Thread by @tdbrothers

Inspired by @dr_jdlivingston & @CoreyRanger, here is a thread on the recent Alberta safe consumption sites (SCS) review, from my perspective as a doctor training in addiction medicine and co-organizer of an SCS/OPS. 1/

https://twitter.com/dr_jdlivingston/status/1235943692596371458?s=20

A medical perspective shouldn't even be needed, as review mandate was supposed to focus only on identifying social/economic concerns.

But the report is chock-full of misleading statements about the health benefits of SCS, harm reduction, & addiction treatment- so here we go! 2/

The emphasis on "detox" as a reasonable alternative to SCS (or referral to detox as a goal) is either disingenuous or ignortant.

For opioid addiction, detox alone leads to loss of tolerance, relapse, and increased risk of death... 3/

In fact, our national treatment guidelines explicitly advise AGAINST detox alone as a treatment strategy.

cmaj.ca/content/190/9/…

Very strange that detox is prioritized in this document co-authored by addiction physicians. 4/

Of course we DO need improved access (with lower barriers) to evidence-based opioid addiction treatment incorporating medications (eg. methadone, suboxone)

But SCS offer something different- inclusion, connection & keeping people alive

It's not either/or! 5/

Opioid overdose causes people to stop breathing and die from lack of oxygen. Oxygen keeps people alive.

Naloxone reverses overdoses but can precipitate withdrawal, so often isn't needed if oxygen is available.

Don't need an MD to know that oxygen keeps people alive. 6/

This one is terrifying. It's been known for decades that restricting needle distribution to 1-to-1 exchange leads to re-use of needles, increasing risks of HIV, hep C, and bacterial infections/endocarditis. This is a terrible, terrible idea.

cbc.ca/news/canada/ot… 7/

Misleading again. Exemptions to Section 56.1 of CDSA were not created in response to fentanyl. The Supreme Court declared that blocking SCS violated the charter rights of people who use drugs, because it needlessly increased harm.

History lesson here! communityinsite.ca/legal.html 8/

A huge benefit of SCS is that they give people space and time to use without fear of arrest. Using clean equipment in a clean space & connecting with community & health care support has health benefits for injecting all types of substances - not just opioids! 9/

Even without formal drug checking, SCS can reduce risk of overdose & infection by providing space & time to use carefully, try test dose to check potency

tandfonline.com/doi/full/10.31…

communityinsite.ca/Stoltz07_Injec…

communityinsite.ca/Kerr07_Micro-e… 10/

Smoking is actually FAR safer than injecting in terms of risk of HIV, hep C, and bacterial infection. We @halifix902 wish we could offer safe smoking area to support people transitioning to safer route of ingestion. 11/

catie.ca/en/practical-g…

SCS/OPS benefit fundamentally from the expertise, wisdom, thoughtfulness, creativity, passion, and connections of peer staff with lived experience. Of course working in SCS will not be for everyone. 12/

Anonymous attendance at SCS is enormously important in our society that stigmatizes & arrests people who use drugs and excludes them from traditional healthcare.

Identifying clients is not actually an operational issue. The authors' "distress" seems to be related to costing? 13/

I read this as saying that this human being would be dead if not for @ARCHESLeth 14/

After using at an SCS, people go on about their day.

After using in an alleyway, people go on about their day.

After using in a McDonald's bathroom, people go on about their day.

15/

A. people die when they use alone; B. there are many more injection drug users who could be using SCS; C. when there's a wait, people may still use nearby SCS/nearby caring people with naloxone.

These seem like convincing arguments to increase capacity, not shut them down! 16/

This is also supported by existing research. People who attend SCS and also inject in public explain that their public injecting is related to wait times at SCS (and also to homelessness). 17/

tandfonline.com/doi/full/10.10…

Overall, while there are medical people on the panel, the emphasis on "detox", dismissal of oxygen as life-saving overdose therapy, & embrace of 1-for-1 needle exchange are the "tells" for me that the report was never meant to be informed by science & should not inform policy 18/

I just can't get over this terrible recommendation 1-for-1 needle exchange restriction. 19/

To reduce publicly discarded needles, we need easy access to sharps disposal bins & should employ people with lived experience to help collect discarded needles. @needleexchange2 Peer Navigator project is a shining example.

https://twitter.com/needleexchange2/status/1116320570730340352?s=20

20/

With spurious methods, political aims, and couched in the scientific language of policy evaluation, this report may lead to immense harm. While we feel we are making progress with government & neighbours in Nova Scotia, we are preparing for the blowback from the report 21/

Love and support to colleagues & friends in Alberta and beyond fighting to make things better ❤️ end/

That typo makes me feel ignortant