Pubdate: Fri, 12 Mar 2010
Source: Calgary Herald (CN AB)
Copyright: 2010 Canwest Publishing Inc.
Contact: http://www2.canada.com/calgaryherald/letters.html
Website: http://www.calgaryherald.com/
Details: http://www.mapinc.org/media/66
Author: Liz Evans
Note: Liz Evans is executive director of the PHS Community Services 
Society, the not-for-profit organization that runs InSite, a 
safe-injection site in Vancouver's downtown eastside

INSITE SAVES ADDICTS' LIVES

About a month ago, In-Site staff came to work in the morning and 
found a woman lying, in tears, in crisis, in the street outside the 
facility in Vancouver's downtown eastside.

Trauma Mama (In-Site users check-in at the reception desk using 
pseudonyms) had been visiting the facility for four years to inject 
cocaine, so they knew her well and approached, hoping to help.

Thirty-nine years old, but looking more like she was in her late 40s, 
Trauma had been using heavily, she hadn't slept in days and she had 
just been robbed. Staff took her to the site's lounge and gave her a 
blanket and fluids. Two weeks later she came in, used the injection 
room, then approached In-Site's counsellor and asked to be admitted 
to the OnSite detox and recovery facility upstairs.

We have repeatedly invited Stephen Harper to visit the safe injection 
site personally and take the time to meet some of the people helped 
by the lifesaving service it provides.

Herald columnist Susan Martinuk deserves credit for doing what he has 
failed to do. And one of the people she met was Trauma Mama. 
Transformed, Trauma had just finished breakfast, and was clean for 
the first time in years. Martinuk's recent column doesn't mention the 
encounter; instead, she argues that engaging with drug users just 
encourages them to feel better about their choices. InSite staff 
engage with drug users out of compassion, but more importantly, 
because engagement works.

After her crisis on Hastings Street that late January morning, Trauma 
told InSite staff she didn't have anywhere else to go. Whether to use 
drugs or to recover after the traumas from which she derives her 
name, her alternative is the street. Engagement is a prerequisite for 
treating addiction in Vancouver's downtown eastside because 
alienating drug users means banishing them to the places where they 
are most at risk.

Like many people with strong opinions on this issue, including Prime 
Minister Harper and Martinuk, I assumed I had the solutions before I 
fully understood the problems. When I first came to the downtown 
eastside 19 years ago after training as a nurse, I was out of touch, 
but I didn't realize that I was. Unfortunately, the price we 
collectively pay for this lack of understanding is perpetuating pain, 
suffering, death and disease in our cities.

Now, after having met hundreds of people who have taught me 
otherwise, I no longer think treating addiction is simple. As the 
executive director of the non-profit organization that runs InSite, 
I've learned that drug use is a lot more complicated than the 
"lifestyle choice" paradigm frequently touted by drug war advocates. 
This ideology leaves little room for Trauma.

The vast majority of drug addicts have experienced abuse -- 
emotional, physical, sexual or some other variant -- in their lives. 
The correlation between trauma and addiction is borne out by 
scholarly consensus, the observations of InSite's counsellors, and my 
own experience listening to their too often heart-wrenching stories. 
Many InSite users are people for whom trust and understanding are 
among a phalanx of social and institutional barriers making treatment 
often feel impossible.

The supervised injection site never promises to hold any magic 
solution. Rather, its existence acknowledges that there are realities 
for which simplistic paradigms have failed. There are people for whom 
we have failed. As an effort to engage with those we fail, Insite's 
approach has led to proven success in promoting detox and recovery.

A 2006 study in the New England Journal of Medicine found that 
addicts who use the facility have been 18 per cent more likely to use 
addiction treatment and counselling services, including detox.

These data confirm that meeting people where they are and listening 
to what they need is an effective way to facilitate treatment and 
recovery. Canada desperately needs a comprehensive national 
four-pillar approach to drug policy like Vancouver's; the safe 
injection site is only one part of the addiction solution, but it's a 
necessary part. We don't work to reduce the spread of disease and the 
risk of overdose associated with using drugs because we think 
recovery is impossible, we do it because dead drug addicts can't recover.

The safe injection site is an effective gateway to counselling and 
health services, but its primary function is saving lives. In-Site 
staff have intervened in more than 1,500 overdoses since 2003, 
without a single death. In the same period, the spread of HIV-AIDS in 
the downtown eastside, the only area in the developed world where 
infection rates once rivalled those of sub-Saharan Africa's 
worst-affected countries, has declined significantly. Research 
published in the International Journal of Drug Policy last year found 
that the site prevents enough new cases of HIV to save the public 
health-care system $6 million each year.

The reasons people choose to pursue treatment are as complex as the 
reasons they choose to use drugs, so we listen to what they need and 
we try to make it less likely that they'll die before they ask to be 
admitted to a facility like OnSite. When Trauma Mama came to InSite 
in January, it wasn't, as Martinuk suggests, to "feel better about 
(her) behaviour," it was just to feel better. Then she came back two 
weeks later for the same reason and she did, eventually, feel better.

Liz Evans is executive director of the PHS Community Services 
Society, the not-for-profit organization that runs InSite, a 
safe-injection site in Vancouver's downtown eastside
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MAP posted-by: Keith Brilhart