Safe Injection Sites

RSS Feed for this category

Feature: First Drug User Union Forms in San Francisco

Thanks to the on-the-ground efforts of local harm reductionists and the funding largesse of the Drug Policy Alliance, San Francisco is now the home of only the second drug user union in the United States. The nascent effort is just getting off the ground, but plans to follow in the footsteps of Canada's Vancouver Area Network of Drug Users (VANDU) and the New York City VOCAL drug user union affiliated with the NYC Aids Housing Network.

https://stopthedrugwar.org/files/sfusersunion3.jpg
While self-identified drug user unions are rare in the US, they have a history dating back to the Dutch "junkiebund" of the 1970s. The movement is currently spreading internationally, with affiliates of the International Network of People Who Use Drugs (INPUD) operating in Europe, North America, South America, and Asia. And while medical marijuana patients did not refer to themselves as drug users, they have done similar organizing based on their use of the weed.

"We gave a $35,000 grant to the Harm Reduction Therapy Center to organize drug users in San Francisco, said Laura Thomas, DPA California state deputy director. "It is an annual grant, and future funding depends on HRTC re-applying for the funds. We have funded VOCAL in New York for several years."

DPA sees drug user groups as a key component in efforts to reduce the harms of both drug use and prohibitionist drug policies, said Thomas. "We hope that drug users in San Francisco will have a voice in policy decisions that affect them," she said. "We hope that they will become an active and organized part of efforts to reduce the harm related to both drugs and the war on drugs in San Francisco. The group is still in the process of forming and determining what their priority issues are, so I can't speak for what they are going to be working on."

"While we haven't quite chosen our main campaign, we've been talking about what we would ideally like San Francisco to look like, about having a safe place to inject, and about having a safe place to consume other drugs, too," said Alexandra Goldman, the organizer for the group. "Within a couple of months, we will choose our first official campaign," she vowed.

"We are also interested in working to decrease the stigma, both within and outside the drug using community," Goldman added. "We're trying to work with health care providers to make it a more positive experience. Our people tend to wait until they are very seriously ill because they are not treated very well. In our meetings, I'm hearing about how people don't get the prescribed pain medications they need because the doctors don't like them."

The group has already been active, joining in protests against the city's proposed ordinance barring people from sitting or lying on public sidewalks. Homeless people in neighborhoods like Haight-Asbury have roused the ire of business owners with their presence, but activists say they have no place to go and should not be criminalized.

The SF Drug User Union participation in the sit/lie protests makes sense given that many of its members are homeless and that its meetings are generally being held in homeless drop-in centers in the Tenderloin and the Mission. The group boasts about 25 members, with an emerging core group of 10 or 12, but is looking to expand by working with lower income communities and people involved in local harm reduction networks.

"We plan to be active consumers, giving our opinions and our voice on issues and policies that affect us," said Isaac Jackson, the other paid staffer for the union. "People are already asking us for our expertise."

So who can join the union? Anyone who identifies as a drug user, past or present, organizers said. Defining members in that manner allows people to get active without necessarily outing themselves as current users.

https://stopthedrugwar.org/files/sfusersunion4.jpg
"There is no piss test to get into this group," said Jackson. "We have heroin users, speed users, people who drink, pot smokers. Some people think pot's not a big issue, but anyone who wants to work with us, we say 'right on.' We support the legalization campaign and we support medical marijuana. That's a success story, and so is needle exchange, and we'll be trying to learn from those."

The only rule at meetings is no drug dealing, said Jackson. "We don't want people to deal drugs at the meeting or endanger other people in the group by that kind of activity, but if people are carrying, so what? Some people have showed up tweaking. We don't want to say they can't come because they're too high. We want people to feel welcome whatever their level of sobriety."

Forming a drug user union in San Francisco has been an idea that's been batted around for at least a couple of years, but it took some cold, hard cash to make it happen. "There were some attempts to organize drug users in the past, and I was involved in those, but they didn't stick because people had other jobs," said Goldman. "But once that Drug Policy Alliance grant came in, I got hired in November and we had our first meetings in February."

"I worked at a small health agency working with homeless people with substance use here in the Tenderloin, and was also working with some people with the Youth Homeless Alliance in the Haight," said Jackson. "A lot of people said we ought to do something like VANDU. We had a conference here a couple of years ago to try to jump-start a safe injection site, but that was mostly health care providers, not drug users."

San Francisco has one of the highest rates of drug use per capita in the country, Jackson noted. "Since there is so much civil disobedience going on already -- the laws are wrong, when you have thousands of people doing something for a long period of time, it's like passive civil disobedience -- there was an opportunity there to give drug users a voice in a more organized way. We're consumers of all these services -- treatment, law enforcement, the whole drug industrial complex -- we're consumers and have no voice. The time was right for it to start here."

San Francisco organizers took advantage of last fall's DPA conference to learn from existing drug user groups on the continent. "I met with Ann Livingston from VANDU and I got in touch with some of the folks from VOCAL," Goldman said. "They work on stuff around syringe exchange, trying to pass statewide ordinances to keep police from hassling people with needles, things like that. And, of course, they're subject to the same ridiculous drug laws we are."

"Drug user groups such as VOCAL in New York, VANDU in Vancouver, and hopefully this group in San Francisco play an important role in drug policy change and ending the war on drugs," Thomas said. "Drug users are usually the people most directly affected by bad drug policies, and the least likely to have a voice in debates. Drug users as active participants in the political process also helps reduce the stigma that is attached to drug use and makes people reconsider their prejudices about what they think 'drug users' are like. The drug policy reform conversation can only benefit from the active participation of drug user groups."

Separate drug user union meetings are taking place every three weeks in the Tenderloin and Mission districts. For more information about joining the union, send an email to sf.users.union@gmail.com.

Canada: Federal Government to Appeal Ruling Okaying Safe Injection Site

The Conservative federal government of Prime Minister Stephen Harper will ask the Canadian Supreme Court to overturn a provincial court ruling that okayed Vancouver's InSite safe injection site. Justice Minister Rob Nicholson said the government will appeal because the case raised important questions about the division of powers among the federal and provincial governments, the CBC reported Tuesday.

http://stopthedrugwar.org/files/insite1.jpg
InSite (courtesy Vancouver Coastal Health)
InSite is the only supervised drug injection site in North America. It has been in place since 2003, when British Columbia health authorities won a temporary exemption from Canada's federal drug law. While the then-Liberal government approved, the now-governing Conservatives do not.

Over 20 peer-reviewed studies showed the supervised injection site to reduce the spread of HIV/AIDS and incidences of drug overdoses while increasing the number of drug users accessing rehabilitation services.

InSite originally won a three-year exemption from the federal drug law. Under tremendous pressure, the Conservatives grudgingly gave InSite a 15-month extension, and then extended it to 22 months ending in June 2008.

But fearing the Conservatives' intentions, InSite operator the Portland Hotel Society, the Vancouver Area Network of Drug Users (VANDU), and two InSite clients filed a lawsuit in the BC courts seeking to have the provincial government, which under Canadian law is responsible for health care, declared the sole authority over InSite -- not the federal government or federal drug laws.

InSite and its supporters won in the BC Supreme Court in 2008 and won again last month in the province's highest court, the Court of Appeals. It is those decisions, which puts decisions on whether to keep InSite open firmly in the hands of BC health officials, that the federal government now seeks to overturn.

In his remarks Tuesday, Justice Minister Nicholson said nothing about shutting down InSite, instead saying the appeal was about clarifying provincial versus federal powers. "The case we'll be presenting before the court is to ask for clarification," he said. "I think it is important to do that."

But Portland Hotel Society director Mark Townsend was running out of patience with the Conservatives. "The courts have now ruled twice in favor of InSite," he said in a statement Tuesday. "Last time, they thought the feds were so out of line they made them pay all the costs. We wish Stephen Harper would stop wasting court time and the taxpayers' money and start helping to solve the drug problem in our community."

So does New Democratic Party MP Libby Davies, who represents Vancouver's east side, including the InSite location. "InSite saves lives," said Davies. "The science proves it, and the BC Supreme Court and BC Appeal Court agree," she continued. "Yet the Conservatives continue to spend tens of thousands of taxpayer dollars on legal fees to try to shut it down. If the Conservatives are really so tough on crime, they should respect the law and support these harm reduction strategies that work," said Davies. "Evidence-based success should be shaping our drug policy, not Conservative ideology."

Canada: Federal Government to Appeal Ruling Okaying Vancouver Safe Injection Site

The Conservative federal government of Prime Minister Stephen Harper will ask the Canadian Supreme Court to overturn a provincial court ruling that okayed Vancouver's InSite safe injection site. Justice Minister Rob Nicholson said the government will appeal because the case raised important questions about the division of powers among the federal and provincial governments, the CBC reported Tuesday. InSite in the only supervised drug injection site in North America. It has been in place since 2003, when British Columbia health authorities won a temporary exemption from Canada's federal drug law. While the then Liberal government approved, the now governing Conservatives do not. InSite originally won a three-year exemption from the federal drug law. Under tremendous pressure, the Conservatives grudgingly gave InSite a 15-month extension, then extended it to 22 months ending in June 2008. But fearing the Conservatives' intentions, InSite operator the Portland Hotel Society, the Vancouver Area Network of Drug Users (VANDU), and two InSite clients filed a lawsuit in the BC courts seeking to have the provincial government, which under Canadian law is responsible for health care, declared the sole authority over InSite—not the federal government and the federal drug laws. InSite and its supporters won in the BC Supreme Court in 2008 and won again last month in the province's highest court, the Court of Appeals. It is those decisions, which puts decisions on whether to keep InSite open firmly in the hands of BC health officials, that the federal government now seeks to overturn. In his remarks Tuesday, Justice Minister Nicholson said nothing about shutting down InSite, instead saying the appeal was about clarifying provincial versus federal powers. "The case we'll be presenting before the court is to ask for clarification," he said. "I think it is important to do that." But Portland Hotel Society director Mark Townsend was running out of patience with the Conservatives. "The courts have now ruled twice in favor of InSite," he said in a statement Tuesday. "Last time, they thought the feds were so out of line they made them pay all the costs. We wish Stephen Harper would stop wasting court time and the taxpayers' money and start helping to solve the drug problem in our community."
Location: 
Ottawa, ON
Canada

Heroin Maintenance: SALOME Trials Set to Begin in Vancouver

In the Chronicle's review of the top international drug policy stories of the year last week, the slow spread of heroin maintenance was in the mix. This week, it's back in the news, with word that a new Canadian heroin maintenance study in Vancouver is about to get underway.

http://stopthedrugwar.org/files/hastings.jpg
Hastings St., on Vancouver's Downtown Eastside (courtesy vandu.org)
The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) will choose a Downtown Eastside location next month and begin taking applications from potential participants in February, according to a Tuesday press release from the Inner Change Foundation, which, along with the Canadian Institutes of Health Research, is funding the trial. With selection of participants supposed to last only three weeks, that means SALOME could be underway by March.

SALOME will enroll 322 hard-core heroin addicts -- they must have been using at least five years and failed other treatments, including methadone maintenance -- in a year-long, two-phase study. During the first phase, half will be given injectable heroin (diacetylmorphine) and half will be given injectable Dilaudid® (hydromorphone). In the second phase, half of the participants will be switched to oral versions of the drug they are using.

The comparison of heroin and Dilaudid® was inspired by unanticipated results from SALOME's forerunner, NAOMI (the North American Opiate Medication Study), which began in Vancouver in 2005 and produced positive results in research reviews last year. In NAOMI, researchers found that participants could not differentiate between heroin and Dilaudid®. The comparison of success rate among injection and oral administration users was inspired by hopes of reducing rates of injection heroin use.

SALOME was also supposed to take place in Montreal, but Quebec provincial authorities effectively killed it there by refusing to fund it. SALOME researchers have announced that it will now proceed in Vancouver alone.

With an estimated 5,000 heroin addicts in the Downtown Eastside and a municipal government that has officially embraced the progressive four pillars approach to problematic drug use -- prevention, treatment, harm reduction, and law enforcement -- Vancouver is most receptive to such ground-breaking research. It is also the home of Insite, North America's only safe injection site.

The NAOMI and SALOME projects are the only heroin maintenance programs to take place in North America. Ongoing or pilot heroin maintenance programs are underway in Britain, Denmark, Germany, the Netherlands, Spain, and Switzerland.

Move Over NAOMI, Here Comes SALOME--Vancouver's New Heroin Maintenance Trial About to Get Underway

In the Chronicle's review of the top international drug policy stories of the year last week, the slow spread of heroin maintenance was in the mix. This week, its back in the news, with word that a new Canadian heroin maintenance study in Vancouver is about to get underway. The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) will choose a Downtown Eastside location next month and begin taking applications from potential participants in February, according to a Tuesday press release from the Inner Change Foundation, which, along with the Canadian Institutes of Health Research, is funding the trial. With selection of participants supposed to last only three weeks, that means SALOME could be underway by March. SALOME will enroll 322 hard-core heroin addicts—they must have been using at least five years and failed other treatments, including methadone maintenance—in a year-long, two-phase study. During the first phase, half will be given injectable heroin (diacetylmorphine) and half will be given injectable Dilaudid® (hydromorphone). In the second phase, half of the participants will be switched to oral versions of the drug they are using. The comparison of heroin and Dilaudid® was inspired by unanticipated results from SALOME's forerunner, NAOMI (the North American Opiate Medication Study), which began in Vancouver in 2005 and produced positive results in research reviews last year. In NAOMI, researchers found that participants could not differentiate between heroin and Dilaudid®. The comparison of success rate among injection and oral administration users was inspired by hopes of reducing rates of injection heroin use. SALOME was also supposed to take place in Montreal, but Quebec provincial authorities effectively killed it there by refusing to fund it. SALOME researchers have announced that it will now proceed in Vancouver alone. With an estimated 5,000 heroin addicts in the Downtown Eastside and a municipal government that has officially embraced the progressive four pillars approach--prevention, treatment, harm reduction, and law enforcement—to problematic drug use, Vancouver is most receptive to such ground-breaking research. It is also the home of Insite, North America's only safe injection site. The NAOMI and SALOME projects are the only heroin maintenance programs to take place in North America. Ongoing or pilot heroin maintenance programs are underway in Britain, Denmark, Germany, the Netherlands, Spain, and Switzerland.
Location: 
Vancouver, BC
Canada

Feature: Fired Up in Albuquerque -- The 2009 International Drug Policy Reform Conference

Jazzed by the sense that the tide is finally turning their way, more than a thousand people interested in changing drug policies flooded into Albuquerque, New Mexico, last weekend for the 2009 International Drug Policy Reform Conference, hosted by the Drug Policy Alliance. Police officers in suits mingled with aging hippies, politicians met with harm reductionists, research scientists chatted with attorneys, former prisoners huddled with state legislators, and marijuana legalizers mingled with drug treatment professionals -- all united by the belief that drug prohibition is a failed policy.

http://stopthedrugwar.org/files/vigildpa09.jpg
candlelight vigil outside the Albuquerque Convention Center (courtesy Drug Policy Alliance)
As DPA's Ethan Nadelmann said before and repeated at the conference's opening session: "We are the people who love drugs, we are the people who hate drugs, we are the people that don't care about drugs," but who do care about the Constitution and social justice. "The wind is at our backs," Nadelmann chortled, echoing and amplifying the sense of progress and optimism that pervaded the conference like never before.

For three days, conference-goers attended a veritable plethora of panels and breakout sessions, with topics ranging from the drug war in Mexico and South America to research on psychedelics, from implementing harm reduction policies in rural areas to legalizing marijuana, from how to organize for drug reform to what sort of treatment works, and from medical marijuana to prescription heroin.

It was almost too much. At any given moment, several fascinating panels were going on, ensuring that at least some of them would be missed even by the most interested. The Thursday afternoon time bloc, for example, had six panels: "Medical Marijuana Production and Distribution Systems," "After Vienna: Prospects for UN and International Reform," "Innovative Approaches to Sentencing Reform," "Examining Gender in Drug Policy Reform," "Artistic Interventions for Gang Involved Youth," and "The Message is the Medium: Communications and Outreach Without Borders."

The choices weren't any easier at the Friday morning breakout session, with panels including "Marijuana Messaging that Works," "Fundraising in a Tough Economy," "Congress, President Obama, and the Drug Czar," "Zoned Out" (about "drug-free zones"), "Psychedelic Research: Neuroscience and Ethnobotanical Roots," "Opioid Overdose Prevention Workshop," and "Border Perspectives: Alternatives to the 40-Year-Old War on Drugs."

People came from all over the United States -- predominantly from the East Coast -- as well as South Africa, Australia, Canada, Europe (Denmark, England, France, Hungary, the Netherlands, Poland, Portugal, Scotland, and Switzerland), Latin America (Argentina, Brazil, Colombia, and Mexico), and Asia (Cambodia and Thailand).

Medical marijuana was one of the hot topics, and New Mexico, which has just authorized four dispensaries, was held up as a model by some panelists. "If we had a system as clear as New Mexico's, we'd be in great shape," said Alex Kreit, chair of a San Diego task force charged with developing regulations for dispensaries there.

"Our process has been deliberate, which you can also read as 'slow,'" responded Steve Jenison, medical director of the state Department of Health's Infectious Disease Bureau. "But our process will be a very sustainable one. We build a lot of consensus before we do anything."

Jenison added that the New Mexico, which relies on state-regulated dispensaries, was less likely to result in diversion than more open models, such as California's. "A not-for-profit being regulated by the state would be less likely to be a source of diversion to the illicit market," Jenison said.

For ACLU Drug Policy Law Project attorney Allen Hopper, such tight regulation has an added benefit: it is less likely to excite the ire of the feds. "The greater the degree of state involvement, the more the federal government is going to leave the state alone," Hopper said.

At Friday's plenary session, "Global Drug Prohibition: Costs, Consequences and Alternatives," Australia's Dr. Alex Wodak amused the audience by likening the drug war to "political Viagra" in that it "increases potency in elections." But he also made the more serious point that the US has exported its failed drug policy around the world, with deleterious consequences, especially for producer or transit states like Afghanistan, Bolivia, Colombia, Mexico, and Peru.

At that same session, former Mexican foreign minister Jorge Castaneda warned that Latin American countries feel constrained from making drug policy reforms because of the glowering presence of the US. Drug reform is a "radioactive" political issue, he said, in explaining why it is either elder statesmen, such as former Brazilian President Cardoso or people like himself, "with no political future," who raise the issue. At a panel the following day, Castaneda made news by bluntly accusing the Mexican army of executing drug traffickers without trial. (See related story here).

It wasn't all listening to panels. In the basement of the Albuquerque Convention Center, dozens of vendors showed off their wares, made their sales, and distributed their materials as attendees wandered through between sessions. And for many attendees, it was as much a reunion as a conference, with many informal small group huddles taking place at the center and in local bars and restaurants and nearby hotels so activists could swap experiences and strategies and just say hello again.

The conference also saw at least two premieres. On the first day of the conference, reporters and other interested parties repaired to a Convention Center conference room to see the US unveiling of the British Transform Drug Policy Foundation publication, After the War on Drugs: A Blueprint for Legalization, a how-to manual on how to get to drug reform's promised land. Transform executive director Danny Kushlick was joined by Jack Cole of Law Enforcement Against Prohibition, Sanho Tree of the Institute for Policy Studies, Deborah Small of Break the Chains, and DPA's Nadelmann as he laid out the case for moving beyond "what would it look like."

"There's never been a clear vision of a post-prohibition world," said Kushlick. "With this, we've tried to reclaim drug policy from the drug warriors. We want to make drug policy boring," he said. "We want not only harm reduction, but drama reduction," he added, envisioning debates about restrictions on sales hours, zoning, and other dreary topics instead of bloody drug wars and mass incarceration.

"As a movement, we have failed to articulate the alternative," said Tree. "And that leaves us vulnerable to the fear of the unknown. This report restores order to the anarchy. Prohibition means we have given up on regulating drugs; this report outlines some of the options for regulation."

That wasn't the only unveiling Thursday. Later in the evening, Flex Your Rights held the first public showing of a near-final version of its new video, 10 Rules for Dealing with Police. The screening of the self-explanatory successor to Flex Your Right's 2003 "Busted" -- which enjoyed a larger budget and consequently higher production level -- played to a packed and enthusiastic house. This highly useful examination of how not to get yourself busted is bound to equal if not exceed the break-out success of "Busted." "10 Rules" was one of a range of productions screened during a two-night conference film festival.

The conference ended Saturday evening with a plenary address by former New Mexico Gov. Gary Johnson, who came out as a legalizer back in 2001, and was welcomed with waves of applause before he ever opened his mouth. "It makes no sense to spend the kind of money we spend as a society locking up people for using drugs and using the criminal justice system to solve the problem," he said, throwing red meat to the crowd.

We'll do it all again two years from now in Los Angeles. See you there!

Harm Reduction: Overdose Prevention Bill Introduced, Study Released

In response to a rapid increase in the number of drug overdose fatalities -- doubling from 11,000 in 1999 to 22,000 in 2005 -- US Rep. Donna Edwards (D-MD) Wednesday introduced the Drug Overdose Reduction Act, which would allocate $27 million a year to cities, states, tribal governments, and nonprofits to implement overdose reduction strategies. Accidental drug overdoses are now the second leading cause of accidental deaths, second only to auto accidents.

Edwards introduced the bill in conjunction with a new report from the Drug Policy Alliance, Preventing Overdose, Saving Lives: Strategies for Combating a National Crisis, which lays out a number of ways in which the overdose toll can be reduced:

  1. Enhance overdose prevention education.
  2. Improve monitoring, research, outreach and coordination to build awareness of the overdose crisis, its ramifications and public health approaches to reducing it.
  3. Remove barriers to naloxone (Narcan) access.
  4. Promote 911 Good Samaritan immunity law reform.
  5. Establish trial supervised injection facilities.

"We've got the science, we've got the technology and the medicine to do this," said Dr. Donald Kurth, head of the American Society of Addiction Medicine during a Wednesday conference call. Yet despite a national overdose death toll "like a jumbo jetliner crashing every three days," the US "as a nation hasn't had the political will to let physicians use what's already available."

Canada: New Heroin Maintenance Pilot Program to Get Underway Later This Year

Despite fighting in the courts to shut down Insite, Canada's only safe injection site, Canada's conservative federal government is providing funding for a heroin prescription pilot program in Vancouver and Montreal. The program will begin providing heroin to some 200 hard-core users later this year.

Known as SALOME (the Study to Assess Longer-term Opioid Medication Effectiveness), the program builds on a similar multi-year program in Vancouver that ended last summer. That program, NAOMI (the North American Opiate Medication Initiative), was funded with $8 million from the Canadian Institutes of Health Research with the approval of Health Canada, but the government of Prime Minister Steven Harper has refused to publicly acknowledge research findings that participants' physical and mental health improved and that they committed fewer crimes.

Still, the Institutes of Health Research are quietly throwing in $1 million for SALOME. Josee Bellemare, press secretary to Health Minister Leona Aglukkaq, told the Toronto Globe & Mail: "Our government recognizes that injection drug users need assistance. That's why we are investing in prevention and treatment, to help people recover from their drug addictions."

The three-year trial will offer heroin in both pill and injectable forms, and will also offer hydromorphone to see if it could be used as a substitute. The trial will seek to assess whether prescription heroin is a safe and effective treatment and whether users will accept the drug in pill form. Researchers are currently recruiting hard-core users who have not responded to conventional treatments and say they expect to have clinics operating in the two cities by this fall.

Canada joins Britain, Denmark, the Netherlands, Spain, and Switzerland as countries where heroin prescription programs are in place either permanently or on a trial basis. The German parliament voted last week to join the club, too.

Feature: Effort to Bring Safe Injection Facility to New York City Getting Underway

Last Friday, more than 150 people gathered at John Jay College of Criminal Justice in New York City for a daylong conference on the science, politics, and law of safe injection facilities (SIFs) as part of a budding movement to bring the effective but controversial harm reduction measure to the Big Apple. Sponsored, among others, by the college, the Harm Reduction Coalition, and an amalgam of 17 different New York City needle exchange and harm reduction programs known as the Injection Drug User Health Alliance (IDUHA), the conference targeted not only harm reductionists but public health advocates and officials, law enforcement, service providers, and the general public.

https://stopthedrugwar.org/files/johnjaycollege.jpg
John Jay College, NYC (courtesy wikipedia.org)
The Safe Injection Facilities in New York conference aimed to create public awareness of SIFs, provide evidence that they are cost-effective, and start developing a plan for implementing SIFS in New York. As the conference program indicates, organizers relied heavily on experts from Vancouver, where the Downtown Eastside Insite SIF has been in operation -- and under evaluation -- since 2003, to provide the evidence base.

The first SIFs opened in Switzerland in the mid-1980s. Since then, they have spread slowly and there are now 65 SIFS operating in 27 cities in eight countries: Switzerland, Germany, the Netherlands, Spain, Australia, Norway, Luxembourg, and Canada. Although advocates have been working for the past year-and-a-half to bring an SIF to San Francisco, that effort has yet to bear fruit.

SIFS are credited with saving lives through overdose prevention, reducing the spread of blood-borne disease, reducing public drug use and attendant drug litter, and creating entryways to treatment and other services for hard-core drug users not ready to abstain. The results reported by the Vancouver delegation on Insite were typical:

  • No fatal overdoses at the SIF.
  • No increase in local drug trafficking.
  • No substantial increase in the rate of relapse into injection drug use.
  • Reductions in public drug use, publicly discarded syringes and syringe sharing.
  • SIF users 1.7 times more likely to enter detox programs.
  • More than 2,000 referrals to counseling and other support services since opening.
  • Collaboration with police to meet public health and public order objectives.

But despite such research results, the United States remains without an operating SIF. The obstacles range from the legal, such as the federal crack house law and its counterparts in many states, to the political and the moral. But for harm reduction and public health advocates, it is the failure to embrace such proven life-saving measures that has the stench of the immoral.

"The reality is that we have people shooting up in unsafe injection facilities as we speak," said Joyce Rivera, executive director of St. Ann's Corner of Harm Reduction and chair of the conference. "The reality is they are not shooting up in a safe, hygienic environment with the possibility of a transition into a range of care. That's what's not happening. As public health advocates, we are saying let's recognize that reality and create those safe facilities. Let these people enter through the portal of public health into a safe environment and start to pace their own change," she said.

"We have to acknowledge the social fact that people are shooting up in unsafe venues," Rivera said. "It's not some esoteric or academic argument. The question is what do we do about it? Public health is supposed to protect the community, and SIFs are a necessary evolution in our public health policy."

"The big issue here is that we know we have about 200,000 injection drug users in the city, and the needle exchange programs only serve a few thousand of them," said Robert Childs of Positive Health Project, one of the members of the IDUAH. "Most of them are getting needles from unregulated needle exchanges, shooting galleries, from friends. That is a large part of why New York City has the most HIV and Hepatitis C cases in the US and one of the highest rates of infection in North America," he said.

"The other big issue is that we're giving injectors the tools to inject, but not a safe space to do it," Childs pointed out. "Many shoot up in the public domain, in the bathrooms at Starbucks or McDonalds or White Castle, in libraries, parks, alleys, phone booths. They leave their syringes in locations that aren't evident to a non-injector, and that's a public health issue."

They also overdose. Drug overdose is the fourth leading cause of death in the city. While it is a tragedy for the victim, overdoses both lethal and non-lethal are also a burden to the city. "Taxpayers have to pay these costs," said Childs. "For an ambulance to respond to an overdose costs between $400 and $1,200, and that's going on many times a day every day."

It's not just ambulances. Failing to address injection drug use under prohibition conditions costs real dollars in other ways as well. Each new diagnosis of HIV in the city comes with a $648,000 price tag for life-long medications and medical care, and even that may be on a low end estimate. A case of hepatitis C often requires $280,000 to $380,000 for a liver transplant; for those cases that do not warrant a liver transplant, treatment costs anywhere from $60,000 to $100,000.

And it's not just taxpayers paying. According to Childs, local businesses, including service providers, spend thousands of dollars a year on plumbing repairs -- from needles disposed of in toilets for lack of biohazard containers.

Now, said advocates, it is time to move forward. The conference was but the opening shot in what will likely be a long and frustrating campaign.

"The conference went very well and it will be a bit of a lift," said John Jay Professor Richard Curtis, who addressed the topic of moving forward from here at the conference. "The evidence is piling up from Sydney and Vancouver and Europe, and that is helping us, too. But this isn't something the health departments and the politicians aren't quickly going to jump on the bandwagon for. We have to give them a push, and if we don't start working on it now, it'll never happen. We didn't get where we are today by behaving ourselves," he added, relating how his own needle exchange effort first faced official opposition before being accepted.

The audience included people from the city and state health departments, Curtis said. "The health officials are all very supportive... unofficially," he said. "They didn't want to be on the agenda, but they say they're supportive. But this is an election year, and that makes it hard for them."

There will be an organizing meeting in two weeks to map out strategy, Curtis said. "We'll see who is willing and able, whether there is an existing agency bold enough to forge ahead or whether we will have to create some alternative organizations. We want to put this issue on the table now."

"We're forming an action group to bring this into New Yorkers' consciousness," said Childs. "The people who do know about -- drug users -- are one of the most stigmatized populations in the city. We are going to a campaign similar to Vancouver about how these people are not bogeymen, but our sons and daughters. We're also trying to organize some media events around it. A group of lawyers will help by challenging some codes. And we'll be trying to work with our legislators and city councilors," he said.

But Curtis and others are not willing to wait forever. "I'm not hopeful that federal crack house laws will end any time soon," he said. "But we started needle exchanges by just doing it. If it has to come to that, we'll have to make them arrest us again. We need to back them into a corner at the very least."

Harm Reduction Coalition Western Coordinator Hilary McQuie has been involved in the ongoing SIF effort in San Francisco. Just because something isn't happening officially doesn't mean it isn't happening, she noted.

"I don't know much about shooting galleries in New York," she said, "but out here, it's no big secret that the bathrooms of service providers, drop-in centers, homeless shelters, soup kitchens are used for shooting up. What people are doing to try to make these current injection spaces safer is perhaps having safe injection instructions, syringe disposal devices, soap and water, things like that," she said. "Also, it's sort of semi-supervised. If someone's in the bathroom and doesn't come out, you can open the door and save them from an overdose. That happens every day in San Francisco."

Free Conference: Safe Injection Facilities of New York

It is with pride that we invite you to join us for a Day Conference on ‘Safe Injection Facilities of New York’ on Friday May 22, 2009 at John Jay College of Criminal Justice. Since syringe exchange has proven to be such an effective HIV Prevention intervention over the past 20 years in New York, we think it is time to take a next step and look at safe injection facilities as another proven intervention in the context of public health. Safe Injection Facilities are also a portal that draws injection drug users into positive engagement with other services. The program of the day conference reflects the many facets of studying the implementation of Safe Injection Facilities in New York. The practice, the consumers, the politics, the research of SIFs will be presented. We have several professionals presenting from Vancouver, Canada, where the only SIF in North America exists. We have legal experts to discuss the implementation of SIFs under USA law. We have the consumer point of view through the presentation of a consumer and a presentation about a survey among 200 IDUs from New York. There will be time for discussion. The conference is free. Lunch and snacks will be provided. There will be performances of National Slam Poetry champion Jon Sands. Finally, to start your Memorial Day weekend in right fashion we will close the day with a wine reception. Please, RSVP with name & affiliation at safeinjectionfacility@gmail.com. Conference Sponsors: Injection Drug User Health Alliance The Comer Foundation Harm Reduction Coalition NYS Psychological Association/Division on Addictions John Jay College of Criminal Justice
Date: 
Fri, 05/22/2009 - 9:00am - 5:00pm
Location: 
445 W. 59th Street
New York, NY
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