Pubdate: Thu, 15 Mar 2001 Source: Vancouver Sun (CN BC) Copyright: 2001 The Vancouver Sun Contact: 200 Granville Street, Ste.#1, Vancouver BC V6C 3N3 Fax: (604) 605-2323 Website: http://www.vancouversun.com/ Page A17 Author: Evan Wood Note: Evan Wood is a PhD student in the department of health care and epidemiology, in the faculty of medicine, at the University of B.C. THE ONLY WAY TO KNOW IF SAFER INJECTION SITES WORK IS TO TRY THEM Recently there has been a heated controversy over a proposal to create places in Vancouver where addicts would be able to safely inject their drugs. This suggestion flies in the face of the "Say No to Drugs" dogma, but it is at the heart of harm reduction, a philosophy aimed at curbing crime rates and containing the spread of disease by enabling drug users to inject safely until they can be helped off drugs. The debate surrounds the potential of harm reduction in Canada's most notorious neighborhood, where an explosive HIV epidemic has garnered attention in the pages of some of the world's most prestigious medical journals. Studies from the mid-1990s suggested our approach to drugs was not working, and evidence suggests things are only getting worse. Opponents to harm reduction are rightly concerned that the European experience with harm reduction may not work in Canada. In an effort to raise awareness about the potential of harm reduction, Vancouver researchers have explored several factors of the Downtown Eastside HIV epidemic that could potentially be changed if a safer injection facility was established here. Safer injection rooms have three primary aims: to alleviate the public disorder problems associated with public injecting and improper needle disposal, to prevent fatal overdoses that often happen when people inject alone by having medical services at hand, and to limit blood-borne disease epidemics by providing sterile needles and supervising users to prevent needle sharing. The Vancouver Injecting Drug Users Study (VIDUS) is a project that has recruited more than 1,400 addicts into an ongoing survey of injecting behavior and the spread of HIV. To see whether a safer injecting room could achieve its aims in Vancouver, VIDUS researchers have investigated the proportion of addicts who shared a needle, injected alone, overdosed by accident, needed help injecting, injected outdoors and found it hard to find clean needles. The numbers, regarding these behaviours over the last six months, make a strong case for safer injection rooms: - - 28 per cent of drug users shared a needle; - - 75 per cent of drug users reported injecting alone at least once; - - 10 per cent of drug users experienced a non-fatal overdose; - - 14 per cent of drug users reported injecting in a public space; - - 25 per cent of drug users reported needing help injecting; - - 18 per cent of drug users found it hard to access sterile needles. Sadly, those who needed help injecting were almost twice as likely to report sharing a needle in the last six months. Even more alarming is that those who found sterile needles difficult to access, were more than three times more likely to report sharing a needle. Based on these numbers, the drug problem can no longer be ignored. Or can it? In 1997, a study entitled Needle Exchange is Not Enough was published in one of the most prestigious infectious disease journals. In it, the VIDUS researchers showed that Canada's strategy of dealing with drug addiction was not working. The only service being offered to addicts to help them avoid either spreading or contracting HIV were places to trade in dirty needles for clean ones. The researchers advocated harm reduction interventions as an alternative strategy to the War on Drugs approach. Unfortunately, no sweeping policy changes were made and instead law enforcement was stepped up. That year, the annual rate of new HIV infections among Vancouver injection drug users peaked at 18 per cent, a level of spread that remains among the highest ever documented in the developed world. The inaction of health policy makers led to a subsequent study entitled Deadly Public Policy, and in it the authors demonstrated that the withdrawal of social services may have lit the spark that ignited the Vancouver epidemic that we are still dealing with. Specifically, the curbing of federal government support for low-income housing resulted in more than 6,000 individuals being forced into Downtown Eastside hotels. Addicted individuals were refused access to social housing, and detox and mental health facilities were eliminated as budget reductions were imposed, further concentrating at-risk individuals in the neighbourhood. Here, driven deep into the low-income hotels by the "war" on drugs, with little access to drug treatment and in fear of police, injection drug users shared needles and the HIV epidemic raged on, much as it does today. Can a safer injection facility help change these behaviours? The only way to know is to try. Increased law enforcement may only lead to driving addicts away from services and displace the problem into neighbouring areas. With the current level of drug crime, exploding disease rates, a groaning health care system and avoidable human misery, Vancouver residents should support Mayor Philip Owen's proposal to explore alternatives. In several European cities, safer injection rooms have greatly reduced drug-related harm. With public support and political will, Vancouver may one day be recognized as a model for modern and sensible approaches to addiction, instead of an example of public policy gone mad. - --- MAP posted-by: Keith Brilhart