TIME TO FIND NEW WAYS TO FIGHT DRUGS

Safe-injection sites for addicts make a lot more sense than spending
billions on law enforcement

Albert Einstein defined insanity as doing the same experiment over and
over again while expecting a different result. Given the health,
social and economic costs of Montreal's illicit drug-use problem, it's
unfortunate that our political leaders have been caught up in the same
experiment for many years.

Throughout the last decade, Montreal has tried to curb illicit drug
use through law enforcement, while ignoring many proven public-health
strategies. Anyone who has recently toured such areas as Shaughnessy
Village and St. Henri knows that this experiment has been a well
documented and expensive failure.

In terms of federal expenditures, Canada's auditor-general estimated
recently that law enforcement eats up about $475 million of the $500
million Canada spends every year on problems associated with illicit
drug use. Those efforts have failed to yield demonstrable benefits.

Further evidence of the failure of "get tough" approaches to drug use
can be found in the U.S., where the Office of Drug Control admits that
illicit drugs have become cheaper, purer and more available even as
the federal government spent more on enforcement and interdiction.
Canada, Quebec and Montreal appear destined to repeat the same doomed
experiment.

Reducing the harm of illicit drug use is not as daunting a task as
many believe. Bustling urban centres around the globe have
dramatically reduced the social and economic impact of open drug
scenes and the downstream health consequences with comprehensive
harm-reduction and treatment programs.

For example, 26 cities in Europe, one city in Australia and recently
Vancouver have opened safe-injection facilities - legally sanctioned
sites where individuals can inject pre-obtained drugs under the
supervision of health-care professionals and receive medical
attention, as well as referrals to health and social services.

In these cities, safe-injection sites have improved access to drug
treatment, provided early intervention for bacterial infections, and
reduced overdose rates and the risk of contracting HIV, the virus
associated with AIDS.

These facilities also improved the community by reducing the number of
discarded syringes, public intoxication, and the expropriation of
public spaces by drug users. In fact, research studies, including one
published in the Canadian Medical Association Journal, have
demonstrated that it is people who use drugs in public places who are
most likely to shift to using a safe-injection facility. In contrast,
recent studies have shown that increasing policing presence in an open
drug scene does little more than displace the problem to adjacent
neighbourhoods and scare drug users away from the health services they
need.

Last week, a Montreal cinema screened the documentary film FIX: The
Story of an Addicted City, which documents the struggle to establish
safe-injection facilities in Vancouver. Critics appearing in the film
say that safe-injection facilities will only encourage drug use and
attract users to the area.

Two years after the film was shot Vancouver has a safe-injection
facility and, as in other cities, the negative effects projected by
critics have not occurred. In fact, the Vancouver Police Department
has reported a reduction in public drug use in the area.

While researchers are still evaluating the health impact of the site,
most people would agree that injecting drugs in a supervised setting
with access to sterile syringes and health care is preferable to
injecting in a parking lot or alley with a used syringe, and is
clearly a humane and effective alternative to large-scale police crackdowns.

There are those who will advocate more, and perhaps even mandatory
drug treatment for drug users. However, this position creates a false
dichotomy between treatment and harm reduction. Certainly, the
accessibility of a range of treatment services is essential, and has
played a role in the curbing of drug-related harm in cities where
safe-injection facilities have been established. In fact,
safe-injection facilities represent only one of many elements designed
to reduce harm related to the use of drugs.

Before the implementation of safe-injection sites in these cities,
however, a large proportion of drug users did not go for treatment,
even when it was readily accessible. Many more required repeated
attempts at recovery before they were able to abstain from illicit
drug use.

The safe-injection facilities, however, provided a point of contact
between health-care professionals and drug users. On-site staff have
more time to interact with users on all types of issues and make
appropriate referrals to health and social services. When the
safe-injection sites were established, many more users began drug treatment.

Recently, a project conducted by McGill researchers found that over 75
per cent of individuals who inject drugs in public places were willing
to make the transition to using a safe-injection facility if one were
available. Those willing to use a safe-injection facility were more
likely to inject drugs frequently and to have had a non-fatal overdose.

Safe-injection facilities would address much of the harm that drug use
does to individuals and the community that cannot be addressed by
simple expansion of existing treatment programs or increased police
presence. If implemented, the safe-injection facility would be opened
on a trial basis so that a rigorous scientific evaluation could take
place. Such an experiment might just be the city's first step out of
its current cycle of insanity.

Thomas Kerr is director of Health Research and Policy, Canadian
HIV/AIDS Legal Network

Darlene E. Palmer works with CACTUS Montreal and is co-ordinator of
Reseau SurvUDI Montreal

Ralf Jurgens is executive director of the Canadian HIV/AIDS Legal
Network