Safe Injection Sites

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Fraser Health Authority Urged to Push Needle Exchanges Into Hostile Cities

Location: 
Canada
Injection drug addicts are at much greater risk of catching and spreading disease in the Fraser Health region because health authority officials have failed to deliver on the promise of their harm reduction policy, reform advocates charge. They say access to needle exchanges, safe injection sites and methadone clinics is much poorer than in the Vancouver area – largely due to opposition from hostile city councils and police forces who think an abstinence policy is best.
Publication/Source: 
Hope Standard (Canada)
URL: 
http://www.bclocalnews.com/fraser_valley/hopestandard/news/106728428.html

Swiss Drug Policy Should Serve As Model: Experts

Location: 
Switzerland
Switzerland's innovative policy of providing drug addicts with free methadone and clean needles has greatly reduced deaths while cutting crime rates and should serve as a global model, health experts said. Countries whose drug policy remains focused on punishing offenders, including Russia and much of Eastern Europe and Central Asia, should learn from a Swiss strategy based on "harm reduction" that protects both users and communities, they said.
Publication/Source: 
Reuters
URL: 
http://www.reuters.com/article/idUSTRE69O3VI20101025

Sydney Safe Injecting Site Trial Ends

Location: 
Sydney, NSW
Australia
Sydney, Australia's safe injecting site at Kings Cross will become a permanent fixture after operating on a trial basis since 2001. Legislation lifting the center's trial status will also confirm it will remain the only safe injecting center of its kind in New South Wales.
Publication/Source: 
The Sydney Morning Herald (Australia)
URL: 
http://news.smh.com.au/breaking-news-national/sydney-drug-injecting-centre-trial-ends-20100915-15b4b.html

Canadian Medical Association Journal Article Sides with Drug Injection Site

Location: 
Vancouver, BC
Canada
An article in the Canadian Medical Association Journal slams the federal government for its efforts to shut down Insite in downtown Vancouver, Canada's only safe injection site for drug addicts.
Publication/Source: 
CBC Radio-Canda (Canada)
URL: 
http://www.cbc.ca/consumer/story/2010/08/30/con-insite-cmaj.html

A Failed "War on Drugs" Prompts Rethinking on HIV Infections Among Injection Drug Users

Drug policy has focused on a policing approach of prohibition and incarceration, which has contributed to spreading HIV within the injection-drug community. Comprehensive drug reform policies are showing better results. Despite massive investments in drug law enforcement in the past three decades, with much of the international interdiction effort paid for by the U.S. government through assistance to national military and police forces, there is "a general pattern of falling drug prices and increasing drug purity" throughout the world, according to the Vienna Declaration.
Publication/Source: 
Scientific American (NY)
URL: 
http://www.scientificamerican.com/article.cfm?id=a-failed-war-on-drugs

Europe: Norwegian Committee Calls for Heroin Prescription Trials, Harm Reduction Measures

A blue-ribbon committee in Norway has called for heroin prescription trials and expanded harm reduction measures, such as expanding safe injection sites. The Stoltenberg Committee presented its findings in a 49-page report (sorry, Norwegian only) issued last month.

http://stopthedrugwar.org/files/norwegianfjord.jpg
Norwegian fjord (courtesy Erik A. Drabløs via wikimedia.org)
The committee was created last year by then Health Minister Bjarne Hakon Hanssen to review the situation of hard drug users in Norway. It was tasked in particular with evaluating whether the government should allow a trial heroin prescription program because the notion was so controversial in Norway. The committee did not address soft drug use.

Committee head Thorvald Stoltenberg is a well-known and well-respected political figure in Norway, having served in the past as foreign minister. He is the father of the current prime minister. He is also the father of an adult daughter who is a former heroin addict.

Current Health Minister Anna-Greta Strom-Erichsen agreed with the committee's call for more harm reduction and expanded treatment services, but wasn't ready to sign off on prescribed heroin just yet.

"I agree with the committee that services for the most vulnerable drug addicts must be better," she said in a press release. "The committee wants greater degree of coordination of services. This is a task that is central to the work of collaborative reform, which is especially important for people with drug problems," she added.

But heroin prescribing is "a difficult question" on which the government must move carefully, Strom-Erichsen said. "The government has not reached a conclusion on the question of heroin assisted treatment. Regardless of the conclusion to this question, there is a need for an intensified effort for people with drug problems, including medical treatment, "she said.

The committee report will now form the basis for a broad dialog on its recommendations among government officials, local officials, drug users, relatives, and other interested parties. After that, the Health Ministry will send a proposal to parliament.

While the committee report is quite moderate by international standards, it represents a major break from traditional Norwegian responses to hard drug use and an embrace of the harm reduction philosophy.

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.

http://www.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.

http://www.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.

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