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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.
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.
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 [email protected] to reserve a space. ###
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.
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."

Vancouver Mayor Sam Sullivan and City Councillors Voted for a City Council Resolution to Support Two Important Drug Policy Measures

For Immediate Release: June 14, 2007 Contact: David Hurford, Director of Communications, City of Vancouver - Office of the Mayor, T: 604.873.7410 or 604.561.3970 Vancouver Mayor Sam Sullivan and City Councillors today voted for a City Council resolution to support two important drug policy measures, including: a.. Vancouver Coastal Health Authority's federal application for a 3.5 year extension of Vancouver's safe injection site b.. the general principles and objectives of the Inner Change Society's Chronic Addiction Substitution Treatment (CAST) research trial The measures were introduced by Vancouver City Councillor Kim Capri and seconded by Mayor Sullivan. "The resolution passed by City Council further supports the development of compassionate solutions to the social challenges we face," said Mayor Sullivan. "In addition to supporting the five goals I have established for my government, the extension of the safe injection site and the CAST research trial will help us meet the objectives of Project Civil City." A complete copy of the approved resolution and a background document regarding CAST general objectives and principles are included below. In addition to supporting these measures, Council has asked City Staff to report back to City Council on how the CAST goals and objectives can support Vancouver's drug policy. -END- Test of the Vancouver Drug Policy Resolution: WHEREAS The Vancouver Coastal Health Authority's Safe Injection Site: a.. was first formally introduced by former Mayor Philip Owen with Vancouver's Four Pillars strategy to improve conditions in the Downtown Eastside; b.. is one element of a drug strategy that also includes prevention, treatment and enforcement; c.. has been successfully operating for the last 3.5 years under a federal regulatory exemption which expires this year; d.. has been the subject of research studies that support its effectiveness in reducing the harm associated with drug use and addiction; e.. supports the City of Vancouver's goal of civility on our streets and finding compassionate solutions to challenging social issues; f.. supports Vancouver's objectives as identified in Project Civil City; g.. complements the groundbreaking North American Opiate Medication Initiative (NAOMI) heroin assisted treatment trials led by researchers at the University of British Columbia and University of Montreal, and funded by the Canadian Institutes of Health Research; h.. will be an important agenda item on Mayor Sam Sullivan's meeting next month with the Four Pillars Coalition; i.. has submitted an application to Health Canada for a 3.5 year extension of their federal exemption. AND WHEREAS The Inner Change Society's Chronic Addiction Substitute Treatment (CAST) research trial: a.. will work with addicted people to change their drug addiction from illegal street drugs to legally available, orally-administered prescription medications; b.. will analyze the effects on both the user's health and the community at large; c.. will include regular interaction with health professionals and facilitate interventions to help users develop an "exit strategy" to end their drug dependency; d.. proposes to help reduce the open drug market and other illegal activity, improve health, increase access to housing and more employment opportunities for individual addicts; e.. is being developed by some of the most experienced health researchers in the field of mental health and addiction; f.. is based in Vancouver and has garnered support from a broad range of key stakeholders and an experienced Board of Directors; g.. is consistent with the drug substitution elements of the Four Pillars strategy; h.. supports the City of Vancouver's goal of civility on our streets and finding compassionate solutions to challenging social issues; i.. supports Vancouver's objectives as identified in Project Civil City; j.. is one element of a drug strategy that also includes prevention, treatment and enforcement; k.. will be an important agenda item on Mayor Sam Sullivan's meeting next month with the Four Pillars Coalition; l.. will also require a federal regulatory exemption; m.. complements the objectives of Vancouver's safe injection site and NAOMI heroin assisted treatment trials; n.. is likely to receive referrals from Vancouver Coastal Health's supervised injection site. THEREFORE BE IT RESOLVED THAT Vancouver City Council formally express its support for the Vancouver Coastal Health Authority's federal application for a 3.5 year extension of Vancouver's Safe Injection Site. BE IT FURTHER RESOLVED THAT Vancouver City Council formally express its support for the general principles and objectives of the Inner Change Society's Chronic Addiction Substitute Treatment (CAST) research trial as part of a comprehensive plan with additional effort to support the Four Pillars strategy and request that staff report back on the CAST program and how it would be incorporated into the City's drug policy. -END- Chronic Addiction Substitution Treatment (CAST) Research Trial Background Vancouver's rates of illegal drug use, drug-related mortality and drug-related pregnancy & childbirth complications present problems that concern all Canadians. Chronic Addiction Substitution Treatment (CAST) is a proposed research trial targeting chronically addicted people in Vancouver's Downtown Eastside. It represents one element of a Vancouver drug strategy that also includes prevention, treatment and enforcement. CAST is being led by the Inner Change Society, a non-profit organization under the leadership a well established Board of Directors. CAST is being developed by some of the most experienced health researchers in the field of mental health & addiction. CAST is also supported by AIDS Vancouver, Insite for Community Safety, West End Citizens Action Network, Gastown and Downtown Vancouver Business Improvement Associations. There is growing evidence that treating drug addiction from a health perspective dramatically decreases crime and provides significant public cost savings. Global research on substitution programs - and the positive impact of methadone maintenance programs in Canada - shows these initiatives reduce income from illegal activities, health problems, use of emergency services and police contact. General Objectives & Principles CAST Objectives a.. Ultimately end drug dependency. b.. Move addicts from illegal & injection street drugs to legal & orally-administered prescription medications. c.. Improve health and increased access to housing & employment for individual addicts. d.. Reduce crime. e.. Advance research discovery and further establish BC as a centre of excellence & innovation in the fight against drug addiction and for improved mental health. f.. Complement Vancouver's Project Civil City and Four Pillars objectives. CAST Principles a.. Participation will be voluntary. b.. Minimum eligibility will be established & include minimum residency requirements. c.. Emphasis on survival sex trade workers & chronic offenders arrested five or more times within the last year. d.. Regular interaction between addicts & health professionals to facilitate interventions and help users develop an "exit strategy" to end their drug dependency. e.. Clients monitored on a regular basis and provided with addiction counseling & help accessing supportive housing options. f.. Referrals taken from the Vancouver Coastal Health Authority, existing DTES agencies, InSite, Community Court & the Police. g.. Analysis to include the effects on the user's health and the community at large. h.. Ongoing consultation with physicians and stakeholders. i.. Will respect all rules associated with conducting research trials & operating a non-profit society.
Vancouver, BC

War on drugs a loser

Edmonton Journal (Canada)

Study backs safe-injection site's work

Vancouver, BC
The Globe and Mail (Canada)

Tories to shun 'safe drug' sites

Ottawa, ON
National Post (Canada)

it isn't balance when opinion runs as fact

Vancouver, BC
The Vancouver Sun (Canada)

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