Needle vending machines prompt harm reduction vs treatment debate

They all have the same aim, they say, and that’s helping people addicted to drugs.

How they’re approaching the issue is another matter, and it’s one that sparked a debate around the allocation of resources toward harm reduction services, such as needle exchange programs and supervised injection sites, and treatment programs like methadone clinics and rehab.

Ottawa Public Health has a tender out to purchase five clean needle vending machines for Ottawa’s downtown. It’s among the harm reduction measures being considered by the City. The other, a supervised injection site, is in the hands of the Board of Health, according to Mayor Jim Watson.

Ottawa’s Deputy Officer of Health, Dr. Vera Etches told CFRA’s Ottawa Now with Evan Solomon the machines would distribute needles to drug users already on needle exchange programs.

“It’s a vending machine that’s secure and only people who have a token can access it,” she says. “These tokens, we’re proposing, will be distributed by existing needle exchange programs, so only to people who are using drugs, and they can get those supplies after-hours.”

Etches says these kinds of machines have been in use internationally for decades, and the effects have been noted.

“If you put up a vending machine, do people get more access to supplies when they can’t otherwise get them? The answer is yes. Do they stop coming to get face-to-face services? We’ve seen that people continue to want that human interaction, so this is not a replacement for that, it’s an extension of the hours when people can access sterile supplies.”  

But Dr. Mark Ujjainwalla, the Medical Director of Recovery Ottawa, tells Solomon these kinds of program miss the bigger picture.

“What everybody is missing here is we have an opiate epidemic and an epidemic of mentally ill people and severely addicted people who need our help,” he says. “There are people out there with a treatable illness that require our help, taxpayers’ help, the Ministry of Health’s help, the hospital’s help, to get them out of a horrible situation that they, for whatever reason, got into and become addicted to drugs, and they need treatment.”

Ujjainwalla insists he’s not opposed to harm reduction, but feels too much money and time is devoted to those measures, as opposed to treatment measures.

 “In Ottawa, the resources available are exceedingly limited, to the point you cannot access them,” Ujjainwalla says. “I tried to get money from the Local Health Integration Network to get counsellors and opiate case managers and I was told there was no money available. I don’t have any problem with needle exchanges, but in the great scheme of our problem, that’s about two per cent of the issue. The ninety-eight per cent we should be working on, nobody’s looking at it.”

Etches says the vending machines would not be costly, and would save money in the long run.

“These are small dollars, relatively speaking, to make sure we don’t get some of these other negative outcomes like Hepatitis C and HIV that are expensive to treat long-term in the community.”

Rob Boyd, the director of the Oasis Clinic at the Sandy Hill Community Health Centre tells Ottawa Now the Centre hasn’t applied for a supervised injection site yet, but it’s something he feels would benefit the community.

“We are going to be bringing this to our board of directors on January 18th, for their approval to go forward with the submission,” Boyd says.

Boyd says it’s not an either-or issue, when it comes to harm reduction or treatment, because Oasis offers both.

“We run an addictions medicine clinic here that’s going to be in conjunction with these other types of services, so we think they’re totally compatible,” says Boyd. “Providing people with some access to safer drug-using supplies, in addition to providing a place where they can be supervised is really an important front-end to a comprehensive addictions treatment system.”

It’s a sentiment echoed by Etches.

“These kinds of needle supply distribution services are a bridge, potentially, to help people get onto a path of more support, better access to counselling and so on.”

Ujjainwalla says, however, harm reduction is a self-defeating goal.

“Harm reduction is palliation. Palliation in medicine is ‘you’re going to die.’ It’s really a narrow-minded look at a gigantic issue that’s beyond all of us. Really, we should be all ashamed at how little money and effort we’re putting into the treatment of mental health and addiction.”

 Boyd, however, says, it’s all part of the same continuum.

“I think that we have been seriously underfunding our addictions treatment system and I think that we’ve been also seriously underfunding our harm reduction services,” he says. “Harm reduction services are addictions treatment services for people who are actively using drugs.”