SAFE INJECTION SITE SENSIBLE, HAWAIIAN OFFICIAL SAYS

Peter Whiticar says the drug problem has simply become too big to ignore

VANCOUVER - To Peter Whiticar, Vancouver's safe-injection site -- North
America's first -- simply makes good sense.

As a public-health administrator in Hawaii, he believes Vancouver has taken
the obvious initiative in dealing with a problem which has simply become too
big, too destructive and too costly to ignore.

He compares the process the city has gone through with the kind of
progression that comes with death or divorce, starting with denial and
ending up with acceptance.

"They finally get to the point of, 'Hey, we've got to do something about
this, and what we've been doing hasn't been working'," he says. "That takes
a period of years and years, and I guess Vancouver's been going through that
for quite some time to reach that kind of point where people sit down and
say, 'God, maybe there's a different way we need to look at this.'"

Whiticar, interviewed while on a private visit to Vancouver, has some
experience in looking at things in different ways. In addition to sitting on
several boards that deal with AIDS and public-health policy, he's the
program manager of the STD/AIDS program for the Hawaii Department of Health,
which deals with sexually transmitted diseases, AIDS and viral hepatitis.
The program has an annual budget of $13 million US, and 60 employees who are
responsible for planning, coordination and implementation of statewide
STD/AIDS surveillance, prevention, HIV care and treatment services, and HIV
research programs.

Among other things, it runs a needle exchange, something that is too hot
politically for U.S. federal authorities to risk funding. Instead, the costs
are borne by state and civic bodies. But public-health cost benefits are
easy to calculate, particularly in terms of prevention of needle-related
illnesses such as HIV, for which the lifetime treatment cost is steadily
rising.

"Because there are more and more drugs available, people are staying alive
longer," he points out. "It used to be after 10 years, if you had HIV, you
were dead, and that's not the case now. We're looking at $150,000 US to
$200,000 per-person lifetime treatment costs.

"So the way we look at it, if you can prevent five cases of HIV each year
and your program costs $1 million, you're basically breaking even on your
costs."

He says public-health officials worldwide are also worried about the spread
of hepatitis C, another ailment that afflicts intravenous drug-users.

"Hep C is something of a silent epidemic in North America, and hepatitis is
actually more easily communicable than HIV. The real concern there is if you
share syringes with somebody that has hepatitis C not very many times,
almost certainly you're going to get hepatitis."

A diagnosis of hepatitis C was once considered a death warrant, but now
victims can be treated, adding to the cost of needle-related illness.

Vancouver's safe-injection site opened last September on the Downtown
Eastside as a three-year trial, funded by the provincial and federal
governments, including a $1.5 million grant from Health Canada to study its
effectiveness.

By late last year, it reported that 2,100 out of an estimated intravenous
drug-user population of 4,700 in the Downtown Eastside had registered to use
the facility. It logs approximately 500 visits a day by drug users.

"It was a brave move and clearly there have been a lot of attempts to deal
with that kind of situation, and I guess they haven't been successful,"
Whiticar says.

One of the big advantages of a safe-injection site like Vancouver's, he
says, is that it draws drug-users who have been marginalized back into the
public system.

Once they start getting involved, they have the opportunity to avail
themselves of various forms of assistance. Whiticar says one of the keys to
improving public health is modelling -- getting people to change their
behaviour to a less-destructive mode.

"When people are injecting in that site, they're coming there, they're
getting clean syringes, they're getting clean cotton, clean water, clean
cookers, so they're actually learning the skills of clean, safe injection,
and then they're disposing of the syringes afterward, so it's pretty good
modelling."

Contrary to some public opinion, he says, many drug-users are quite capable
of rational choice and are willing to change their behaviour to lessen the
risks their condition poses.

"Many of them live with chaotic circumstances in their lives and they stay
alive -- it's quite remarkable. If we had to deal with the social and
environmental factors every day that injection drug users do, I think we
would soon be overwhelmed."

Despite initial neighbourhood concerns about the "honeypot" effect of a
safe-injection site -- the fear that it would attract more criminal activity
to the area -- Whiticar says frontline public-health facilities like the one
his program operates in Hawaii have to go where the needle-users are found.

"It's the same issue we have with the needle exchange," he says. "The reason
we put the needle-exchange van where we do is because that's where the users
are. If we park it in another part of the city or the island the users
aren't going to go up there and get their needles."

He says the best way to deal with local resistance is to draw the
neighbourhood into the process: "It's much easier to stereotype or
categorically misunderstand the issues of others when you keep them at a
distance. Once you become more involved with it, you understand more about
it.

"I don't think communities like to have gaping wounds," he says. "I think it
wounds civic pride and I think when a city or a jurisdiction takes on those
issues, it energizes the community. Sometimes you don't know how things are
going to turn out, but the fact that people are actually doing something
about it or trying to do something about it energizes the whole community."