THE DEAD CAN'T KICK DRUGS

Vancouver's safe injection site isn't the whole solution to the drug
problem in the Downtown Eastside -- but it has done a great deal of
good

Liz Evans

Citizen Special

I was saddened by Margret Kopala's recent column, "Revoke this licence
to enable" (Dec. 8). Like Ms. Kopala, I remember my first experiences
in the Downtown Eastside as shocking, and I too was naive about the
problems there when I left the hospital as a nurse to work in the
community. It's now been almost 17 years working in the very
neighbourhood Ms. Kopala describes.

Addiction is clearly dreadful and tragic, but those who offer
simplistic solutions offer false hope. Clearly if it were as simple as
Ms. Kopala believes, there would be no debate.

Meanwhile, people suffer and die living with addictions.

Ms. Kopala's one sensible point regarding a young girl facing the
tragic consequences of addiction is that she could have been her
sister. Indeed, those suffering with addiction across Canada,
including those helped by InSite, Vancouver's supervised injection
site, are someone's sister, or brother, or son, or daughter.

I have called the parents of addicts who had overdosed to tell them
their child was dead. I met one mother, at the airport, who had flown
across the country to visit her dying son. She arrived too late and
fell to the floor screaming in grief when she heard the news.

I was a young, inexperienced nurse. What comfort could I really offer
in this tragedy? She wanted her addict son alive, addicted or not.
There are things we can do. Harm reduction is one. It can keep people
alive, so one day, they can enter treatment.

Harm reduction strategies buy time because not everyone is ready to
enter treatment. Clean needles and condom distribution prevent the
spread of disease. These are basic health interventions that are
accepted across the world, from the United Nations to the medical
health officers of every single jurisdiction of this country.

InSite is neither the problem nor the solution. It is one measure
designed to prevent drug overdose deaths, which it has done; reduce
public disorder, which it has done; reduce the spread of HIV, which it
has done; provide a doorway into the health system and into treatment,
which it has also done.

Twenty-five academic papers have now been published in the world's
most renowned medical journals including The Lancet, the New England
Journal of Medicine, the British Medical Journal, and the Canadian
Medical Association Journal. To date there has not been one single
independently peer-reviewed article disputing the scientific evidence,
which Health Canada paid close to $2 million to compile.

The most recent piece of research indicates that there has been a
30-per-cent increase in the number of people entering detox and
methadone therapy as a result of using the injection site -- which
strengthens further the argument that harm reduction is a necessary
part of the health-care continuum. Making this link from the chaos of
the streets to the path of recovery even stronger, OnSite opened above
InSite this September, offering 30 beds to addicts wanting to detox,
and escape the cycle of addiction.

The public is aware that addiction is a complex issue that requires a
comprehensive strategy -- one that incorporates improved enforcement,
comprehensive prevention programs, and flexible and accessible detox
and treatment interventions. But it also needs to include harm
reduction -- so people don't die unnecessarily, and parents don't
continue to lose their children.

Other jurisdictions now also involve harm reduction strategies as part
of their overall plans to tackle addiction. Sweden, as was mentioned
by Ms. Kopala in her column, has now established needle-exchange
programs in order to stop the spread of disease and comply with UN
expectations, while conforming to international efforts to limit the
global AIDS pandemic. Britain, where a heroin prescription maintenance
program has been in place for many years, has now expanded its
addiction treatment program to include stimulant maintenance for
cocaine addicts.

In no place where harm reduction approaches have been used have
advocates argued they be implemented exclusive of prevention,
treatment and enforcement. In every jurisdiction where harm reduction
is practised, it is done so in collaboration with local police,
business and residents to ensure both the individual users and the
broader community equally benefit.

Since InSite opened in 2003, there has been a dramatic decrease in the
number of public injections and injection-related litter. As a
resident of the neighbourhood, I have witnessed a stark contrast in
the livability of the Downtown Eastside since InSite opened its doors.
Over the past four years of operation, InSite nurses have now
supervised more than one million injections, each of which would have
otherwise occurred outside, in the public view, and with a much higher
risk of drug overdose death, or spreading HIV and hepatits C.

While I welcome the significant improvement to my neighbourhood for
both myself and my children, the primary reason I continue to support
InSite is its ongoing life-saving work. More than 900 overdose
interventions have happened at InSite -- each someone's child who
would not be with us today if InSite nurses had not been there to take
immediate action.

Like Ms. Kopala, I hope politicians like Stephen Harper and Health
Minister Tony Clement think about the children when they consider
public health policy relating to drug addiction. I hope desperately
that resources are finally put into prevention efforts to stop kids
from using drugs in the first place. But I also hope to never again
explain to a crying mother why her child died from a drug overdose
that could have been prevented, in a civilized country like Canada.

Liz Evans is a nurse and the executive director of the PHS Community
Services Society, which operates InSite, Vancouver's supervised
injection site.