By Michelle Gamage, Local Journalism Initiative Reporter THE TYEE
Harm reduction vending machines are being closed across British Columbia while the Ministry of Mental Health and Addictions reviews the low-barrier distribution model.
In late August Conservative candidate Gwen O’Mahony and party leader John Rustad critiqued the Care and Connection Kiosks, alleging low barrier access to harm reduction supplies like sterile injection and snorting kits “enabled addiction,” calling the machines “appalling and irresponsible,” respectively.
The Tyee ran a fact-checking article where experts debunked these claims, citing research, evidence and best practices.
The vending machines also distribute naloxone kits, which can be used to temporarily reverse an overdose testing strips to check drugs for fentanyl or benzodiazepine contamination and safer sex supplies and sharps containers.
Following the Conservatives’ criticism, on Aug. 27 Premier David Eby asked for the Ministry of Mental Health and Addictions to review Health Authority programs where “harm reduction services are distributed without involving the direct contact between a service provider or peer support worker with somebody struggling with addiction,” the Premier’s Office told The Tyee in an emailed statement.
Health Authorities have removed the kiosks while this review is taking place, the statement continued. Harm reduction supplies continue to be available through emergency departments.
“It’s very concerning that these interventions, these machines, are being closed for review,” said Thomas Kerr, head of the division of social medicine in the department of medicine at the University of British Columbia and director of research with the BC Centre on Substance Use.
“They should clearly stay open while a review takes place. There’s no clear argument for these machines being harmful.”
Vancouver has a long history of distributing harm reduction supplies. The first needle exchange program opened in Vancouver in 1989. It was later replaced by a free needle distribution program in 2002.
A 2002 study in the International Journal of Drug Policy found that limited access to sterile syringes increased people’s likelihood of sharing needles, and a 2010 study in the American Journal of Public Health found that free needle distribution was more effective than needle exchanges at reducing needle sharing and HIV rates.
Many of the people at the highest risk of overdose, death and infectious disease acquisition experience an “immense amount of stigma and discrimination in society at large and within health-care settings,” Kerr said.
“By making these supplies available in a more private, anonymous format, we actually increase the coverage of these interventions because more people will be able to access them,” he said.
BC Green Party Leader Sonia Furstenau told The Tyee in an emailed statement her party is “deeply concerned” about the removal of “an evidence-based solution to fill a service gap,” such as for people who needed to access harm reduction supplies outside of a hospital or medical clinic’s operating hours.
“When these kiosks were launched, the province committed to monitoring their use,” Furstenau said. “If they’ve been removed, we want to see data justifying the decision and details on any consultations with those impacted — people who use drugs, drug policy advocates and frontline workers.”
The Tyee asked the Ministry of Mental Health and Addictions how many vending machines have been closed, where they were located and how many people this could impact. The Tyee also asked what evidence the ministry is basing this decision on.
The MMHA did not respond to The Tyee’s questions and instead provided an emailed statement that said it is working to “increase both the access to these supplies and connection with health care workers and peers” for people who use drugs.
Fraser Health said it did not have any kiosks and would continue to distribute harm reduction supplies at public health units and other harm reduction sites. Interior Health said it closed one kiosk in Princeton on Sept. 5. Northern Health and Vancouver Coastal Health did not respond to The Tyee’s media request by press time.
Kiosks were set up on Vancouver Island last fall and collectively dispensed 18,253 items, Island Health said. The kiosk at the Nanaimo hospital dispensed 8,580 items.
Island Health said there was also a vending machine at Victoria General Hospital which was closed in mid-December “due to challenges with the location related to constrained space and fire alarm activity.”
In-person interactions “provide contact, and those conversations are important, but low-barrier harm reduction supplies are also helpful, and we need to be able to do both,” said Mark Haden, a UBC adjunct professor in the faculty of medicine, at the school of population and public health.
Accessing harm reduction supplies in-person requires a person to admit they use drugs and that barrier will prevent some people from using harm reduction altogether, Haden said.
“Saving lives is important, and that’s what harm reduction does. For those who say, `I don’t support harm reduction, I support treatment,’ the answer is that dead people don’t seek treatment,” Haden said.
In addition, limiting access to naloxone during an overdose crisis that is killing more than six British Columbians per day is “reckless,” Kerr said.
“We know that, even with the widespread distribution efforts we have now, some people still have difficulty accessing naloxone when they need it,” Kerr said. “We should be doing absolutely everything we can to ensure access.”
Naloxone kits are available for free in many pharmacies and health care facilities across B.C. If you don’t know how to administer naloxone, a health-care provider can give a free tutorial in around five minutes.
Haden criticized politicians for using the toxic drug crisis as a political tool and called for leaders to let health authorities “navigate these complex issues based on the evidence.”
“That’s not what’s happening here,” he added. “What’s happening here is it’s becoming a political tool, and that’s unfortunate.”
The Office of the Premier told The Tyee “the review is looking at ways to improve connection to the health-care system, including treatment options, through in-person interactions at the point of distribution. We want to make sure people are talking to a doctor, a nurse or a social worker to get them connected to the system.”
Kerr said there is nothing about a face-to-face interaction that improved the efficacy of a naloxone kit when reversing an overdose, or the efficacy of a sterile injection kit in preventing HIV or hepatitis C infections.
The Tyee contacted the Conservative Party of BC for comment but did not hear back by press time.
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