Category Archives: Study Results

Health-care system could be spared high cost of new hepatitis C treatments.

A drug user injects at Insite in Vancouver. The facility, where addicts shoot up their own drugs under the watchful eyes of a nurse to prevent overdoses, is the only legal safe injection site in North America. Studies and advocates have pushed for similar sites in other major cities.

Opening five safe-injection sites in Ontario makes financial sense, says a medical researcher who based his study on a Vancouver clinic where drug users shoot up under supervision.

Dr. Ahmed Bayoumi of St. Michael’s Hospital in Toronto said establishing facilities such as Insite in that city and in Ottawa would save money and reduce the incidence of diseases such as HIV and hepatitis C.

“Three facilities for Toronto and two for Ottawa represent a good investment compared to other things that we ordinarily invest in in health care,” he said in an interview Monday.

The study follows up on earlier research that said safe injection sites in Toronto and Ottawa would improve the health of intravenous drug users. The latest information takes into account new treatments for hepatitis C which, though effective, are also much more expensive.

A typical six-month course of hepatitis C treatment costs about $60,000, Bayoumi said.

“So preventing hepatitis C becomes particularly important because it helps avert those costs that would otherwise be incurred by the health-care system,” he said.

Insite is North America’s only supervised-injection site, where addicts shoot up their own drugs under the watchful eyes of a nurse to prevent overdoses.

The site provided a baseline for estimating the approximate cost of operating a safe-injection site as well its effectiveness at improving users’ health, Bayoumi said.

Victoria and other cities across Canada have considered establishing similar facilities.

Montreal announced its intention to open a safe-injection site after a 2011 Supreme Court of Canada decision ruled against the former Conservative government’s attempts to shut down Insite for violating federal drug laws.

Ahmed Bayoumi
Dr. Ahmed Bayoumi of St. Michael’s Hospital in Toronto says safe injection sites would save money and reduce the incidence of diseases such as HIV and hepatitis C. (CBC)

Multiple facilities

Unlike in Vancouver’s Downtown Eastside, Bayoumi said multiple facilities would be more appropriate in Ontario, where populations of drug users are more spread out.

He said the study’s economic estimates are conservative because they’re based on Insite being a freestanding clinic, compared to an approach that would incorporate safe-injection facilities into existing health centres.

While the study focused on needs in Toronto and Ottawa, Bayoumi said other Ontario cities could also benefit from such facilities.

“The next step is mostly a political decision rather than a research decision, as in, ‘Is there an interest and a will to actually establish some facilities?”‘

Ontario’s health minister said a national strategy to deal with intravenous drug users, rather than a piecemeal approach, would be most beneficial.

“I think that more than anything, this is an opportunity to bring together all jurisdictions and look at this in a uniform way,” Eric Hoskins said.

“We, up until recently, had a federal government that made it clear they didn’t support such sites. We now have a government that understands the science and is willing and prepared and wants to make decisions based on evidence.”

The minister said any request for a safe-injection site would have to come from municipal governments.

hi-safe-injection
Researchers say multiple safe injection sites would be more appropriate in Ontario cities, where populations of drug users are more spread out, in contrast to the more concentrated population in Vancouver’s Downtown Eastside.

Reducing deaths, disease

Insite opened in 2003 as part of a harm-reduction plan to tackle an epidemic of HIV-AIDS and drug overdose deaths in the Downtown Eastside.

The facility provides clean needles to addicts to stop the spread of infectious diseases before they inject drugs at one of 12 booths.

Studies in major medical journals have hailed the success of Insite, suggesting it has helped reduce overdose deaths, infectious diseases and crime in the 10-block area that draws addicts.

The former federal government was criticized for wanting Insite to be shut down over concerns it promotes drug use, but lost a series of legal battles that kept the clinic open.

The Canadian Press (with files from CBC News), November 30, 2015

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A new study says that the opening of three supervised injection sites in Toronto would be good value for money.

Dr. Ahmed Bayoumi, Scientist, St. Michael’s Hospital and Associate Professor, University of Toronto

A new study bolsters the case for opening five safe injection sites in Ontario, including three in Toronto, by showing they would be more cost effective than previous research has projected.

Because of a recent surge in the cost of treating hepatitis C, there is now a better economic case to be made for preventing the spread of the potentially deadly virus through the sharing of needles in the first place, according to a paper published Monday in the journal Addiction.

Advocates of safe injection sites hope the findings put the issue back on the front burner and nudge the federal Liberals into making good on a commitment to expanding supervised injection services across the country.

The study points out that new drugs on the market are highly effective in treating hep C, but come at a steep price.

“Because hepatitis C treatment is so expensive now, preventing a very costly infection becomes much more attractive,” said lead author Dr. Ahmed Bayoumi, a physician at St. Michael’s Hospital and a researcher in its Centre for Research on Inner City Health.

The study builds on findings of a 2012 report which showed that opening three supervised injection facilities in Toronto and two in Ottawa — Ontario’s two largest cities — would be good value for the money. They would reduce public drug use and prevent new hep C and HIV infections.

Since that report’s release, new hep C drugs, with astounding cure rates in excess of 94 per cent, have become available. Two were approved earlier this year under the Ontario Drug Benefit exceptional access program — Holkira Pak and Harvoni.

Prior to that, they were out of reach for most patients because they came with a price tag of up to $60,000.

The new study shows that a Toronto safe injection site has an incremental cost-effectiveness ratio of $10,763 per quality adjusted life year, compared to $31,781 in the 2012 report. This is a technical measurement that assesses the dollar value of a medical intervention, taking into account life expectancy and quality of life.

“Another way to say that in plain English is that if you look at the return on investment, it’s more favourable now than it was in our initial report,” said Bayoumi, who also contributed to the 2012 report.

The new analysis shows there is an 86 per cent chance that one or more supervised injection facilities would be cost-effective in Toronto. It takes into account the number of people who use drugs, how frequently they would use an injection site, the cost of the facility, and the cost and availability of hep C treatment.

Bayoumi said the conclusion is conservative and that the cost would be much lower if the services were incorporated into existing health facilities.
The annual cost of operating a free-standing facility is pegged at $1.5 million for rent, insurance, cleaning and maintenance, and $130 per patient for equipment and personnel.
A 2013 report from Toronto Public Health suggested the city should create supervised injection sites for drug users, integrating them into existing health services.

It is estimated that 10,000 people in Toronto use injection drugs, including heroin, cocaine and crystal methamphetamine.
Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, said the future of safe injection sites in Canada looks good given mounting evidence supporting their value and the election of a new government supporting their existence.
“We have more evidence that there is a benefit … and a new government that has expressed its support for supervised consumption services,” he said.

Asked whether her office would support opening safe injection sites in Ontario, Health Minister Jane Philpott issued the following statement:
“Our government believes in evidence-based decision making. When properly established and managed, supervised consumption sites have the potential to reduce the harms associated with drug abuse on individual users and communities.
“Decisions regarding applications for safe injection sites are evaluated carefully by Health Canada to ensure health and safety requirements are met,” the statement read.

The Canadian HIV/AIDS Legal Network sent a briefing paper to all MPs on Monday, the eve of World AIDS Day, calling on the federal government to move forward on a number of HIV-related issues, including the scrapping of Bill C-2, which forces proposed injection sites to meet a lengthy list of requirements before opening.
The bill, passed by the House of Commons earlier this year, has widely been viewed as an attempt by the previous Conservative government to impede the operation of Vancouver’s Insite safe injection site and to thwart the opening of new sites.

It requires applicants to consult with police, community members and public health officials and to gather crime statistics before getting an exemption from federal drug laws.
The Conservative government introduced the legislation after the Supreme Court blocked its attempt to close the Insite centre, ruling that health services could not be denied to addicts.
“It would seem like a fairly straight forward, no-brainer kind of move that the government should repeal Bill C-2 and actually get on with issuing the appropriate exemptions to the applications it has received,” Elliott said.

He was referring to applications for a federal health act exemption from a community group in Montreal and from Vancouver’s Dr. Peter Centre.

Story by:  Theresa Boyle

Toronto Star, November 30, 2015.

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