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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.

http://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

Swiss Voters Approve Heroin Prescriptions, But Reject Marijuana Decriminalization

I don’t know quite what to make of this news from Switzerland:

GENEVA (AP) — The world’s most comprehensive legalized heroin program became permanent on Sunday with overwhelming approval from Swiss voters, who separately rejected the legalization of marijuana.

The heroin program, started in 1994, is offered in 23 centers across Switzerland. It has helped eliminate scenes of large groups of drug users shooting up openly in parks and is credited with reducing crime and improving the health and daily lives of addicts.

Of the 2.26 million Swiss who voted in the national referendum, 68 percent approved making the heroin program permanent. But 63 percent voted against the marijuana proposal, which was based on a separate citizens’ initiative to decriminalize consuming marijuana and growing the plant for personal use. [NY Times]

Pete Guither has some good analysis explaining how concerns about Amsterdam-type drug tourism helped to torpedo the proposal. It’s a harsh reality that any nation that considers tolerating recreational marijuana sales must inevitably come to terms with a potential influx of pot smoking tourists. They’re easy enough to deal with, but the idea just makes some people uncomfortable.

A policy that prohibits sales to foreigners might mitigate these concerns, but I can’t get over the absurdity of restricting marijuana sales while permitting tourists to get drunk off their asses anywhere they please. The problem in Amsterdam isn’t that marijuana laws are too loose, it’s the fact that marijuana laws everywhere else are completely unreasonable. So-called "marijuana tourism" is just another symptom of marijuana prohibition in the U.S. and beyond. Can you even imagine what Amsterdam would be like if it were the only place you could legally purchase alcohol?

Canada: BC Local Elections Bring Another Drug Reform Mayor to Vancouver, A Drug Reform Mayor Back to Grand Forks, and a Drug Reformer to Victoria's City Council

Municipal elections in British Columbia Saturday saw Vancouver get another in a string of pro-drug reform mayors, while a marijuana reformer was returned to the mayor's office in Grand Forks in the interior, and another prominent reform advocate was elected to the city council in Victoria.

In Vancouver, the civic electoral coalition Vision Vancouver succeeded in placing its candidate, Gregor Robertson in the mayor's seat as well as sweeping eight of 11 council seats. Robertson and Vision Vancouver are strong supporters of the city's pioneering Four Pillars drug policy.

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Philippe Lucas (from vicgreens.com)
As Vision Vancouver notes in its platform, it will: "Focus on the Four Pillars to deal with drugs in our communities. Prevention, treatment, harm reduction, and enforcement are the most effective tools to make our communities safer. This includes support for InSite, a focus on access to treatment, and expanding prevention education programs."

Meanwhile, in the small interior border town of Grand Forks (pop. 5,000), former mayor and leader in Marc Emery's BC Marijuana Party Bryan Taylor was reelected. Taylor came to drug reform initially around industrial hemp but soon emerged as a leading BC Marijuana Party campaigner in the 2001 elections. He is barred from entering the US, which he can see from his hillside home outside Grand Forks, originally because he was arrested for hemp cultivation ("drug trafficking," in official US-speak). But even after the Canadian government dropped charges against him, US border control authorities continue to deny him entry, accusing him of "fraud and misrepresentation" if he fails to admit he smokes marijuana and deeming him ineligible to enter the country if he does admit it.

And on Vancouver Island, one of the Canadian drug reformers most familiar to his American counterparts, Philippe Lucas, won a seat on the Victoria city council running as a Green Party candidate. Lucas will be joined by Mayor-elect Dean Fortin, who also supports harm reduction and has vowed to find a permanent location for the city's needle exchange program.

In a Victoria radio interview after the election, Fortin said Lucas "is going to challenge the council a lot" and "will be pushing the harm reduction model."

That's no surprise. In addition to running the Vancouver Island Compassion Society, Lucas also authored the BC Green Party drug policy and substance abuse platform planks, which include calls for a legal, regulated market in marijuana. The soft-spoken but keenly focused Lucas will no doubt be a strong force for reform in Victoria.

All in all, a good day for drug reform and its advocates in British Columbia. It looks like BC will retain its position in the vanguard of drug reform in the Western hemisphere.

Canadian Police Hire Researchers to Attack Harm Reduction

The battle over harm reduction in Vancouver just gets uglier all the time:

VANCOUVER -  The Pivot Legal Society has asked federal Auditor-General Sheila Fraser to examine whether the RCMP exceeded its law-enforcement mandate by commissioning studies into Vancouver's supervised injection site.

Pivot lawyer and spokesman Doug King on Wednesday revealed RCMP e-mails indicating the national police force commissioned reports researching Insite.

"The RCMP Act gave the RCMP a mandate to act as peace officers for the citizens of Canada. Using public funds entrusted to them to fund a cynical critique of health-based research clearly does not fall within this mandate," King said. [Vancouver Sun]

Indeed, police are responsible for enforcing the law, not shaping social policy. Law enforcement’s backhanded attempt at inserting itself into the academic debate over harm reduction is completely inappropriate and disturbing. Does anyone believe that police-sponsored research will ever reach conclusions other than the need for more police power?

RCMP now claims that it conducts research all the time, which may be true, but misses the point. Police research should focus on measuring the effectiveness of their own programs, not producing political ammunition against non-police programs that police don’t like.

Australia: Strong Support for Medical Marijuana, Needle Exchange Programs, National Survey Finds

Australia's 2007 National Drug Strategy Household Survey, in which more than 23,000 people over the age of 12 were quizzed by the Australian Institute of Health and Welfare about their drug use and attitudes toward various drug policy positions, has demonstrated broad support for medical marijuana and harm reduction measures aimed at hard drug users.

Regarding heroin use, the survey found that 67% supported needle exchange programs, 68% supported methadone maintenance, 75% supported the use of naltrexone for overdose avoidance, and 79% supported the use of rapid detox therapy. On the other hand, only 50% supported heroin injection sites, and only 33% supported heroin maintenance therapy.

Medical marijuana also won strong support. Some 69% supported legal medical marijuana, while an even larger number, 75%, supported clinical trials for medical marijuana. In all the policy choices cited here, support was at higher levels than the most recent national survey in 2004.

Marijuana legalization for personal use did not fare so well. Only 21% supported legalization, down from 27% in 2004. The intervening period has been one of Reefer Madness Down Under, with Australian authorities and a complicit media waxing hysterical about the alleged dangers of the weed.

When it comes to legalizing other drugs, support was in the single digits, and relatively unchanged from 2004.

Frighteningly, large majorities of Australians favored increased criminal penalties for drug sales offenses. More than 80% favored harsher sentences for hard drug sales, while even for marijuana, nearly two-thirds (63%) wanted stiffer penalties.

Canadian Health Minister Attacks Doctors for Supporting Safe Injection Sites

The latest outrage in Canada's heated harm reduction debate came at the hands of Health Minister Tony Clement who went off the rails by questioning the ethics of doctors who practice harm reduction:

MONTREAL — The association representing Canada's doctors rapped Health Minister Tony Clement on Monday after he questioned the ethics of physicians who support the use of supervised injection sites for drug addicts.


"Is it ethical for health-care professionals to support the administration of drugs that are of unknown substance, or purity or potency, drugs that cannot otherwise be legally prescribed?" Clement said.

He said that in any other medical setting, supervised overdoses would be considered "highly unprofessional." [Canadian Press]

Canada's doctors beg to differ:

The Canadian Medical Association's president responded to Clement by saying 79 per cent of members agree that safe-injection sites and harm-reduction programs work.

Dr. Brian Day said sites that allow addicts to inject their own narcotics under the supervision of medical staff have been successful in curbing illegal drug use and slowing the spread of disease.

"We specifically take issue with the minister using that phrase," Day told reporters after Clement's speech.

"The minister was off base in calling into question the ethics of physicians involved in harm reduction.

"It's clear that this was being used as a political issue."

Doctors are not politicians. They work to save lives and they are the experts on how to do that. If they all agree that existing programs are working, and some politician disagrees, then he is just wrong and he should shut up.

The drug war debate is ugly and that's not gonna change anytime soon. But one thing we can do without is politicians feigning moral superiority over the doctors who are saving lives every day. That's what this is about. Harm reduction shouldn't be a political issue and if you succeed in politicizing it for the wrong reasons, people will die.

Canada: Quebec to Open Series of Safe Injection Sites

Spurred by a favorable court ruling in May allowing Vancouver's safe injection site, Insite, to stay open, health officials in Quebec say they are preparing to open a safe injection site in Montreal in coming months, and there could be many more to follow in the province.

http://stopthedrugwar.com/files/insite1.jpg
InSite (courtesy Vancouver Coastal Health)
So far, InSite is the only safe injection site in North America, but the idea of creating a network of such sites is already part of Quebec's public health plan. Officials there told the Canadian Press they are working to establish the Montreal site soon.

"There is a team in Montreal looking at the feasibility and acceptability of all this, but there is no date set yet," said public health director Alain Poirier. "We're working on it at the moment and we hope there will be one soon."

Vancouver's Insite, which was set up as a pilot project five years ago, operated under a limited exemption from Canada's drug laws. With the Conservatives controlling the federal government, Insite's future was precarious, but in May, the British Columbia Supreme Court ruled that Insite is a health facility subject to provincial -- not federal -- regulation and thus constitutionally exempt from federal drug laws. That ruling has cleared the way for other provinces to ponder starting similar facilities.

"It's an interpretation that views injection sites as health services and those are under provincial jurisdiction," Poirier said, referring to the ruling. "We're the ones who pay for the treatments of (addicts), we pay for their care if they contract HIV. It short, it falls under the panoply of preventive services."

But the Conservative federal government continues to oppose safe injection sites. Earlier this month, it announced it would appeal the BC Supreme Court ruling. Health Minister Tony Clement has repeatedly claimed that safe injection sites don't work.

"We don't consider it the best health outcome to keep people in a position where they continue to use the illicit drugs, to inject the illicit drugs," he said in May.

Quebec has already embraced harm reduction strategies to combat the ills of drug abuse. The province boasts nearly 800 needle exchange locations. Poirier said establishing safe injection sites was the logical next step.

"We can't do this in hiding without saying or announcing anything," Poirier said. "The public has to be aware that this is one step more. We'll probably start in Montreal, then look at Quebec City's downtown area," Poirier said. "We haven't ruled out other cities being chosen. We would like to have sites where they are justified by the need."

Public Forum on InSite and Harm Reduction

As you may know, the BC Supreme Court recently ruled that the application of Canada's Controlled Drugs and Substances Act in regards to InSite, Vancouver's Supervised Injection site is inconsistent with Section 7 of the Charter of Right and Freedoms, protecting life and security of the person. As a result, Justice Ian Pitfield's judgment grants InSite a permanent constitutional exemption from federal drug laws, allowing InSite to legally continue its life saving work. This was a unique court decision and has implications for communities across the country. Each community has its own drug problems to be dealt with in a unique manner, and this public forum will allow for discussion about these issues, as well as provide an opportunity to learn about other harm reduction initiatives around the world. Speakers will include Liz Evans, the founder and executive director of the Portland Hotel Society - the non-profit that operates Vancouver's supervised injection site, and Tony Trimingham, an Australian advocate for supervised injection sites whose own son died as the result of a drug overdose. Please RSVP to info@communityinsite.ca, as seating at these forums will be limited, and are expected to fill up quickly. If you are not in the Toronto area, please forward this invitation to anyone you know who does live close by. Thank you for your interest - we look forward to seeing you.
Date: 
Thu, 07/17/2008 - 7:00pm
Location: 
100 Queen St. West
Toronto, ON
Canada

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