Pubdate: Wed, 11 May 2016
Source: Daily News, The (South Africa)
Copyright: 2016 Associated Press
Author: David Klepper, Associated Press


ACROSS the US, heroin users have died in alleys behind supermarkets, 
on city pavements 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% from heroin 
and related painkillers such as 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. 
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 US, 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 tsar under president 
George 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 US, 
pointing to examples where they offer not only a place to shoot up, 
but also health care, counselling and even treatment beds. In many 
cases, the users are there to shoot up heroin or dangerous opioids, 
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 has yet to record a death.

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. Coloured 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 centre opened on an 18-month trial basis after a sharp increase 
in heroin use in Sydney. The trial was repeatedly extended by 
government officials until 2010, when it was granted permanent 
status. 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 programme 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 neighbourhood, 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 
programme, the clinic said.

A woman who gave her name as Rhea Jean was interviewed after recently 
injecting herself there.

She felt nauseous and ran outside to vomit. Her face covered with 
scabs, the long-time 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 programmes," said Jean, who 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 programme that requires anonymity said he had 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 demonised.

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

The three clinics we visited 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

Surveillance cameras, right, are mounted underneath a metal table 
with chairs bolted to the floor where addicts can inhale heroin fumes 
in a clinic in Amsterdam, Netherlands.

has been no discernible negative impact on the public safety and 
health objectives of Canada during its eight years of operation."

Advocates in the US 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.  ANA-AP
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