Vancouver appears closer than ever to becoming the first North American city with a working safe injection room, a place where intravenous drug users can inject their drugs in a safe and secure environment as well as receive other services based on harm reduction principles. The governmental machinery of Canada -- the city of Vancouver, the province of British Columbia and the Canadian federal government -- is grinding slowly in that direction, but organized drug users and their supporters in Vancouver's Downtown Eastside will act on their own if no official action comes soon.
The gritty Vancouver neighborhood is home to the continent's most flagrant hard drug scene, with users and dealers creating a constant crowd whose epicenter is the corner of Main and Hastings. Although the city has okayed harm reduction programs, including an active needle exchange program, and is now embarking on a drug court program, the scene continues to thrive, the neighborhood continues to suffer from petty thefts, break-ins, prostitution, and the use of alleyways as shooting galleries and bathrooms. And the junkies continue to fall prey to the police, diseases such as AIDS and Hepatitis C, and overdose.
"We've had a hundred fatal overdoses in
Vancouver alone this year," said Dean Wilson of the Vancouver Area Network
of Drug Users (http://www.vandu.org).
"Not having a safe injection site is criminal," he told DRCNet. "Law
Vancouver appears closer than ever to becoming
the first North American city with a working safe injection room, a place
where intravenous drug users can inject their drugs in a safe and secure
environment as well as receive other services based on harm reduction principles.
The governmental machinery of Canada -- the city of Vancouver, the province
of British Columbia and the Canadian federal government -- is grinding
slowly in that direction, but organized drug users and their supporters
in Vancouver's Downtown Eastside will act on their own if no official action
comes soon.
The gritty Vancouver neighborhood is home
to the continent's most flagrant hard drug scene, with users and dealers
creating a constant crowd whose epicenter is the corner of Main and Hastings.
Although the city has okayed harm reduction programs, including an active
needle exchange program, and is now embarking on a drug court program,
the scene continues to thrive, the neighborhood continues to suffer from
petty thefts, break-ins, prostitution, and the use of alleyways as shooting
galleries and bathrooms. And the junkies continue to fall prey to
the police, diseases such as AIDS and Hepatitis C, and overdose.
"We've had a hundred fatal overdoses in
Vancouver alone this year," said Dean Wilson of the Vancouver Area Network
of Drug Users (http://www.vandu.org).
"Not having a safe injection site is criminal," he told DRCNet. "Law
enforcement can't do it. The police come in and do a big bust and
everyone vanishes for about 24 hours, but then it's business as usual.
If the government fails to act, we will do it ourselves before November
1," Wilson vowed.
Provincial prime ministers from across
Canada will meet on September 13 to discuss safe injection sites, and Wilson
hopes that meeting will prod the British Columbia provincial government
to act. "The provincial government is the weak link now," he said.
"We've got strong local support with Mayor Philip Owen and we've got good
support from the Liberal federal government. Health Minister Alan
Rock is open to us."
"We would like to do it with government
support and government funding, we would like it to be like Frankfort,
with a full range of services," said Wilson, "but if we have to open up
in a storefront, we will do it. Right now we have eight people kicking
in $150 a month each for a space, and we will open for limited hours with
volunteers. We want to reduce the harm to the users and to the community
at large," he said. "We'll run a tight ship, there won't be a bunch
of drug dealers outside the door even if I have to run them off myself,
it will be a place where people can use in a safe and dignified way.
We'll have information in front, peer-to-peer counseling. We'd like
to do methadone and detox, but we have to get the doors open," he explained.
Even though Wilson anticipates few legal
hassles in the event of an unauthorized opening -- "The Vancouver police
quietly support us," he claimed -- he emphasized that the planned action
was not an official VANDU action, but that of "concerned drug users and
non-using friends."
Wilson and other safe injection site advocates
got some heavy-gauge ammunition earlier this week when the Canadian Medical
Association Journal (http://www.cma.ca/cmaj/),
the country's premiere medical publication, published two studies of Vancouver
hard drug users calling for the inauguration of the rooms now. The
journal's editors also gave a ringing endorsement of the recommendations,
calling for serious consideration of safe injecting rooms.
The two studies examined hospital utilization
and costs and needle-sharing practices among Vancouver injection drug users,
and they found that their subjects fill scarce hospital beds and emergency
room space at huge cost, suffer a high number of overdoses, and continue
to share needles despite the existence of needle exchange programs.
In the hospital use study, St. Paul's Hospital
internal medicine specialist Dr. Anita Palepu tracked 598 injection drug
users over three years and found they accounted for 2,763 emergency room
visits and 495 actual hospital admissions. Nearly all those visits
were medical problems caused by unsafe injection practices, with the most
common reasons for admission being abscesses and pneumonia caused by bacteria-bearing
needles, the study found.
"Those numbers are very high, especially
when you consider most of these people are in their early to mid-30s,"
Palepu told reporters at a press conference announcing the research results.
"There is a segment of society that will always misuse drugs. But
they are not necessarily horrible people. It is important to treat
them as human beings," she said. "Safe injection sites are an investment
to prevent medical problems that we would otherwise end up paying for downstream."
Martin Schechter, head of the University
of British Columbia's Department of Health Care and Epidemiology, authored
the study of needle-sharing practices among Vancouver drug users.
He found that 28% of his subjects had shared needles within the previous
six months and that "expansion of the needle exchange program alone will
not be sufficient to eliminate" this risky behavior. Schechter identified
several factors linked with needle sharing. Being refused access
to needles at pharmacies, requiring help to inject drugs, having a mental
illness diagnosis, reusing needles, and frequent cocaine or heroin injection
were all identified as associated with needle sharing among the 962 injection
drug users studied since 1996. (More than 10% of them, 124, have
died since the study began.) Schechter also identified problems with
police as contributing to needle sharing, as well as other behaviors that
raise public order and safety concerns, such as injecting in public or
failing to safely dispose of used needles.
"Given the high prevalence of HIV risk
behaviors, overdoses, and other health-related concerns that persist in
Vancouver, it is crucial to evaluate whether the European experience with
safer injection rooms can be replicated in Canada," Schechter concluded.
The Canadian Medical Association Journal
editorialists, for their part, went a bit further than Schechter, calling
outright for safe injection rooms. The editorial warned that there
was no easy solution to severe drug problems within Canada. "But
we can make the lives of people with drug addictions a little better and
the neighborhoods a little safer," ran the editorial. "Supervised
injection rooms are a logical next step, one that combines the merits of
realism and compassion."
The studies have provoked extensive press
coverage and editorial comment in Canada, most of it favorable toward safe
injection rooms. For VANDU's Wilson, it can't come soon enough.
"There's always a new batch of kids on the street," he said. "It
brings tears to my eyes. But we have a real chance here in Vancouver,
because we have educated our users. We have 120 people showing up
for our general membership meetings, and they all say working with us is
the most incredible experience they've ever had."
Wilson also has his eye on the big picture.
"We will have a safe injection site, and Vancouver will be the test case
for North America. With our proximity to the border and the United
States, the Americans are very scared. If we can do it, then Baltimore
will have to do it, Portland will have to do it."
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