Insite Ruling

[apache]

i don't really know you so i'm not sure what your values are, but essentially youre allowed to have an alternative perspective, just as long as you don't make too big of a deal out of it, or you don't blow the whistle on anything.

 

Do you think I'm afraid of speaking out? I've been doing it all my life and probably even had some against-the-grain answers on my interview.

 

If the CPSBC wants to enforce a cookie cutter ideology that breeds doctors with absolutely no alternative perspective, then I'll fight them on it. That's only if what you say is true.

[apache]

i can't say, but this isn't chatter, this is more a i've seen hardcopy explicit e-mails thing. it'll all come out eventually though.

 

wow, where did you find out about all this? that's all a bit scary. as though there is no limit to their power :| where did you get all this from though

[questforstarfish]

I am not getting it. They inject them drug to treat them from addiction? Can someone clarify it for me?

 

 

They allow them a safe place to inject with sterilized equipment and medical staff available in case of ODs or infections. They are also, as first time users of Insite, taken on a tour through a room with listed options for detox and treatment. The staff are there 18 hours a day who offer almost full-time access to treatment, whenever people are ready.

 

People who attend the facility are 70% less likely to share syringes (Stoltz). In a study by Pinketon they calculated that, over ten years, 1191 cases of HIV infection and 54 cases of hepatitis C virus infection would be prevented because of Insite. In its first two years of operation, Insite employees made over 2000 referrals to other services, with 800 of them being to addiction counselling. In 2009 there were 491 admissions into Insite’s detox program and 6242 referrals to other services, the majority for detox and addiction treatment programs. The counsellor works out of Insite to limit access barriers, and one in five regular users of Insite have accessed their detox services (Vancouver Coastal Health). The facility has twelve injection stations but also twelve detox beds in the building, which are available immediately upon request. That sounds a hell of a lot better to me than what we've been doing! There have been a lot of journals published that look into the different aspects of Insite as well. The following are the ones I used in my research essay (hence why the following is in MLA format, haha) but there are dozens more available on the same journal websites I used-

 

Bayoumi, A. et al. “The cost-effectiveness of Vancouver’s supervised injection facility.” Canadian Medical Association Journal (2008): n. pag. Web. 8 April 2011.

 

Condon, Sean. “Sobering Statistics.” The Dominion. The Dominion, 8 August 2005. Web. 8 April 2011.

 

Kerr, T. et al. “High rates of primary care and emergency department use among injection drug users in Vancouver.” Journal of Public Health 27.1 (2004): 62-66. 8 April 2011.

 

Kerr, T. et al. “Drug-related overdoses within a medically supervised safer injection facility.” The International Journal of Drug Policy (2006): 436-441. 6 April 2011.

 

Pinketon, Steven D. “How many HIV infections are prevented by Vancouver Canada’s supervised injection facility?” The International Journal on Drug Policy (2010): n. page. Web. 5 April 2011.

 

Stoltz, Jo-Anne et al. “Changes in injection practices associated with the use of a medically supervised safer injection facility.” Journal of Public Health (2007): 1-5.Web. 7 April 2011.

 

UNICEF. Botswana Statistics. N. p. March, 2010. Web. April 2011.

 

Vancouver Coastal Health. “Findings from the Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility.” Urban Health Research Initiative (June 2009): 5-43. Web. 8 April 2011.

 

Wood, E. et al. “Changes in public order after the opening of a medically supervised safer injection facility for illicit injection drug users.” Canadian Medical Association Journal 171.7(2004): n. pag. Web. 3 April 2011.

 

Wood, E. et al. “Methodology for evaluating Insite: Canada’s first medically supervised safer injection facility for injection drug users.” Harm Reduction Journal (2004): 1-9. Web. 5 April 2011.

[keepontrying]

Because law enforcement doesn't kill supply; it just pushes supply to the unmonitored underground and makes the drug business lucrative for criminal organisations.

 

I was referring to anti-supplier enforcement, not anti-user enforcement. At the end of the day, you still need law enforcers to eliminate the drug cartels even under a system of drug decriminalization like Portugal.

[future_doc]

This was just reported on CBC News. It should be up and running in months with the Quebec government to provide a safe environment to inject.

[thatonekid]

This was just reported on CBC News. It should be up and running in months with the Quebec government to provide a safe environment to inject.

That's not quite what was announced. The Quebec government is setting up a program to look at the opening of these clinics. Also, the communities have to deem them "socially acceptable" which may cause delays. As for being up and running in months, that's only if everything goes as planned. The government hasn't even approved proposals yet.

[future_doc]

Thanks for the clarification. I reported what was said on the evening news which obviously was not complete.

[Divinearch]

Sorry, but after watching an 8min video on their insite website and reading through all the comments on this thread, I still don't get it.

 

Why should the society continue to pay for someone who is CLEARLY, A STRAIN on the healthcare system. As if the current healthcare system isn't already in dire state, financially.

 

It may seem cruel of me to say this, but I personally think that drug addicts should NOT be entitled to free healthcare if they show no signs of redemption. Billions of dollars "wasted" on these people could have been used to save others who are suffering from diseases/disorders that are entirely out of their control.

 

Of course, it is not to say that someone who abuses drugs once should be ripped of his healthcare privilege. My suggestion is that if a person was found to be abusing drugs, he would have to go through a series of blood/urine check-ups for the next few months and be certified that he is drug-free, if he wants to be continue receiving free healthcare. The fight against addiction will never be effective if you don't make it hard on these people.

 

Please feel free to criticize and help me gain "enlightenment" in this topic of discussion. Thanks!

[future_doc]

I still don't get it.

 

Why should the society continue to pay for someone who is CLEARLY, A STRAIN on the healthcare system. As if the current healthcare system isn't already in dire state, financially.

 

It may seem cruel of me to say this, but I personally think that drug addicts should NOT be entitled to free healthcare if they show no signs of redemption. Billions of dollars "wasted" on these people could have been used to save others who are suffering from diseases/disorders that are entirely out of their control.

 

Please feel free to criticize and help me gain "enlightenment" in this topic of discussion. Thanks!

 

You need enlightening indeed. You seem to value money more than people who you judge and don't value. What about denying medical care to the elderly, but at what age 75? 80? or do we provide the elderly who made major contributions to society and deny the homeless, those who have been chronically unemployed. What about those in chronic vegitiative treatmstate, do we starve them or just deny them treatment? Recent advances have shown many such people think like you and I but are unable to communicate it. Do we deny health care to those of low I.Q.?

 

You are on a very slippery slope but I guess we need people like you not to treat patients but to be the bad guy I intend to fight during my career. I will advocate for those incapable of advocating for themselves. Humans are imperfect and are not to be judged by physicians. They are to be honoured, treated, given respect and dignity w/o judgment.

 

ic

[aaronjw]

You need to stop judging people who hold a different view or one that is not as complete as yours.

 

This person has a legitimate reason to question these facilities as do A LOT of people do but instead of trying educate and help this person understand you pull a self righteous act and belittle his thinking instea without ANYTHING that was constructive to counter their argumemt.

 

This person may be trolling as i suspect they are but no doubt there are people who think this way and you just gave up an opportunity to education for cheap insults and rhetoric.

 

 

Edited to remove some foul language lol

 

 

 

 

You need enlightening indeed. You seem to value money more than people who you judge and don't value. What about denying medical care to the elderly, but at what age 75? 80? or do we provide the elderly who made major contributions to society and deny the homeless, those who have been chronically unemployed. What about those in chronic vegitiative treatmstate, do we starve them or just deny them treatment? Recent advances have shown many such people think like you and I but are unable to communicate it. Do we deny health care to those of low I.Q.?

 

You are on a very slippery slope but I guess we need people like you not to treat patients but to be the bad guy I intend to fight during my career. I will advocate for those incapable of advocating for themselves. Humans are imperfect and are not to be judged by physicians. They are to be honoured, treated, given respect and dignity w/o judgment.

 

ic

[Divinearch]

You need enlightening indeed. You seem to value money more than people who you judge and don't value. What about denying medical care to the elderly, but at what age 75? 80? or do we provide the elderly who made major contributions to society and deny the homeless, those who have been chronically unemployed. What about those in chronic vegitiative treatmstate, do we starve them or just deny them treatment? Recent advances have shown many such people think like you and I but are unable to communicate it. Do we deny health care to those of low I.Q.?

 

You are on a very slippery slope but I guess we need people like you not to treat patients but to be the bad guy I intend to fight during my career. I will advocate for those incapable of advocating for themselves. Humans are imperfect and are not to be judged by physicians. They are to be honoured, treated, given respect and dignity w/o judgment.

 

ic

 

You don't really know me very well, so I hope you would refrain from personal judgements.

 

I understand your altruistic beliefs and your anger, but I hope you also realize that there is a limit on the amount of funds available. This money will be depleted one day, if people keep taking and not giving. If all underprivileged people started to turn to drugs, I have no doubt that that day will be soon. If people are going to indulge in self-destruction knowingly, how is the healthcare system going to work for these people? As I once read somewhere, providing healthcare is like a pair of hands; it takes 2 to clap. You can keep treating the same guy of infections, but if he doesn't take the extra precaution to protect himself, your professional efforts will be in vain.

 

Those people in the examples you gave were put in an underprivileged state entirely out of their control, and as I mentioned above, they should be entitled to healthcare. It's only those who are self-destructive and showing no signs of redemption, that should be denied.

 

I hope to hear more criticisms about my ideology Thanks!

[PhoenixFlare500]

Let's try to keep the debate respectful guys. If you can't, maybe it's time for a break. Keep in mind that people will have different views than you and you'll have to deal with those people in the real world as professionals (on all sides of the arguments). We probably shouldn't be holding the mentality of everyone else that disagrees with you is a bad guy.

 

P.S. I just love how people assume that those with different views from them are going to make bad doctors and not treat patients. People are different, live with it.

[NLengr]

If you wanna deny healthcare to people who engage in self destructive behaviour, you will have nobody with healthcare coverage. I garuntee you that every single person in the country engages in some activity someone else says is self destructive:

 

Drugs, smoking, drinking, overweight, sedentary lifestyle, speeding, driving while exhausted, riding a bike with no helmet, climbing a ladder without someone holding the bottom, using power tools with no safety glasses, pulling the plug by the cord, etc.

 

There is a reason pretty much no first world country agrees with you.

[aaronjw]

basically doing anything can be considered destructive. I play or played sports and lift heavy ass weights (lol). My joints are shot and likely going to undergo some knee repair. Do I deserve to go without care because of this? No.

 

Problem is morality of what we, individually, view as acceptable activities is what causes the friction between justified and self-inflicted.

 

While I agree with the stance that we all likely engage in activities that another would deem destructive I am also a human being with biases (like EVERYONE ELSE) that thinks some activities are more detrimental in general. Should those activities limit people's access to tax-payer funded healthcare? The humane side of me says no but the logical side of me says maybe.

 

Then again, I broke my neck while speeding which I am sure cost the province a boatload of cash to fix me so I tend to side with the humane approach when it comes to healthcare.

[Clever]

You don't really know me very well, so I hope you would refrain from personal judgements.

 

I understand your altruistic beliefs and your anger, but I hope you also realize that there is a limit on the amount of funds available. This money will be depleted one day, if people keep taking and not giving. If all underprivileged people started to turn to drugs, I have no doubt that that day will be soon. If people are going to indulge in self-destruction knowingly, how is the healthcare system going to work for these people? As I once read somewhere, providing healthcare is like a pair of hands; it takes 2 to clap. You can keep treating the same guy of infections, but if he doesn't take the extra precaution to protect himself, your professional efforts will be in vain.

 

Those people in the examples you gave were put in an underprivileged state entirely out of their control, and as I mentioned above, they should be entitled to healthcare. It's only those who are self-destructive and showing no signs of redemption, that should be denied.

 

I hope to hear more criticisms about my ideology Thanks!

 

People on this forum tend to be highly liberal, unfortunately, and there is no point in having a discussion about topics like this with them because of their ethnocentricity. They tend to believe that the mess they're in are due to genetic, psychological, and/or sociological reasons and should not be punished for their actions, but helped to be restored to functional, contributing citizens.

[thatonekid]

If you don't have something to contribute that moves this thread forward or that provides information that relates to Insite, don't post in this thread. Not everyone has the same views/opinions and we all need to respect that. This is a warning for everyone. Any more blatant or passive-aggressive attacks will lead to the closing of a good thread.

 

Thanks.

[A-Stark]

Sorry, but after watching an 8min video on their insite website and reading through all the comments on this thread, I still don't get it.

 

Why should the society continue to pay for someone who is CLEARLY, A STRAIN on the healthcare system. As if the current healthcare system isn't already in dire state, financially.

 

Aside from anything else you've said, there are many, many patients who are - arguably - disproportionate "strains" on the healthcare system. This covers everything from injection drug users to people with Crohn's disease or SLE or CHF.

 

It may seem cruel of me to say this, but I personally think that drug addicts should NOT be entitled to free healthcare if they show no signs of redemption. Billions of dollars "wasted" on these people could have been used to save others who are suffering from diseases/disorders that are entirely out of their control.

 

Lots of diseases/disorders exist that have a "behavioural" component. Drug addiction is not some sort of "moral" failing requiring "redemption", and whatever element of "free will" might play into it, is certainly multifactorial in origin. Environment - especially a history of physical and/or sexual abuse in childhood - and genetics play substantial roles. They are not wholly determining, but then few risk factors for any disease are.

 

Of course, it is not to say that someone who abuses drugs once should be ripped of his healthcare privilege. My suggestion is that if a person was found to be abusing drugs, he would have to go through a series of blood/urine check-ups for the next few months and be certified that he is drug-free, if he wants to be continue receiving free healthcare. The fight against addiction will never be effective if you don't make it hard on these people.

 

Well, I'm not sure you understand the purpose of Insite. The first point is that someone who abuses drugs is still a human being with no less right to medical care than anyone else. Attempting to determine who is "worthy" is a dangerous game. Having established that, there is considerably greater expense required to treat someone who has overdosed and requires ICU admission or requires longterm treatment for HIV or HCV than there is for (a) providing free clean needles in needle exchanges and ( safe injection sites to further prevent disease transmission and death or serious morbidity from overdoses.

 

And, frankly, the "get tough" or "abstinence-only" approaches have little evidence of their effectiveness. You cannot treat addiction as a moral problem anymore than you can treat schizophrenia that way.

 

People on this forum tend to be highly liberal, unfortunately, and there is no point in having a discussion about topics like this with them because of their ethnocentricity. They tend to believe that the mess they're in are due to genetic, psychological, and/or sociological reasons and should not be punished for their actions, but helped to be restored to functional, contributing citizens.

 

Someone who develops HIV-AIDS due to injection drug use will be "punished" adequately by their own morbidity and (possible) reduced lifespan. And I don't think you understand what ethnocentrism.

[keepontrying]

I've spoken with one of the docs who is heavily involved with Insite and had an informative, yet neutral discussion on what Insite does and how it can resolve our current drug problems. Here are the answers to some of the common questions and misconceptions:

 

1, Drug users are troublemakers of the society. They should not be helped.

 

If anything, drug suppliers are the main troublemakers of the society. Drug users are in fact victims, and in medicine, they are patients. Drug addictions can be seen as a health problem rather than a crime. It's true that some drug users have chosen to live such lifestyle, like a smoker or heavy drinker, and one would believe that they should take full responsibility of their actions. But are we simply going to ignore them? No, that's not how healthcare works because we are not in the position to judge.

 

2, Drug usage is a crime. Drug users should be arrested. That'll teach them a lesson.

 

If they steal or murder someone because of drug-related issues, then yes they would be criminalized. A crime is a crime. Drug usage is NOT a crime per se. Drug trafficking is. Imprisonment may discourage drug usage in the form of punishment, but more often that not, addiction takes time to cure. Serving time in jail without medical support is probably not the best way to treat an addiction.

 

3, Insite is too expensive to operate. We should use the money to hire more cops to hunt all drug-related personnel down.

 

Treatment and harm reduction are more cost-effective than imprisonment in controlling drug problems. Using illegal drug is like hurting yourself - can you get arrested for self-damage? Enforcement should focus more on hunting down drug suppliers instead of drug users.

 

Conclusion is that Insite can treat addictions and reduce harm, that's it. Prevention comes from public education and enforcement comes from tackling the drug lords - hence the 4 pillars of drug policies in BC. We need all 4 areas to work together. A misconception is that Insite will replace enforcement. It won't - instead, it refocuses whom the enforcement should target at. We can also emulate some of the policies that have worked in Portugal. I'm not suggesting that we decriminalize all drugs, not yet, but we can "punish" drug users by removing their rights to drive or accessibility to certain areas of the city (i.e. school areas) because while drug usage isn't a crime, their actions under intoxications are what concern the public.

[Renoir]

So often, an individusl's story is much more telling than broad, sweeping ideologies. After all, we should be investing our efforts in things that make us more human, not less. We will always have vulnerabilities, social problems, injustices in the world, and I think that the highest calling for anyone is to make the system more "human", no matter what their careers are. For some of us gunners, we understand that the social capital of being a doctor may aid us somewhat in this endeavour.

 

Anyhow, to the point - I have recently had a family friend return here from the streets of vancouver. mid-fourties, highly successful, he moved out there seven years ago with his partner. Got involved in crystal meth through socialite friends, his life spiralled downward until he was living on the streets for a number of years, his partner left him, any number of really huge falls from grace. He's hurt his friends and family in various stages of trying to get up again, and it's been a long climb. When I saw him for thanksgiving, I was blown away that this guy could have once lived on the streets. Speaks french, spanish, & english perfectly, has a well-paying job with his MA, passionate about travel, incredibly worldly and knowledgeable, well-spoken, etc. etc.

 

I think of this person, how truly amazing he is, what a "low-life" he must have seemed to people on the street, and am very thankful for those who have committed, even a little, to helping make sure he had a minimum level of safety and health through those rough times. It may not be over, but I'm still convinced he deserves every bit of help I do. Thank god we live in a country as awesome as this - despite bickerings over minor poltical spectrum adjustments, where we have decided that a slant to socialism is indeed something that makes us more human. Of course this goes far beyond economics - the world over it is the compassion of people - but I'm glad those monies are in place to support those whose calling it is to serve the "less deserving". Thank the nurses, social workers, lawyers, volunteers, etc, who have made it their life to afford opportunities to those who want out. And in the meantime (And it's often a LONG meantime), they keep them somewhat safe from harm.

 

Cheers!

[palco61]

Oh man that's awesome. Why doesn't this exist in every country already?

[questforstarfish]

3, Insite is too expensive to operate. We should use the money to hire more cops to hunt all drug-related personnel down.

 

Treatment and harm reduction are more cost-effective than imprisonment in controlling drug problems. Using illegal drug is like hurting yourself - can you get arrested for self-damage? Enforcement should focus more on hunting down drug suppliers instead of drug users.

 

 

Good point! Also, from a financial standpoint, the real strain is that the hundreds of IV drug users "clogging" the ERs with overdoses, abscesses, infections, etc, plus the cost of care for people living with hepatitis and HIV, is unmanageable. Insite is extremely cost-effective (and I posted a link to the research study done on this on page 2 or 3 I believe) when compared to the above care, requiring very few staff members who are able to make referrals to proper services and offer a limited amount of primary and emergency care.

 

And of course what everybody else said about every single person being a drain on the healthcare system. Everybody makes bad choices, but this is Canada and everyone is equal in our health care system, and we all have the right to it! No matter what some doctors think of the choices or mistakes we make

[apache]

Actually the billions of dollars wasted go back into the economy paying physicians. The reason these people are such a "burden" on the health care system is because drugs are illegal, in fact, that is the very purpose for making them illegal. When you make drugs illegal, you artificially put a tax on drug users, because the price of drugs is disproportionate to the cost by thousands of percent, this disproportionate profit drug dealers make goes back into the economy via the purchase of cars, houses, electric generators, real estate agents for grow ops... dealing drugs is actually quite complex, and when you get caught, the police seize your assets... of course, functional drug users wont complain about the artificially inflated cost of their drugs because they like their blow and well, what their doing is illegal. policing drug use is also a huge supplier of jobs, as is the legal system (judges, lawyers, clerks, corrections officers) that tries drug users/dealers and the prison system which houses them (moreso in the u.s., where this is a private enterprise). making drugs illegal also allows for a health care boom, treating aids, overdoses (because your doctor will tell you not to mix your adhd meds with alcohol, but no one will tell the cocaine user that mixing cocaine with alcohol produces cocaethylene, which is far more scary, cardiacly), providing prescriptions for people who come in for anxiety (really they just want some valium to come down from their cocaine), treatment for psychosis caused by marijuana laced with pcp (they thought it was fertilizer!!)...

 

the list goes on and on, drug use isn't a scourge on society. making drugs illegal and the consequences which follow are a scourge on the poor and uneducated. educated, wealthy people know to keep tabs on their heart and respiratory rate when they use oxycodone (instead of heroin), just like lawyers know to take a valium and some a1/b1 blockers if they've had a bit too much cocaine, or if they can find the right psychiatrist (more in the states) desoxyn (prescription methamphetamine)... kind of see a trend, rich people tend to abuse pharmaceuticals and alcohol... the legal drugs, and are educated about use, they also tend to be the ones who tend to profit from the war on "dirty street" drugs.

 

Sorry, but after watching an 8min video on their insite website and reading through all the comments on this thread, I still don't get it.

 

Why should the society continue to pay for someone who is CLEARLY, A STRAIN on the healthcare system. As if the current healthcare system isn't already in dire state, financially.

 

It may seem cruel of me to say this, but I personally think that drug addicts should NOT be entitled to free healthcare if they show no signs of redemption. Billions of dollars "wasted" on these people could have been used to save others who are suffering from diseases/disorders that are entirely out of their control.

 

Of course, it is not to say that someone who abuses drugs once should be ripped of his healthcare privilege. My suggestion is that if a person was found to be abusing drugs, he would have to go through a series of blood/urine check-ups for the next few months and be certified that he is drug-free, if he wants to be continue receiving free healthcare. The fight against addiction will never be effective if you don't make it hard on these people.

 

Please feel free to criticize and help me gain "enlightenment" in this topic of discussion. Thanks!

[apache]

that's a cool concept in fantasyland, now back to real life...

 

actually, the harder you make it on people, and the more you continue to punish them in spite of their effort, the more you enforce an external locus of control and lack of self efficacy... the more likely they are to engage in risk taking behaviour (they essentially become risk-apathetic), because of learned hopelessness (check out the animal models, they're really cool)... so this isn't really true, they'll just pass out on the street from a heroin od, and what sane politician would allow an ambulance to refuse care to a man in cardiac arrest on the street as a modus operandi, certainly one that's not likely to be re-elected after the sensationalist news coverage of ems showing up (anyways) to pick up the body of the deceased... you've obviously never been in a health care environment, these people don't have family doctors, they come in through the er, where you don't exactly have time to "test" them before you try and get their respiratory rate up

 

My suggestion is that if a person was found to be abusing drugs, he would have to go through a series of blood/urine check-ups for the next few months and be certified that he is drug-free, if he wants to be continue receiving free healthcare. The fight against addiction will never be effective if you don't make it hard on these people.

[apache]

i think you might mean xenophobia or bigotry (yes, there are liberal bigots, lol), there are a lot of black, hispanic, and brown liberals yo

 

People on this forum tend to be highly liberal, unfortunately, and there is no point in having a discussion about topics like this with them because of their ethnocentricity. They tend to believe that the mess they're in are due to genetic, psychological, and/or sociological reasons and should not be punished for their actions, but helped to be restored to functional, contributing citizens.