge and perspective on supervised consumption sites.

Supervised consumption sites (SCSs) are medically-supervised, legally-sanctioned facilities that allow individuals to consume recreational drugs in a safe and sanitary environment. They provide appropriate tools for drug administration (i.e. hygienic needles) and allow individuals experiencing “highs” to be contained within a secure area. Although SCSs may reduce the harms associated with drug use, they have stirred a lot of controversy and in this reflection, I will discuss my knowledge and views regarding SCSs.

I originally thought that SCSs weren’t a good idea because I thought it would encourage drug abuse. I looked at this issue through the lens of a taxpayer, because I myself have never been a drug user and it was hard for me to see the benefits of SCSs on a broader scale. This thought process of mine was challenged as I realized I was looking at this issue with a narrow viewpoint and was forming these opinions with no factual basis. I then looked at this issue from different perspectives – from the perspective of medical professionals, the drug addict, the residents within the neighborhood, etc. What helped me do this was the role-play situation in class in which I was able to think in terms of the mayor of the London community. Through class discussions and self-informing, I have been able to see the advantages that SCSs may have in relation to drug abuse and the wellbeing of the London community in general.

            SCSs are beneficial in that they allow drug users to have a safe, hygienic environment in which they can consume their drugs. This involves the provision of clean needles and other drug administration tools, helping to lower the risk of diseases such as HIV and Hepatitis C. In the class discussion with Michael Annett, we learnt that crystal meth abuse rates are rising within London. He mentioned that the main administration route for crystal meth is through injection which can lead to a multitude of infectious diseases through shared needles. Since amphetamines are among some of the most addictive substances, SCSs would be beneficial through the provision of hygienic needles and safe disposals. Additionally, medical staff are present so individuals suffering from overdose are able to receive immediate medical attention.

            When thinking about SCSs, something that comes to mind is how they can be seen as non-ostracizing, accepting areas for drug users. So often, drug users face judgement and discrimination. Though we don’t often explicitly state our judgement, they are aware of it and in a way, feel separated from society. SCSs allow drug users to see that society is really still trying to care for their well-being through the provision of services that reduce the risk of the adverse effects of the drugs they use. Thus, SCSs may shed a positive light on the acceptance of substance-abusing populations within society.

            The idea of SCSs is applicable to me personally since, I want to pursue addiction medicine. As someone that is concerned about the rates of drug use and what the implications of widespread illicit drug use are on society, I am happy that users are getting the care they need. However, I am also concerned about the potential long-term effect of rising rates of drug abuse that SCSs may contribute to.

            When discussing my perspectives and knowledge regarding SCSs, I think it’s important to analyze the role of scientists, a class outcome that has been highly emphasized. Scientists are vital in the health outcomes related to drug use and abuse because they must be able to track the trends that arise upon introduction of SCSs and present this information such that appropriate action can then be taken. For example, scientists should keep their eyes on rates of HIV among drug users – are the rates rising, falling or staying the same? Scientists’ roles are vital as they can produce scientific knowledge which will help advance the goal of mitigating drug use through SCSs.

            Furthermore, although I am a supporter of SCSs, I do understand why other individuals may be less accepting of SCSs. This ties into the concepts of science and health literacy. It is important to be able to effectively communicate with the general public in order to make them aware of all the pros and cons of SCSs. A lot of people immediately say “no!” to SCSs, just like I did, because they think it encourages drug use, but they are unaware of all the multifaceted nature of SCSs. It’s up to scientists, educators and public health officials, among others, to use their literacy skills to educate the public

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Considering my pros/cons list that and contrasting it to the pro/ con list that developed with my group, as well as considering the relation between SCSs and my CEL project.

When comparing the pros and cons of SCSs with the members of my group, it was interesting to hear the insight they had to offer. I was able to gain a broader understanding of the implications of SCSs within London. In this section, I will discuss the pros and cons and how this relates to my CEL project.

            There are many concerns that arise when considering the implementation of SCSs. There may be increased congregation for drug users and drug dealing around SCSs, which may have overall negative effects on a neighborhood. In class, we discussed the implementation of the SCS in front of the John Bellone Music store, which is in close proximity school. There are some serious considerations that need to be accounted for when deciding whether this is a good location for the SCS or not. SCSs will most likely be run during normal daytime hours (i.e. 8 a.m. to 5 p.m.) which is when children are at school; this could lead to drug users wandering on school grounds and posing danger to the school children and staff. While talking among my group, one member mentioned that children, out of curiosity, may wander into the SCS and be exposed to all the drug use. SCSs may have a negative impact on the desirability of a neighborhood for shopping, living or business operation which can be detrimental, especially if the neighborhood was already within a low SES bracket. This may, in turn, lead to higher crime rates. A major problem with SCSs is that they don’t tackle the root of drug abuse, but rather help mitigate the effects. This suggests the role of scientists within society, as they need to shift research focuses onto the true causes of drug abuse rather than simply solutions for symptom mitigation.

SCSs are beneficial to London in many ways. First, it clearly will improve the personal and physical safety of individuals using drugs through the provision of clean drug administration tools and constant medical supervision. This in turn will lead to a reduced transmission of hepatitis C and HIV, and other infectious diseases. Additionally, SCSs would most likely improve neighborhood safety as individuals who are experiencing intense highs can be contained within a safe environment, reducing the risks to themselves and others. As mentioned earlier, SCSs may be a welcoming area for drug users, making them feel less ostracized and isolated within society. SCSs are also a wonderful way to introduce the ideas of therapy and recovery to patients.

      The topic of SCSs ties in with my CEL project, Yoga for Addiction Recovery, in that it is a recovery solution that can be offered to drug users at the SCSs. I had the privilege to attend one of the yoga sessions and found that the poses were very soothing and relieving. I could see how they could be used to calm anxiety and stress, and deal with uncomfortable states or emotions that a recovering individual may be going through. I think that with the implementation of SCSs, there is an opportunity for individuals like Evonne (founder of this yoga program) to reach out and offer her services to help addicts recover and deal with the psychological withdrawal symptoms. One thing that especially stood out to me was the way in which the yoga class attendees found support and community with one another – they were all former alcoholics and were able to find encouragement and hope with one another. Therefore, I think that if SCSs are able to promote recovery programs, it could open up the door to hope, community and healthy coping mechanisms through activities such as yoga. 

      Overall, the relation between yoga and SCSs emphasizes the course outcome of working in concert with community health organizations to promote health initiatives because in SCSs, we can use recovery programs to help individuals battle their addictions, which will ultimately lead to a better London community. This shows how different disciplines within the community can work with one another towards the common goal of lowering drug abuse within London

What does Chris Mackie have to say about this?

Chris Mackie is London's chief Medical Officer of Health.

Mackie stated that based on the

"research from other jurisdictions...it’s clear this sort of facility helps neighbourhoods to get injection drug use off the street and reduce needle waste in public.”

(Retrieved from: MLHU to present business case for 2 permanent supervised injection sites in London)

He further stated that,

"This type of service is crucial for those hardest to reach clients to get them into addictions treatment. From a culture where we have often looked at drugs in a shame and blame and marginalization sort of way … It is a big shift in mindset, and I understand why it takes some time to get there,"

(Retrieved from: London New Democrats worry about fate of supervised consumption sites, but health unit CEO remains unruffled)