Evaluating The Impact of Safe Injection Sites in Kingston

Canada continues to face an ever-increasing opioid overdose catastrophe that has claimed more than 8000 lives in the country since 2016 (Strike & Watson, 2019). Opioids are effective drugs that are used by most Canadians for pain management. However, it can cause a variety of harms even it is prescribed or obtained from illicit sources (Canadian Institute for Health Information, 2018). The excessive prescription practice in Canada has exposed people to very addictive opioid drugs, causing them to be opioid-dependent and misuse the drugs (Fischer, Pang, & Tyndall, 2019). By 2012, there was a drastic reduction in medical opioid prescriptions, which led to an emergent rise in the availability of synthetic opioids (e.g., fentanyl) and harmful analogs that cause opioid fatalities (Fischer, Pang, & Tyndall, 2019). According to KFL&A data, carfentanil, the hazardous undetectable drug, has made its way to the Kingston community (Krause, 2019). Data from Public Health Ontario suggests that the number of deaths has increased by 246 % taking 1250 lives of Ontarians in 2017 (Public Health Ontario, 2019). As a comeback to this crisis, the four harm reduction interventions- injectable opioid agonist treatment, naloxone distribution programs, overdose prevention sites (OPS), and drug checking services are expanding rapidly. With this innovative intervention, the nation sees a slight decline in opioid overdose rates (Strike & Watson, 2019).

Canada has a population 31 million and approximately 80000 to 125000 people are addicted to drugs. Opioid users suffer from several chronic diseases such as hypertension, diabetes, and psychiatric disorder. The social cost of an untreated opioid user is approximately 000/year. The various harm reduction strategies like safe injection sites (SIS) can improve the quality of life, increase life expectancy and reduce social costs (Popova, Rehm, & Fischer, 2006).

SIS are a health-care setting where individuals can inject drugs under the supervision of trained health workers. This harm reduction service provides sterile injection supplies, drug preparation materials, overdose prevention and intervention, education, primary care, psychiatric and counseling services, and referrals to drug treatment, housing, and other health and social services. The chief goal of SIS is to improve the physical and mental well-being of people who inject drugs. SIS intend to reduce the spread of infectious diseases (such as HIV and hepatitis), the number of overdoses fatalities, and incidents of community issues or health risks (such as public drug use or discarded needles). SIS also facilitate provide other health and social services as well (Registered Nurses' Association of Ontario, 2018).

Since Kingston has the highest opioid fatalities than the provincial average, the Opioid prevention site (OPS) in Street Health Centre, Kingston, is of utmost importance. Between 2016 and 2017, the number of cases of opioids related morbidity and mortality in the KFL&A public health region has skyrocketed by 200% (Public Health Ontario, 2019). “In 2017, there were 188 opioid-related emergency department visits, and 25 opioid-related deaths in the KFL&A region, ranking our community ninth highest for opioid-related deaths out of the 35 Ontario public health regions” (KFL&A Public Health, 2019). As a response to this, the Ministry of Health and Long-term Care made provisions for community-based organizations to apply for overdose prevention sites (KFL&A Public Health, 2019).

Problem Identification

The Kingston site, located at Street Health’s Barrack Street office, opened in July 2018. Even though data from various safe injection sites from around the world give the benefits of a safe injection site, the Ontario premier, Doug Ford does not believe it is the right approach to reduce the overdose mortality and morbidity rates. The Ford government is planning to “pause” the rollout of safe injection sites across the province (Dhanraj, 2018). Ceasing the safe injection sites in this condition will put lives at risk. With potential funding cuts, Street Health Centre CEO, Mike Bell, says safe injection sites would continue to be able to operate, but only through donations. The Street Health Centre says it needs around 0,000 to operate its safe injection facility (Krause, 2019). Street Health center already has written support from KFL&A Public Health, Frontenac Paramedic Services, HIV/AIDS Regional Services, Addictions, and Mental Health Services, the Kingston Police and other agencies. However, statistics from the police show there has been “no increase or changes in calls” from the location since the site opened, and residents and businesses have expressed no concern (Ferguson, 2018).

As Ford government is looking for an evidence-based review, our main objective is to collect data and assess the effectiveness of the opioid prevention site in Kingston. The various shreds of evidence from different SIS are to be compared and collaborated to estimate the efficacy of OPS Kingston. Through our capstone project, the responsible government should be able to take the right decision on funding the Street Health Centre.

Literature review

• Kerr T. et al. (2017) examined that in Canada, harms arise due to drug injection overdose. In 2003, Canada started SIS and some large bodies of evidence found that this service is helpful in reducing the health and social harms. After that, they focused on creating a more relevant environment for supervised injection facilities through amendment of federal legislation. Along with SISs, they started safe inhalation of drugs to promote this program. They conclude that supervised injection facilities are considerable progress according to the review of Canada's experience. They found that there is a need to take more efforts to establish more SISs across Canada because people accept SIS positively.
• Wood, E. (2018) stated that in the United States, drug overdose death increased between 1999 and 2015. In 2016, there were approximately 64000 people died due to drug overdose and according to research, the main cause of deaths involved synthetic opioids. United state follows the actions of Canada with the aim of reducing the number of deaths related to opioids such as fentanyl and fentanyl analogs. The Canadian government made an overdose reversal drug naloxone and supervised injection facilities. This is also implemented in some regions of the United State. Several researchers found that in communities where there is high drug overdose rate, 30% of fatal overdose can be reduced by SISs. In British Columbia, the opioid overdose crisis increased, and the province developed some standards for free access of naloxone drug in community agencies and pharmacies.
• (CCSA, 2019) Canada and the United States both experienced that drug overdose deaths increased in recent years. 3,998 Canadians and 47,600 lives of the United States were lost in 2017. They understand that drug overdose crisis increased, and they start to try to prevent this crisis. They acknowledge that there is a need for collaboration, comprehensiveness and evidenced-based approaches to prevent this crisis. According to this research, they provide harm reduction recommendations to the public. They educate them to ensure sites for safe injecting of drugs. Their strategies are to provide primary care, substance use treatment, provide pharmaceutical opioids and conduct an evaluation of safe injection site programs. Their strategy is to educate people about opioid overdose prevention by using safe injection sites and naloxone treatment.
• (Lingle, 2013) There are several health issues such as HIV and HCV due to injection drug use and these are easily transmitted through needles when people inject drugs. SIS are introduced with the aim of approaching high-risk injection drug users. These facilities include a safe place where drug users inject drugs under medical supervision. There is an excellent record of SIS to reduce the overdose death and also prevent and spread of diseases such as HIV and HCV. Their expectations are targeting the population with a high risk of injection drug users, to provide the place for injecting drug safely, reduce the drug overdose, provide them education about health and social issues due to drug overdose and last is decrease the crime rate.

The problems with SISs, due to law and law enforcement, some drug users fear that if they went to SISs, they will be arrested for drug use and staff members also fear the unlawful behavior of drug addicts.

• (OHTN, 2014) Supervised injection services help in reducing injecting behaviors and also increases the number of clients that take efforts for addiction treatment services. Supervised injection services are cost-effective and prevent transmission of blood born diseases, named as HIV and HCV. It is safer and reduces morbidity and mortality rate. According to this research, there are some challenges in this project such as long lines for SIS because these clinics are not open every time. This research found that there are some records and evaluations which shows a reduction in harmful behaviors. 75% of clients change their injecting behavior and 23% stop injecting and another 57% choose to take de-addiction treatment. They are mainly focused on client safety, cost-effectiveness, nursing care during drug injection, safer injection education and public safety. Some Supervised injection services open 24 hours because they give them facilities publicly or out of clinic also. It reduces the long lines in the clinics that only 20% of clients prefer to wait in the lines.
• (Knowles, 2017) From January 2001 to September 2003, there are various drug overdose deaths in Vancouver. According to researchers, the benefit of a safe injection site is to prevent blood transmission diseases HIV and HCV. Because they found several indicators of community disorders such as public injection use, improper disposal of syringes and litter related to syringes. Data shows that approximately 8000 drug users use the injection site in 2008. In 2003, there is a big cut in overdose deaths in Vancouver. SIS provides great access to health care to drug users, reducing the number of HIV rate and improving public order.
• (City of Hamilton Public Health Services, 2017) The main purpose of this study is to determine the need for SIS in Hamilton, determine its feasibility and involve the community in this project. According to this research, the main benefits of SIS are to reduce overdose deaths and prevent blood transmission diseases. If it was in community health centers, around 90% of drug users visit SIS. SIS helps to improve the health and safety of community people by providing a safe place and environment to inject drugs. SIS is located where people easily inject illicit drugs in a safe environment under proper supervision.

Project Description

Research goals:

The broader topic of our research project is opioids; we want to put emphasis on the effectiveness of the safe injection sites within the community. This knowledge related to safe injection sites aids us to identify the devotions for continuing funding program to the Kingston site. Further, nowadays, there is a heated discussion going on about safe injection site funding, so through our search, we can provide enough data to the authorities to make an effective declaration. As safe injection sites also affect the other traits of opioids linked issues through capstone outcome, we also expect to know them as well.

Our objective is to first understand the normal arrangement of safe injection sites and then to assess how it works to help people by offering opioids treatment and education. We want to determine how much fund is allocated to achieve the desired organizational outcomes. For this reason, our study evolves Kingston community SIS staff, website data, and individuals who take services of these sites.

The values of our project:

Our experiments result in a better understanding of the function of safe injection sites as per the disseminated resources to serve people with opioid addiction and overdose within the Kingston region. This discovery helps us to comprehend some areas which play a major role in the success or catastrophe of SIS efficiency. The project provides guidance to authority regarding the economical distribution of finance to operate sites that it can serve more folks with high quality and higher success outcomes which directly uphold the level of health of people of Kingston community.

Areas which require more attention are:

1. Research bias: As it is fact and statistical data-based study, which we are observing must be considered in which the authenticity cannot be verified.
2. Time: There are a lot of articles and web sites on the internet which offers similar content of the topic. So, time will not be enough for many referrals.
3. Ethics: Even though this project as a proposal for the Canadian government to continue funding, it may also affect some belief, values, and freedom of person and organization.
4. Communication: proper communication with staff and community is mandatory to collect the most recent data.

Timeline:

1. Week first: Review and finalize the problem topic and identify the source of resources by research.
2. Week two: Search problem aspects which might hinder our project progress and refine the capstone proposal.
3. Week three: Design our data collection method and arrange a group meeting to decide a day on which we can go and collect data from the organization for our project.
4. Week four: Meeting with the professor to analyze the collected records and to judge the outcome from the statistics.
5. Week five: Do research on how to structure all collected documents in a manner through which we can make a judgment on whether sites are helpful or not.
6. Week six: capstone draft preparation and formulation
7. Week seven: Submission of the final capstone project.

References:

1. Canadian center and substance use and addiction. (n.d.). Retrieved from Strategies for Addressing the Opioid Crisis in the United States and Canada: Cross-Border Knowledge Sharing: https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Strategies-Addressing-Opioid-Crisis-Canada-US-Report-2019-en.pdf
2. Canadian Institute for Health Information. (2018). Opioid-Related Harms in Canada. Ottawa: CIHI.
3. CCSA. (2019). Strategies for addressing the opioid crisis in the United States and Canada: cross-border knowledge sharing. Retrieved from Canadian Centre on Substance Use and addiction: https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Strategies-Addressing-Opioid-Crisis-Canada-US-Report-2019-en.pdf
4. City of Hamilton Public Health Services. (2017). Hamilton supervised injection site. McMaster University, 1-96. doi:https://d3fpllf1m7bbt3.cloudfront.net/sites/default/files/media/browser/2017-11-30/hamilton-sis-study-report.pdf
5. Dhanraj, T. (2018). Drug user says ‘blood is on their hands’ regarding Doug Ford government’s ‘pause’ on safe injection sites. Toronto: Global News. doi:https://globalnews.ca/news/4433326/ontario-safe-injection-sites-opioids/
6. Ferguson, E. (2018). City council to be asked to support Kingston overdose prevention site. Kingston: The Kingston Whig-Standard.
7. Fischer, B., Pang, M., & Tyndall, M. (2019, February 01). The opioid death crisis in Canada: crucial lessons for public health. The Lancet Public Health, 4(2), E81-E82. doi:https://doi.org/10.1016/S2468-2667(18)30232-9
8. Hamilton supervised injection site. (2017, december). Retrieved from https://d3fpllf1m7bbt3.cloudfront.net/sites/default/files/media/browser/2017-11-30/hamilton-sis-study-report.pdf
9. Kerr, T., Mitra, S., Kennedy, M. C., & McNeil, R. (2017). Supervised injection facilities in Canada: past, present, and future. Harm Reduction Journal, 14-28. doi:https://doi.org/10.1186/s12954-017-0154-1
10. KFL&A Public Health. (2019). KFL&A Public Health. Retrieved from Opioids: https://www.kflaph.ca/en/healthy-living/fentanyl.aspx
11. Knowles, Z. (2017). Prevention in focus. Retrieved from CATIE: https://www.catie.ca/en/pif/fall-2017/research-update-supervised-injection-facilities-canada-past-present-and-future
12. Knowles, Z. (n.d.). Research Update: Supervised injection facilities in Canada: past present and future. Retrieved from Prevention in Focus: https://www.catie.ca/en/pif/fall-2017/research-update-supervised-injection-facilities-canada-past-present-and-future#bios
13. Krause, K. (2019). Carfentanil found in Kingston: Public health unit. Canada: Global News.
14. Krause, K. (2019, March 29). Kingston’s Street Health Centre awaits news of provincial funding for safe injection site. Retrieved from Global News: https://globalnews.ca/news/5108240/kingstons-street-health-centre-awaits-news-of-provincial-funding-for-safe-injection-site/
15. Krause, K. (2019). Kingston’s Street Health Centre awaits news of provincial funding for safe injection site. Kingston: Global News. Retrieved from https://globalnews.ca/news/5108240/kingstons-street-health-centre-awaits-news-of-provincial-funding-for-safe-injection-site/
16. Lingle, C. A. (2013, April 9). A critical review of the effectivness of safe injection facilities as a harm reduction strategy. University of Pittsburgh, 1-55. Retrieved from http://d-scholarship.pitt.edu/18375/1/CarrieLingle_-_FinalThesisEssay.pdf
17. Lingle, C. A. (n.d.). A critical review of the effectiveness of safe injection facilities as a harm reduction strategy. Retrieved from 2011: http://d-scholarship.pitt.edu/18375/1/CarrieLingle_-_FinalThesisEssay.pdf
18. OHTN. (2014, May). What is the effectiveness of supervised injection services? Retrieved from Rapid Response Service: http://www.ohtn.on.ca/Pages/Knowledge-Exchange/Rapid-Responses/Documents/RR83-Supervised-Injection-Effectiveness.pdf
19. Popova, S., Rehm, J., & Fischer, B. (2006, April). An overview of illegal opioid use and health services utilization in Canada. Public Health, 120(4), 320- 328. doi:https://doi.org/10.1016/j.puhe.2005.09.010
20. Public Health Ontario. (2019, March 20). Opioid-related morbidity and mortality in Ontario. Retrieved from Public Health Ontario: https://www.publichealthontario.ca/en/data-and-analysis/substance-use/interactive-opioid-tool#/trends
21. Registered Nurses' Association of Ontario. (2018, February ). RNAO. Retrieved from Implementing supervised injection services: https://rnao.ca/sites/rnao-ca/files/bpg/Implementing_supervised_injection_services.pdf
22. SfN. (n.d.). Sample research project description. Retrieved from Society for Neuroscience: https://www.sfn.org/~/media/SfN/Documents/Advocacy/Sample%20Research%20Project%20Description.ashx
23. Strategies for Addressing the Opioid Crisis in the United States and Canada: Cross-Border Knowledge Sharing. (n.d.). Retrieved from Canadian centre and substance use and addiction: https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Strategies-Addressing-Opioid-Crisis-Canada-US-Report-2019-en.pdf
24. Strike, C., & Watson, T. M. (2019). Losing the uphill battle? Emergent harm reduction interventions and barriers during the opioid overdose crisis in Canada. International Journal of Drug Policy. doi:https://doi.org/10.1016/j.drugpo.2019.02.005
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26. Wood, E. (2018, April 26). Strategies for Reducing Opioid-Overdose Deaths- Lessons from Canada. The New England Journal of Medicine, 1565-1567. doi:https://mfprac.com/web2018/07literature/literature/Pain/OpioidsCanada_Wood.pdf