Safer injection facilities for injection drug users: the debate continues
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* Mark Latowsky

Although superficially unrelated, several articles in a recent issue of *CMAJ* share a common theme of great importance.1,2,3,4 Thomas Kerr and Anita Palepu1 and *CMAJ*'s editors2 argue that the time has arrived for consideration of safe injection facilities in Canada. They point to the morbidity and mortality associated with injection drug use and the failure of current methods to adequately control this public health epidemic. I agree.

Philip Berger succinctly argues that the Ontario government's proposed mandatory addiction screening is an example of science misapplied: in reality it is a government tool to achieve ideologically motivated social change.3 I agree.

Wayne Weston argues that informed and shared decision-making is the crux of patient-centred care and that although we are the experts in disease, patients are the experts in their own experience of it.4 I agree.

It is when applied to the injection drug user's life experience that the above themes converge. The user's experience is one of marginality, stigma and reduced opportunity. This life experience is strongly affected by the moral views of the public and the medical community. Despite 2 decades of harm reductionism, the moral and prohibitionary view of addiction remains dominant: a state-centred stodgy old horse of expert ideology.

It is a breath of fresh air to read these authors' views of pragmatism over morality. The time has come to view injection drug users as genuine human beings in dire need of help: we must let go of the notion that they are simply bad people in need of punishment. This will allow us to assist them in the political fight for harm reduction strategies such as safe injection houses and against any government proposal that may violate human rights. Then and only then will we be able to truly treat injection drug users as patients who are expert in their disease experience and potential partners in their treatment.

## References

1.  1. Kerr T, Palepu A. Safe injection facilities in Canada: Is it time? [editorial]. CMAJ 2001; 165 (4):436-7.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjUvNC80MzYiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY2LzQvNDE5LjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Harm reduction: closing the distance [editorial]. CMAJ 2001;165(4):389.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjUvNC8zODkiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY2LzQvNDE5LjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  3. Berger PB. Science misapplied: mandatory addiction screening and treatment for welfare recipients in Ontario [editorial]. CMAJ 2001; 165 (4):443-4.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjUvNC80NDMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY2LzQvNDE5LjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

4.  4. Weston WW. Informed and shared decision-making: the crux of patient-centred care [editorial]. CMAJ 2001;165(4):438-9.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjUvNC80MzgiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY2LzQvNDE5LjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)