Pubdate: Tue, 23 Feb 2016
Source: Ithaca Journal, The (NY)
Copyright: 2016, The Ithaca Journal
Author: Kelsey O'Connor
Bookmark: (Supervised Injection Sites)


Ithaca Mayor Svante Myrick wants the city to be the first in the U.S. 
to offer a supervised injection facility, where heroin users would be 
able to shoot up under the care of a nurse. The facility is one piece 
of a comprehensive new approach he wants Ithaca to take against the 
scourge of addiction.

A comprehensive approach following the four pillars of treatment, 
harm reduction, public safety and prevention will be announced 
officially Wednesday, when Myrick and the Municipal Drug Policy 
Committee unveils "The Ithaca Plan: A Public Health and Safety 
Approach to Drugs and Drug Policy."

A supervised injection facility fits into the harm reduction 
category, and is just one part of a much larger plan that will 
include steps like creating an Office of Drug Policy, a 24-hour 
Crisis Center, a Law Enforcement Assisted Diversion program and a 
medicated treatment facility.

"I think we need a comprehensive plan because I think every community 
does," Myrick said. "I mean I think the federal government needs a 
different plan but they're not doing it, and the state's not doing 
it. So we sort of had to do it ourselves. And we did it ourselves not 
because we're the heroin capital of America, our problem is no worse 
than anywhere else, but we do lose people just like you're seeing 
everywhere across the country."

The Vancouver model

There are only two sanctioned facilities for injecting illegal drugs 
in North America, both are in Vancouver, British Columbia.

One of the facilities, Insite, is in downtown Vancouver, on its 
Eastside, which is known to have a high concentration of homelessness 
and drug use. Insite was founded in 2003.

About 700 people visit Insite each day, according to Anna Marie 
D'Angelo, senior media relations officer for Vancouver Coastal 
Health. Insite is open to the public, whereas another similar 
facility in Vancouver, the Dr. Peter Centre, is client-based.

D'Angelo said people who come into Insite are screened and must be a 
long-term drug user. If they are not long-term users, Insite will 
connect them with social services. After being screened, people 
receive an "alias" for each time they come back. Each time they come 
in, users are given clean needles and inject in a booth with a mirror.

"It's all very visible, and there's [nurses] there that are 
supervising, so if you do overdose, they're right there, they can 
provide naloxone ... afterwards you go into what's called a 'chill 
room,' where you stay there for a little bit longer in case there's a 
reaction, then you leave," D'Angelo said.

Right above Insite is a place called "Onsite," D'Angelo said, which 
is a detox facility.

"It's a harm reduction model. You do reduce the harm that illicit 
drugs are doing to you, but you're also connecting the client to 
care," she said. "It's just not someplace where you inject, there's a 
whole kind of process." Insite also offers other services like wound 
care, counseling and referrals to other health and addiction services.

As a result of the facility, overdoses have gone down in the area, as 
well as the transmission of disease like HIV and Hepatitis C, 
D'Angelo said. According to a 2011 study published in The Lancet, 
overdose death decreased by 35 percent within 500 meters of Insite 
after the facility opened, compared to 9 percent in the rest of Vancouver.

Insite and the Dr. Peter Centre are small parts of a larger 
perspective, D'Angelo said. "Insite is just a very small program that 
we have. Our budget for Insite is $3 million per year  $1.5 [million] 
plus Onsite  but we spend over $200 million in addiction prevention 
and treatment."

Funding comes from the province of British Columbia, and the 
facilities remain open because of an exemption from Canada's drug 
laws. After a lengthy legal process, in 2011, the Supreme Court of 
Canada unanimously supported Insite's operation.

In a commentary in The Lancet that accompanied the study, Dr. Chris 
Beyrer, of the Johns Hopkins Bloomberg School of Public Health in 
Baltimore, said "Supervised injection facilities clearly have an 
important part to play in communities afflicted by injection drug use."

Myrick said an Ithaca facility would be modeled after Vancouver's, 
though smaller.

"I think it will be smaller, and not just because we're a smaller 
city, but because our problem is a bit smaller," Myrick said. In 
addition to being smaller, it would be more discreet, Myrick said. 
"What you don't want to do is normalize drug use. You don't want to 
romanticize it, and you don't want to advertise it."

A supervised injection facility would be groundbreaking not just for 
Ithaca, but for the United States. Myrick said he expects to face big 
hurdles, possibly at the local, state and federal level.

The Ithaca Plan

The supervised injection facility is one part of a comprehensive plan 
that will be revealed Wednesday. Since 2014, the Municipal Drug 
Policy Committee, commissioned by Myrick, has been working on a new 
approach to fighting drug addiction. The task force will lay out a 
local strategy called "The Ithaca Plan: A Public Health and Safety 
Approach to Drugs and Drug Policy" that will focus on treatment, harm 
reduction, public safety and prevention.

According to a news release issued Monday, "Bucking the tide of 
punitive responses to drug use, this report is rooted in public 
health and harm reduction principles and charts a new way for cities 
across the U.S. to respond to drug-related problems. This 
groundbreaking report aims to prevent drug use and sales, reduce 
overdose deaths and infectious disease, decrease rates of 
incarceration, expand access to treatment, and save taxpayers money."

More than 20 recommendations have emerged from the committee, the 
release stated.

On Monday, as people learned of the plan for supervised injection 
facility, many were quick to oppose the idea on social media. Many 
were also quick to applaud it.

"... I think even people who oppose this (plan) are opposing this 
with good intentions. They want people to get healthy and they don't 
want people using drugs, and neither do I." Ithaca Mayor Svante Myrick

To those who oppose it, Myrick said he understands.

"What we're proposing is different, and different is scary. And you 
don't want to seem like you're condoning drug use. So I think even 
people who oppose this are opposing this with good intentions. They 
want people to get healthy and they don't want people using drugs, 
and neither do I. The only thing I can say to people who oppose it, 
it's not enough to be angry about the problem if all you're going to 
do is what you did before. If you keep seeing the same problems and 
proposing the same solutions, then you'll never make progress. So 
it's not enough to get angry, you've got to get smart, and you've got 
to be willing to try," Myrick said.

Kassandra Frederique, New York state director at the Drug Policy 
Alliance, said in a news release that municipalities play a vital 
role in reversing "failed drug policies."

"Ithaca is leading the way by showing how cities can create effective 
and innovative solutions to drug problems by listening to their 
citizens and local experts and by drawing on the rich research base 
about what works. We applaud Mayor Myrick, the Municipal Drug Policy 
Committee, and the hundreds of Ithacans who participated in this 
process and hope other cities across New York will follow their 
lead," Frederique said.

Aside from the supervised injection facility, other recommendations include:

Research Heroin Assisted Treatment: Heroin Assisted Treatment (HAT) 
is a form of medical care that involves the carefully regulated and 
controlled prescription of heroin for people who have failed on other 
drug treatments. Research has shown that HAT can reduce drug use, 
overdose deaths, infectious disease, and crime, while saving money 
and promoting social integration.

Create of an Office of Drug Policy: One the central problems with 
drug policy in Ithaca and elsewhere is that agencies often work at 
cross pursues with little coordination. By creating a central Office 
of Drug Policy, Ithaca will be able to coordinate its response to 
drugs and work to implement the recommendations in The Ithaca Plan.

Open a 24-hour Crisis Center: A central finding of the Municipal Drug 
Policy Committee was the need of a centralized place to help people 
navigate the treatment and social service systems. Creating a 
centralized crisis center will facilitate entry into treatment, 
provide a much need space for people in immediate crisis, and help 
coordinate across systems of care. Implement of Law Enforcement 
Assisted Diversion: Law enforcement officials frequently act as the 
first point of contact for drug-related offenses, but criminalization 
generally results in more harm than good. Law Enforcement Assisted 
Diversion (LEAD) is a pre-arrest or pre-booking diversion program 
that has been piloted and evaluated in Seattle, WA. Instead of 
arresting and booking people for certain petty offenses, including 
low-level drug possession and sales, law enforcement immediately 
directs them to housing, treatment, and other services.

Create a Youth-serving Apprenticeship Program with Local Businesses: 
Economic and community development build healthier and safer 
communities. Strong emphasis on youth employment, like an 
apprenticeship program, can improve academic achievement and lessen 
the likelihood of boredom, disengagement, and lack of civic 
engagement, all of which are factors contributing to drug use or 
illicit involvement in the drug trade.

A news conference discussing the comprehensive plan will take place 
at 9:30 a.m. Wednesday at the Tompkins County Public Library.

State health officials did not respond to a request for comment.

Includes reporting from the Associated Press.
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MAP posted-by: Jay Bergstrom