Pubdate: Thu, 12 Oct 2006 Source: Martlet (CN BC Edu) Copyright: 2006 Martlet Publishing Society Contact: http://www.martlet.ca/ Details: http://www.mapinc.org/media/3140 Author: Eric Szeto INTO INSITE Dispelling The Myths Of Drug Addiction In Vancouver's Downtown Eastside VANCOUVER (CUP) -- On any given morning on the corner of East Hastings and Columbia in front of the Radio Station Cafe, a drug dealer can make up to $35,000. Their customers approach in a nonchalant fashion, do their business and quickly scuttle off in various directions. Some may venture back to hotel rooms, rented out at cheap monthly rates. Others will drift into the nearest alley and quickly dose. But these days, most will probably walk into Insite, Vancouver's highly publicized and contentious safe injection facility, just eight doors away. Even on the slowest day, the Vancouver Area Network of Drug Users (VANDU) estimates that nearly 15,000 heroin injections take place in the Downtown Eastside. Tyrone Caldwell used to take his fair share. Caldwell, 39, spent the last 14 years dabbling with different substances, and after nearly a decade of drug use, he started dealing drugs (including heroin) to support his $300-a-day cocaine habit. Last May, he entered the facility as he did on any normal day. He proceeded into the injection area, a booth the width of a desk with a mirror in front and two walls, to shoot up. "The minute the buzz or rush started coming on, I knew it wasn't a cocaine rush," he says. "I knew I was in trouble, and that's the last thing I remember." Caldwell was put into an ambulance after the paramedics revived him with a shot of Narcan, a drug that reverses the effects of opiates. Caldwell later discovered he hadn't injected pure cocaine, but a nasty mix of cocaine and heroin that led to his overdose. The staff at Insite are the reason Caldwell didn't die that day, and he knows it. "If Insite wasn't there and I was in the alley, I'd be dead," he says. Caldwell isn't the only one. Since its inception in 2003, Insite has grown in popularity on the Downtown Eastside--averaging around 700 visits per day--and of the 500 overdoses, none have resulted in death. Section 56 of the Controlled Drugs and Substances Act allows Insite to have legal possession of controlled substances. Because of this exemption, Insite is currently the only place in Canada where a person can legally carry narcotics. Before Insite, the number of overdoses and rates of infection for HIV and hepatitis A, B and C were soaring in the Downtown Eastside. According to Anne Livingston, a project co-ordinator for VANDU, deaths by overdose climbed from 35 in 1989 to 350 in 1994. The 1995 Vancouver Injection Drug User Study sampled 5,000 users in the area and estimated that the prevalence of HIV/AIDS in the area was around 40 per cent, while hepatitis C hovered around 90 per cent. The community was dying. With the alarming rates of infection and death escalating rapidly, the city soon realized traditional drug enforcement and treatment strategies were failing. Vancouver subsequently adopted its "Four Pillars Drug Strategy," which consists of harm reduction, prevention, treatment and enforcement. Insite was created as a progressive step toward harm reduction. Open 18 hours a day, it has become one of the busiest safe injection facilities in the world, with 7,000 registered members. (Other sites exist in Portugal, Australia, Germany and Switzerland.) Though how the facility has had an impact on the rate of HIV/AIDS is not known, Insite has found that its users are twice as likely to get into detox. In spite of this, the future of the facility was in limbo at the end of August, with the federal exemption that allowed Insite to operate due to expire on Sept. 12. When Health Minister Tony Clement announced the government's decision to extend the exemption, he shortened the time span from three years to a deadline of December 2007. "Do safe injection sites contribute to lowering drug use and fighting addiction?" Clement said in a media release. "Given the need for more facts, I am unable to approve the current request to extend the Vancouver site for another three and a half years." Jeff West, a co-ordinator at Insite, has witnessed firsthand the changes the facility has brought to the Downtown Eastside. He's working to dispel the myths he says are circulating in Ottawa and educate people about the many other services they provide. "We teach people; we never hold or touch the needle, that's the bottom line," says West. "[The staff] can tie people off, help them find a vein, [pick] what kind of angle to insert the needle. We also have a prosthetic arm that has veins and use that as a teaching tool." West stresses the strictness of these guidelines--if someone dies and Insite workers have gone beyond their immediate duties, it's an automatic charge of manslaughter. But the big appeal, West says, is giving a shelter to the people living in squalor. Insite gives the lost and hopeless a place to go. When Darcy (who is using only her first name to protect her identity) was 22, her sister became a crystal methamphetamine addict and Darcy took custody of her sister's children. Twenty-five years later, she found herself living in the Balmoral Hotel in Vancouver's Downtown Eastside after a back injury forced her onto welfare. Darcy started using drugs--everything except crystal meth. "I wanted to experience it all. My sister was a junkie; it was like I wanted to experience what she experienced." At the height of her drug addiction, she was visiting Insite nearly four times a day. "What I went for was the congeniality, and I'd go there because it's a nice, clean place. I don't actually inject anymore." Before Insite, she says, women were contracting HIV at enormous rates, and adds that women are the most vulnerable on the Downtown Eastside. Darcy says that prostitutes are often too messed up to do their own drugs. They receive help from their pimps, who inject the women with used needles, increasing the risk for HIV and other diseases. "Closing the site would force many women back into the alleys," she says. She admits there are many misconceptions about Insite and says that, given the lack of understanding about addiction in general, that's not surprising. "[Drug addicts] are seen as a subhuman species here," she says, "but they aren't." Case in point: The Globe and Mail held an online debate before the extension to the exemption was granted. Randy White, founder of the Drug Prevention Network of Canada, former Reform-Alliance-Conservative MP and vice-chairman of the parliamentary committee studying the non-medical use of drugs, gave a list of reasons why Insite's exemption should not be renewed. Among The Reasons: 1) Injection sites do not prevent and treat drug use. 2) Since its opening, crime and addiction have increased in Vancouver and the injection site has contributed to the problem. 3) Responsible governments do not sanction a person walking through a door and getting assistance to shoot up crystal meth. 4) Injection sites are the exception, not the rule, in most countries worldwide. Former mayor of Vancouver and current senator Larry Campbell retorted, "To be blunt, [White] is a dinosaur and refuses to even consider scientific, peer-reviewed evidence. I suspect that deep in his mind, he believes the earth is flat." The inability to get past archaic misconceptions about the realities of drug use is at the root of the problem, says Nathan Allen, an organizer for the advocate group Insite for Community Safety. Libby Davies, a proponent of Insite and an NDP MP, echoed Allen's concerns. "The evidence [about] Insite is irrefutable; there's no research that suggests it's not working as it should be.... You can't ignore the scientific evidence from incredibly reputable sources. It's been under a microscope for three years. It's not a panacea for the drug solution; its part of the solution." The "federal government doesn't fund any component," adds Allen. "Insite doesn't provide drugs. They aren't asking for a single red cent, just for the blessing, just for the exemption to be renewed." Though perceptions of addiction range from a crime to an illness, in almost all drug addiction cases, there's a story behind it being overlooked. "People have experienced trauma, and some of these injection drug users are basically self-medicating, and they basically become criminals because of what they start using. It's a downward spiral from there," says Davies. "It's an insane situation." Darcy agrees. "[Drug addicts have] lost their self-esteem," she says. "A lot of people are forced here. A lot of people are unable to take care of themselves and they get into drugs." Even for those opposed to the work of Insite, there are many right-wing libertarian arguments that point to a decrease in tax dollars being spent. According to VANDU and Insite, every ambulance coming into the Downtown Eastside costs $1,000. Each case of HIV/AIDS costs the health-care system $320,000. The financial burden the area once carried has decreased significantly. One of the strongest messages of support comes from the Chinatown Merchants Association. Before the site opened, the association was among those most vehemently opposed to the injection site. Now they are one of its biggest supporters. "There aren't any people shooting up in front of the businesses anymore and Insite has [shown] by example that it works," says Allen. Six to eight hours after their last dose of heroin, a person can begin to experience withdrawal symptoms that include severe anxiety, depression, diarrhea, convulsions, vomiting and uncontrollable body movements. Mary Miller used to dose at Insite frequently to avoid these symptoms. Months before the creation of Insite, VANDU--which was created in 1998 by a group of intravenous drug users that advocated living healthy, productive lives--opened their own de facto safe injection site for people like Miller. The rogue site could barely operate and their hours were limited (10 p.m. to 2 a.m.), but according to Ann Livingston, that site gave the city the gumption to eventually open a legally sanctioned facility in 2003. The municipal government, she says, had repeatedly dropped the idea for the site in previous years. When the Sept. 12 shutdown seemed imminent, VANDU sought an injunction to the BC Supreme Court stating that it was unconstitutional for the site to be closed. The following day, Tony Clement announced the government would extend the exemption. The news was less than encouraging to Livingston, who feels that the federal government is stalling in making a real decision. She sees Ottawa's non-committal attitude as an indication that a shutdown, regardless of the extension, is looming. "It's unprecedented to have a minister of health ignoring info that's published in the [New England Medical Journal]," Livingston says, referring to studies published about the impact of Insite. She is lobbying to open four more government-sanctioned sites. "It's the equivalent of your whole body covered in running sores and one patch is cleared up," she says. "We know it works, but we can't put it on the rest of our bodies. I said, 'Fuck you, we can't.'" But the likelihood of more sites popping up once the exemption expires in December seems small. Livingston knows it, and that's why VANDU is doing whatever it can to help. Spotted easily from a block away, VANDU's team of 10 people in fluorescent vests patrol the streets, educating and, in many cases, illegally assisting with the injections of addicts who are unable to inject alone. These rogue patrols complement the limited services Insite can legally provide. Often, people have to be rejected from the facility because they are not capable of injecting their own drugs. This squadron of injectors, all trained health-care workers certified in CPR, will do what Insite workers can't. "It's considered illegal," Livingston says. "But if I inject you with drugs [you're] much less likely to die with a trained expert who knows CPR and has gloves on." Livingston expects illegal sites will replace Insite if it's closed. Before the extension was announced, VANDU and other groups were getting one ready. There are also rumours of a site built by the Portland Hotel Society, a Vancouver-based substance abuse advocacy group. The future of Insite after December remains uncertain, but regardless of what the government decides, support for Insite remains strong. Livingston can attest to that. "[Ottawa is] going to mud-wrestle with us," she says. "I don't think that they want that, because we would win." - --- MAP posted-by: Elaine