NEEDLING THE NEIGHBOURS

The First Drug-Injection Clinic Comes To North America

BEAUTIFUL though it appears, Vancouver has an ugly drug problem. The past ten
years have seen a steady rise in gang killings, violent robberies and
break-ins. Drug-dealing is done openly. Hospitals report soaring rates of
disease from dirty needles, as well as shocking deaths from overdoses.

Three years ago the former mayor, Philip Owen, launched a new drug strategy
with "four pillars": harm-reduction, prevention, treatment and enforcement. On
September 15th his successor, Larry Campbell, whose keen support for the plan
helped him get elected last year, took a big practical step by opening the
first supervised drug-injection clinic in North America.

The clinic, called "Insite", is in a renovated shopfront in the heart of the
gritty Downtown Eastside, home to more than half the city's estimated 8,000
intravenous drug addicts. If they go there, it is hoped, they will stop
shooting up in squalid back alleys. Instead, as many as 800 addicts a day will
be able to inject their own drugs with clean needles in a safe place,
supervised by a nurse and without fear of arrest. Nurses will also treat minor
wounds and infections, and make referrals for further health care. "Peer
counsellors" (former addicts) will teach safe injection practices and, with
addiction counsellors, will help addicts enter treatment when they are ready.

Insite will cost about C$2m ($1.5m) a year to operate, and is funded by both
the British Columbian and Canadian governments. But it is not yet intended to
be permanent. It has been set up as a three-year research project (hence its
exemption from the reach of the law) to assess whether a service like this can
reduce drug diseases and deaths.

It will not be easy. The clients care little about their health, and the
problems are immense. More than 30% of local addicts have HIV, the precursor to
AIDS; more than 90% have hepatitis C, and the past five years have seen 524
deaths from overdoses. "We are never going to cure addiction," admitted Mr
Campbell at Insite's opening. "But what we can do is help those who have that
addiction to stay alive and healthy until we can help them get into some sort
of treatment."

Experts say this approach has succeeded in the 27 other injection sites in
Europe and Australia. But addicts take time to be persuaded that they will not
be arrested on the doorstep. Vancouver police want this project to succeed,
says their chief, Jamie Graham, vowing that his men will exercise discretion in
letting people get to the clinic. But there will be "no bubble zone" around the
site; drug-dealers loitering there will be nicked. Addicts say they still feel
wary of what the police may do.

Much of the public is sceptical, too, but few have attacked the scheme
outright. An exception is the right-wing Canadian Alliance Party, which argues
that Insite will simply encourage abuse. Unsurprisingly, more concern has come
from south of the border. The Insite experiment--together with a bill in
Parliament to decriminalise possession of marijuana--has brought dark
murmurings from top anti-drug officials in the United States: Canada, they say,
is going soft in the war on drugs.

The plain fact is that for almost three decades, buttressed by the
recommendations of a national commission and two parliamentary reports,
Canadian public opinion and official policy have been moving away from treating
drug abuse solely as a criminal offence. "We're heading very cautiously down a
path that more closely resembles European than American drug policy," says Neil
Boyd, a criminologist at Simon Fraser University. Mr Boyd would like Vancouver
to take the next step, already endorsed by many European cities and by a
Canadian commission 30 years ago, of prescribing heroin to hard-core addicts.
That, he believes, might reduce both the growth of heroin addiction and
criminal activity. But try telling that to the United States.