Pubdate: Sun, 02 Dec 2012
Source: Jamaica Observer (Jamaica)
Copyright: 2012 The Jamaica Observer Ltd,
Author: Ingrid Brown


Vancouver's legal supervised injection site for drug addicts

IT'S just after 7:00 am but already a group of men and women stand
shivering in the chilly Vancouver air, but it's not only the frigid
Canadian weather and spending the night outdoors that has caused the
shakes. These are drug addicts anxiously waiting for the doors of
Insite - a safe and legal drug injecting facility - to open.

This facility, operated by the Portland Hotel Society with partial
government funding, provides drug addicts with all the sterile
paraphernalia needed to inject illegal substances - such as heroin -
in a safe environment where they are monitored by the staff to prevent
them overdosing.

Here at the centre the 1,000 drug addicts who utilise its services
daily, are never short of what the staff refers to as harm-reduction
supplies as they are issued a steady diet of condoms, lubricants,
alcohol swabs, sterilised water, tourniquets, syringes, matches,
candles and a spoon-like contraption used 'cook' the drugs.

Insite operates on a harm-reduction model, which focuses on decreasing
the adverse health, social and economic consequences of drug use
without requiring abstinence from drug use.

Explaining how the centre operates, Russell Maynard, programme
director, said new participants undergo a brief registration process
and thereafter they are just asked to log in when they arrive, and to
indicate what drugs they will be using for that day. They are then
assigned a booth and allowed to fill their tray with the
harm-reduction supplies that they need. The addicts usually spend 15
minutes on average before they must make the booth available to
someone else.

Maynard said the staff constantly monitors their 'clients' through a
mirror for signs that they have overdosed. If they do, there are
medical personnel on hand to ensure that if the person stops breathing
CPR is administered while the in-house nurse renders medical attention.

There is also a mobile needle distribution unit which goes out combing
the streets for those who won't come to the centre.

In justifying the centre's existence Maynard said several countries
have tried the big stick approach to curb drug addiction among its
population, but to no avail.

"The US has more people in prison for drugs, and yet there is more
drugs on the streets in that country. Therefore, if we can't keep
drugs out, how can we manage it?" he asked. He noted that drugs have
been coming through the Vancouver port for years mainly from South
East Asia, resulting in a long history of deaths from drug overdose.

Ten years ago, before the centre opened its doors in downtown
Vancouver, it is said that at least one addict would overdose in a
back alley almost every day.

According to Maynard, deaths from overdose are down 37 per cent in the
downtown Vancouver area where the facility operates, while it's only
down nine per cent outside of this circle.

In addition to its safe injection facility, Insite also operates a
detox and treatment centre which sees some 450 persons a year.

"There is no other project in North America sending 450 people a year
into treatment," he said.

Maynard explained that the province is broken into five regions and a
centre like his is only allowed to operate in the Vancouver Coastal
Health Authority.

"So this is how it is in downtown Vancouver, but 15 minutes east of
here is the next authority, and there it would be quite different," he

The centre is the only one of its kind throughout Canada and one of
two safe drug-injecting sites in Vancouver. The other one operates on
a much smaller scale out of the Dr Peter AIDS Foundation facility
which provides residential and day programmes for HIV-infected persons.

Maynard said a safe drug-injecting set up like Insite can reduce the
spread of HIV and Hepatitis C among the drug-injecting population,
which is one of the groups most prone to getting infected through
shared needles.

"This is one of the few jurisdictions on the planet where the rate of
HIV and HPC is going down, especially among injecting drug users,"
Maynard said.

Although drug use is illegal, the centre was first allowed to operate
as a research centre, out of which some 30 peer reviews have since
been done.

"The only place you can have drugs where the police won't arrest you
is Insite, so it had to be a research project," Maynard said.

Although the research aspect ended more than a year ago, the centre
was allowed to remain open, despite resistance from the Federal
Government, because of a recent Canadian Supreme Court ruling.

Meanwhile, at the Dr Peter AIDS Foundation, executive director Maxine
Davis said an element of the residential and day programme for
HIV-infected persons offers a supervised drug injecting services.
Having such a site operating in a larger clinic, she said, has
generated a lot of interest as other persons contemplate a similar

She noted further that despite the push by the federal government to
close down such sites, the decision by the Supreme Court to keep them
open has been a major victory.

The chief justice, Davis explained, ruled that the federal government
was not only interfering but infringing on the charter of rights. The
ruling also noted that when other jurisdictions come forward for
similar exemptions, the minister needed to use the guidelines
governing these facilities, in order not to contravene the charter of
rights and freedoms.

Additionally, she argued in defense of the controversial programme,
the College of Registered Nurses of British Colombia has said it is
within the scope of nursing practice to supervise injections for the
purposes of preventing illness and promoting health. The code further
requires that employers are required to have an environment which
support nurses in their practice.

"So we could be sued if someone went and overdosed because we did not
allow the nurses to practice according to their code," Davis said.
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