Safer injection facilities for injection drug users: the debate continues
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* Stanley de Vlaming

If we had an unlimited supply of money, safe fixing sites would have little opposition.1 Who would argue against a fully staffed facility for people to safely inject their drugs? But the reality is that money is limited and we need to set priorities.

Those of us who treat addiction understand that there are 3 ways in addition to harm reduction to address addiction: law enforcement, prevention and treatment. I currently treat about 200 injection drug users, most of whom are or have been severely addicted. Currently our most effective treatment intervention is methadone therapy for the heroin part of the addiction coupled with a stay in a first-stage recovery house that gets the user out of the downtown open drug scene. He or she can then begin working on his or her cocaine addiction and psychological issues. Only one 6-bed first-stage recovery house is currently funded in the Lower Mainland of British Columbia. The rest of the first-stage recovery houses that we use have insufficient funding for food, counsellors and after-hours staff. The addict on the street is left to choose between numerous well-funded drug-tolerant residential hotels downtown with a myriad of well- intentioned outreach nurses, street workers and drop-in centres (all operating under the flag of harm reduction) and a spartan, underfunded and stressed treatment system.

It would be refreshing to see a comparison of European and Canadian addiction treatment and prevention approaches with a subsequent call to action rather than a headline-grabbing comparison of harm reduction approaches. Who knows? There may be some who attribute the dramatic differences in the addiction scene between Europe and Canada to factors other than harm reduction.

## Reference

1.  1. Kerr T, Palepu A. Safe injection facilities in Canada: Is it time? [editorial]. CMAJ 2001; 165 (4):436-7.
    
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