Pubdate: Sun, 08 May 2016
Source: News & Observer (Raleigh, NC)
Copyright: 2016 The News and Observer Publishing Company
Author: David Klepper, Associated Press


Across the United States, heroin users have died in alleys behind
convenience stores, on city sidewalks and in the bathrooms of
fast-food joints - because no one was around to save them when they

An alarming 47,000 American overdose deaths in 2014 - 60 percent from
heroin and related painkillers like fentanyl - has pushed elected
leaders from coast to coast to consider what was once unthinkable:
government-sanctioned sites where users can shoot up under the
supervision of a doctor or nurse who can administer an antidote if

"Things are getting out of control. We have to find things we can do
for people who are addicted now," said New York state Assemblywoman
Linda Rosenthal, who is working on legislation to allow supervised
injection sites that would also include space for treatment services.
"The idea shouldn't be dismissed out of hand. I don't see anyone else
coming up with anything new and innovative."

Critics of the war on drugs have long talked about the need for a new
approach to addiction, but the idea of allowing supervised injection
sites is now coming from state lawmakers in New York, Maryland and
California, along with city officials in Seattle, San Francisco and
Ithaca, New York, who note that syringe exchanges were once
controversial but now operate in 33 states.

While such sites have operated for years in places such as Canada, the
Netherlands and Australia, they face significant legal and political
challenges in the U.S., including criticism that they are tantamount
to waving a white flag at an epidemic that should be fought with
prevention and treatment.

"It's a dangerous idea," said John Walters, drug czar under President
George W. Bush. "It's advocated by people who seem to think that the
way we should help sick people is by keeping them sick, but
comfortably sick."

But proponents argue such sites are not so radical outside the U.S.,
pointing to examples where they offer not only a place to shoot up,
but also health care, counseling and even treatment beds. In many
cases, the users are there to shoot up heroin or dangerous opioids
like fentanyl, though some take painkillers in pill form.

At Sydney's Medically Supervised Injecting Centre, more than 5,900
people have overdosed since it opened in 2001. No one has died. It's
the same at Insite in Vancouver, British Columbia. About 20 overdoses
happen there every week, but the facility, which is jointly operated
by a local nonprofit and the Vancouver Coastal Health Authority, has
yet to record a death.

"A big fat zero," said Insite site coordinator Darwin

Sydney's facility is tucked between a hostel and a Chinese restaurant
in Kings Cross, the city's red-light district. Aside from the security
guard posted just inside the front door, it looks like a typical
health clinic.

At least two staffers, including a registered nurse, monitor the
injection room. They are not allowed to administer drugs, though
sterile needles are provided. If a patient overdoses, the nurse
delivers the antidote Narcan, which quickly reverses the overdose.

After users get their fix, they head to a second room with a decidedly
warmer feel. Colored Christmas lights hang from the ceiling; books and
magazines line the shelves. Clients can relax with a cup of coffee or
tea or talk to staff. Some stay for 15 minutes; others spend hours.
They exit through a back door to protect their privacy.

The center opened on an 18-month trial basis following a sharp
increase in heroin use in Sydney. The trial was repeatedly extended by
government officials until 2010, when it was granted permanent status.
It's run by the social services arm of the Uniting Church and is
funded by police-seized proceeds of various crimes.

A clinic in Amsterdam - one of three injection sites in the Dutch
capital - goes even further, distributing free heroin to long-term
addicts as part of a government program created for hardened addicts
who might otherwise commit a crime to pay for their fix.

About 80 users visit up to three times a day. Most are men, and the
average age is 60. Many began using in the 1970s and 1980s.

"We would ideally like them to cut back their use," said Fleur
Clarijs, a doctor at the facility.

But, she said, the main objective of the facility is to reduce risk to
users - and their effects on the community.

In Vancouver's seedy Downtown Eastside neighborhood, Insite offers
patients treatment services just up the stairs from where they shoot
up. About a third of Insite's visitors request referral to a detox
program, the clinic said.

A woman who gave her name as Rhea Jean spoke to The Associated Press
after recently injecting herself there. She felt nauseous and ran
outside to the curb to vomit. Her face covered with scabs, the
longtime heroin user looks far older than her 33 years.

"It's a great place for active users in full-blown addiction. It links
you up to other programs," said Jean, who herself hasn't sought
treatment through Insite.

A 65-year-old man who gave his name only as James because he's in a
12-step program that requires anonymity said he has been using heroin
since age 22. He was clean for 17 years before relapsing; he said he
was sexually abused as a child and spent 23 years in prison.

He keeps returning to heroin, he said, because it provides release
from his problems. Insite is the one place he can go and be treated if
he reacts badly to the drug, he said.

"They saved my life three times," he said, adding that addiction
shouldn't be demonized.

"There's a large section of society that still refuses to accept it as
a disease," he said.

The three clinics visited by the AP initially faced opposition from
politicians and members of the public but gradually won support, in
part because of studies showing reductions in overdose deaths and
open-air drug use in the surrounding community.

A 2010 survey of residents and businesses in Kings Cross, for
instance, found strong support.

Insite was targeted for closure by Canadian Prime Minister Stephen
Harper and his Conservative Party. The case went to the Supreme Court
of Canada, which in 2011 told the government to issue an exemption to
the drug laws allowing Insite to operate.

"Insite saves lives," Chief Justice Beverley McLachlin wrote in the
decision. "Its benefits have been proven. There has been no
discernible negative impact on the public safety and health objectives
of Canada during its eight years of operation."

Advocates in the U.S. have long discussed the potential benefits of
injection sites - but they point to the tripling of heroin and opioid
overdose deaths since 2000 as one reason why the suggestion is
starting to get serious consideration.

The deaths of actors Philip Seymour Hoffman and Heath Ledger put
celebrity faces on the risks of overdosing alone, and it was revealed
recently that representatives for Prince sought help for his addiction
to painkillers just a day before the musician was found dead.

In an effort to stay safe, some addicts are taking matters into their
own hands. In Boston, after Massachusetts General Hospital equipped
security guards with Narcan, the hospital began seeing an uptick in
addicts shooting up in bathrooms and parking garages.

Elsewhere in the city, a nonprofit recently set aside a room where
addicts can go after using drugs. The users can't inject there, but a
nurse monitors those in the room and will intervene in case of overdose.

U.S. federal law effectively prohibits injection facilities, but
supporters say that if a state or city were to authorize one,
Washington officials could adopt a hands-off approach similar to the
federal response to state medical marijuana programs.

Kevin Sabet, a former drug policy adviser to the Obama administration,
put the chances of injection sites getting approval anytime soon at
zero. He believes supporters want full legalization of all drugs and
are exploiting the opioid crisis to advance their agenda.

California Assemblyman Tom Lackey, who served on the California
Highway Patrol for 28 years, said he understands that supporters are
looking for a new approach. But he has deep reservations about
legislation in his state which would create clinics where users could
use heroin, crack or other drugs.

"These facilities send a message that there is a safe use, and I don't
think there is any safe use of heroin," he said.

In Maryland, state House of Delegates member Dan Morhaim is an
emergency physician who himself has administered Narcan "many, many
times." He sees his bill for supervised injection sites as just one of
many creative approaches that will be needed to solve the heroin problem.

"It's not going to cure everyone," he said. "But moving people from
more dangerous behavior to less dangerous behavior is progress."

Marianne Jauncey, medical director at Sydney's Medically Supervised
Injecting Centre, said she would prefer better ways to help hardened
addicts. Her facility will work to keep them alive until that happens.

"Given their histories," she said, "I think the least that we can do
as a society is try."
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