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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

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)
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

Vancouver, BC
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.
The Vancouver Courier (Canada)

Melbourne, Australia Council Votes Yes to Supervised Drug Injecting Room

Melbourne, VIC
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.
ABC News Online (Australia)

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

Vancouver, BC
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.
The Vancouver Sun (Canada)

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."


‘Shooting Galleries’ Take Aim at Illicit Drug Market

United Kingdom
Lately, a few British politicians have revived the idea of dispensing taxpayer-funded heroin. Spurred by successful trials in the U.K. and elsewhere in Europe, the idea that governments can reduce both addiction and street crime — and maybe bleed black markets dry — by managing drug distribution has gained momentum. "It is time to replace our failed war on drugs with a strict system of legal regulation," a British MP named Bob Ainsworth said at the end of last year. "We must take the trade away from organized criminals and hand it to the control of doctors and pharmacists."
Miller-McCune (CA)

Copenhagen Safe Injection Site Set to Open

A private safe injection site for heroin users is set to open in Copenhagen this week despite warnings from police and over the objections of neighbors. The harm reduction operation will be located in the city's Vesterbro district near Central Station. It will be the first in Denmark.

Copenhagen's Vesterbro district (Image via Wikimedia)
Police said they did not oppose the site's opening, but would shut it down if they find people using drugs there. "The room is not illegal per se, but possession of narcotics is illegal," Copenhagen Police spokesman Arne Wissing told the Copenhagen Post.  "We have no intention to sit passively and witness criminal acts, so if we see people in possession of illegal drugs, we will certainly act."

But safe injection site organizer Michael Lodberg Olsen said there was nothing illegal about it. "If that's the case, then they could just as well have shut down all of Vesterbro 30 years ago," he said, referring to needle exchange programs that have operated there for decades. "A report from the UN states that handing out clean needles to drug abusers is the same as establishing an injection room," he said.

Safe injection sites are already operating in Australia, Canada, Germany, Luxembourg, the Netherlands, Norway, and Spain. There are no safe injection sites in the US, although there has been talk about establishing one in San Francisco.


The Prospects for Drug Reform: California [FEATURE]

[Editor's Note: This is the first in a series of reports on the prospects for drug reform in a handful of states where the chances of legalizing marijuana are the strongest. But these reports will also look at medical marijuana, harm reduction, and sentencing reform prospects. They are a work in progress and will be revised. Look for reports on Colorado, Oregon, and Washington in coming weeks.]

California, viewed from space
The West Coast is a different world when it comes to progress on drug policy reform. Three of the four states most likely to see strong pushes for marijuana legalization in the next couple of years are on the West Coast (the other being Colorado). And medical marijuana is a fact of life from San Diego to Seattle, even if many bruising battles remain, and is certain to be an area of contention in coming years.

But it's not just pot politics that makes the West Coast different. The region has also been a pioneer in sentencing reform and harm reduction practices, even if countervailing forces remain strong and both policy areas remain contested terrain.

And the fact that all three states are initiative and referendum states adds another dimension to the politics of drug reform. In all three states, the initiative process has been an important vehicle for drug reform, although it has also been used for anti-reform efforts, most notably with Oregon sentencing initiatives.

Will the West Coast continue to be the drug reform vanguard? Here, we look at the prospects for reform in four broad areas -- medical marijuana, marijuana legalization or decriminalization, drug sentencing reform, and the enactment of harm reduction practices -- and assess where the reform movement can most productively apply its energies. We also attempt to identify areas and issues around which larger coalitions can be formed to advance drug policy and criminal justice reform objectives.

We begin with California, the first state to legalize medical marijuana and that state where advocates last year came within a handful of percentage points of winning voter approval for pot legalization. California is the nation's most populous state and has long been at the cutting edge of social change, but now it is also faced with a monstrous $25 billion budget deficit. How social change and fiscal crisis interact in the realm of drug reform policy-making will be a key issue for advocates as they attempt to deepen existing drug reforms and introduce new ones.

Marijuana Legalization

Last year saw efforts to legalize pot both in Sacramento and at the ballot box in November. Rep. Tom Ammiano (D-San Francisco) made history when his legalization bill was approved by the Assembly Public Safety Committee, but that bill later died. Ammiano is back at it again this year, but getting a legalization bill through the legislature will be a tough fight.

The tax and regulate marijuana legalization initiative led by Oaksterdam's Richard Lee managed to put together an impressive coalition of labor, civil rights, and other groups in the run-up to the November election, but that wasn't enough to get the measure over the top. Proposition 19 scored 46.5% of the vote. Legalization advocates are already laying the groundwork for another initiative; several hundred people gathered at a sold-out California NORML (CANORML) conference in Berkeley late last month in a bid to take the first steps toward consensus among the state's complex, variegated, and often fractious marijuana community.

While Prop 19 failed to win a majority, reformers see the coalition-building that took place around it as a basic building block toward eventual victory. For the first time, pot legalization enjoyed organized support from outside the marijuana community.

"Prop 19 has opened up everything and moved marijuana legalization into the mainstream of American politics, particularly in the Western states," said Steve Gutwillig, California state director for the Drug Policy Alliance. "Its defeat was at most a speed bump, and the Prop 19 campaign process itself accelerated the marijuana reform movement. It created unprecedented mainstream media coverage, educated millions of voters, and forged a new coalition that is poised to be recreated and expanded on in California and other states in 2012," he said.

Winning a legalization vote in California means continuing to mobilize labor and civil rights groups, he said. And the stars are aligning.

"Organized labor has to be at the table of what is clearly a burgeoning industry with thousands of viable jobs from agriculture to retail. For mainstream civil rights organizations, the racial profiling that is at the center of marijuana enforcement is an issue that intersects with groups with whom they are naturally allied on other issues. We're seeing a confluence of economic and racial justice issues at a time when mainstream voters are expressing a fatigue with the drug war in general and a contempt for marijuana prohibition in particular," Gutwillig argued.

"The SEIU's endorsement of Prop 19 in California opened the door to a serious conversation with the service employee unions all across the country, said Gutwillig. "The SEIU also took a long look at the Washington initiative, but didn't think the numbers were there. But even that examination was significant. The SEIU thought the timing wasn't right last year, but all of this will be in play again and all of this represents real progress in coalition building. This conversation is taking place in a way that was unimaginable five years ago."

Gutwillig identified one more constituency reformers will be working to draw closer: the Democratic Party and its voters.

"The California Democratic Party took a neutral position, but a majority of county Democratic committees endorsed Prop 19," he noted. "That signals that there will be real conversations about what role marijuana legalization will play in terms of turnout among traditional Democratic voters."

Long-time CANORML head and veteran scene-watcher Dale Gieringer doesn't think winning outright marijuana legalization is going to be easy despite the coalition-building. Instead, he is talking about getting to the Promised Land through small steps and by broadening the existing medical marijuana system with its population of legally sanctioned adult users and providers.

Gieringer wants to down-grade minor marijuana distribution and cultivation offenses from felonies to misdemeanors, legalize private adult use, and establish a legally-regulated production system that includes manufacturing, processing, delivery, and legal sales to legally authorized users, namely anyone who has a medical marijuana recommendation.

"That would leave room for local governments to expand the universe of authorized users" without explicitly legalizing non-medicinal sale to adults, Gieringer said. "Taking on adult sales at this moment is premature, but we can write a law that opens the door to adult sales without explicitly doing it immediately."

Medical Marijuana

Using California's existing medical marijuana program as a segue to adult legalization, however, requires something the state still lacks: clarity about what is and is not allowed by Proposition 215 and the legislature's attempt to clarify it, SB 420. Some state prosecutors insist that no medical marijuana sales are legal, and the courts have yet to provide rigorous guidance. Cases have been and are being prosecuted in those counties, meaning that access to medical marijuana depends to a great extent on where one lives within California.

"Fixing the medical marijuana system has to be integral and a number one priority," said Gieringer. "We have to make changes to the medical marijuana system. The public is not happy with the current situation and would like something that is better regulated. A lot of operators feel the same way, but have differing opinions about what would be nice."

While a fix could come through the legislature, Gieringer was leery. "I can't see the legislature passing anything we would like," he said. "Given the level of support we have in Sacramento, we could probably get a bill to clearly allow medical marijuana sales, but it would also likely be loaded down with things we would find unacceptable, like 1000-foot provisions, no on-site smoking, no sale of edibles and the like," he predicted.

"They dickered around with it last year, but it was mainly about extracting money from everybody," Gieringer continued. "What's really needed is to clarify what's legal and what isn't."

Gieringer suggested that the people working on marijuana legalization initiatives include clarifying medical marijuana sales. "I think we could get something better through a vote of the people," he said. "I am hoping that medical marijuana reform will be part of the next legalization effort if there is one."

Such a strategy also has the potential of blunting opposition to a legalization initiative within the medical marijuana community. Some dispensary operators and medical marijuana patients were among the harshest critics of Prop 19.

Job protection for medical marijuana users is another area with the potential for coalition-building. State Sen. Mark Leno (D-San Francisco) has introduced a bill to prevent most employers from firing medical marijuana users who test positive for the drug. Perhaps unions, who, after all, represent workers, would be amenable to working on the issue.

Sentencing Reform

California's bloated prison system, with its insatiable, dollar-gobbling budgetary demands has seen some sentencing reform, most notably the passage by initiative of the "treatment not jail" Proposition 36. But the prisons remain full, and with no state money for the treatment end of Prop 36, it's only the law enforcement side of the equation that is fully functioning.

In announcing his budget proposal last month, Gov. Jerry Brown (D) including diverting people convicted "nonviolent, non-serious, non-sex offenses, and without any previous convictions for such offenses" to county jails instead of the state prison system. That includes first-time drug offenders. 

"Governor Brown set an important tone and made it clear that our expensive state prisons should be reserved for people convicted of serious offenses, not for everyone who's ever made a mistake,"  said Margaret Dooley-Sammuli, DPA deputy state director for Southern California. "California is expected to save $500 million a year by handling more petty offenses, including low-level drug possession, at the county level. We think the savings would be even greater if drug treatment were made more available in the community. Under the plan, counties would have that option."

An opportunity to save big bucks and reduce the yawning budget gap could appeal to fiscal conservatives, but in California, conservatives have a long tradition of using tough on crime politics to fill the prisons. Whether they could swallow a measure that to some degree empties them remains to be seen.

"The challenge is finding fiscally conservative Republicans who are willing to publicly challenge the drug war orthodoxy that has long been a mainstay of the Republican Party," said Gutwillig. "There are plenty of Republicans who are willing to say privately they know the mass arrests and incarceration of low-level drug offenders is not a good use of scarce resources, but they have a hard time breaking ranks with a GOP leadership that still needs inflexible tough on crime rhetoric to beat up on the substantial Democratic majorities in both houses of the legislature. It's one of their main tools to undermine the Democratic reform instinct.

Still, the continuing budget crisis may allow reformers to peel off a conservative or two, Gutwillig said. "The economics of the state are in such open-ended crisis that no one can deny the reality that we can no longer afford the blank check we perpetually give to law enforcement and the corrections system."

A 2008 sentencing reform initiative, the Nonviolent Offender Rehabilitation Act (NORA) would have deepened and vastly broadened the Prop 36 reforms, but was defeated thanks to last minute attacks by prison guards and politicians. The time could be approaching for another effort on that front, either in the legislature or via the initiative process. 

Harm Reduction

Access to clean needles, preventing not only heroin, but, increasingly, prescription opioid overdose deaths, and opening a safe injection site in San Francisco are some of the issues facing California's harm reduction community. As in other reform areas, the perpetual budget crisis means if anything is going to happen, it better be inexpensive.

"We can't do anything this year that costs money, so we have to be about erasing some of the rules and barriers that exist," said Hilary McQuie, Western director of the Harm Reduction Coalition. "Jerry Brown is pretty good on these issues, and we have a solidly Democratic government, so we should be able to get some of these things through as long as there is no fiscal impact."

Brown's predecessor, Gov. Arnold Schwarzenegger (R), wasn't so good on harm reduction issues. Last year, he failed to sign two bills that would have eased access to syringes. One expanded a pilot pharmacy syringe sales program statewide; the other expanded access to needle exchanges statewide.

"It looks like those bills will be reintroduced this year," said McQuie.

Overdose prevention continues to be a key harm reduction issue. Last year, a bill extending liability protection for the opioid antagonist naloxone to peer providers passed, but it only applies in a limited number of counties.

"We would like to see Naloxone made more easily available to people," said McQuie. "Maybe pharmacists could prescribe it along with opiates."

McQuie mentioned prescription opiates because that's where the action is now. And that means harm reductionists have to adapt their tactics to new clienteles. With prescription drug overdoses rising dramatically, programs aimed mainly at injection heroin users must now broaden their focus.

"Most of our overdose education happens through needle exchanges and other sites that reach injection drug users, but the trend in overdoses is toward prescription drugs," said McQuie. "We hope we can build coalitions with pharmacists, drug treatment people, and medical associations around peer intervention for overdose prevention among prescription drug users."

But coalition-building with drug and alcohol treatment providers means harm reductionists come up against abstinence-based advocates. "It is a long-term project for us to get them to recognize that they are serving people who are currently using rather than just addressing needs of people in treatment," McQuie sighed. "That will be really important for us. We need a bigger coalition in place."

And then there's the San Francisco safe injection site. At this point, it's little more than a gleam in the eye of harm reductionists, although the creation of such a site has been recommended first by the San Francisco HIV planning council and just last month by the mayor's Hepatitis C Task Force.

But given budgetary constraints, as well as morality-based opposition certain to emerge, if a safe injection site is going to happen, it's most likely to happen from the ground up. Vancouver, where drug users organized themselves and started their own safe injection site, could be a possible model, said McQuie.

"It's out on the horizon, and we're going to try," she said. "But nobody has the staff, resources, and willingness to risk their program sites and funding for this project. The way this could happen is if one of the agencies or drug user groups just starts doing it. It seems unlikely they would get prior permission."

Given the strain that existing harm reduction programs are under, maybe a new, expensive safe injection site program isn't the highest priority right now, McQuie. "But what this proposal does is open up a bigger conversation about harm reduction. Still, we need to set the stage for when the economy rebounds, and also to be prepared to step up and support whoever starts doing it."

California is fertile terrain for drug policy reform. It is also fiercely contested terrain. The coming years will tell whether the forces of reform can forge the alliances they need to emerge victorious on any number of fronts.

United States

SF Mayor's Hep C Task Force Recommends Supervised Injection Facilities (Press Release)

For Immediate Release: February 9, 2011                                   

Contact: Laura Thomas at (415) 283-6366 or Tommy McDonald (510) 229-5215

SF Mayor’s Hepatitis C Task Force Issues Recommendations for Fighting Epidemic, Including Supervised Injection Facilities (SIF)

SIF Allow People to Consume Their Drugs with Sterile Equipment in Presence of Medically-Trained Staff; Reduce HIV, Overdose Deaths and Public Drug Use, While Not Increasing Drug Use

SF Elected Officials Need to Embrace Science and Public Health Approach

The San Francisco Mayor’s Hepatitis C Task Force issued its report a few weeks ago, with strong recommendations for how San Francisco can better address the hepatitis C epidemic here. There are an estimated 12,000 people living with hepatitis C in San Francisco, most of whom do not know that they are infected. San Francisco has the opportunity to ensure that everyone knows their risk, knows their status, has access to hepatitis C treatment and support if they need it, and has the tools and information that they need to protect themselves from hepatitis C. One of those tools, as recommended by the Task Force, is a supervised injection site, where people could consume their drugs with sterile equipment in the presence of medicallytrained staff.

“Supervised injection facilities reduce HIV and overdose deaths without increasing drug use,” says Laura Thomas, deputy state director, San Francisco for the Drug Policy Alliance. “This has been done around the world and it has been proven to work effectively.”

Supervised injection facilities (SIFs) are operating in many countries around the world. They are not a new idea and the science has shown that they work. Insite, in Vancouver, British Columbia, has been extensively evaluated and has shown that a SIF can reduce public drug use, hepatitis C and HIV risk behaviors, overdoses, and other health problems, while not increasing crime or drug use.

In fact, Insite increased the number of people entering treatment for their problematic drug use. SIFs are a serious and well-researched approach to a significant problem. Politicians who are committed to reducing the harms that drugs create for our communities would be well served by paying attention to the evidence.

“San Francisco has led the way in dealing with HIV. The City needs to take these recommendations seriously and begin to address hepatitis C with the same courage and leadership it has shown for HIV,” Thomas added. “Politics can’t trump science in this case. There are too many lives on the line and here will be a serious price for slow learning curve.

“We need elected officials who are not afraid to do the right thing, and who are willing to put all of the options on the table as we fight the spread of hepatitis C and HIV.”

San Francisco, CA
United States

Drug War Issues

Criminal JusticeAsset Forfeiture, Collateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Court Rulings, Drug Courts, Due Process, Felony Disenfranchisement, Incarceration, Policing (2011 Drug War Killings, 2012 Drug War Killings, 2013 Drug War Killings, 2014 Drug War Killings, 2015 Drug War Killings, Arrests, Eradication, Informants, Interdiction, Lowest Priority Policies, Police Corruption, Police Raids, Profiling, Search and Seizure, SWAT/Paramilitarization, Task Forces, Undercover Work), Probation or Parole, Prosecution, Reentry/Rehabilitation, Sentencing (Alternatives to Incarceration, Clemency and Pardon, Crack/Powder Cocaine Disparity, Death Penalty, Decriminalization, Defelonization, Drug Free Zones, Mandatory Minimums, Rockefeller Drug Laws, Sentencing Guidelines)CultureArt, Celebrities, Counter-Culture, Music, Poetry/Literature, Television, TheaterDrug UseParaphernalia, ViolenceIntersecting IssuesCollateral Sanctions (College Aid, Drug Taxes, Housing, Welfare), Violence, Border, Budgets/Taxes/Economics, Business, Civil Rights, Driving, Economics, Education (College Aid), Employment, Environment, Families, Free Speech, Gun Policy, Human Rights, Immigration, Militarization, Money Laundering, Pregnancy, Privacy (Search and Seizure, Drug Testing), Race, Religion, Science, Sports, Women's IssuesMarijuana PolicyGateway Theory, Hemp, Marijuana -- Personal Use, Marijuana Industry, Medical MarijuanaMedicineMedical Marijuana, Science of Drugs, Under-treatment of PainPublic HealthAddiction, Addiction Treatment (Science of Drugs), Drug Education, Drug Prevention, Drug-Related AIDS/HIV or Hepatitis C, Harm Reduction (Methadone & Other Opiate Maintenance, Needle Exchange, Overdose Prevention, Safe Injection Sites)Source and Transit CountriesAndean Drug War, Coca, Hashish, Mexican Drug War, Opium ProductionSpecific DrugsAlcohol, Ayahuasca, Cocaine (Crack Cocaine), Ecstasy, Heroin, Ibogaine, ketamine, Khat, Marijuana (Gateway Theory, Marijuana -- Personal Use, Medical Marijuana, Hashish), Methamphetamine, New Synthetic Drugs (Synthetic Cannabinoids, Synthetic Stimulants), Nicotine, Prescription Opiates (Fentanyl, Oxycontin), Psychedelics (LSD, Mescaline, Peyote, Salvia Divinorum)YouthGrade School, Post-Secondary School, Raves, Secondary School