By Patrick Sullivan, Canadian Medical Association
Results from a survey of CMA members indicate that physicians strongly support the use of harm reduction efforts such as supervised injection sites as part of a comprehensive public health strategy to reduce the harmful effects of drug addiction.
The survey, which involved 1,500 physicians belonging to the CMA’s e-panel, was conducted in July and attracted a response rate of 36% - the highest rate among the 14 e-panel surveys conducted to date. The panel was formed in 2006 to deliver rapid input from members concerning CMA policy issues. It has members from every province and territory.
The doctors were asked: “Do you agree that harm reduction strategies, including safe injection sites, should be part of a publicly funded strategy to treat addiction?”
Seventy-eight percent of the 540 respondents agreed with the statement (46.9% strongly agreed and 31.1% agreed). The remaining 22% either disagreed (12.4%) or disagreed strongly (9.6%).
Supervised injection sites are controversial. The Insite Supervised Injection Site in Vancouver - it is operated by Vancouver Coastal Health (VCH) and has more than 250,000 visitors a year - is currently the only one in North America, although a few dozen operate in Europe and Australia.
The CMA supports harm reduction efforts such as injection sites that are part of a comprehensive approach to addictions that includes prevention, treatment and rehabilitation. The CMA says that under such a multidimensional approach, which requires rigorous monitoring and evaluation, supervised injection sites can help reduce the harm associated with the use of illicit drugs.
During the CMA’s August annual meeting in Montreal, then federal Health Minister Tony Clement challenged the supervised injection model by arguing that “injections are not medicine and they do not heal.” He was countered by Dr. Bonnie Cham, chair of the CMA’s Committee on Ethics. “IV drug users have the right to compassion and access to care that has proven to be beneficial,” she said.
Similar differences of opinions were clear in the comments offered by e-panel participants. “Addiction is a medical problem requiring a multipronged and personalized treatment approach,” one doctor wrote. “Harm reduction is an essential element in reaching out to addicts to help them engage in treatment.”
“There is good evidence from the research and from my clinical experience that these strategies decrease the risk of life-threatening and disabling infections, and that they may increase motivation to seek treatment for addictions,” added another.
However, another physician argued: “Where is the proof that making it easier to inject helps treat addiction? It may decrease disease but it does not ease addiction.”
More than one in five of the 540 respondents (22%) frequently treat patients who have addiction problems, while a quarter (25.3%) treat them occasionally. Another quarter (25.5%) said they never treat such patients, and 27.2% treat them infrequently.
According to VCH
, research supporting the Insite centre’s operation has been published in CMAJ, the New England Journal of Medicine, BMJ and The Lancet. VCH says the centre now attracts 750 to 800 visitors a day and its users are “twice as likely to engage in addiction treatment as non-Insite [drug] users.”
