Pubdate: Wed, 29 Nov 2006
Source: Manitoban, The (CN MB, Edu)
Copyright: 2006 The Manitoban Newspaper Publications Corporation
Contact:  http://www.themanitoban.com
Details: http://www.mapinc.org/media/2665
Author: Andrew Lodge

VANCOUVER'S SAFE INJECTION SITE RECEIVES PASSING GRADE

Vancouver is renowned for many things, a truly cosmopolitan city, 
voted by The Economist magazine as the most livable city in the world 
in 2005. But Vancouver also has another side to it, a more notorious 
side. Vancouver is the heroin capital of North America.

This past week, the Canadian Medical Association Journal (CMAJ) 
released a summary of findings related to Vancouver's Insite, North 
America's first supervised injection site. Insite is a place where 
heroin addicts and other injection drug users can go to inject under 
clean, safe, and supervised conditions. The report, led by British 
Columbia epidemiologist Mark Wood, found that the site generated "a 
large number of health and community benefits, [while] there have 
been no indications of community or health-related harms."

Insite was opened in 2003 amidst growing concerns relating to 
injection drug use and the problems associated with it. In Vancouver, 
the drug of choice has historically been heroin, although there has 
been a recent rise in the injection of cocaine and methamphetamine as 
well. Advocates for safe injection sites point to repeated studies 
that peg Vancouver's Downtown

As with so much of drug policy in Canada -- the most obvious example 
is marijuana -- lawmakers must contend with pressure from south of the border.

Eastside addict population, estimated at up to 10,000 people, with an 
HIV prevalence of anywhere from 20 to 40 per cent, making the 
Eastside home to one of the worst HIV epidemics in the world.

Insite has not come without controversy, however. As with so much of 
drug policy in Canada -- the most obvious example is marijuana -- 
lawmakers must contend with pressure from south of the border. Back 
when Insite opened in 2003, John Walters, director of the White House 
Office of National Drug Control Policy, called it "state-sponsored 
suicide," "immoral," and "a lie." Also, earlier this fall, the 
Canadian Police Association voted unanimously on a motion to press 
Ottawa to stop financing Vancouver's safeinjection site.

Drugs and prohibition

Underlying the safe injection site issue is the fundamental question 
of how to deal with drugs deemed immoral and therefore illegal.

Though, to many, the distinction between acceptable drugs such as 
nicotine and alcohol and illegal ones is arbitrary.

The tempest that surrounds discussion over drugs, prohibition and 
legalization is by no means new. Alcohol was illegal for a good part 
of the 20th century, while, paradoxically, heroin and cocaine, not to 
mention marijuana, were quite legal. Products containing opiates (the 
broad class of substance of which heroin is a part) and cocaine were 
marketed, not to the bad boys on the block, but to housewives for all 
sorts of quotidian purposes.

When it comes to heroin today, though, the issue becomes a bit more 
pointed, even if the heroin legalization lobby garners much less 
support than its softer sister, marijuana.

While marijuana stirs emotions on various sides of the public debate, 
from an academically informed public policy-point of view, it isn't a 
very complex issue. Throw away its subversive jazz history and our 
culture's puritanical trappings and marijuana is sitting in its jar 
on the kitchen shelf beside last year's Beaujolais. The same cannot 
be said for heroin.

Use and addiction

Heroin is the aging queen of hard drugs.

While it derives from the more benign opium, and while morphine, from 
which heroin is synthesized, is one of the most commonly used drugs 
in health care worldwide, heroin conjures up nasty images of 
addiction and depravity.

The image is not totally undeserved. A walk down East Hastings in 
Vancouver's Downtown Eastside is like walking through a Canadian 
urban war zone. Boarded-up buildings interspersed with pawn shops and 
covered by all manner of garbage sets the backdrop. But it is the 
human condition that forms the haunting impression. Vacant eyes and 
strung out bodies, the prostitution, the using, the pushing: it all 
serves to reveal the violence of heroin addiction.

The battle against addiction is both a personal and a societal one. 
In the latter instance, the response falls, in simplest terms, into 
two broad paradigms. On the one hand, law-and-order advocates agitate 
for a general "get tough on crime" approach.

In that perspective, most famously enshrined in the U.S. "war on 
drugs," substances, of which heroin is one of the most notorious, are 
criminalized, as are those who use them. By cutting off supply and by 
punishing those who generate a demand, the theory goes, society moves 
towards ridding itself of the offending substance and problem.

The junk is illegal, and those who possess it and use it are criminals.

On the other hand lies the notion that addiction is a social ill, a 
problem that exists and needs to be addressed.

Just how that happens is contentious. Some health professionals argue 
for the medicalization of substance abuse and addiction, and 
therefore treat the condition as an illness and the addict as a patient.

Others see the problem from a broader societal scope and argue that 
its very illegality is what creates so many of the problems.

By making drugs like heroin illegal, the argument goes, the market is 
forced underground and prices rise, making it a lucrative trade for 
suppliers and compelling (ab)users to resort to other illegal 
activities to feed their habit.

Benefits and . . . benefits

Vancouver's experiment falls along medical lines. Medical proponents 
of the site refrain from going so far as to calling for legalization 
of heroin, but the idea behind the site requires that the space be 
granted a "waiver of law," where users can inject without the threat 
of being arrested. That "waiver" is now in jeopardy as Stephen 
Harper's government did not grant the requested threeand- a-half year 
extension, instead only permitting it to remain open until the end of 2007.

Does Insite work? The CMAJ report provides some useful insight.

In a survey of addicts on the Eastside, 42 per cent reported using 
the site. Users of Insite also tended to represent some of the most 
vulnerable members of an already marginal population; by and large, 
patrons were more likely to be younger, to be homeless, to have 
previously overdosed, and to be daily users. Heroin was the most 
frequently injected substance, followed by cocaine.

The study also reported that those using the facility were less 
likely to share needles, a major step in the prevention of the 
transmission of HIV and other bloodborne diseases.

The findings related to the Vancouver site mirror the "experience" of 
similar facilities that have existed over the past decade in 
Australia and Europe. Numerous studies have shown that programs 
promoting the use of clean syringes and needles and needle/syringe 
exchange have resulted in reduced transmission rates of HIV and other 
infectious agents and have saved lives," according to Mark Wainberg, 
in a commentary for CMAJ. Wainberg is a professor of medicine at 
McGill and a Director of the McGill University AIDS Centre. He has 
pushed strongly for more projects like Insite.

Nonetheless, the project still has plenty of detractors. The current 
government until now has not had the stomach to support something 
that goes against the law-and-order perspective they enthusiastically espouse.

And they are not without support.

Randy White is a former Reform-Alliance-Conservative MP and founder 
of the Drug Prevention Network of Canada, which claims a substantial 
membership. "Just how does encouraging people to shoot up in a 
government-sponsored drug centre break the cycle of addiction?" he 
asks in an interview with the Globe and Mail earlier this year. "Harm

The study also reported that those using the facility were less 
likely to share needles, a major step in the prevention of the 
transmission of HIV and other bloodborne diseases.

reduction initiatives that encourage or facilitate drug use will 
inevitably lead to more drug addiction and more despair for our 
Canadian citizens."

Another component to the reluctance of policy-makers to espouse the 
supervised injection site concept revolves around the concern over 
what such a site would do to further compromise the neighbourhood. 
Specifically, there are worries that Insite's presence will attract 
drug dealers and concentrate criminal activity, as well as act as a 
siphon for non-addicts to access and ultimately become addicted to 
illicit drugs.

But the CMAJ report, as well as a study commissioned by the RCMP and 
led by Ray Corrado and Irwin Cohen, both found that these fears have 
not come to fruition.

The site has not exacerbated the drug problem, nor have crime levels increased.

It remains to be seen what effect the CMAJ report will have on policy.

With the threat of funding cuts looming overhead, this latest report 
adds to the RCMP-commissioned study and a chorus of other voices, 
including Health Canada, that have called for more supervised 
injection site initiatives. While the idea may appear radical given 
the proximity of this country to its anachronistic neighbour to the 
south, safeinjection sites have been implemented and studied in 
Europe and Australia for some time. The results have been largely positive.

Time will tell what direction Canada will take in what is very much a 
public health issue.
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MAP posted-by: Elaine