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Feature: BC Supreme Court Rules Vancouver Safe Injection Site to Stay Open, Federal Drug Law Controlling It Unconstitutional

In a ruling that stunned and very pleasantly surprised advocates for Vancouver's Insite safe injection site, the British Columbia Supreme Court Tuesday held that Insite can stay open indefinitely. Canada's federal drug law is unconstitutional when applied to Insite because it conflicts with the Charter of Rights and Freedoms and health matters that are a provincial responsibility, the court held.

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InSite (courtesy Vancouver Coastal Health)
The future of Insite has been a bitter political battle between the Conservative federal government of Prime Minister Stephen Harper and harm reductionists, scientists, academic specialists, and broad swathes of the Vancouver community, including Mayor Sam Sullivan and BC Health, the provincial health agency. Begun in 2003, under Harper, Insite has limped along on a series of temporary exemptions from Canada's drug law. The latest was set to expire June 30, and a campaign to save it was in full swing when the court made matters moot.

While the political fight was brewing, some actors sought recourse in the courts. Represented by Vancouver attorney John Conroy, the Portland Hotel Society, which operates Insite for BC Health, and the Vancouver Area Network of Drug Users (VANDU) filed suit in the provincial courts seeking protection for the site, and in particular, for workers at the site who might be at risk under the federal drug law. By imposing an absolute, unqualified prohibition on the possession of controlled substances, the law prevented access to Insite and its health services. That was an improper expansion of the federal government into what should be a provincial sphere, they argued. It was this lawsuit that brought Tuesday's victory.

In his ruling in PHS Community Services Society v. Attorney General of Canada, Justice Ian Pitfield declared part of the Controlled Drugs and Substances Act unconstitutional and null and void, and gave Ottawa one year to rectify the law so it does not interfere with medical treatment. In the meantime, Pitsfield declared, Insite is constitutionally exempt from the drug law.

"In my opinion," Pitfield wrote, "section 4(1) of the CDSA, which applies to possession for every purpose without discrimination or differentiation in its effect, is arbitrary. In particular it prohibits the management of addiction and its associated risks at Insite. It treats all consumption of controlled substances, whether addictive or not, and whether by an addict or not, in the same manner. Instead of being rationally connected to a reasonable apprehension of harm, the blanket prohibition contributes to the very harm it seeks to prevent. It is inconsistent with the state's interest in fostering individual and community health, and preventing death and disease."

The drug law blocks addicts from receiving health care that could reduce their chances of overdose or death by infectious disease, and that violates their rights under the Charter, Pitsfield wrote. "While users do not use Insite to directly treat their addiction, they receive services and assistance at Insite which reduce the risk of overdose that is a feature of their illness, they avoid the risk of being infected or of infecting others by injection, and they gain access to counseling and consultation that may lead to abstinence and rehabilitation," he said. "All of this is health care."

He pointed out that people who drink alcohol or smoke tobacco to excess aren't denied treatment. "I do not see any rational or logical reason why the approach should be different when dealing with the addiction to narcotics," he wrote. "Simply stated, I cannot agree with Canada's submission that an addict must feed his addiction in an unsafe environment when a safe environment that may lead to rehabilitation is the alternative."

Advocates for Insite, who fought for years to create it, then again to keep it going in the face of the ideological opposition of the Conservatives, wavered between ecstasy and disbelief. "I just want to cry, I'm so ecstatic," Liz Evans, one of the directors of PHS, told the Vancouver Sun.

"This is a significant victory for the people in our community," said New Democratic Party provincial parliamentarian Jenny Kwan, in whose district Insite is located.

NDP Member of Parliament Libby Davies, who represents the district at the federal level, went on the offensive in Ottawa Wednesday. "Mr. Speaker, yesterday BC's Supreme Court decision makes it abundantly clear that Insite, the supervised injection facility in east Vancouver, is a health facility," she said during parliamentary questions. "The ruling also makes it clear that closing Insite would be 'inconsistent with the state's interest in fostering individual and community health and preventing death and disease.' Can the Minister of Health assure the House today that his Conservative government will abide by the court's decision and not appeal this important case?"

While Health Minister Tony Clement denied any responsibility for any decision on an appeal, he let it be known his government was not happy. "We are disappointed with the judgment," he responded. "We disagree with the judgment. We are, of course, examining our options and I would say to the House that we on this side of the House care about treating drug addicts who need our help. We care about preventing people, especially our young people, from becoming drug addicts in the first place. That is our way to reduce harm in our society and we are proud of taking that message to the people of Canada."

"If the Minister of Health claims that he cares about people who use drugs and the issues they face, then he will respect the decision of the court," Davies retorted. "The medical, scientific and now legal conclusions just could not be any clearer. Insite is a life-saving facility and harm reduction is an essential component of Canada's drug strategy. When will the minister put aside his personal ideological position, respect the court's decision and get to work on changing Canada's drug laws to allow access to health facilities such as Insite? When is he going to do that? He is taking too long."

Clement did not respond, except to say, "We are here to help our kids, prevent them from getting on drugs in the first place. We are here to help addicts."

If he wants to help addicts, Clement should quit opposing the safe injection site, said the Canadian HIV/AIDS Legal Network. "The court has recognized that criminalizing drugs and drug users cannot be allowed to deny people the benefits of a health facility such as Insite, and that to do so would violate the constitutional rights of some of those who are most vulnerable and in need of such health services," said Richard Elliott, the network's executive director.

"It's time to end the waffling and misdirection that we've seen so far," said Elliott. "The evidence is extensive and shows the benefits of such health facilities, including reducing injecting behavior that risks transmitting HIV and hepatitis C. Ideology cannot be allowed to block the delivery of health services and perpetuate a public health crisis."

Update: Late Thursday the government announced it would appeal the decision.

Feature: Vancouver's Safe Injection Site Fights for Its Life -- Again

The only officially-sanctioned safe injection site in North America, Vancouver's InSite will have to close its doors June 30 if the Canadian federal government does not extend its exemption from Canada's Controlled Drugs and Substances Act. But while the Conservative government of Prime Minister Stephen Harper has made no secret of its distaste for the program, it has very strong community, local, provincial, and international support, and its supporters are now engaged in a strong campaign to ensure its continued existence.

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InSite (courtesy Vancouver Coastal Health)
Situated on Hastings Street in Vancouver's Downtown Eastside, home to one of the hemisphere's largest concentrations of hard drug users, InSite has operated since 2003, when it was granted a three-year exemption by the then Liberal government. With the advent of Conservative government, with its ideological opposition to programs that "encourage" or "facilitate" drug use, InSite's continued existence has been shaky. Twice, the Conservatives have granted the program temporary 18-month exemptions, saying that more research on its efficacy was needed.

But now, after five years of monitoring and evaluation, the results are in: According to peer-reviewed scientific studies, InSite increased the use of addiction treatment services, increased the use of detox services, reduced needle sharing, led to improvement in neighborhood public order and quality of life, resulted in no increase in drug-related crime, prevented overdose deaths, and helped reduce the spread of HIV/AIDS among drug injectors.

As if the nearly two-dozen studies of InSite were not enough, the Conservative government last year commissioned its own study, "Vancouver's INSITE service and other Supervised injection sites: What has been learned from research?," which was released in early April. According to Simon Fraser University criminologist Neil Boyd, who was hired by the government to advise the committee overseeing the study, the research shows that InSite has no apparent negative impacts, has resulted in "modest decreases" in drug use, and has not disturbed public order.

In fact, said Boyd at a press conference announcing his findings, InSite should not only be continued, but the program should be expanded to other locations. "I think our data suggests... the building of additional facilities of a similar kind in neighborhoods where they are needed would yield benefits much in excess of the costs required for such projects," he said.

That's unlikely under the Harper government, which is ideologically opposed to such harm reduction practices and in fact removed funding for them from its anti-drug budget. As Harper put it last October: "Because if you remain an addict, I don't care how much harm you reduce, you're going to have a short and miserable life."

Harper has also scoffed at empirical evidence when it conflicts with his agenda. In a January speech to party faithful, he mocked opponents who cited falling crime statistics in challenging his emphasis on law and order. "They try to pacify Canadians with statistics," said the prime minister. "Your personal experiences and impressions are wrong, they say; crime is really not a problem."

More recently, Health Minister Tony Clement and his underlings have sounded similar themes. Science would not be the only factor in determining whether to continue InSite's exemption, Clement's undersecretary, Winnipeg MP Steven Fletcher told The Canadian Press earlier this month. While the government would make a "rational and thoughtful decision based on science," it must also take into account "the realities of the situation," Fletcher explained. "There's multiple sides to this and they all have to be taken into consideration," said Fletcher.

When pressed in parliament by Vancouver East MP Libby Davies, a staunch InSite supporter, Clement vowed to make a decision before June 30 and responded to her criticism about rejecting the science supporting the program: "We are the government that actually wants more research, that actually commissioned more research because we want to make sure this decision is the right decision for Canada, for addicts and for the community in Vancouver," he said. "That is the decision we have made, more research and more consideration. That is because we are open-minded and we want to make the best decision for Canada and Canadians."

Now, as the June 30 deadline looms, InSite's supporters have mobilized. Already this month, the International Journal of Drug Policy published articles by scientists from around the world condemning the federal government for interfering politically with the site's research, Boyd held his Ottawa press conference, advocates held a rally in a Downtown Eastside park featuring 1,000 white crosses to symbolize the people who didn't die from drug overdoses while injecting at InSite, Vancouver street nurses picketed the office of the Vancouver Police Union, whose president is a leading critic of the site, BC Nurses Association president Debra MacPherson held a press conference to tout the health benefits of InSite, and all three BC civic parties have signaled their joint support of the program.

"We're fully behind the effort to keep InSite open," said David Hurford, director of communications for Vancouver Mayor Sam Sullivan. "It is part of the solution, not part of the problem, and it is a bottom-up solution from the grassroots. The federal government has said it supports grassroots decision-making, so why should bureaucrats from 3,000 miles away be making decisions for us here?" he asked.

The mayor's office is "working with local stakeholders to help communicate the benefits of InSite," said Hurford. "We wrote to the health minister last week asking him to keep the site open, and at a minimum, to extend the permits until all pending legal issues are heard."

Hurford is referring to a lawsuit pending in the BC courts that challenges Health Canada's jurisdiction over InSite. That suit argues that since under Canadian law, health care is the domain of the provinces, the federal government should not have control over InSite. But that lawsuit will not be settled by the end of next month.

Opposition politicians have also joined the fight. "This government chooses to view harm reduction as nothing more than dirty words, at the expense of protecting the safety and health of Canadians," said Liberal Party public health spokesperson Dr. Carolyn Bennett.

"The results from the InSite project show measurable evidence that it saves lives," said Liberal MP Dr. Hedy Fry, who played a key role in bringing the agreement that allowed InSite to open. "This has won it widespread support not only from experts in Canada but from the international scientific community, from the Vancouver police and from residents of the Downtown Eastside," said Dr. Fry. "It is simply irresponsible to ignore scientifically-based proof of the efficacy of harm reduction programs like this, and base public policy on ideology alone because real people suffer the consequences."

"The Conservative government must stop its unconscionable interference in scientific research on Vancouver's safe injection site," added New Democratic Party MP Libby Davies, who represents the Downtown Eastside. "Medical researchers from the University of British Columbia have revealed that Harper and his team have been suppressing evidence and denying funding to scientists who are looking objectively at the merits of Insite," she said.

"More than 20 medical and academic studies have been published showing the health and social benefits of InSite. We now have both scientific fact and evidence from users in our community that this facility is helping, not hurting the people of our city. The research record shows that Insite saves lives and increases public safety," Davies continued. "Harper doesn't understand that you can't just hide the facts whenever they don't suit your political agenda. We need a change in direction. It's time for this government to make decisions based on evidence instead of ideology -- InSite needs to be kept open."

"What we want is a 3 ½ year renewal of the exemption from the Controlled Substances Act," said Nathan Allen of InSite for Community Safety. "The fact that the Harper government has not granted this renewal shows they are very reluctant to support the community."

While the Harper government has previously said it needed more research to evaluate InSite's efficacy, that dog won't hunt anymore, said Allen. "They've already spent more than $1.5 million studying InSite, they've produced two dozen academic papers, and they've concluded that it has all kinds of positive impacts. We're wondering what questions the government has left to ask," he scoffed. "InSite has undergone the most thorough and well-funded scrutiny of any health clinic in the country."

In the event the government refuses to grant another exemption, Allen said he hoped it would respect provincial authority and local autonomy. "This has been a regional response to a local crisis here in Vancouver. We need to let the people here on the ground do what they need to do. If not, people will die," he predicted bluntly.

The clock is ticking for InSite, but the pressure is mounting on the Harper government. The next few weeks will determine if that pressure is sufficient to overcome the government's ideological opposition to the safe injection site.

If You Oppose Harm Reduction, You Support AIDS and Death

The Drug Czar's blog has been very concerned about harm reduction lately. They've taken the counterintuitive position of opposing efforts to save the lives of drug users, which seems like a strange choice. Now I understand why: they think harm reduction is the opposite of what it actually is.
These so-called "harm reduction" strategies are poor public policy because their underlying philosophy involves giving up on those who can successfully recover from drug addiction. [PushingBack.com]
This is wrong for a very simple reason: you cannot recover from addiction if you're dead. Harm reduction programs are not an alternative to treatment, rather they go hand in hand. Harm reduction keeps people healthy and alive, thereby creating opportunities for them to subsequently recover from addiction.

We could do nothing. That would be "giving up." We could ask drug addicts to either quit or die. That would be "giving up." Instead, harm reduction activists have taken to the streets and attacked this problem directly. They've studied the leading causes of death among drug users and created programs to reduce those casualties. That's the opposite of giving up.

Just pretend for a moment that you're cruel and you want drug users to die in large numbers. How would you go about it? Well, you would begin by eliminating regulated distribution so that users are forced to obtain unsafe products from criminals on the street. You would reduce access to clean needles in order to spread AIDS. You would enforce criminal sanctions against users so that they're afraid to seek help. And you would lobby aggressively against anyone who's studied the problem and proposed programs to reduce AIDS and overdoses.

Now I'm not saying the Drug Czar wants to kill people. I'm just saying he presides over a policy that is perfectly tailored to achieve that outcome. And he dares to suggest that the people out there working with addicts and saving lives are the ones who've given up.
Location: 
United States

Sign-on letter to San Francisco officials in Support of a Safer Injection Facility

[Courtesy of the Harm Reduction Coalition] By changing San Francisco, we change the world A major part of addressing the expanding HIV/AIDS and overdose mortality rates in the United States is good public policy. The legacy of democracy is that when elected officials falter on implementing public policies that save lives, the public itself must step forward and urge those officials to take a stand. We need 200 signatures by December from organizations and individuals living or working in San Francisco on a petition that will be delivered to the desk of Mayor Gavin Newsom, the San Francisco Board of Supervisors, and the San Francisco Department of Health Director Mitchell Katz demanding that our city create a legal safer injection facility to reduce the number of deaths by overdose and to curb the transmission of HIV and Hepatitis C. Your activism does make a difference. With your support we were able to beat back an amendment in Congress by conservative South Carolina senator Jim DeMint that sought to ban all federal funding from any city that chose to slow the spread of HIV/AIDS and save lives through the creation of a safe injection center. Join our petition to Mayor Newsom and help to save lives. Visit our website and sign our online petition today. http://www.democracyinaction.org/dia/organizations/HRC/petition.jsp?peti... Other nations around the world have built 65-safer injection facilities in twenty-seven cities and eight nation, let's make San Francisco the first city in the U.S. to create one and begin a national trend that starts putting lives above politics. Hilary McQuie, Western Regional Director Harm Reduction Coalition www.harmreduction.org mcquie@harmreduction.org
Location: 
San Francisco, CA
United States

Harm Reduction: Anti-Safe Injection Site Amendment Killed in Conference Committee

An amendment to the Labor-HHS-Education appropriations bill that would have barred the dispersal of federal funds from those departments to any city that opened a safe injection site for drug users was killed in conference committee this week. The measure was deleted "without prejudice," meaning committee members did not have to go on record as opposed to the amendment.

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drug war bad guy Jim DeMint
Officially, it was deleted because it was not in the House version of the bill. But drug reform activists say it was because committee Democrats got lots of calls from constituents urging them to oppose it.

"This is a victory for harm reduction and the drug policy reform movement," said Bill Piper, director of national affairs for the Drug Policy Alliance, which led the effort to kill the amendment. "Congress came close to adopting something that would have the same sort of impact as the federal ban on funding needle exchanges. It's good to see that in this case, at least, Congress didn't let politics trump science."

The amendment was sponsored by Sen. Jim DeMint (R-SC) in reaction to talk in San Francisco about opening a safe injection site there. Although the sites have been proven to reduce needle-sharing and the spread of infectious blood-borne diseases such as HIV and Hepatitis C and are open in eight European countries, Australia, and Canada, no such sites are operating in the US.

Two weeks ago, DeMint was crowing about his victory. "The Senate sent a clear message to cities that it's beyond ridiculous to ask Americans to pay for drug addicts to inject themselves with heroin and cocaine," he said. "The officials in San Francisco that gave credibility to this absurd idea should be embarrassed. This would undermine federal law and promote illegal behavior. These safe havens for drug users would only encourage more addiction and support the illegal drug market."

DeMint is eating those words now.

Harm Reduction: Measure to Bar Federal Funds for Cities With Safe Injection Sites Passes Senate

An amendment to a Senate appropriations bill that would bar cities that open safe injection sites from receiving federal education, health, and labor funding was adopted by the Senate last week. The bill is now in conference committee, where drug reform activists are working to kill it.

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drug war bad guy Jim DeMint
Sponsored by Sen. Jim DeMint (R-SC) in apparent reaction to talk about such a facility in San Francisco, the amendment to the Labor-Health and Human Services-Education annual appropriation bill would cut off funding from those departments to any city that opens a safe injection site.

At least 27 cities in eight European countries, as well as Vancouver, Canada, and Sydney, Australia, are operating safe injection sites. They have been shown to reduce needle-sharing and the rate of new HIV and Hep C infections among injection drug users without causing increases in drug use or criminality.

No American locality has so far tried to establish such a facility. But in San Francisco, discussions are underway.

"Drug war extremists in Congress are trying to ban cities from adopting a drug policy reform that no US city has even adopted yet," warned Bill Piper, national affairs director for the Drug Policy Alliance, in an email to supporters in states whose representatives are on the conference committee. "That's how scared they are of the growing drug policy reform movement. And they might win unless you take action today. We're in a major fight and we urgently need your help because at least one of your members of Congress is a key vote."

The measure needs to be nipped in the bud, Piper warned. "If this amendment passes, we can expect members of Congress to try to pass bolder amendments, like denying federal aid to any city that decriminalizes marijuana and cutting off highway funding to any state that enacts alternatives to incarceration for nonviolent drug law offenses," Piper wrote. "Obviously no city will consider such reforms if it means losing all their federal aid. That's why we have to stop this amendment right here, right now. We have to show the drug war extremists that there's no support in Congress for escalating the war on drugs."

Residents of Hawaii, Illinois, Iowa, Louisiana, New Jersey, Rhode Island, West Virginia and Wisconsin need to call their senators now, Piper said. "The bill is now in conference. If we don't get this stricken from the final bill, it could be years or decades before this draconian ban is repealed," he predicted.

Feature: San Francisco Ponders a Safe Injection Site, Would Be the Nation's First

San Francisco city officials last Thursday took a tentative first step toward opening the nation's first safe injection site for drug users. In an effort to reduce the city's high number of fatal drug overdoses, as well as slow the spread of blood-borne infectious diseases, such as HIV and Hepatitis C, the city's public health department teamed up with a coalition of health and social service nonprofit groups to present a daylong forum on safe injection sites, how they work, and how they can be established.

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O'Farrell St., Tenderloin district, SF (courtesy Wikimedia)
San Francisco's needle-using population is estimated at between 11,000 and 15,000, with many of them being homeless men. While injection-related HIV rates are relatively low, Hepatitis C is spreading quickly among drug users. About 40 San Franciscans die from drug overdoses each year.

Injection drug use is also a quality of life issue for businesses and residents in areas of the city like the Tenderloin, where public injecting is not rare and dirty needles can be found on the streets. The neighborhood, a center of services for down and out residents, is often mentioned as a potential location for a safe injection site.

Safe injection sites are up and running in some 27 cities in eight European countries, as well as Australia and Canada. They have been shown to reduce overdoses, needle-sharing, and the spread of disease, as well as entice some users into drug treatment -- all without causing increased drug use, crime or other social disorder.

The symposium was cosponsored by the Harm Reduction Coalition, the Drug Policy Alliance, and the San Francisco AIDS Foundation, and was organized by a local consortium of community-based groups known as the Alliance for Saving Lives. That broad-based umbrella group includes public health officials, service providers, legal experts, injection drug users, and researchers.

"Having the conversation today will help us figure out whether this is a way to reduce the harms and improve the health of our community," said Grant Colfax, director of HIV prevention for the San Francisco Department of Public Health.

Vancouver's Insite safe injection site, the only one in North America, was held up as a model for a potential similar program in San Francisco. Both Dr. Thomas Kerr of the British Columbia Center on Excellence in AIDS, who has evaluated InSite, and the facility's program manager, Sarah Evans, addressed the forum about their experiences.

Evans described the Downtown Eastside Vancouver facility as a bland place where drug users can come in and inject in a safe, sterile environment under medical supervision, then relax in a "chill out" room where they are observed. "It looks kind of like a hair salon," Evans said of the bustling space. "If we were a restaurant, we would be making a profit."

While InSite has seen some 800 drug overdoses, said Kerr, none of them had been fatal because of the medical supervision available at the site. His research has found increases in addicts seeking treatment and decreases in abandoned syringes, needle-sharing, drug-related crime and other problems since the clinic opened three years ago, he said. Those findings suggest it is worth doing elsewhere, despite the criticism it will attract, Kerr said.

But while the science appears to be on the side of such facilities, political reality is a different matter. San Francisco Mayor Gavin Newsome's office has said that he does not support safe injection sites, and by this week, even public health department spokesmen were keeping mum. "We're not talking to the media at all any more," Colfax said on Tuesday in response to inquiries about what comes next.

While there has been community concern, the only vocal reaction has been coming from Washington, DC, where one senator, Republican James DeMint (SC), has introduced an amendment that would cut off federal health funds for any locality that starts a safe injection site, and where the Office of National Drug Control Policy (ONDCP) has attacked the idea via the press and its Pushing Back blog.

Bertha Madras, ONDCP deputy director of demand reduction, told the Associated Press the fact that the idea was even being discussed was "disconcerting" and "poor public policy." According to Madras, "The underlying philosophy is 'We accept drug addiction, we accept the state of affairs as acceptable.' This is a form of giving up."

But Hilary McQuie, Western Director for the Harm Reduction Coalition, and one of the guiding forces behind the push for a safe injection site in San Francisco, pronounced herself unworried about either DC opponent. "DeMint's measure is a rash overreaction that won't go anywhere," she predicted, "and as for ONDCP, well, I won't even debate them. It's none of their business; this is a local issue, not a national one."

It's a local issue that McQuie and others have been working patiently on for some time now. "We initiated the Alliance for Saving Lives about a year ago," she explained. "It's mostly agencies that work with drug users, and we've been meeting monthly. We've had some quiet conversations with the health department, and we decided it was time to take the next step."

Now it's time for advocates to build more community support for a safe injection site, including bringing the mayor and the Board of Supervisors on board. Even with science on their side, they have some work ahead of them.

"We know the issues and the science," said Randy Shaw, a long-time community activist working on homeless issues in the Tenderloin, "but no one here wants more of these kinds of facilities." "Why should the poor people of the Tenderloin have to live with all these problems? There are junkies in Golden Gate Park, there are junkies in SOMA, there's more drug traffic at the 16th Street BART station than anywhere in the Tenderloin," he said. "If some neighborhood wants to accept it, that's fine, we just don't want it in the Tenderloin."

City officials have made the neighborhood "a containment zone," Shaw complained. "We already have methadone clinics, needle exchanges, food programs, shelters, drug treatment programs. Now they don't even think about putting things in other neighborhoods." Some activists want to turn the Tenderloin into Hamsterdam, the industrial neighborhood turned into a drug trafficking free zone in the HBO show The Wire, Shaw said. "But we're a residential neighborhood."

"It's controversial," conceded Tenderloin Economic Development Project executive director Julian Davis, a supporter of the idea. "Some folks think the Tenderloin already has too high a concentration of these kinds of services, while others think like this sort of facility would enable drug users as opposed to ending drug addiction in the Tenderloin."

But Davis has a different perspective. "I look at the Tenderloin and I see that our city, our society is already enabling open drug use and drug dealing," he argued. "The idea behind the site is to get some of these users off the street and inside, where they can get access to services, and also to stop the needle-sharing and the spreading of HIV and Hep C. I see quite a few potential benefits from this."

And so the public discussion begins in San Francisco. It will be a long and twisting path between here and an actually existing safe injection site, with much work to be done at the neighborhood, municipal, state, and federal levels. It could take years, but advocates are confident its day will come.

"I think we will have a safe injection site eventually," McQuie predicted, "but how long that will take depends on how well we organize, who's in power, and how much pressure those in power locally feel from the feds."

Harm Reduction: San Francisco Safe Injection Site Discussions Underway

Vancouver is now the only city in North America with a safe injection site for drug users, but if some activists and public health officials have their way, San Francisco could be next. The city Public Health Department held an all-day symposium on the topic Thursday, and while public officials are keeping their distance, the symposium could be the first step in a push to bring the harm reduction measure to the US.

Currently, safe injection sites are operating in some 65 cities in eight countries -- mostly in Europe, but also in Australia and Canada. Such sites have been shown to reduce overdoses, needle sharing and the spread of blood-borne diseases like HIV/AIDS and Hepatitis C, as well as petty crime and other social problems. They have also been shown to entice some clients into drug treatment without increasing overall drug use.

In San Francisco, drug overdoses are one of the leading causes of death and Hepatitis C is reaching epidemic levels, according to public health officials. The Public Health Department says it is not taking a position on safe injection sites, but merely wants to open a dialog on the topic.

"All we want to do is get input," the department's Grant Coffax told KGO News. "The department's goal is to get addicts, drug users, into treatment, to get them into treatment to reduce their harm, to get them ultimately to stop using," he said.

Still, the department sounds quite interested in the idea. "There are data that support the approach in terms of reducing overdoses and actually reducing discarded needles around the perimeter of these sites," Coffax pointed out.

San Francisco police are less enthused. "You would still have those people that are selling narcotics on the streets of San Francisco, that so often turn into violent confrontations, still being able to do that and facilitating that," said Deputy Police Chief Morris Tabak. As is so often the case with law enforcement officials, Tabak failed to note that the problems he described are a result of drug prohibition, not any quality inherent in the drugs or drug users themselves, or that the city already has to contend with street sales of those drugs now.

And the mayor's office is not exactly clamoring to get onboard with the idea, either. "The mayor is not inclined to support this approach, which quite frankly may end up creating more problems than it addresses, " spokesman Nathan Ballard told San Francisco Chronicle columnist C.W. Nevius, who has been writing about the topic for the past couple of months.

That's no surprise to activists like Hilary McQuie, Western director of the Harm Reduction Coalition. "Down the road there will be a lot of strong feelings," she said. "It's a big topic, and we hope to start a conversation."

That conversation officially got underway yesterday, too late for details to make the Chronicle this week. Look for an update next week.

Press Release: Symposium to Explore Solutions to Injection Drug Use in SF, Including Feasibility of Legal Safe-Injection Facility

For Immediate Release: October 17, 2007 Contact: Laura Thomas 415-846-4614 Public Heath Officials, Injection Drug Users and Advocates Join to Explore Solutions to Injection Drug Use in San Francisco October 18 Symposium Will Examine Needs, Feasibility, Support and Options for Legal Safe-Injection Facility 27 Cities in Eight Countries Have Adopted Safe Injecting Sites; Evidence Shows they Reduce HIV, Crime and Drug Use Public health officials, injection drug users, drug war reform adovocates and others will convene for a day-long symposium to examine the needs, feasibility, support, and various options for a legal Safe Injection Facility in San Francisco. The envisioned Safe Injection Facility would serve homeless and marginally housed injection drug users, and the communities most affected by them. The symposium, which is free of charge, will be held on October 18, from 9:30 a.m. to 4:00 p.m., at the Women's Building auditorium, 3543 18th St. & Valencia in San Francisco. Speakers include public health officials, service providers, legal experts, injection drug users, community groups, leaders in the faith community and evaluators from InSite, a safe injection facility in Vancouver, Canada. San Francisco has several large concentrations of injection drug users (IDUs), and while prevalence of HIV/AIDS remains relatively low among IDUs, rates of hepatitis C have reached epidemic levels, and fatal opiate overdose remains one of the leading causes of death in San Francisco. Community concerns regarding public drug use and improperly discarded syringes have been raised repeatedly over the last few decades. Twenty-seven other cities in eight countries around the world facing similar issues have opened Safe Injection Facilities, and this symposium will open a broad discussion about this option. The symposium is sponsored by the San Francisco Department of Public Health, and the Alliance for Saving Lives (ASL), a community consortium working to promote community and individual health through legal safer substance use sites. ASL members include the Harm Reduction Coalition, Tenderloin Health, Mission Neighborhood Resource Center, Homeless Youth Alliance, Drug Policy Alliance, and individual researchers and service providers throughout San Francisco. Continuing Education Units are available for a small fee for RN's, Certified Addiction Treatment Specialists, LCSW's and MFT's. As seating is limited, please RSVP to hrcwest@harmreduction.org to reserve a space. ###
Location: 
San Francisco, CA
United States

Canada: Vancouver Safe Injection Site Granted Six-Month Extension, Again

As the Conservative government of Prime Minister Steven Harper prepares to launch its already widely attacked new national anti-drug strategy (look for a Chronicle feature article next week), it has moved to deflect opposition somewhat by announcing this week it has granted another six-month extension to Insite, the Vancouver safe injection site for hard drug users. But granting Insite only a limited extension has drawn flak from harm reductionists and other site supporters who say it has been proven to reduce injection drug use, needle sharing and overdoses without increasing criminality or social disorder and deserves better than to be left on tenterhooks awaiting semi-annual renewals of its exemption from Canadian drug laws.

https://stopthedrugwar.org/files/insitebrochure.jpg
Insite brochure
The Harper government has made no secret of its ideologically-driven disapproval of safe injection sites, but has found stopping Insite politically unpalatable given the strong support it has in Vancouver and from experts around the world.

On Tuesday, Health Minister Tony Clement announced in a terse statement that he "has advised the Vancouver Coastal Health Authority which operates Insite, a supervised injection site, that their exemption under Section 56 of the Controlled Drugs and Substances Act has been extended until June 30, 2008. This extension will allow research on how supervised injection sites affect prevention, treatment and crime to be continued for another six months."

The evidence of Insite's efficacy is already in, protested the Canadian AIDS Society in response to the limited renewal. The limited renewal is an "irresponsible decision on a public health program that is proven to work," the group said.

"This is the second time that the federal government has stalled on this decision and said that more research is needed. But the fact is, Minister Clement is asking questions that have already been answered and calling for research that's already been done," said Richard Elliott, executive director of the organization. "The evidence is unequivocal: Insite is saving lives and lowering the risk of HIV infection in one of the most marginalized communities in Canada, and increasing the chances of referring people who use drugs to addiction treatment services."

Uncertainty over Insite's continued existence is hard on staff, clients, and medical personnel alike, Insite worker Mark Townsend told the Toronto Globe & Mail Wednesday. "It's like constantly debating the same tiny speck of dust," Townsend said. "It's stressful on the ground for the human beings, the doctors and nurses involved with it. It's stressful for the people who work in the bureaucracy and care about people on the ground and are trying to put together programs that help people. The clients do get stressed about it as well. It's like you're constantly about to be fired from your job."

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