My biggest philosophical comment would be how counterproductive it can be to pit public health interventions against medical treatments and recovery interventions, because they don't need to be viewed in opposition or as isolated interventions.
I'm very sympathetic to my colleague's frustration with the sort of attention being given to public health interventions when the treatment system has yet to be developed. We need a comprehensive approach. In the absence of that, as I alluded to, we are hemorrhaging health care dollars. Each and every case of HIV infection on average costs the health care system about $500,000. Consider the amount of money that gets spent looking after somebody who has had a hypoxic brain injury and who will, because of that brain injury, have to be institutionalized for the rest of their life and cared for at the expense of the taxpayer. Chronic hepatis C infection is prevalent. Upwards of 70% of people who inject drugs have it. The pills to treat hepatis C are about $1,000 per pill. It's not just an issue of people dying and the fact that government should be responding. These are huge health care costs.
In terms of addressing those costs, Insite has been shown to reduce overdoses as well as syringe sharing and other high-risk behaviour, so of course I support it. I think everybody should, because we already have programs across Canada that, just as an example, in an effort to mitigate these harms and costs, give out clean needles to people. A program like Insite is actually what I would call a more conservative approach, in that it allows the health care system to ensure that a needle doesn't end up in a park, that young people don't see a person injecting, that an intervention is delivered in an environment where a person can be encouraged into treatment, such as it is.
Unfortunately—and I know this is a huge source of frustration among my addiction medicine colleagues—you see injection sites in the news, and it is implied that the taxpayer is investing a great deal here. I'll just share with you that Vancouver Coastal Health, of which I'm the medical director for addiction services, spends hundreds of millions of dollars every year on mental health. They spend an almost insignificant amount, less than one-sixth of that, on addiction, and a miniscule amount of that, a really inconsequential amount, on supervised injecting, which then saves the taxpayer a huge amount of money. Among the things it is able to do is that it has a detox program upstairs called Onsite, which can take in individuals, help them through detox, and transition them into treatment. They're very effective in doing so.
To people who want to pit one of these things against another, it really is nonsensical. We need a comprehensive approach. We need an addiction system of care that can meet people where they're at, and these low-threshold programs are very effective. We need a door to addiction treatment and recovery, but that door, as the literature from Europe would suggest, means meeting people where they're at. To be honest, these interventions are associated with reduced rates of injecting in the community, so I certainly support a public health approach, and it has been effective in Vancouver.
If there has been any mistake made, it has been the lack of emphasis on addiction treatment going back to the 1990s. That's something that we're trying to dig ourselves out of now in terms of some of the interventions I talked about. These include training health care providers and developing standards and guidelines, but from an evidence-based medicine perspective, the supervised injecting facility has certainly been effective. We need a more comprehensive approach, obviously.