DETOX FACILITIES TO COST MILLIONS

Safe injection site will create huge demand for treatment: health region

The biggest cost of a supervised-injection site for users isn't necessarily
the $1.7 million needed to run the site every year.

It's the demand it will create for treatment.

Health planners from the Vancouver Coastal Health Authority say a minimum of
about $8.6 million in new services, including detox, methadone, housing, day
treatment and counselling, should really be added to take care of the new
clients who will want to get treatment after going to an injection site.

"People would be surprised at how little there is in the way of treatment in
Vancouver now," said Ida Goodreau, the CEO of the health authority, which is
responsible for strengthening two of the pillars -- treatment and harm
reduction -- in Vancouver's ambitious "four pillars" drug-addiction
strategy. "We don't have enough for the population that is in need."

She said the lack of treatment, especially for young people, is the most
glaring gap in the city's addiction services.

Planners estimate a Downtown Eastside injection site would attract about
1,000 users a day and about two per cent of them would ask for referrals to
some kind of treatment.

Those numbers are based on the trends they have seen at the contact centre,
a year-old drop-in facility on Hastings Street the health authority operates
for drug addicts.

While two per cent might seem low, that's 20 new people a day, day after
day, who would be entering the system. Those people would also likely come
from a different sector of the drug-user population -- those who are less
functional and more street-oriented.

Studies of other injection sites in Europe and Australia have shown that
such sites, which do not demand a commitment to abstinence, tend to attract
new people to treatment who haven't been reached in other ways.

Heather Hay, director of health services for the Downtown Eastside, said the
authority's addictions team estimated the minimum level of new services
needed would include:

* $2.3 million for 18 new detox beds added to the current 54, which would be
targeted for women and young adults. Vancouver's two detox sites are
currently at capacity, with a wait list of three to five days.

* $1.1 million for new methadone services for the up to 2,000 new clients
expected. The authority would like to add a "low-threshold" methadone
service that has fewer rules and is therefore more accessible to people who
are less functional.

* $1.8 million for temporary shelter beds above the injection site, where
people can be stabilized for a short term.

*$1 million for day treatment services that would be targeted, as are the
rest of the services, to this group of street-living addicts. The money
would allow for 400 new adult clients and 200 new younger addicts in the 16-
to 24-year-old range. Currently, there is a nine-week waiting list in the
Downtown Eastside for day treatment.

*$1.4 million for counselling services.

Goodreau said the $1.7 million estimate of the annual cost of the injection
site by itself is based on the model of the site in Sydney, Australia, where
the drug-using population is most like that in Vancouver.

And, she said, although there have been some questions about that budget
estimate, with Mayor Larry Campbell suggesting the authority could run a
leaner operation, Goodreau said the current budget the authority has
developed would cover just the most basic staffing level and would allow the
site to be open only 18 hours a day.

The $1.7 million would allow for one registered nurse, one licensed
practical nurse, and one alcohol and drug counsellor to be present at all
times, along with some auxiliary staff from the drug-user community who
would help greet people, get their registrations filled in, and provide the
kind of peer contact that would encourage addicts to use the site.

"Our experience has been that it's much better if users are involved," Hay
said.

Ideally, the health authority would like to add many more services than that
and its addiction team developed a comprehensive, ideal, $56-million-a-year
plan last September as a starting point for talking about what the city
needed.

That three-year plan envisions expanding or creating dozens of services,
from housing to youth outreach, counselling and residential-treatment
services to a new medical cocaine unit to six supervised-consumption
facilities.

But even the smallest start any of that -- the first injection site, the
wraparound services to the site, or the entire Cadillac plan --has been
stalled as the health authority tries to figure out where to get the money.

"The biggest issue for us now is funding," Goodreau said. The authority's
annual budget is $1.9 billion, but that has to cover all health services
from the Sunshine Coast to Vancouver and Richmond, which includes one
million people and 12 hospitals. That budget has been frozen for the next
three years.

Goodreau said the authority is looking at the most effective way inside its
region of delivering services, to see if it can find savings. It is also
looking for money from either private sources or other government sources
outside the region.

The Vancouver Agreement -- the three-government initiative aimed at
restoring the economic and physical health of the Downtown Eastside --
currently has $20 million from federal and provincial contributions but no
one has said what is going to be done with that money.

Another possibility is Health Canada or medical-research institutes, to help
with the $500,000 cost of doing a full evaluation of the injection site,
which Health Canada will require as part of its permission to operate the
country's first injection site.

Goodreau said she expects the Health Canada approval to come through at the
beginning of May, 60 days from the date the authority put in its
application. Although Health Canada staff had some questions recently about
the application, Goodreau said she got no indication from them that approval
would be delayed.

Vancouver police moved ahead with their "enforcement pillar" of the
four-pillar plan last week, putting 40 extra officers into the Downtown
Eastside to break up the open drug market.