THE ONLY WAY TO KNOW IF SAFER INJECTION SITES WORK IS TO TRY THEM

Recently there has been a heated controversy over a proposal to create
places in Vancouver where addicts would be able to safely inject their drugs.

This suggestion flies in the face of the "Say No to Drugs" dogma, but it is
at the heart of harm reduction, a philosophy aimed at curbing crime rates
and containing the spread of disease by enabling drug users to inject
safely until they can be helped off drugs.

The debate surrounds the potential of harm reduction in Canada's most
notorious neighborhood, where an explosive HIV epidemic has garnered
attention in the pages of some of the world's most prestigious medical
journals. Studies from the mid-1990s suggested our approach to drugs was
not working, and evidence suggests things are only getting worse.

Opponents to harm reduction are rightly concerned that the European
experience with harm reduction may not work in Canada. In an effort to
raise awareness about the potential of harm reduction, Vancouver
researchers have explored several factors of the Downtown Eastside HIV
epidemic that could potentially be changed if a safer injection facility
was established here.

Safer injection rooms have three primary aims: to alleviate the public
disorder problems associated with public injecting and improper needle
disposal, to prevent fatal overdoses that often happen when people inject
alone by having medical services at hand, and to limit blood-borne disease
epidemics by providing sterile needles and supervising users to prevent
needle sharing.

The Vancouver Injecting Drug Users Study (VIDUS) is a project that has
recruited more than 1,400 addicts into an ongoing survey of injecting
behavior and the spread of HIV. To see whether a safer injecting room could
achieve its aims in Vancouver, VIDUS researchers have investigated the
proportion of addicts who shared a needle, injected alone, overdosed by
accident, needed help injecting, injected outdoors and found it hard to
find clean needles. The numbers, regarding these behaviours over the last
six months, make a strong case for safer injection rooms:

- - 28 per cent of drug users shared a needle;

- - 75 per cent of drug users reported injecting alone at least once;

- - 10 per cent of drug users experienced a non-fatal overdose;

- - 14 per cent of drug users reported injecting in a public space;

- - 25 per cent of drug users reported needing help injecting;

- - 18 per cent of drug users found it hard to access sterile needles.

Sadly, those who needed help injecting were almost twice as likely to
report sharing a needle in the last six months. Even more alarming is that
those who found sterile needles difficult to access, were more than three
times more likely to report sharing a needle. Based on these numbers, the
drug problem can no longer be ignored. Or can it?

In 1997, a study entitled Needle Exchange is Not Enough was published in
one of the most prestigious infectious disease journals. In it, the VIDUS
researchers showed that Canada's strategy of dealing with drug addiction
was not working. The only service being offered to addicts to help them
avoid either spreading or contracting HIV were places to trade in dirty
needles for clean ones. The researchers advocated harm reduction
interventions as an alternative strategy to the War on Drugs approach.
Unfortunately, no sweeping policy changes were made and instead law
enforcement was stepped up.

That year, the annual rate of new HIV infections among Vancouver injection
drug users peaked at 18 per cent, a level of spread that remains among the
highest ever documented in the developed world. The inaction of health
policy makers led to a subsequent study entitled Deadly Public Policy, and
in it the authors demonstrated that the withdrawal of social services may
have lit the spark that ignited the Vancouver epidemic that we are still
dealing with.

Specifically, the curbing of federal government support for low-income
housing resulted in more than 6,000 individuals being forced into Downtown
Eastside hotels.

Addicted individuals were refused access to social housing, and detox and
mental health facilities were eliminated as budget reductions were imposed,
further concentrating at-risk individuals in the neighbourhood. Here,
driven deep into the low-income hotels by the "war" on drugs, with little
access to drug treatment and in fear of police, injection drug users shared
needles and the HIV epidemic raged on, much as it does today.

Can a safer injection facility help change these behaviours? The only way
to know is to try. Increased law enforcement may only lead to driving
addicts away from services and displace the problem into neighbouring
areas. With the current level of drug crime, exploding disease rates, a
groaning health care system and avoidable human misery, Vancouver residents
should support Mayor Philip Owen's proposal to explore alternatives.

In several European cities, safer injection rooms have greatly reduced
drug-related harm. With public support and political will, Vancouver may
one day be recognized as a model for modern and sensible approaches to
addiction, instead of an example of public policy gone mad.