First, we have to define the “opioid crisis”

Agreement on safe injection sites is impossible without a common definition of "opioid crisis."

There are two distinct camps when it comes to how people feel about safe injection sites for opioid addicts. One camp believes safe injection sites are the best, most effective way to address the “opioid crisis” gripping North America. The other camp believes safe injection sites make the crisis even worse.

Both camps want the crisis to end. And, both camps are right.

Injection site proponents think their anti-injection site opponents are cold, heartless bastards who don’t value human life. Injection site opponents believe proponents are value-signalling frauds who don’t truly care about helping people living in misery.

At the heart of their disagreement is a fundamental difference in how they define “the opioid crisis.”

What is the Opioid Crisis?

Proponents of safe injection sites define the crisis as the massive and rapid increase in the number of people dying from opioid overdoses.

Opponents of safe injection sites define the crisis as the massive and rapid increase in the number of people addicted to opioids.

If you believe the crisis is the number of deaths, then safe injection sites make sense. Addicts who do opioids in a supervised site are less likely to die from an overdose, because there are trained healthcare professionals present to treat them if they OD. Safe injection sites reduce deaths among users.

If you believe the crisis is the number people addicted to opioids, then safe injection sites do little or nothing to address the crisis. Areas served by injection sites report increases, not decreases, in addict population.

Most publicly-funded safe injection sites have referral programs to assist addicts who want to kick their habits and rehabilitate their lives. Proponents like to describe these sites as important “gateways” to treatment. However, statistics show very few opioid users avail themselves of these programs. Those who do quickly discover there are few or no spaces available for them in treatment programs.

Safe Injection Sites cater to the poorest and least functional opioid addicts: the homeless or near-homeless users. High functioning users don’t leave their 20th floor luxury condos to travel downtown and shoot heroin.

Many high functioning addicts want to quit. But, even those with enough money to access private clinics find that hard to do in Ontario. Spaces are few and far between. The wait to get into a treatment centre may be days or weeks, by which time the motivation to seek treatment may have passed. Addicts without deep pockets find it almost impossible to access residential treatment through public healthcare.

Some addicts, finally ready to seek help, show up at treatment centres only to be turned away because they need acute care detoxification which is often not available at a rehab centre. Instead, they’re referred to hospital. By the time they’re detoxified and stable, ready for the rehab centre, they may feel “better” and no longer be interested.

Both sides of the argument are right

Safe injection sites do a good job of keeping the addicts who use them alive. For the night. One injection at a time. But, they may die tomorrow, if it’s inconvenient to return to the clinic to shoot up. Still, addicts must be alive to be rehabilitated.

Safe injections sites do little or nothing to help users get off drugs. Money spent on injection sites is not available for rehabilitation programs. So, users are kept alive, but they are trapped in a miserable lifestyle with no reasonable prospect of improvement. Referrals from injection sites are rare and largely pointless because there is nowhere to refer users to.

Governments must spend more money on rehabilitation – and set useful, humane targets for access to treatment. Getting addicts off drugs should be the goal. Not, just keeping them alive.

The economic benefits of lower, long-term healthcare costs only accrue if addicts stop using drugs. Keeping them alive – and addicted – actually drives up the cost to our healthcare system, and to society at large as increasingly desperate addicts turn to petty crime to fund their habit.