Pubdate: Mon, 09 May 2016
Source: Record, The (Troy, NY)
Copyright: 2016 The Associated Press
Author: David Klepper, The 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 overdosed.

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 necessary.

"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 Fisher.

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."

Klepper reported from Albany, New York. Contributing to this report 
were Associated Press writers Mike Corder in Amsterdam, Kristen 
Gelineau in Sydney and Jeremy Hainsworth in Vancouver.
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