Safe Injection Sites

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Report Calls for Safe Injection Sites in Toronto, Ottawa

A long-awaited report from Canadian researchers is recommending that Toronto could use three supervised drug injection sites and Ottawa could use two. The report said the sites would be a good health care investment, would reduce drug use, and would reduce the rate of new HIV and hepatitis C infections.

Vancouver's InSite (BCCHA)
The study, the Toronto and Ottawa Supervised Consumption Assessment (TOSCA), did not make specific location recommendations for the sites, saying that should be left up to the cities themselves, should they decided to follow the recommendations.

"Supervised injection facilities in Toronto have the potential to offer meaningful improvements for the health of people who use drugs," said the study's co-principal investigator, Dr. Ahmed Bayoumi from the Center for Research on Inner City Health at St. Michael's Hospital. "The facilities could also make neighborhoods where drug use is common more livable."

But within hours after the study was released, some Toronto elected officials were expressing hesitation.

Deputy Mayor Doug Holyday told the Toronto Star local official need to see all the "facts and figures" behind the study before they decide to approve a safe-injection site. "I have some doubts as to whether or not there is real benefit and whether or not you don't just attract more problems so I would like to really get the thorough results of other places that have done this and I'd like to hear from other experts on the matter," he said.

"There has not been enough research done on the topic in Toronto -- whether that is the way to go with Toronto," echoed Councillor John Filion, chair of the city's board of health, which will consider TOSCA's recommendations.

Toronto Police Chief Bill Blair told reporters late Wednesday that he opposes supervised injection sites, a stance that TOSCA noted in its report. "My concern is there need to be sufficient assurances within the community that the quality of life will not be put in jeopardy," Blair said.

But not everyone at City Hall was so hesitant. There is already ample evidence of the benefits of supervised injection sites, Councillor Gord Perks, chair of the Toronto Drug Strategy Implementation Task Force, told the Star.

"We have today in front of us research that shows there are lives to be saved, money to be saved and neighborhoods to be improved," said Perks. "When you have differing views you go to the evidence, and the evidence is clear -- supervised injection sites save money, save lives and improve the quality of our neighborhoods."

The province of Ontario said it was open to evidence, but had no immediate plans to move forward.

"We are always prepared to listen to good advice, and we make our decisions based on evidence," Health Minister Deb Mathews said in a written statement Wednesday. "Experts continue to be divided on the value of the sites. We have no plans to pursue supervised sites at this time."

Canada's only operating supervised injection site is InSite in Vancouver. It is operating under an exemption from Canada's drug laws, much to the chagrin of the Conservative national government. Any future supervised injections sites would have to win similar exemptions. But at this point, worrying about that seems premature.

Toronto, ON
Canada

New Mexico Legislature to Study Supervised Injection Sites [FEATURE]

In a groundbreaking move, the New Mexico legislature has approved a proposal to study how to enhance and expand the state's already cutting edge harm reduction programs, including a look a medically supervised injection sites (SIJs -- sometimes also known as safe injection sites) for hard drug users. That could clear the way for an eventual SIJ pilot program to operate in the state, although considerable political and legal hurdles remain.

The legislation, Senate Memorial 45, was sponsored by Sen. Richard Martinez, whose constituency includes Rio Arriba County, which has a drug overdose fatality rate five times the state's rate. The state's rate is double the national rate, making New Mexico the nation's leader in drug overdose-related deaths per capita.

"These deaths are preventable," said Martinez. "Overdose spares no one and affects everyone, especially families."

State health officials estimate the state has at least 24,000 injection drug users. Other estimates put that figure as high as 50,000.

The memorial, which was also endorsed by the New Mexico Public Health Association, passed the Senate on a 43-0 vote Monday night and does not need any further action to go into effect. It directs the University of New Mexico's Robert Wood Johnson Foundation Health Policy Center to undertake the study of emerging and evidence-based harm reduction approaches, including SIJs, and report back to the legislature by November 1.

"Sadly, our drug overdose epidemic has outgrown our current harm reduction approaches," said Emily Kaltenbach, director of the Drug Policy Alliance (DPA) New Mexico office. "On Monday, our state senators realized this and did not let politics trump science. They clearly stated their intent to go beyond the status quo and explore innovative strategies to help New Mexico’s families."

"Wow, getting something like that on the state level is huge," said Hilary McQuie, Western director for the Harm Reduction Coalition (HRC). "New Mexico once again takes the lead in state harm reduction efforts; it's one of the few states to take a statewide approach to these things."

"Heroin is still the number one cause of ODs here, but we're also seeing a high number of prescription drug overdose deaths," said Kaltenbach, "so I'm incredibly encouraged that the legislature is willing to look beyond the status quo and start studying proven programs like supervised injection sites. We're hoping to study the feasibility and legal and ethical implications, leading to a pilot site in New Mexico."

If that actually happens, it would be the first SIJ in the nation. Although SIJS are operating in at least 27 cities around the world, including Vancouver and Sydney, and have been proven to reduce the spread of HIV, Hep C, and other blood-borne diseases, as well as prevent overdoses, without increasing criminality or drug use, political and legal obstacles in the US have so far prevented them from spreading here. They face morality-based opposition as well as federal issues including a "crack house law," which bars anyone from knowingly allowing others to use controlled substances.

"These same sorts of issues came up when syringe exchange programs were first discussed," said Kaltenbach. "I think the legal issues can be overcome, but the states have to be willing to look at it as an extension of syringe exchange. This study will address those issues."

While New Mexico is the first state to order a study of SIJs, it isn't the only place in the country where they are on the agenda. In San Francisco, drug user groups, activists, and advocates are working toward winning approval for one there, while in New York City, a similar effort is going on.

"The biggest obstacle is the perception of legal barriers," said DPA's Laura Thomas, who has been working on the San Francisco effort. "We have these crack house statutes, as well as state laws, that say it's illegal to knowingly allow people to use controlled substances. We have to figure out if there's room for a research project, like in Sydney, or create an exemption, like in Vancouver, or get a state law passed, like in New Mexico. We need a ruling that says 'yes,' this is not a violation."

http://stopthedrugwar.org/files/richard-martinez.jpg
Richard Martinez
In the meantime, the achingly slow process of building political support for an SIJ, or at least a feasibility study, goes forward. A year ago this week, a city Hep C task force recommended looking at SIJs. That followed on a similar recommendation from the city's HIV coalition.

"We continue to try to build support for a safe injection site," said Thomas. "During the mayoral campaign last year, at one of the candidate forums, they were all asked if they would support evaluating whether it would work for San Francisco, and most of them said they did, including our current city attorney, Dennis Herrera."

But despite the recommendations and expressions of support, nothing has happened yet. The San Francisco Drug Users' Union is trying to change that.

"We will be pressing the Board of Supervisors to study the possibilities," said the group's Isaac Jackson. "We're also doing a SIJ community design competition, a project in community imagineering. We'll give the winner a nominal prize and we'll present the winning design to the Board," he said.

"We think the city's Human Rights Commission will recommend safe injection sites in April," said HRC's McQuie. "But there have been other bodies and other recommendations. It's a matter of where the political will is and the priorities are."

For HRC, said McQuie, getting a safe injection site up and running in San Francisco is a back burner issue right now, but that could change.

"We have a lot of really great harm reduction projects going on, like the DOPE Project, that aren't getting financial support, and while there was a lot of enthusiasm for awhile about working toward a safe injection site, we kept planning meetings, but nobody would show up. It didn't feel like the energy was there. If the San Francisco Drug Users' Union wants to take some leadership, we would be happy to support it," said McQuie. "I think we will be going back to San Francisco and asking somebody to do something on this issue, but we're not sure who yet."

On the other side of the country, street-level activists are aiming for an SIJ in New York City. Citiwide Harm Reduction in the South Bronx, which is on the verge of opening the city's first fully staffed primary care clinic at a syringe exchange, is preparing to build a full-scale model of an SIJ at its 144th Street building. It may seem like performance act, but its purpose is educational.

"Our inspiration is the Smithsonian museums, where you can go inside the cockpit of the space shuttle," said Citiwide executive director Robert Cordero. "People have this grisly misconception of what a safe injection site would be like, and we want them to be able to have this Smithsonian experience here in the Bronx."

Such a model could be quite useful in educating elected officials and law enforcement, Cordero said.

"SIJs are a humane public health approach to reducing overdoses, HIV, Hep C, and crime, and can provide compassionate care for addicted people until they are ready to get into treatment," he said. "Do we want that, or do we want them just hanging out in front of the bodegas on 149th all day?"

Citiwide isn't going it alone on agitating for SIJs, and it isn't even taking the lead. Instead it is working with groups like HRC and the Vocals-NY Users' Union in a broader campaign.

"We're not trying to be the HRC or Vocals-NY," said Cordero. "We advocate through demonstrating what it would be like while partnering with others who are advocating every day. Our effort is to build the SIJ model, and when anyone comes to New York who is interested in these issues, there can be an educational moment."

Supervised injection sites are not a reality yet in the US, but pressure for them is mounting. Whether it's New Mexico, New York City, or San Francisco, one of these years someone is going to lead the US into the ranks of nations that understand their utility -- and their humanity. New Mexico has just taken a giant step, but let's hope it has to move fast to beat San Francisco and New York.

Santa Fe, NM
United States

Montreal Agency Calls for Four Safe Injection Sites

In a report released Friday, the city of Montreal's public health agency recommended that the city create four safe injection sites for hard drug users, including one that would be mobile. The mayor's office said the same day it agreed with the proposal.

A client prepares to fix at Vancouver's Insite safe injection site. (Image: Insite)
The city must now seek funding to operate the sites from the Quebec provincial health department and then seek an exemption from the federal Controlled Drugs and Substances Act to be able to legally operate the sites.

The Conservative Harper government is not friendly toward safe injection sites, but its effort to shut down Canada's only existing safe injection site, Vancouver's Insite, was rejected by the Supreme Court of Canada in September. The court held that shutting down Insite would violate drug users' rights to life, liberty, and security.

Montreal public health director Richard Lessard said that ruling "opened the door" for Montreal's proposal and that it was desperately needed.

"There is an abnormally high death rate among intravenous drug users in Montreal and an epidemic of infections of hepatitis and HIV," he said on Friday.

Lessard's report found that 68% of intravenous drug users in Montreal are infected with hepatitis C and 18% are infected with HIV. It also found fatal overdoses on the rise. While an average of 51 users overdosed each year between 2000 and 2005, an average of 72 users overdosed each year between 2006 and 2009.

"We are convinced -- and all the scientific studies back us up on this point -- that supervised injection sites do not create new problems," Lessard told The Montreal Gazette. "On the contrary, they reduce the problem of syringes found on the streets and in the parks, and they reduce the number of overdose deaths."

There are still obstacles to overcome, ranging from federal hostility to local NIMBYism, but if all goes well, Montreal could join Vancouver in providing safe injection sites as a public health measure by next year.

Montreal
Canada

New Canadian Drug Reform Coalition Emerges [FEATURE]

Even as Canada's Conservative federal government attempts to drag the country back into the last century with its drug and crime policies, a new drug reform umbrella group has emerged to fight for smart, sensible, evidence-based alternatives. The Canadian Drug Policy Coalition (CDPC) unveiled itself and its new web site late last month.

http://stopthedrugwar.org/files/cdpc-logo.jpg
Enlisting many of Canada's leading experts in drug policy, the coalition is headed by Donald Macpherson, the former head of Vancouver's ground-breaking Four Pillars approach to the drug problem. It also includes researchers, public health officials, front-line harm reduction and treatment providers, people who use drugs, HIV/AIDS service organizations, youth organizations, parents, and community members, all of whom are concerned with the health and safety outcomes of Canadian drug strategies. Its emergence couldn't be more timely. (See a complete list of member organizations here.)

Tuesday, the House of Commons approved a draconian omnibus anti-crime bill, C-10, that would, among other things, create mandatory minimum sentences for growing as few as six marijuana plants and for manufacturing small amounts of hashish or hash oil. The Tories were able to shove the bill through despite broad opposition from across Canada after winning an outright parliamentary majority in the last elections.

Reformers say they will be unable to stop the bill's passage, although they will likely challenge it in the courts, which have proven friendlier to innovative drug policy reforms. The Supreme Court of Canada earlier this year blocked the federal government from shutting down Insite, Vancouver's safe injection site. It is in this contested terrain of federal drug policy, as well at the provincial level, that the coalition seeks to intervene.

"We're letting the world know we're here and we're a coalition that wants to grow," said Macpherson. "We’re working toward trying to change the paradigm and the direction of the federal government and introducing a public health and human rights perspective on drug policy in Canada."

The coalition went public last week, marking its coming out with a press conference in Vancouver, a Macpherson op-ed in the Vancouver Sun, and joining with the British Columbia Health Officers' Council (HOC) in releasing an HOC report, Public Health Perspectives for Regulating Psychoactive Substances, which describes how public health oriented regulation of alcohol, tobacco, prescription and illegal substances can better reduce the harms that result both from substance use and substance regulation than current approaches.

"This paper highlights the large number of needless and preventable deaths, hospitalizations and human suffering consequent to our current approaches," said Dr. Richard Mathias of the HOC. "The Health Officers’ Council is inviting feedback on its ideas and requesting that organizations and individuals join with us in a call for immediate changes to put the public’s health first."

"The story about the emperor's new clothes is replayed time and again by governments unwilling to own up to realities," said Robert Holmes, head of the British Columbia Civil Liberties Association, as he saluted the report. "Public health professionals in B.C. are right to point out that our current chaotic and contradictory drug laws and policies need to be reviewed against scientific evidence of what works to reduce consumption, social harms, and costs," he said.

"People routinely get put in jail for conduct related to active drug addictions, but the criminal justice system is hardly a surrogate for medical care. It is plain that we have inadequate treatment and detox available for people with addictions to help them cope, recover or quit," noted Holmes. "By making cannabis taboo, our society both prohibits and makes more alluring its use. It is, of course, widely used. But instead of recognizing that and taxing it like tobacco and liquor products, with the tax revenue going to the cost of education and care, we leave the massive profits of this industry to organized crime and leave taxpayers with the bill for police efforts to contain it."

"This report is important because it's not about which drugs are legal and which are not," Macpherson said. "We need to look at all drugs through a public health lens. We're trying to get beyond 'good drug, bad drug' and move toward finding a regulatory system that minimizes the harm and maximizes the benefits of these substances."

The provincial health officers' report is also noteworthy because it actually addresses the benefits of drug use, Macpherson said.

"It takes courageous public health doctors to dare to talk about the benefits of drug use," he said. "We all know that drugs can be beneficial from our use of alcohol to relax or become more social or our use of pharmaceuticals to kill pain, but you're not allowed to talk about that in the drug policy arena. It's all about reducing harm, but we need to acknowledge that drug use has its benefits."

More broadly, the CDPC is working toward:

  • A health, social and human rights approach to substance use;
  • The important role harm reduction approaches play;
  • Removing the stigma of criminalization for people who use drugs;
  • Moving beyond the current approach to drug prohibition;
  • A national dialogue on drug policy for Canada.

"We'll advocate for a comprehensive public health and human rights approach," said Macpherson. "It's not just about health, but also looks at social and human rights issues. And it's not just about ending the drug war, but to start talking about alternatives to the failed war on drugs."

The CDPC sees itself as facilitating the dialog, Macpherson said. "A lot of change in drug policy requires political leadership, but politicians also need support in taking those courageous steps, so that when you bring people together to talk reasonably in an informed way and bring the evidence to bear, you can then move forward. They can see that despite their fears about safe injection sites or cannabis regulation, those are actually sound ways to go that make their communities safer in the long run than the way we're going now," he said. "We're trying to position ourselves as the organization than can help find the answers through our expertise and by looking at what's worked and what hasn't in other jurisdictions, and by convening people who care about these issues to look for solutions that actually work instead of the same old same old."

And despite Conservative domination at the federal level, there is still plenty that can be done, both in Ottawa and in the provinces, Macpherson said. "There is a lot that can be done around health and harm reduction because most of the health approaches emanate from provincial health ministries," he said. "Harm reduction can also be done locally by municipalities, for example, by making the criminalization of drug users a low priority for police."

While any decision to end Canada's drug war will have to come from Ottawa, Macpherson said, the provinces can still move forward themselves. "We can expand the number of safe injection sites and other harm reduction programs, and we can move toward a more comprehensive public health approach. They're doing that in some provinces," he said.

Given the obstinacy and recalcitrance of the government of Prime Minister Steven Harper, the CDPC certainly has its work cut out for it, but there couldn't be a group more suited for the task.

Vancouver, BC
Canada

Canada Supreme Court Okays Safe Injection Site [FEATURE]

Rebuffing the Conservative government of Prime Minister, the Canadian Supreme Court Friday ruled unanimously that Vancouver's safe injection site for heroin addicts can stay open. Known as Insite, the Downtown Eastside facility is the only safe injection site in North America.

Vancouver's safe injection site wins a reprieve. (Image: Vancouver Coastal Health)
The Downtown Eastside, centered on the intersection of Main and Hasting, streets, has one of the highest concentrations of injection drug users in the world. An overgrown Skid Row flush with prostitution and destitution, most of its residents live in decaying SRO hotels lining Main Street. Out of 12,000 residents in the area, some 5,000 are estimated to be drug addicts.

At Insite, drug users are provided clean needles and sterilized water with which to mix their drug. Insite does not provide the drugs; users must bring their own. The users inject under medical supervision at one of 12 injecting alcoves.

Insite operates under the auspices of the British Columbia Ministry of Health and the local public health authority, Vancouver Coastal Health. Numerous research reports on Insite have found that it has reduced fatal drug overdoses, reduced HIV and Hepatitis C transmission rates, reduced crime rates in the neighborhood, and increased the number of drug users entering treatment.

It has operated since 2003 under an exemption to Canada's drug laws, but since coming to power, the Harper government has attempted to shut it down, claiming it "enables" drug users. Friday's decision by the Canadian Supreme Court is the final chapter in that effort.

The Harper government argued that the federal drug law took precedence over British Columbia's public health policies. British Columbia and other Insite supporters argued that because Insite is providing a form of health care, its operation is a provincial matter. The federal government's concerns did not outweigh the benefits of Insite, the court said.

"The grave consequences that might result from a lapse in the current constitutional exemption for Insite cannot be ignored," the court said. "Insite has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada."

Hundreds of Insite supporters gathered at the facility at dawn and broke out in cheers after the decision was announced. As the news spread, harm reduction, public health, and drug reform groups in Canada and around the world lined up to applaud it.

"We are absolutely delighted that we finally have a clear decision on the legal framework for Insite," said Dr. Patricia Daly, Vancouver Coastal Health Chief Medical Health Officer. "Since 2003, Insite has made a positive impact on thousands of clients, saved lives by preventing overdoses, and provided vital health services to a vulnerable population. Today's ruling allows us to continue the outstanding work Insite, its doctors, nurses, staff and partners provide."

"This represents a victory for science," said Dr. Julio Montaner, Director of the BC Center for Excellence for HIV/AIDS. "Prior attempts from the federal government to stop the activities of Insite have been ruled unconstitutional. We are thankful for the continued and unwavering support from the provincial government that has allowed us to set an example in Canada and the world for how to deal with addiction which is, indeed, a medical condition."

"We applaud today's landmark decision by the Canadian Supreme Court to uphold the human rights of all Canadians by allowing Insite to remain open," said the Canadian HIV/AIDS Legal Network, CACTUS Montreal, and Harm Reduction International in a joint statement. "We are heartened the Supreme Court of Canada has recognized that criminal laws on drugs must give way to good public health practices and harm reduction."

"This is a victory for science, compassion and public health -- and, given the fiscal benefits of such programs, the Canadian taxpayer. The Supreme Court of Canada recognized that Insite saves lives, and that that should be a guiding principle in deciding drug policy," said Laura Thomas, California deputy director for the Drug Policy Alliance. "Congratulations to the advocates, drug users, researchers, nurses, and elected officials who have campaigned for Vancouver's supervised injection facility for so long. This is a complete validation of their work."

The Supreme Court of Canada's Insite ruling applies only to Insite. Other Canadian localities seeking to establish safe injection sites must win permission from the federal government. Canadian activists urged them to do so.

"In light of today's Supreme Court decision, jurisdictions Canada-wide should act fearlessly on evidence and make harm reduction services modeled on Insite available to those in need in their locales," said the Canadian groups. "The Minister of Health must respect the court's decision and grant similar exemptions to other sites so that people across Canada will be able to access the public health services they desperately need."

There are 67 safe injection sites operating today, with one in Australia, Insite in Vancouver, and the rest in Europe. There are no safe injection sites operating in the United States, although a move is afoot in San Francisco to get one underway there. The Drug Policy Alliance's Thomas said it is time to start pushing harder.

"For communities in the US which have been hard hit by drug use, it is time to look at the evidence from Canada and start opening supervised injection facilities here," she said. "We look forward to implementing the same desire to save lives in the US."

Vancouver, BC
Canada

Chronicle Book Review: Drugs and Drug Policy

Drugs and Drug Policy: What Everyone Needs to Know, by Mark Kleiman, Jonathan Caulkins, and Angela Hawken (2011, Oxford University Press, 234 pp., $16.95 PB)

http://www.stopthedrugwar.com/files/drugs_and_drug_policy.jpg
Mark Kleiman isn't real popular among the drug reform set. The UCLA professor of public policy is no legalizer, and even though he's too much of an evidence-minded academic to be a wild-eyed drug warrior, he still seems to have an unbecoming fondness for the coercive power of the state. Kleiman, who gets top-billing over coauthors Jonathan Caulkins of Carnegie Mellon and Angela Hawken at Pepperdine, also ruffles reformers' feathers with unnecessary snideness and snark.

But I watched Kleiman address Students for Sensible Drug Policy conventions a couple of times, and I thought it was a good thing, a very useful jolt to the group-think that can grip any gathering of congregants committed to a cause. I thought having the students have to hear the arguments of a leading academic thinker on drug policy who, while not "the enemy," was not especially saying what the average SSDPer wanted to hear, was salubrious for their critical thinking skills. I still think so.

In Drugs and Drug Policy, Kleiman and his coauthors continue with the occasional jibes aimed at the drug reform movement, at times reach conclusions at odds with my own, but also serve up a surprisingly chewy work of drug policy wonkery in delicious bite-size chunks. The innovative format, something like a series of FAQs organized within broader chapters -- "Why Have Drug Laws?" "How Does Drug Law Enforcement Work?" "What Treats Drug Abuse?" "Can Problem Drugs Be Dealt With at the Source?" -- allows us to unpack that all-encompassing monster called "drug policy" one subset at a time, and for that achievement alone, is worthy of praise. That it manages to cover so much ground in a paltry 234 pages is all the more laudable.

Overall, Drugs and Drug Policy is smart, reasonable, and thoughtful. It wants policies based on evidence and it advocates for some intelligent alternatives to current policies. It recognizes the utility of needle exchanges, safe injection sites, and opiate maintenance, even as it complains that "harm reduction" has been hijacked by legalizers. It explains that most people who use drugs -- even those diagnosable as suffering from substance abuse disorders -- will quit using drugs themselves without recourse to treatment. And it even allows that drug use can have beneficial effects, even if it doesn't do so until the seventh chapter.

But Kleiman et. al dismiss decriminalization as unlikely to have a big impact on the social fiscal burden of drug law enforcement because, even though it doesn't appear to have much impact on consumption, drug consumers are not, for the most part, filling our prisons -- drug dealers are. While they do concede that not criminalizing otherwise law-abiding citizens could have "significant benefits," they seem to underplay the negative, life-long impact of a criminal drug record on one's life prospects.

In fact, they seem all too comfortable with maintaining the pernicious role of the criminal justice system in drug policy even as they recognize that enforcing the drug laws is "unavoidably an ugly process," with its reliance on snitches, surveillance, and other "intrusive methods" of enforcement. To give them credit, they want smarter drug law enforcement -- concentrating police repression on violent drug dealers while turning a blind eye to discreet dealing, triaging coerced drug treatment spots so they are reserved for the people who could most benefit from them, giving up on interdiction and source country eradication as ineffective -- that might actually reduce the social and fiscal costs of both drug abuse and enforcement, and since drug prohibition isn't going away anytime soon, at least wasting less money on drug war tactics that don't work well should be on the table.

And they reject drug legalization as too scary to experiment with, but seem to imagine it as possible only within a corporate-controlled, heavily-advertised, low-priced scenario similar to that which has accreted around the alcohol industry. Yes, it's probably true that selling cocaine like Coors, would lead (at least initially) to a significant increase in use and problem use, but why does that have to be the only model? A government monopoly similar to the state liquor store model, with reasonable taxes and no corporate pressure to advertise could conceivably allow legalization without the increases in consumption that the authors predict, even though they concede they don't know how large they might be.

Still, when you get to what it is Kleiman et al. would do if they had their druthers, all but the most purist of legalization advocates will find a lot to like. They create three separate lists of recommendations -- a "consensus list" of reforms they think are politically doable now or in the near future, a "pragmatic list" of reforms that would appeal to dispassionate observers but could raise the hackles of moralists, and a "political bridge too far list" of reforms too radical for mainstream politicians to embrace.

The "consensus list" includes expanding opiate maintenance therapy, encouraging evidence-based treatment, early intervention by the health care system, encouraging people to quit on their own (as opposed to being "powerless"), relying less on interdiction, ending the charade that alternative development is drug control, and concentrating drug enforcement on reducing violence and disorder, as well as smarter, more effective coerced treatment in the legal system. If we saw the drug czar's office produce a National Drug Control Strategy with these recommendations, we would consider that a great victory. It ain't legalization, but its headed in a more intelligent, more humane direction.

The "pragmatic list" includes recommendations to lower the number of drug dealers behind bars, not reject harm reduction even if it's been "hijacked," stop punishing former dealers and addicts, reduce barriers to medical research on illegal substances, and be open-minded about less harmful forms of tobacco use.

The authors don't neglect alcohol and tobacco -- the two most widely-used drugs -- and that is really evident in their "political bridge too far" recommendations. The first three items there are aimed squarely at reducing alcohol consumption and its ill effects. They also argue for the legalization of individual or collective marijuana cultivation, a sort of legalization without the market, increased study of the non-medical benefits of drugs, and increasing cigarette taxes in low tax states.

I think Drugs and Drug Policy needs to be read by anyone seriously interested in drug policy reform. It hits almost all the bases, and it's well-informed, provocative, and challenging of dogmatic positions. You don't like the authors' conclusions? Refute them. It'll be good for you.

Insite Activist Threatens Civil Disobedience

Location: 
Vancouver, BC
Canada
If the federal government seeks to permanently shutter Insite, Vancouverites can anticipate a loud and unrelenting outcry from advocates, health care professionals and drug users who support the Downtown Eastside supervised injection site. Closing Insite, "will be seen as a personal affront to the city of Vancouver," said Vancouver Area Network of Drug Users activist Dean Wilson, noting residents in this city, including Mayor Gregor Robertson and at least four former mayors, are generally in favor of harm reduction drug treatment that includes supervised injection.
Publication/Source: 
The Vancouver Courier (Canada)
URL: 
http://www.vancourier.com/Insite+activist+threatens+civil+disobedience/4815699/story.html

Melbourne, Australia Council Votes Yes to Supervised Drug Injecting Room

Location: 
Melbourne, VIC
Australia
An inner city council in Melbourne has voted almost unanimously in favor of trialing injecting rooms to deal with what's been described as a war zone where brazen drug deals are an everyday occurrence due to prohibition.
Publication/Source: 
ABC News Online (Australia)
URL: 
http://www.abc.net.au/am/content/2011/s3219814.htm?site=melbourne

Proof of Insite's Value in the Numbers, Fatal Overdoses in Vancouver Have Been Reduced 35 Percent

Location: 
Vancouver, BC
Canada
With a Supreme Court of Canada case looming this summer that could decide its future, Vancouver's safe-injection drug site has received an extra shot in the arm from a new report that says it has helped reduce the number of fatal overdoses in the city by 35 per cent. The report, compiled by Canadian scientists from the Urban Health Research Initiative, the B.C. Centre for Excellence in HIV/AIDS and St. Paul's Hospital, goes on to argue that Vancouver's Insite - the country's first safe-injection facility - should be replicated in other North American cities where drug use is a common problem.
Publication/Source: 
The Vancouver Sun (Canada)
URL: 
http://www.vancouversun.com/technology/Proof+Insite+value+numbers/4632903/story.html

Vancouver Safe Injection Site Saves Lives, Report Finds

Drug overdose deaths in Vancouver's Downtown Eastside fell dramatically after a safe injection site opened there, according to a study published online Monday in the British medical journal The Lancet. Fatal drug overdoses declined 35% in the vicinity of the Insite safe injection site in the two years after it opened, compared to only a 9% decline in the rest of the city.

Vancouver's Insite safe injection site on East Hastings Street (Image courtesy Vancouver Coastal Health)
"No one has ever been able to demonstrate a substantial reduction in overdose deaths due to the presence of a safe injection site, but we have done so," said Thomas Kerr of the Urban Health Research Initiative at St. Paul’s Hospital in Vancouver and one of the authors of the study.

The study examined 290 drug overdose deaths between 2001 and 2005, 89 of which occurred within 500 meters of the Insite location. Insite opened in 2003. After Insite opened, the overdose death rate within 500 meters dropped from 253.8 per 100,000 to 165.1 per 100,000, a 35% decrease. In the two years prior to Insite opening, 56 neighborhood drug users suffered fatal overdoses; in the two years after, only 33 did.

Previous research had shown that Insite reduced behaviors that could lead to blood-borne infections like Hepatitis C and HIV and contributed to public order by getting IV drug use off the streets and into a clinical setting.

It is not that drug overdoses do not occur at Insite; in fact, there have been 2,000 of them at the facility, but no deaths. In addition to providing injection booths and clean syringes, Insite has nurses on staff who can and do revive users who have overdosed.

Despite previously demonstrated benefits of Insite and the strong support of provincial health authorities, Canada's Conservative government has sought repeatedly to shut it down. The Canadian Supreme Court next month will hear the government's appeal of British Columbia courts' rulings that denying injection drug users such a service violates their rights under the Charter of Rights and Freedoms and that the province has jurisdiction in the case because Insite is providing a health care service, a provincial function.

For the study's authors, the conclusion was obvious: "Safe injection facilities should be considered where injection drug use is prevalent, particularly in areas with high density of overdose."

Vancouver
Canada

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