Pubdate: Tue, 03 Jun 2014
Source: Vancouver Sun (CN BC)
Copyright: 2014 Postmedia Network Inc.
Contact:  http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Denise Ryan
Page: A7
Cited: VANDU: http://www.vandu.org/
Bookmark: http://www.mapinc.org/find?142 (Supervised Injection Sites)

MANY ADDICTS STILL SHOOTING UP IN ALLEYS

Recent Closure of Underground Supervised Injection Site Has 
Exacerbated the Problem, Say Community Workers

A young woman is slumped on the sidewalk in the 300-block of East 
Hastings. With her creamy skin, full red lips and a fresh flower tied 
up in her ponytail, she bears a resemblance to Sleeping Beauty. She 
also has a needle sticking out of her arm. Blood pours over her wrist.

She has mangled the job, and drifts in and out of consciousness.

At least here, on the street, if she overdoses, there is a chance she 
will be saved.

Although Insite, Vancouver's supervised injection site, is just a few 
blocks away, many users can't or won't use it. They may have been 
"red-zoned" by the police and can't go on that block, they may owe 
money to one of the many dealers that patrol the block, or may 
require assistance injecting, which Insite doesn't allow.

This girl has chosen to shoot up just one doorway down from VANDU, 
the Vancouver Area Network of Drug Users, a community support centre 
run by and for drug users that, until recently, was trying to stem 
the tide of public drug use by offering an unsanctioned injection 
room. It had been running informally at for several years.

But in February, after a visit from police, Vancouver Coastal Health 
sent a cease and desist letter ordering the shutdown of its injection room.

The consequences were immediate, and alarming, said Hugh Lampkin, 
president of VANDU.

"Within 48 hours, there was an exponential increase in drug-related 
debris in our alleyways and on the streets," he said. The alleyway 
behind VANDU and in the surrounding blocks are littered with cookers, 
rigs, rubber ties, clean water ampoules and used needles.

"There are 15,000 injections a day down here (in the Downtown 
Eastside)," he explained. "Six hundred of those injections happen at 
Insite, which is running at near capacity. My biggest fear is that 
all the work we've done to bring down the HIV and Hep-C and overdose 
crisis is all for naught. This is a reversal of all that's been done 
and the direction we've been going in."

Now he's afraid people will die in the alley, or in the bathrooms.

VANDU complied with the shutdown order immediately, but Ann 
Livingston, a longtime DTES resident, advocate and board member with 
the Vancouver Eastside Neighbourhood Council, decided to take matters 
into her own hands.

For 70 days and nights after the room was closed in February, 
Livingston parked a van in the alleyway behind VANDU and operated her 
own unsanctioned injection site, modelled on Denmark's Fixerum. She 
took the seats out of the van, equipped it with two stainless steel 
tables, clean needles, bandages and a small cadre of volunteers.

The police asked her to shut it down.

Livingston says she was trying to save lives because injection use on 
the streets is exploding in a crisis that shows no signs of abating.

She says the shutdown of VANDU's site and the van have pushed the 
most vulnerable addicts onto the streets, and threatens a decade of 
work to turn the problem around.

"Public drug use in the Downtown Eastside is higher than ever. It's 
very depressing. I feel like a failure. It's personal," said Livingston.

She said she has witnessed a new wave of opiate-addicted young people 
seeking heroin and "smoking off foil," as well as people "lying in 
the alleyway, injecting each other in the neck.

"No one should have to do that."

Livingston said her 11-year-old son walks past these scenes on the 
way to his elementary school every day. "He shouldn't have to see 
that. No one should."

The underground supervised injection site at VANDU was modest, but a 
dedicated, CPR-trained volunteer peer "injection team" was on hand to 
help with the 70 to 80 injections a day, and save lives when necessary.

Many injections that took place were assisted, with a member of 
VANDU's injection team helping users who was unable to inject 
themselves. Many users can't inject on their own, either because 
their veins are damaged from chronic use, they are disabled or lack 
proper knowledge.

Assisted injections are not allowed at Insite, but according to 
recent estimates, more than one in three drug users need help injecting.

A 2013 study on VANDU's unsanctioned injection room by the Centre for 
Excellence in HIV/AIDS noted that among the approximately 5,000 
intravenous drug users who live in the DTES, "it is estimated that 
roughly 40 per cent require help injecting," and that people who 
require help injecting are "disproportionally vulnerable to 
drug-related harms." Street "doctors" can "switch rigs," inject in 
unsanitary conditions, may not take precautions to limit infectious 
diseases and leave users vulnerable to violence, overdose and exploitation.

Insite, which opened in September 2003, is North America's first 
legal supervised injection site and is part of a harm-reduction model 
of treating addiction that offers health support without requiring 
abstinence from drug use in order to reduce harms associated with the 
problem. It has an adjoining detox treatment centre, and a study 
published in the Lancet shows that fatal overdoses within 500 metres 
of the site decreased by 35 per cent after its opening. Research also 
shows a reduction in other health-related harms such as HIV and 
hepatitis C infections.

Livingston fears the recent shutdown of VANDU's injection site is a 
sign that the tide is turning away from harm reduction at the very 
moment the problem is rising again.

"This is a foreshadowing of the closure of Insite," she said.

Nikki Schartrand, a recovering addict, says additional safe injection 
sites are desperately needed.

Now, she says, when she looks out her window from her room on Pender 
Street, she sees people shooting up outside, nodding off, passing 
out. "You don't know if they are dead or alive, so you call 911."

Schartrand recalls being on the street and "so heroin sick," people 
stole from her, and switched her rig for one filled with water. She 
recalls being robbed, needles breaking in her arm or neck. She says 
she has also heard of other underground injection sites doing what 
VANDU tried to do: help users inject safely.

Anne McNabb, director of Inner City Mental Health and Addiction 
Services at Vancouver Coastal Health, said the health authorities 
"appreciate that VANDU's intentions are good."

However, she said the closure of its injection room is all about 
saving Insite and moving forward with other harm-reduction efforts.

News of the unsanctioned supervised injection site filtered in to VCH 
last year, said McNabb. "VCH was in an awkward position in the sense 
that it could jeopardize Insite and our exemption under (Section) 56 
(of the Controlled Drugs and Substances Act), which is a requirement 
in order to have a supervised injection site."

Because VCH funds VANDU, allowing it to run an unsanctioned injection 
site could threaten the health authority's efforts with Insite, said McNabb.

"Our own position with Health Canada has always been somewhat 
precarious. They don't actually support Insite, even though we had a 
unanimous decision through the Supreme Court. We didn't want to put 
that out on a limb," she explained. Vancouver Coastal Health is 
awaiting a decision on an application for a Section 56 exemption for 
the Dr. Peter Centre so clients living with HIV/AIDS with substance 
abuse issues can inject under the supervision of nurses.

McNabb said VCH strongly supports expanding supervised injection 
services, and future plans include an "overall concept" involving 
more sites, most likely "embedded sites" at clinics, and a mobile 
site like Livingston's van isn't out of the question.

Livingston is frustrated with the process, the delays, the politics 
and the perception that drug addicts aren't worth saving or don't 
deserve health care. "At some point you just have to move forward 
with it. It's just not palatable. It's not fair. Anyone who thinks 
this can't happen in their own family? I can warn you all. You do not 
have a say in whether your kid becomes a drug addict."

The problem is also not confined to the Downtown Eastside.

"We need five supervised injection sites: boom, boom, boom," said 
Livingston. "We need them in other areas, we need them in Surrey."

She isn't going to give up.

"We just kept working on it," Livingston said, "and we will keep 
working. That's just how I was raised. To do community work."
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MAP posted-by: Jay Bergstrom