Pubdate: Fri, 19 Sep 2003
Source: Drug War Chronicle (US Web)
Author: Phillip S. Smith, Editor
Bookmark: (Safe Injecting Rooms)


Western Hemisphere's First Government-Approved Safe Injection Site
Opens in Vancouver

Members of the Vancouver, British Columbia, political elite mingled
with hard core drug users Monday to mark the opening of the first
officially-sanctioned safe injection site (SIS) for injection drug
users in the Western Hemisphere. Similar sites, based on the tenets of
the harm reduction approach to drug use, were pioneered in Germany in
the early 1990s and have since begun to be accepted across Europe as
an effective means for reducing drug overdoses and HIV/AIDS and
Hepatitis C infection rates among drug users.

The opening marks another step in Vancouver's slow progress in
implementing the city's much vaunted 2001 "Four Pillars" plan to deal
with drug use in the Downtown Eastside, a sleazy corridor of single
room occupancy hotels, cheap bars, ill-stocked convenience stores, and
wide-open drug markets that is home to nearly 50,000 residents. Nearly
one out of ten of them is shooting dope, according to the Vancouver
Coastal Health Authority, which will operate the SIS, or, as the
authority likes to refer to it, the "supervised injection site." With
its population of drug users and sellers, chronic alcoholics (Indians
are conspicuous drunks here), street-walkers and other hustlers, the
mentally and physically disabled, and yes, some perfectly normal
people, the Downtown Eastside is like skid row on drugs.

The Four Pillars plan -- prevention, treatment, enforcement, and harm
reduction -- foresaw the need for an SIS, but unlike the other
pillars, law enforcement in particular, the harm reduction component,
or at least the SIS, was slow in coming. Cobbled together by city,
provincial, and federal officials with considerable input from the
citizenry, including the Downtown Eastside's remarkably well-organized
drug users, the plan aims at reducing drug overdose deaths and the
spread of infectious disease, as well as the criminality and quality
of life problems generated by drug use under prohibition. But funding
questions and bureaucratic requirements stalled the promised SIS.

The logjam began breaking apart this summer, not long after Downtown
Eastside drug users spearheaded by the Vancouver Area Network of Drug
Users (, infuriated by a sudden, massive police
crackdown on the area beginning in April (and still underway), opened
their own, non-sanctioned SIS at 327 Carrall Street. By Monday, it was
time for the grand opening of the official SIS.

Mayor Larry Campbell, the former city coroner who was elected on a
pledge to actually implement the Four Pillars plan, was there in front
of the gleaming, freshly-renovated SIS to be known as InSite at 139
East Hastings Street, the neighborhood's main drag. So was his
predecessor, former Mayor Philip Owen, whose leadership helped bring
the plan into existence, as well as assorted other political luminaries.

"The first thing that went through my head is the huge number of
people that have died and the number that I saw and had to deal with
their families," said Campbell in remarks marking the occasion. The
SIS will not end drug addiction, he added, but it will quickly make a
difference. "Most importantly, we won't have to take people out of
these hotels time and time again."

At least 37 people have died from overdoses in Vancouver so far this
year, and the number of overdose deaths in the last decade is
estimated at somewhere around 800 by the health authority. And
Vancouverites continue to die of AIDS at rate of about 60 per year
(from all causes), while, according to the Vancouver Injection Drug
User Study, 95% of its subjects are Hep C positive.

Member of Parliament Libby Davies, who represents a Vancouver
constituency, was in Ottawa Monday, but told DRCNet it was a good day
for her. "I'd been advocating for a safe injection since I was first
elected," she said. "I was the first elected official to come out, so
I am very glad today. It's been a long time coming. The first barrier
was the attitude that this is enabling drug use in the neighborhood,"
she explained. "It was controversial, but the community ended up
supporting it. Then it was a matter of pushing the federal government
to agree it was an essential public health measure. I raised the issue
in the House, I lobbied health ministers. It is a life-saving measure."

The Hastings Street SIS, which just completed a $900,000 renovation,
is a clean, brightly lit facility lined on one side by mirrored booths
where users can inject drugs under medical supervision. As Vancouver
Coastal Health puts it: "Clients will be assessed and led to a 12-seat
injection room where they can inject their own drugs under the
supervision of trained health care staff. They will have access to
clean injection equipment such as spoons, tourniquets and water, aimed
at reducing the spread of infectious diseases. After injecting, they
will move to a post-injection room where, if appropriate, staff can
connect clients with other on-site services such as primary care for
the treatment of wound and other infections; addiction counseling and
peer support; and referral to treatment services."

The SIS, which will be open from 10:00am to 4:00am seven days a week,
will be staffed by 16 registered nurses, four alcohol and drug
counselors, and peer staff from the needle user community. Addiction
counselors and physicians will be available on an on-call basis.
Health Canada and the government of British Columbia have kicked in
nearly $3 million to cover costs this year. The health authority
estimates the SIS will soon be handling 800 injections per day.

"We are quite hopeful that this type of intervention will have quite a
positive impact in reducing HIV infection rates in the injection drug
user community," said Steven Smith of AIDS Vancouver, an agency that
works to reduce the disease's spread and impact. "Vancouver is
notorious for having the highest rate of infection for any city in the
developed world," he told DRCNet. "We know we have a problem, and harm
reduction strategies like this are a tangible way of reducing the harm
associated with injection drug use. We hope lots of people will use
the site as a way to connect with treatment and other services."

"This is a huge political victory," said Anne Livingston, VANDU's
executive director and a constant thorn in the side of slow-moving
officialdom. "A lot of credit goes to VANDU members and drug users on
the street who kept the pressure up when others were not so
passionate," she told DRCNet.

So far, so good, but tensions remain between the hard drug community
and the police, and the Downtown Eastsiders are cautious about
Vancouver Costal Health as well, according to Livingston. "The police
have done nothing to let us trust them, especially since they dropped
55 officers on our heads in April. We have always been completely
transparent with them, but they seem to operate in complete
isolation," she said. "We intend to watch them closely."

And the police will be looking right back. According to Vancouver
Police Department media relations specialist Constable Anne Drennan,
eight officers have been assigned to work nearby to deal with issues
related to the site. The department is behind the SIS, she told
DRCNet. "Our intention is to facilitate the use of the supervised
injection site as much as possible," Drennan said. "We want this to
succeed, contrary to what some people might say. Vancouver adopted the
Four Pillars approach, and we agreed some time ago that this was the
best approach to take."

Vancouver police will not arrest people for possession of heroin or
cocaine within a four-block radius of the site, Drennan said, "but we
will not tolerate drug trafficking outside the site. If we come across
people near the site who we become aware are carrying heroin or
cocaine and intend to inject, we will direct them to the site. We will
only arrest for simple possession if there is some other crime being
committed," she said.

Livingston was skeptical. "So now people can have their drugs, but
they just can't buy them? You're safe within the four blocks, but now
you have to go six blocks to score?" she asked. "The police haven't
thought this through. Arresting dealers isn't going to help; they are
like the pharmacy for addicted people. In Europe they simply leave
certain dealers alone to avoid these problems. The police say they
want this to work, but they have a huge conflict of interest."

VANDU is also concerned about the quintessentially Canadian impulse to
codify and regulate all endeavors, as manifested in the guidelines for
the site. "The Health Canada guidelines have created a sort of
over-the-top, hyper-medicalized site with over 40 employees," said
Livingston. "They ignored us through the AIDS epidemic, the Hep C
epidemic, the crack epidemic, the overdose epidemic. We fought like
hell to finally get this, and they create guidelines so restrictive
they could cause this place to fail. What we need is a site that
works, not one that necessarily fits the guidelines. The site is meant
to stop the spread of disease and prevent overdoses, not meet police
goals or bureaucratic guidelines."

The guidelines aren't so onerous, responded Vancouver Coastal Health
spokeswoman Vivian Zanocco. "The guidelines require that people
register and provide an address, that people not share drugs, that
they cannot inject someone else, things like that," she told DRCNet.
"The point is to make the site a safe experience for everyone."

Livingston and VANDU and the users they represent, while skeptical,
are determined to make it work. "While this is a victory, it could
well prompt a backlash," she said. "Some people think it should be
shut down right now. Your drug czar has already been up criticizing
it. The drug warriors badly want to see this thing fail, so they can
document the failure and say 'this doesn't work.'"

MP Davies agreed with VANDU's Livingston on both counts. "One thing we
have to watch out for is that there will be a real media spotlight on
this," she said. "If anything goes wrong, they'll get nailed.
Likewise, I am also concerned that Health Canada not impose guidelines
that drive people away."

But with the hemisphere's first safe injection site now open for
business, the weight of the city, provincial, and national governments
behind it, and ever vigilant activists like the VANDU people keeping a
jaundiced eye on officialdom, it won't fail for lack of trying.
- ---
MAP posted-by: Richard Lake