2 days ago
Opinion: Closing Alberta harm-reduction hubs is going backwards
In 2018, a middle-aged man arrived on my patient panel. I will call him Jon. Jon was being treated in our clinic for hepatitis C but did not yet have his own family physician. When I met with him for our first visit, he told me the story of how he had contracted, years prior while incarcerated, this chronic viral infection of the liver. Supplies for tattoos and drug use were contraband at the time, so he and other inmates had shared needles and syringes.
By the mid-1990s, studies were advancing our understanding of harm reduction. Based on growing scientific evidence, Canada began to implement programs that were known then as needle exchanges and have since evolved into low-barrier, wraparound services.
Many today think of harm reduction as being about drug use only — supervised consumption sites for example. But harm reduction is nothing new. It was historically integral to the HIV/AIDS movement of the late 1980s and early '90s, when communities of men who have sex with men and people who use drugs (PWUD) demanded access to care that helped them reduce their risk of disease transmission.
It worked. Today's modern care includes a whole spectrum of public health interventions that sharply decrease the risk of sexually transmitted and blood-borne infections (STBBI). These include things as simple as access to condoms or new syringes. The gold standard is to provide these on demand. Anything less, like having to exchange your used syringe for a new one, increases infections.
In Alberta, harm-reduction services are often co-located with primary health care, including pregnancy and wound care as well as treatment for substance use and other mental health disorders. These centres are resource hubs for people who find themselves in the most painful of life's trying moments. Red Deer's Turning Point Society, founded in 1988 in response to the HIV/AIDS epidemic, is the only resource of this kind in all of central Alberta.
This week, it was announced that all provincial funding for Turning Point will be discontinued on Nov. 1.
What will closures like this mean for Albertans? Without access to wraparound services that include best harm-reduction practices, blood-borne and sexually transmitted infections including hepatitis, HIV, gonorrhea, chlamydia and syphilis will rise. Hospital use and costs will also increase due to more skin, organ and bone infections, more ICU stays, and even amputations. The cost of infections like these is a high price to pay compared to a harm-reduction kit that costs around a dollar.
There is a common conception that the neighbourhoods around resource hubs such as Turning Point are more likely to have many discarded needles and syringes or that they are 'honeypots' for drug dealers. Studies have shown these not to occur. In fact, the hubs' cleanup and outreach crews often ensure that the area is more tidy and safer than they would be otherwise.
My patient Jon came a long way since I first met him in 2018. He was eventually cured of his hepatitis C. He continued to use injection drugs and was careful to never share equipment — he knew the risks. He relied on our centre — one of Calgary's resource hubs — not only for his drug use supplies but also for getting tested regularly for STBBIs, screened for chronic diseases as he aged, and mental health supports. We have all, in fact, come a long way since the days before harm reduction.
Watching, from Calgary, the defunding of central Alberta's resource hub, I fear for other similar centres — places like Alpha House in Calgary and George Spady in Edmonton. What is to become of the places that have always, as the evidence guides, provided low-barrier, wraparound care? That are doing what studies show is safest, healthiest, and most cost-effective. They have not only their clients' and patients' best interests in mind, but also the public's.
By shuttering low-barrier and harm-reduction services, we are going backwards, not forwards. As citizens, we must object to the UCP's misguided and regressive restructuring and fight for places like Turning Point, Alpha House, and George Spady. History and science have shown that these are the places doing the work that helps us all.
Dr. Bonnie Larson is a clinical assistant professor of family medicine at the University of Calgary.
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