News (Media Awareness Project) - CN BC: Web: Canada's Safe Haven For Junkies |
Title: | CN BC: Web: Canada's Safe Haven For Junkies |
Published On: | 2003-09-08 |
Source: | Salon (US Web) |
Fetched On: | 2008-01-19 14:05:16 |
CANADA'S SAFE HAVEN FOR JUNKIES
Vancouver Hopes To Save Hundreds Of Lives By Opening Street Clinics Where
Heroin Addicts Can Shoot Up Safely.
But The White House Is Accusing Canada Of Going AWOL From Its War On Drugs.
VANCOUVER, British Columbia -- It's 11 o'clock on a busy Wednesday night inside
327 Carrall St. A dozen junkies nod on ragged couches and chairs lining the
downtown storefront's cluttered front room, where one handwritten sign on the
wall declares: "End the war on the poor." The Clash rattles through a pair of
stereo speakers ancient-sounding enough to be an AM radio. The occasional flare
of rubbing alcohol spikes through the haze of cigarette smoke and smell of hot
coffee -- in the smaller back room, two or three junkies at a time inject
heroin or crack cocaine into their veins using sterile swabs and fresh needles
under the watchful eye of a registered nurse. In here they can also receive
advice on vein care, skin infections and detox programs, or just temporarily
escape the hustle of one of the bleakest city blocks in all of Canada.
"I can do my fix in here without getting jacked for it," says Shelley, a young
woman with dark, tired eyes. Bruised holes dot the crooks of her arms. She
wears a tight white blouse, fishnets and black boots -- one of the 80 percent
of women who work in the sex trade among the neighborhood's nearly 5,000 drug
addicts. "People are pretty nice to each other here," she says with a slight
smile.
The 327 Carrall St. operation is illegal, but the mayor's office has looked the
other way since it opened on April 7; the guerrilla safe-injection site running
here every night from 10 p.m. to 2 a.m. insures junkies have sterile gear to
shoot up with, and discourages them from fixing alone -- a main contributing
cause of overdose -- in the festering alleys and decrepit residency motels of
the neighborhood. The site is the de facto vanguard of an evolving
"harm-reduction" strategy that the city of Vancouver hopes will help clean up
the streets and halt a decade-long illicit-drug catastrophe that's killed more
than 2,000 via overdose and infectious disease.
Essentially, the situation here has been so bad for so long that the government
is willing to help addicts plunge illegal drugs into their veins if it means
stemming the greater tide of destruction. If the city's official plan stays on
track, by mid-September street junkies will be able to walk into a storefront
at nearby 135 East Hastings St. almost any time of day and get high in a safe,
clean facility administered by the provincial Vancouver Coastal Health
Authority. It's a prospect that's angered conservatives from Ottawa to
Washington.
For now, this makeshift site operating in privately donated space is about all
the street addicts have. The slogan "Solidarity, Resistance, Liberation" is
painted on a sign above the front entrance; inside the front room I'm greeted
by the revolution's unlikely leader: a 26-year-old activist wearing a baseball
cap on her shaved head. Megan Oleson is a registered nurse who works in
critical care at Vancouver General Hospital by day; every night she comes here
to provide clean needles and advice to junkies (who must supply their own
drugs), with the help of volunteers including current and ex-users. Friendly
and mild-mannered, Oleson is modest about her role -- she emphasizes that
staffing a safe-injection site with addicts' peers is vital to promoting its
use. "They really run the site," she says. But it's quickly clear from the way
everyone greets her that Oleson is revered by the dozens of patrons, up to 30
per night who inject drugs and another 70 to 100 who come in just for a little
sanctuary.
Other activists in the neighborhood say Oleson rarely sleeps, but she looks
relaxed and focused -- a petite Florence Nightingale with a pierced nose, red
tank top and combat boots.
To Canadian conservatives, however -- and to an agitated Bush administration
keeping a glaring eye on ever-liberalizing Canadian social policy -- Megan
Oleson is more akin to Public Enemy No. 1. She's a renegade promoting criminal
behavior and the decriminalization of hard drugs -- the patron saint of a
policy that would nurture chronic abuse, the further decay of city
neighborhoods, and capitulation in the long, hard-fought war on drugs. And
Washington may have good reason to fear what's happening in Vancouver: If the
new policy, planned and fought for at the local level, indeed proves effective,
other North American cities troubled by throngs of drug addicts -- Seattle, San
Francisco and New York -- may be eager to follow suit.
Vancouver's bold strategy has provoked the expected ire of conservatives --
especially south of the border, where Washington has recently watched Canada
sanction gay marriage and close in on federal decriminalization of marijuana.
The prospect of government-backed hard-drug use next door has the White House
palpably unsettled: As soon as Vancouver's planned site gained Canadian federal
approval in late June, U.S. drug czar John Walters went off. "It's immoral to
allow people to suffer and die from a disease we know how to treat," he told
the Associated Press. "There are no safe-injection sites," he added, calling
the policy "a lie" and "state-sponsored personal suicide." David Murray,
special assistant in the U.S. Office of National Drug Control Policy, told the
Vancouver Sun on May 2 that likely "unintended consequences" of the
safe-injection site could force the U.S. to tighten border controls to prevent
increased drug trafficking. That could, of course, negatively impact trade of
all sorts.
All of which bounces off Megan Oleson. "There's really nothing radical about
this place," she says, once things slow down and we're able to go into the
less-crowded back room to talk. "It's highly practical.
Safe-injection sites are first-contact work at the ground level.
I do about two or three referrals every night to shelters, to places that offer
detox and prevention, and to recovery homes." At a nearby table partially
curtained off with a sheet, a young woman licks her lips as she cooks a shot of
heroin, her face knotted with anticipation. "The reality of it," Oleson
continues, "is that for those who want to break away from the hustle of the
street, and many of them do, this gives them time to think about it, and to
have someone to talk to."
She keeps a nonchalant eye on the junkie, who now has a skinny rubber tube
cranked around her left bicep.
The woman finds the swollen vein on her forearm, slides the needle in and
presses the plunger down. Oleson quietly notes her good technique; uninformed
junkies often jab needles into their arms, legs or neck, causing abscesses and
other skin problems.
The woman tilts her head back against the wall, eyes closed, her face dropping.
"Drug users and people in poverty deserve dignity and help," Oleson says.
As we exit through the front room for a quick walk to the corner store, Oleson
notes that the rules at 327 -- no fighting, no dealing, no unsupervised fixing
- -- are set by the users themselves. "There's nothing better than people
determining their own health needs, right?" she asks. Looking around at all the
nodding faces tinged with easiness and pain -- many of them Asian, black or
indigenous, most of them impoverished -- it's a tough question to answer.
Since 1993, greater Vancouver has seen an awful share of the needle and the
damage done: an average of 147 overdose deaths annually among an estimated
12,000 injection users of heroin and crack cocaine.
At first, the long-term drug crisis is hard to fathom amid the picturesque
landscape: a prosperous city ringed by lapping bays, green forests and
mountains; home to a vibrant, polyglot community of almost 2 million still
riding the rush of a successful bid for the 2010 Winter Olympics.
But detour into the roughly 10 blocks of the notorious downtown Eastside and
the lush environs give way to the stench of urine, piles of trash, and
discarded needles.
The neighborhood's boarded-up storefronts, few dingy bars and numerous
flophouses give no clue that the tourist-friendly Gastown and Chinatown
districts are close by. Infectious disease has swept through a desperate
populace of back-alley users commonly preparing fixes with dirty needles and
puddle water -- more than 30 percent have HIV and 90 percent hepatitis C.
Fearful of law enforcement and street thugs, some hurried addicts use their own
blood to dissolve powdered narcotics for injection. The concentration of
poverty scattered around the open drug scene's epicenter at Main and Hastings
- -- known locally as "pain and wasting" -- was recognized by the 1996 Canadian
census as the poorest neighborhood in the nation. By 1997, with hundreds of
deaths on the downtown streets, city officials had declared an epidemic.
According to Dr. Evan Wood, an epidemiologist at University of British
Columbia, an abundance of cheap drugs and acute poverty underwrite the ghetto
of despair.
Displacement due to law-enforcement patterns and "ridiculously underfunded"
addiction treatment exacerbate the problem.
"The only really effective way to deal with the drug crisis is to get at the
demand side," says Wood, who also conducts leading HIV/AIDS research at St.
Paul Hospital in Vancouver. "But there's a five-day waiting list to get into
detox, and you have to phone every morning to keep yourself on that list." It's
a striking state of affairs, given Canada's reputation for providing a vast
social safety net. With nowhere to turn, most addicts choose to inject -- the
fastest and cheapest way to get high -- regardless of the health dangers.
The first of its kind on the North American continent, Vancouver's official
safe-injection site will be a proving ground for the city's ambitious "Four
Pillars" drug policy.
The strategy also calls for greater treatment and prevention programs, and
vigorous law enforcement targeting dealers -- but not addicts, whom the policy
says should be treated as a health problem.
At an annual cost of about $2 million (Canadian), the site will offer 12
injection stations, a medical emergency room, counseling offices, and a
"chill-out" room where users can socialize or simply relax after their latest
fix, according to Viviana Zanocco, a spokesperson for the Vancouver Coastal
Health Authority.
Although illicit-drug use inside the site will be permitted by special federal
exemption, defining a boundary for street enforcement may remain tricky. "One
Catch-22 is that people will still have to purchase their illicit drugs from
somebody," says Zanocco. "How does the site work if people are too scared to go
in because they're afraid the police will be standing outside the door? It's a
struggle, I admit it. We're working with the police department on a strategy."
"This is a health problem, not a criminal problem," says Vancouver Mayor Larry
Campbell. Like many other Canadian officials, Campbell appears unfazed by
Washington's rhetoric. "We have conservatives in Canada, too, and they won't
look at fact or reason either," he says flatly. "I've been to Zurich
[Switzerland] where they had a problem way worse than ours, and I've seen the
results." The harm-reduction component of the widely endorsed plan -- Mayor
Campbell was voted into office in 2002 promising to implement it -- is modeled
after programs in Europe and Australia, which have dramatically reduced
overdose deaths and the spread of disease.
Though Canada is tagged a firebrand of progressive social policy next to the
U.S., it, too, has long fought a supply-side war on drugs.
Almost 95 percent of the roughly $500 million spent annually on Canada's drug
strategy goes toward efforts to reduce the illicit drug supply.
But that paradigm may be cracking now, due in part to the dire situation in
Vancouver, and some leading-edge research at University of British Columbia.
With an in-depth study of the city's injection drug users already in progress,
Evan Wood and his colleague Dr. Martin Schechter, head of UBC's epidemiology
department, were able to measure the impact in late 2000 of a seizure of 220
pounds of heroin -- the single largest drug-enforcement win in Canada's
history.
Following more than 120 addicts during the months before and after, the
researchers reported that "the massive seizure appeared to have no impact on
injection users or on the perceived availability of heroin." In fact, the study
found that the median price of heroin in Vancouver dropped 20 percent following
the seizure, with no change in purity, suggesting an even more saturated
supply.
Separate research showed the number of fatal overdoses actually ticked higher
in the following months.
Wood and Schechter also cite a 2001 United Nations report indicating that only
5 percent of the global illegal drug flow is successfully thwarted by law
enforcement. Still, the problem isn't on the enforcement front lines. "The
responsibility lies with the politicians and policymakers who continue to
direct the overwhelming majority of resources into failing supply-reduction
strategies, despite the wealth of scientific evidence demonstrating their
ineffectiveness," they write. "Our strong consensus [is] that curbing HIV and
overdose epidemics requires a shift toward prevention, treatment and harm
reduction."
The devastation visible on Vancouver's downtown streets leaves little doubt
that the war on drugs has failed here. But working with an inherently unstable
clientele of street junkies, there are no guarantees harm-reduction measures
will succeed.
Coaxing marginalized addicts to embrace an official safe-injection site could
prove difficult -- let alone making the site an effective stepping stone to
detox and rehabilitation.
"I used to break into cars all the time, anything to get another fix," says
Robert, a jittery 37-year-old junkie in shorts and a tattered T-shirt who asks
me for 15 cents at the corner of Abbot and West Pender. It's early afternoon
and a couple of businessmen in suits whisk by; normal commercial activity and
the hardcore street hustle blend with a strange ease on this block. Robert's
fingertips are blackened, and scabby holes pock the backs of his hands, his
forearms and the sides of his neck. He says he's heard about the coming
safe-injection site, but quickly adds, "I don't shoot no more." We go into the
McDonald's on the corner, where he pays the few extra cents he needed for his
order: two strawberry sundaes, with extra peanuts. "I think that site is a
foolish idea," he says, repeating unconvincingly that he's been clean for three
months.
Back outside at the bus stop, Robert greets a young addict named Jasmine, then
sits down to eat. He keeps glancing across the street, where a couple of
prostitutes work the corner in broad daylight, a pimp-dealer type lurking close
behind. "You don't think I'm going to be on heroin do you?" he says, jiggling
on the bus stop seat. "I'm not ever going to be a junkie again. Never."
Angelic-faced Jasmine says the site wouldn't get her off the street. "When you
have to fix, you do it wherever you want. You won't wait to go to some other
place."
"Yeah, you just go around the corner," Robert exclaims.
"Think about it, people that fix coke get so retarded," Jasmine chimes. "You
think they'll really stay inside there?
They're gonna boogie straight out the door all jacked up!" she laughs.
"Yeah, tear up ... start ripping the carpets up!" laughs Robert. His face goes
flat again. "It's like a stupid joke," he says, shaking his head.
But the site is a grave matter for Ann Livingston of Vancouver Area Network of
Drug Users, an activist group working out of a ragtag office just down the
block at 50 East Hastings St. The city's harm-reduction plan has wound through
six years of study and debate, with the new safe-injection site promised over a
year ago. "Just what really is a public health emergency?" implores Livingston,
who helped set up the guerilla site at 327 Carrall. "It's a really vicious,
violent thing to leave in place, while people diddle around and argue about
protocols and funding.
It verges on criminal negligence to stand by and watch a group of people year
after year when you can predict extremely accurately how many will get
HIV/AIDS, and how many will die."
The activist group, made up of hundreds of current and former addicts
(Livingston herself is not a drug user), hasn't waited around.
It runs nightly "alley patrols," and now distributes 1.5 million clean needles
per year, according to Livingston -- that's roughly half the 3 million given
out annually in Vancouver, which has the largest needle exchange in North
America.
"We have a really long way to go," agrees Fiona Gold, a "street" nurse at the
nearby office of the B.C. Center for Disease Control. Gold oversees CDC
outreach in the Eastside. "I've told far too many people here they've tested
positive for HIV. It's just nuts. We really have to do something different."
According to the latest Vancouver drug use epidemiology report, injection drug
use was the predominant mode of HIV transmission in B.C. from 1994 to 2000. A
1997 study of more than 1,400 Vancouver needle users revealed an HIV infection
rate of 18 percent -- the highest level anywhere in the developed world. Since
1997 the number of new cases in the city has dropped significantly, but the
report suggests that decline may be due to a "near saturation" of the addict
population considered most prone to infection.
Conservatives, Gold also points out, should be equally invested in the
harm-reduction strategy -- especially those who are fiscally conservative.
Every HIV-infected addict dropped into the healthcare system costs the Canadian
government an average of $150,000 in long-term care; the cost of 12 such
patients would pay for the new site to run for a year, she says.
Gold introduces me to Earl Crow, a middle-aged ex-rocker from southern
California with stringy blonde hair, dark brown eyes and a humble smile.
He tells me how he came to Vancouver four years ago hooked on speedballs, a
potent mixture of heroin and cocaine. "I was really wired, I was shooting a
gram a day," he says. But he made the decision to clean up, joined Vancouver
Area Network of Drug Users in 2000 and became its president for the next year
and a half. He now works outreach for the CDC in the Eastside, giving out
information and clean needles, and watching for medical emergencies in the back
alleys -- sometimes he puts in 12-hour days.
But he also knows the daunting odds harm-reduction tactics must overcome. "When
I was using there wasn't a fucking person in the world who was going to come
and save my life. It had to come from my own heart and head," he says.
Crow agrees to take me around with him, and we head up Powell Street to nearby
Oppenheimer Park. The mild afternoon and oasis of grass belie the park's
reputation as a drug-dealing hub; at night, Crow says, it's one of the city's
most dangerous spots.
We run into a young addict named Michelle who says she's been in the
neighborhood for 15 years, and we talk as she hurries us down the block.
We reach the local welfare office and she darts inside. "She's all jumpy like
that because she's been up for a few days," says Crow. "The beginning of the
month is tough.
It gets busy for us out here because people binge." He adds that some
healthcare workers are worried the new safe-injection site could become a
"revolving door" for addicts who inject coke, a much more fleeting fix than
heroin. "Some of them whack 20 or 30 times a day," he says.
Michelle comes back out, check in hand, and as we hustle back toward
Oppenheimer Park, I ask her what she thinks about the coming site.
"Maybe it'll work, but not if you have to go through all the nurses and a bunch
of forms and shit. You'll be withdrawn by the time you can get a fix," she
says, skipping along. "And it won't work if it's all super-clean and they're
gonna freak out if there's one little drop of blood on the floor." At the
corner of Jackson Street, she spots who she's looking for and flits off across
the block.
For more than a decade, harm-reduction programs in Europe have produced
compelling results.
In Zurich, Switzerland, many streets that were once needle-littered and
crime-ridden are no longer so forbidding. And since the country's first
safe-injection site opened in 1986, there hasn't been a single fatal overdose
at any of the 13 sites operating across three Swiss cities, according to the
U.S.-based advocacy group Drug Policy Alliance. Frankfurt, Germany, a city with
population and drug-user demographics similar to those of Vancouver, opened
five sites beginning in 1994; fatal overdoses there declined from 147 in 1991
to 26 in 1997, and the spread of HIV among drug users declined dramatically as
well.
Studies of the European programs show less clear results, however, in battling
long-term addiction.
Though conservatives often denounce harm-reduction policy in strictly moral
terms, such mixed results may be enough to arm the policy's opponents with a
more practical argument -- that chronic junkies pose a greater criminal threat
than a public health one.
"To many harm-reduction advocates, heroin use is a practical [health] problem,
but that's not a plausible view if you live in a neighborhood where drug
addicts steal your television set," says Mark Kleiman, a drug policy expert and
professor of public policy at University of California Los Angeles. "Ask people
living in those neighborhoods if they want a safe-injection site next door, and
they will say -- perfectly reasonably -- no." In fact, notes Kleiman, many
harm-reduction supporters themselves get caught up in an ideological battle
against the conservative crusade. "As a result," he says, "I don't think they
take into account all the possible consequences of harm-reduction measures."
But the Canadian federal government appears convinced of the potential
benefits; it's promised $1.5 million to fund research at the pilot site, and if
the site proves effective, several more could follow in the Vancouver area and
in other cities facing illicit-drug problems, including Winnipeg and Toronto.
Urban hard-drug havens in the U.S. could be next. According to a New York Times
report on Aug. 11, New York City is estimated to host a staggering 200,000
heroin addicts -- more than 16 times the number in Vancouver, and 20 percent of
the nearly 1 million addicts living in the U.S.
"It's certainly reasonable to expect that if this is successful in Canada, that
some people will want to imitate it here," says UCLA's Kleiman. The prospect of
entering uncharted legal waters may be another reason Washington conservatives
are sounding a defiant note. "It's unclear to me whether or not current federal
law would forbid a safe-injection site," says Kleiman. "It's not at all obvious
to me that it would, because the site does not provide illicit drugs.
There's no doubt that those who want to keep U.S. drug policy very
supply-reduction focused feel threatened by this."
Mayor Larry Campbell, who first saw the Vancouver drug crisis blooming while
working as a narcotics officer three decades ago, says that becoming B.C. chief
coroner in 1996 galvanized his view of harm-reduction policy. "When you're
going into a room every day and there are two people dead with needles still in
their arms, you know the status quo isn't working," he says. "I went from being
an enforcement officer to one whose major job was to prevent death.
Hopefully this policy will do that, and prevent disease, and will give us back
the heart of our city."
But conservatives also argue that the positive results of harm-reduction
programs overseas may not translate across different cultures or cityscapes. "I
think there are far more serious difficulties with the Swiss model than have
been acknowledged," David Murray of the U.S. Office of National Drug Control
Policy, a social anthropologist by training, told the Vancouver Sun in May. "My
impression is that the presumed benefits will turn out to be illusory."
Enabling addicts to pursue their habit, conservatives say, will inevitably
boost neighborhood crime and deepen urban decay.
"It is possible safe-injection sites are a good idea," says UCLA's Kleiman. He
points to the success of needle exchange programs in promoting drug use
abstinence, though he stops short of the controversial heroin distribution
plans that the U.K. and others have tried, with mixed success, in the past.
"But purely from an economist's point of view," he says, "a safe-injection site
makes being a drug user easier, and one would expect that to lead to more
people becoming drug users and staying drug users."
"This isn't a game I'm playing where we win or lose, it's peoples' lives," says
Mayor Campbell. "If it doesn't work, we'll try something else, but we know that
pure enforcement doesn't work. Remember, I'm an ex-narc and I have many friends
in the DEA and FBI. The fact of the matter is, the most compelling reason to do
this is the U.S. system -- just take a look at your jails. Prisons are a growth
industry in the United States, and a vast majority are in there for drugs, of
some form or another." Indeed, more than 70,000 inmates, or roughly 55 percent
of the U.S. federal prison population, are currently locked up for drug
offenses, according to the Federal Bureau of Prisons. "People don't come out
rehabilitated, and the drug and health problems aren't dealt with," says
Campbell. "We're simply trying to move beyond outdated laws."
Evan Wood of University of British Columbia further points to a study published
by his colleague Dr. Mark Tyndall in the April 2003 scientific journal of the
International AIDS Society, which concludes that jailing addicts actually
worsens the HIV epidemic.
Tyndall's study shows that Vancouver injection drug users incarcerated over the
prior six months faced nearly triple the risk of HIV infection. "We know HIV
spreads very rapidly among addicts in prison, where they're sharing rigs," says
Wood, affirming that illicit drug use on the inside is indeed commonplace. "I
go to many [international] public health conferences ... and my understanding
is it's no different in the U.S."
Standing in the pleasant salt breeze of the city's trendy Yaletown
neighborhood, former Vancouver Mayor Philip Owen explains why he defied all
expectations and made harm-reduction policy a hallmark of his nine-year career
in office.
Owen served from 1993 with the backing of the conservative Non-Partisan
Association until the party dumped him from its 2002 election ticket. He was
instrumental in setting the four-pillar drug strategy in motion in 1997. Owen
says his perspective began to shift when a wave of crack cocaine hit the
streets in 1996, and he made several trips to the Eastside to observe the
growing problem. "I got to know some of the people there. It was quickly
obvious: The user is sick and the dealer is evil," he says. "What are you going
to do? Lock up a 16-year-old girl who's selling her body because she needs
dope? You have to lock up the dealers and treat the addicts."
Dressed in a crisp button-down shirt and khakis, the now-retired Owen is more
diplomatic than polemical -- until the discussion shifts to Washington. "In the
State of the Union address, George W. said his approach to the narcotics
problem is to prevent importation, and to treat those who are addicted." Owen
claps boisterously. "Wonderful! Then do it! The problem is, the U.S. hasn't
done it for 30 years and it's just bullshit to cloud over a serious issue like
this. They haven't stopped the importation -- they can't -- and the consumption
is rampant as can be. So that's just fine: Keep flying your planes over
Colombia, Turkey and Afghanistan, and burning crops and blowing planes out of
the sky," he fumes. "It isn't working and we can't wait at the city level
because we've got destruction here. And it's in Seattle and Portland and San
Francisco and New York. We have to deal with this at the street level, so don't
come here and criticize us."
UCLA's Kleiman offers a bit more tempered advice for a displeased Bush
administration.
"A really sensible U.S. government might say to Canada, 'We think this is a
really dangerous experiment, but if you're crazy enough to try it in your
neighborhood, God bless you, and we'll watch,'" he says. "A scientific view of
drug policy would say, 'Here's an opportunity for us to learn something.' Of
course, that's not what I expect to see from Washington."
For Megan Oleson, such debate is almost beside the point.
A little before 1 a.m., Oleson and I are sitting on a bench in Pigeon Park, a
dreary cement strip on the corner a half block from 327 Carrall. The street
hustle is going strong: people dealing, smoking, drinking and using, several
homeless people sleeping on the pavement. "A lot of institutions and healthcare
workers claim they understand harm reduction," Oleson says, "but in the end
you're challenging a lot of stigmas.
You get these people parachuting into ghettos, who don't really care what
people's health needs are."
Still, it seems dubious to assume all these despairing people could rescue
themselves.
When we walk back inside 327 Carrall the relative calm is striking, though it's
still plenty busy an hour before closing time: addicts drinking coffee or
nodding off; a couple of others pacing, anxious to get through the door into
the back room.
It's not hard to imagine the look on John Ashcroft's face, were he to walk
inside this place.
Yet not one person has died here since the site opened over four months ago --
even as a couple of people per week are pulled off the nearby streets in body
bags.
"I'm here because I hate seeing my friends inject in the alley," Oleson says.
"I hate going to fucking memorial services because people go to their hotel
room and OD because they're alone."
She heads for the fixing room, pausing to greet a couple of familiar faces
before she gets back to work.
Vancouver Hopes To Save Hundreds Of Lives By Opening Street Clinics Where
Heroin Addicts Can Shoot Up Safely.
But The White House Is Accusing Canada Of Going AWOL From Its War On Drugs.
VANCOUVER, British Columbia -- It's 11 o'clock on a busy Wednesday night inside
327 Carrall St. A dozen junkies nod on ragged couches and chairs lining the
downtown storefront's cluttered front room, where one handwritten sign on the
wall declares: "End the war on the poor." The Clash rattles through a pair of
stereo speakers ancient-sounding enough to be an AM radio. The occasional flare
of rubbing alcohol spikes through the haze of cigarette smoke and smell of hot
coffee -- in the smaller back room, two or three junkies at a time inject
heroin or crack cocaine into their veins using sterile swabs and fresh needles
under the watchful eye of a registered nurse. In here they can also receive
advice on vein care, skin infections and detox programs, or just temporarily
escape the hustle of one of the bleakest city blocks in all of Canada.
"I can do my fix in here without getting jacked for it," says Shelley, a young
woman with dark, tired eyes. Bruised holes dot the crooks of her arms. She
wears a tight white blouse, fishnets and black boots -- one of the 80 percent
of women who work in the sex trade among the neighborhood's nearly 5,000 drug
addicts. "People are pretty nice to each other here," she says with a slight
smile.
The 327 Carrall St. operation is illegal, but the mayor's office has looked the
other way since it opened on April 7; the guerrilla safe-injection site running
here every night from 10 p.m. to 2 a.m. insures junkies have sterile gear to
shoot up with, and discourages them from fixing alone -- a main contributing
cause of overdose -- in the festering alleys and decrepit residency motels of
the neighborhood. The site is the de facto vanguard of an evolving
"harm-reduction" strategy that the city of Vancouver hopes will help clean up
the streets and halt a decade-long illicit-drug catastrophe that's killed more
than 2,000 via overdose and infectious disease.
Essentially, the situation here has been so bad for so long that the government
is willing to help addicts plunge illegal drugs into their veins if it means
stemming the greater tide of destruction. If the city's official plan stays on
track, by mid-September street junkies will be able to walk into a storefront
at nearby 135 East Hastings St. almost any time of day and get high in a safe,
clean facility administered by the provincial Vancouver Coastal Health
Authority. It's a prospect that's angered conservatives from Ottawa to
Washington.
For now, this makeshift site operating in privately donated space is about all
the street addicts have. The slogan "Solidarity, Resistance, Liberation" is
painted on a sign above the front entrance; inside the front room I'm greeted
by the revolution's unlikely leader: a 26-year-old activist wearing a baseball
cap on her shaved head. Megan Oleson is a registered nurse who works in
critical care at Vancouver General Hospital by day; every night she comes here
to provide clean needles and advice to junkies (who must supply their own
drugs), with the help of volunteers including current and ex-users. Friendly
and mild-mannered, Oleson is modest about her role -- she emphasizes that
staffing a safe-injection site with addicts' peers is vital to promoting its
use. "They really run the site," she says. But it's quickly clear from the way
everyone greets her that Oleson is revered by the dozens of patrons, up to 30
per night who inject drugs and another 70 to 100 who come in just for a little
sanctuary.
Other activists in the neighborhood say Oleson rarely sleeps, but she looks
relaxed and focused -- a petite Florence Nightingale with a pierced nose, red
tank top and combat boots.
To Canadian conservatives, however -- and to an agitated Bush administration
keeping a glaring eye on ever-liberalizing Canadian social policy -- Megan
Oleson is more akin to Public Enemy No. 1. She's a renegade promoting criminal
behavior and the decriminalization of hard drugs -- the patron saint of a
policy that would nurture chronic abuse, the further decay of city
neighborhoods, and capitulation in the long, hard-fought war on drugs. And
Washington may have good reason to fear what's happening in Vancouver: If the
new policy, planned and fought for at the local level, indeed proves effective,
other North American cities troubled by throngs of drug addicts -- Seattle, San
Francisco and New York -- may be eager to follow suit.
Vancouver's bold strategy has provoked the expected ire of conservatives --
especially south of the border, where Washington has recently watched Canada
sanction gay marriage and close in on federal decriminalization of marijuana.
The prospect of government-backed hard-drug use next door has the White House
palpably unsettled: As soon as Vancouver's planned site gained Canadian federal
approval in late June, U.S. drug czar John Walters went off. "It's immoral to
allow people to suffer and die from a disease we know how to treat," he told
the Associated Press. "There are no safe-injection sites," he added, calling
the policy "a lie" and "state-sponsored personal suicide." David Murray,
special assistant in the U.S. Office of National Drug Control Policy, told the
Vancouver Sun on May 2 that likely "unintended consequences" of the
safe-injection site could force the U.S. to tighten border controls to prevent
increased drug trafficking. That could, of course, negatively impact trade of
all sorts.
All of which bounces off Megan Oleson. "There's really nothing radical about
this place," she says, once things slow down and we're able to go into the
less-crowded back room to talk. "It's highly practical.
Safe-injection sites are first-contact work at the ground level.
I do about two or three referrals every night to shelters, to places that offer
detox and prevention, and to recovery homes." At a nearby table partially
curtained off with a sheet, a young woman licks her lips as she cooks a shot of
heroin, her face knotted with anticipation. "The reality of it," Oleson
continues, "is that for those who want to break away from the hustle of the
street, and many of them do, this gives them time to think about it, and to
have someone to talk to."
She keeps a nonchalant eye on the junkie, who now has a skinny rubber tube
cranked around her left bicep.
The woman finds the swollen vein on her forearm, slides the needle in and
presses the plunger down. Oleson quietly notes her good technique; uninformed
junkies often jab needles into their arms, legs or neck, causing abscesses and
other skin problems.
The woman tilts her head back against the wall, eyes closed, her face dropping.
"Drug users and people in poverty deserve dignity and help," Oleson says.
As we exit through the front room for a quick walk to the corner store, Oleson
notes that the rules at 327 -- no fighting, no dealing, no unsupervised fixing
- -- are set by the users themselves. "There's nothing better than people
determining their own health needs, right?" she asks. Looking around at all the
nodding faces tinged with easiness and pain -- many of them Asian, black or
indigenous, most of them impoverished -- it's a tough question to answer.
Since 1993, greater Vancouver has seen an awful share of the needle and the
damage done: an average of 147 overdose deaths annually among an estimated
12,000 injection users of heroin and crack cocaine.
At first, the long-term drug crisis is hard to fathom amid the picturesque
landscape: a prosperous city ringed by lapping bays, green forests and
mountains; home to a vibrant, polyglot community of almost 2 million still
riding the rush of a successful bid for the 2010 Winter Olympics.
But detour into the roughly 10 blocks of the notorious downtown Eastside and
the lush environs give way to the stench of urine, piles of trash, and
discarded needles.
The neighborhood's boarded-up storefronts, few dingy bars and numerous
flophouses give no clue that the tourist-friendly Gastown and Chinatown
districts are close by. Infectious disease has swept through a desperate
populace of back-alley users commonly preparing fixes with dirty needles and
puddle water -- more than 30 percent have HIV and 90 percent hepatitis C.
Fearful of law enforcement and street thugs, some hurried addicts use their own
blood to dissolve powdered narcotics for injection. The concentration of
poverty scattered around the open drug scene's epicenter at Main and Hastings
- -- known locally as "pain and wasting" -- was recognized by the 1996 Canadian
census as the poorest neighborhood in the nation. By 1997, with hundreds of
deaths on the downtown streets, city officials had declared an epidemic.
According to Dr. Evan Wood, an epidemiologist at University of British
Columbia, an abundance of cheap drugs and acute poverty underwrite the ghetto
of despair.
Displacement due to law-enforcement patterns and "ridiculously underfunded"
addiction treatment exacerbate the problem.
"The only really effective way to deal with the drug crisis is to get at the
demand side," says Wood, who also conducts leading HIV/AIDS research at St.
Paul Hospital in Vancouver. "But there's a five-day waiting list to get into
detox, and you have to phone every morning to keep yourself on that list." It's
a striking state of affairs, given Canada's reputation for providing a vast
social safety net. With nowhere to turn, most addicts choose to inject -- the
fastest and cheapest way to get high -- regardless of the health dangers.
The first of its kind on the North American continent, Vancouver's official
safe-injection site will be a proving ground for the city's ambitious "Four
Pillars" drug policy.
The strategy also calls for greater treatment and prevention programs, and
vigorous law enforcement targeting dealers -- but not addicts, whom the policy
says should be treated as a health problem.
At an annual cost of about $2 million (Canadian), the site will offer 12
injection stations, a medical emergency room, counseling offices, and a
"chill-out" room where users can socialize or simply relax after their latest
fix, according to Viviana Zanocco, a spokesperson for the Vancouver Coastal
Health Authority.
Although illicit-drug use inside the site will be permitted by special federal
exemption, defining a boundary for street enforcement may remain tricky. "One
Catch-22 is that people will still have to purchase their illicit drugs from
somebody," says Zanocco. "How does the site work if people are too scared to go
in because they're afraid the police will be standing outside the door? It's a
struggle, I admit it. We're working with the police department on a strategy."
"This is a health problem, not a criminal problem," says Vancouver Mayor Larry
Campbell. Like many other Canadian officials, Campbell appears unfazed by
Washington's rhetoric. "We have conservatives in Canada, too, and they won't
look at fact or reason either," he says flatly. "I've been to Zurich
[Switzerland] where they had a problem way worse than ours, and I've seen the
results." The harm-reduction component of the widely endorsed plan -- Mayor
Campbell was voted into office in 2002 promising to implement it -- is modeled
after programs in Europe and Australia, which have dramatically reduced
overdose deaths and the spread of disease.
Though Canada is tagged a firebrand of progressive social policy next to the
U.S., it, too, has long fought a supply-side war on drugs.
Almost 95 percent of the roughly $500 million spent annually on Canada's drug
strategy goes toward efforts to reduce the illicit drug supply.
But that paradigm may be cracking now, due in part to the dire situation in
Vancouver, and some leading-edge research at University of British Columbia.
With an in-depth study of the city's injection drug users already in progress,
Evan Wood and his colleague Dr. Martin Schechter, head of UBC's epidemiology
department, were able to measure the impact in late 2000 of a seizure of 220
pounds of heroin -- the single largest drug-enforcement win in Canada's
history.
Following more than 120 addicts during the months before and after, the
researchers reported that "the massive seizure appeared to have no impact on
injection users or on the perceived availability of heroin." In fact, the study
found that the median price of heroin in Vancouver dropped 20 percent following
the seizure, with no change in purity, suggesting an even more saturated
supply.
Separate research showed the number of fatal overdoses actually ticked higher
in the following months.
Wood and Schechter also cite a 2001 United Nations report indicating that only
5 percent of the global illegal drug flow is successfully thwarted by law
enforcement. Still, the problem isn't on the enforcement front lines. "The
responsibility lies with the politicians and policymakers who continue to
direct the overwhelming majority of resources into failing supply-reduction
strategies, despite the wealth of scientific evidence demonstrating their
ineffectiveness," they write. "Our strong consensus [is] that curbing HIV and
overdose epidemics requires a shift toward prevention, treatment and harm
reduction."
The devastation visible on Vancouver's downtown streets leaves little doubt
that the war on drugs has failed here. But working with an inherently unstable
clientele of street junkies, there are no guarantees harm-reduction measures
will succeed.
Coaxing marginalized addicts to embrace an official safe-injection site could
prove difficult -- let alone making the site an effective stepping stone to
detox and rehabilitation.
"I used to break into cars all the time, anything to get another fix," says
Robert, a jittery 37-year-old junkie in shorts and a tattered T-shirt who asks
me for 15 cents at the corner of Abbot and West Pender. It's early afternoon
and a couple of businessmen in suits whisk by; normal commercial activity and
the hardcore street hustle blend with a strange ease on this block. Robert's
fingertips are blackened, and scabby holes pock the backs of his hands, his
forearms and the sides of his neck. He says he's heard about the coming
safe-injection site, but quickly adds, "I don't shoot no more." We go into the
McDonald's on the corner, where he pays the few extra cents he needed for his
order: two strawberry sundaes, with extra peanuts. "I think that site is a
foolish idea," he says, repeating unconvincingly that he's been clean for three
months.
Back outside at the bus stop, Robert greets a young addict named Jasmine, then
sits down to eat. He keeps glancing across the street, where a couple of
prostitutes work the corner in broad daylight, a pimp-dealer type lurking close
behind. "You don't think I'm going to be on heroin do you?" he says, jiggling
on the bus stop seat. "I'm not ever going to be a junkie again. Never."
Angelic-faced Jasmine says the site wouldn't get her off the street. "When you
have to fix, you do it wherever you want. You won't wait to go to some other
place."
"Yeah, you just go around the corner," Robert exclaims.
"Think about it, people that fix coke get so retarded," Jasmine chimes. "You
think they'll really stay inside there?
They're gonna boogie straight out the door all jacked up!" she laughs.
"Yeah, tear up ... start ripping the carpets up!" laughs Robert. His face goes
flat again. "It's like a stupid joke," he says, shaking his head.
But the site is a grave matter for Ann Livingston of Vancouver Area Network of
Drug Users, an activist group working out of a ragtag office just down the
block at 50 East Hastings St. The city's harm-reduction plan has wound through
six years of study and debate, with the new safe-injection site promised over a
year ago. "Just what really is a public health emergency?" implores Livingston,
who helped set up the guerilla site at 327 Carrall. "It's a really vicious,
violent thing to leave in place, while people diddle around and argue about
protocols and funding.
It verges on criminal negligence to stand by and watch a group of people year
after year when you can predict extremely accurately how many will get
HIV/AIDS, and how many will die."
The activist group, made up of hundreds of current and former addicts
(Livingston herself is not a drug user), hasn't waited around.
It runs nightly "alley patrols," and now distributes 1.5 million clean needles
per year, according to Livingston -- that's roughly half the 3 million given
out annually in Vancouver, which has the largest needle exchange in North
America.
"We have a really long way to go," agrees Fiona Gold, a "street" nurse at the
nearby office of the B.C. Center for Disease Control. Gold oversees CDC
outreach in the Eastside. "I've told far too many people here they've tested
positive for HIV. It's just nuts. We really have to do something different."
According to the latest Vancouver drug use epidemiology report, injection drug
use was the predominant mode of HIV transmission in B.C. from 1994 to 2000. A
1997 study of more than 1,400 Vancouver needle users revealed an HIV infection
rate of 18 percent -- the highest level anywhere in the developed world. Since
1997 the number of new cases in the city has dropped significantly, but the
report suggests that decline may be due to a "near saturation" of the addict
population considered most prone to infection.
Conservatives, Gold also points out, should be equally invested in the
harm-reduction strategy -- especially those who are fiscally conservative.
Every HIV-infected addict dropped into the healthcare system costs the Canadian
government an average of $150,000 in long-term care; the cost of 12 such
patients would pay for the new site to run for a year, she says.
Gold introduces me to Earl Crow, a middle-aged ex-rocker from southern
California with stringy blonde hair, dark brown eyes and a humble smile.
He tells me how he came to Vancouver four years ago hooked on speedballs, a
potent mixture of heroin and cocaine. "I was really wired, I was shooting a
gram a day," he says. But he made the decision to clean up, joined Vancouver
Area Network of Drug Users in 2000 and became its president for the next year
and a half. He now works outreach for the CDC in the Eastside, giving out
information and clean needles, and watching for medical emergencies in the back
alleys -- sometimes he puts in 12-hour days.
But he also knows the daunting odds harm-reduction tactics must overcome. "When
I was using there wasn't a fucking person in the world who was going to come
and save my life. It had to come from my own heart and head," he says.
Crow agrees to take me around with him, and we head up Powell Street to nearby
Oppenheimer Park. The mild afternoon and oasis of grass belie the park's
reputation as a drug-dealing hub; at night, Crow says, it's one of the city's
most dangerous spots.
We run into a young addict named Michelle who says she's been in the
neighborhood for 15 years, and we talk as she hurries us down the block.
We reach the local welfare office and she darts inside. "She's all jumpy like
that because she's been up for a few days," says Crow. "The beginning of the
month is tough.
It gets busy for us out here because people binge." He adds that some
healthcare workers are worried the new safe-injection site could become a
"revolving door" for addicts who inject coke, a much more fleeting fix than
heroin. "Some of them whack 20 or 30 times a day," he says.
Michelle comes back out, check in hand, and as we hustle back toward
Oppenheimer Park, I ask her what she thinks about the coming site.
"Maybe it'll work, but not if you have to go through all the nurses and a bunch
of forms and shit. You'll be withdrawn by the time you can get a fix," she
says, skipping along. "And it won't work if it's all super-clean and they're
gonna freak out if there's one little drop of blood on the floor." At the
corner of Jackson Street, she spots who she's looking for and flits off across
the block.
For more than a decade, harm-reduction programs in Europe have produced
compelling results.
In Zurich, Switzerland, many streets that were once needle-littered and
crime-ridden are no longer so forbidding. And since the country's first
safe-injection site opened in 1986, there hasn't been a single fatal overdose
at any of the 13 sites operating across three Swiss cities, according to the
U.S.-based advocacy group Drug Policy Alliance. Frankfurt, Germany, a city with
population and drug-user demographics similar to those of Vancouver, opened
five sites beginning in 1994; fatal overdoses there declined from 147 in 1991
to 26 in 1997, and the spread of HIV among drug users declined dramatically as
well.
Studies of the European programs show less clear results, however, in battling
long-term addiction.
Though conservatives often denounce harm-reduction policy in strictly moral
terms, such mixed results may be enough to arm the policy's opponents with a
more practical argument -- that chronic junkies pose a greater criminal threat
than a public health one.
"To many harm-reduction advocates, heroin use is a practical [health] problem,
but that's not a plausible view if you live in a neighborhood where drug
addicts steal your television set," says Mark Kleiman, a drug policy expert and
professor of public policy at University of California Los Angeles. "Ask people
living in those neighborhoods if they want a safe-injection site next door, and
they will say -- perfectly reasonably -- no." In fact, notes Kleiman, many
harm-reduction supporters themselves get caught up in an ideological battle
against the conservative crusade. "As a result," he says, "I don't think they
take into account all the possible consequences of harm-reduction measures."
But the Canadian federal government appears convinced of the potential
benefits; it's promised $1.5 million to fund research at the pilot site, and if
the site proves effective, several more could follow in the Vancouver area and
in other cities facing illicit-drug problems, including Winnipeg and Toronto.
Urban hard-drug havens in the U.S. could be next. According to a New York Times
report on Aug. 11, New York City is estimated to host a staggering 200,000
heroin addicts -- more than 16 times the number in Vancouver, and 20 percent of
the nearly 1 million addicts living in the U.S.
"It's certainly reasonable to expect that if this is successful in Canada, that
some people will want to imitate it here," says UCLA's Kleiman. The prospect of
entering uncharted legal waters may be another reason Washington conservatives
are sounding a defiant note. "It's unclear to me whether or not current federal
law would forbid a safe-injection site," says Kleiman. "It's not at all obvious
to me that it would, because the site does not provide illicit drugs.
There's no doubt that those who want to keep U.S. drug policy very
supply-reduction focused feel threatened by this."
Mayor Larry Campbell, who first saw the Vancouver drug crisis blooming while
working as a narcotics officer three decades ago, says that becoming B.C. chief
coroner in 1996 galvanized his view of harm-reduction policy. "When you're
going into a room every day and there are two people dead with needles still in
their arms, you know the status quo isn't working," he says. "I went from being
an enforcement officer to one whose major job was to prevent death.
Hopefully this policy will do that, and prevent disease, and will give us back
the heart of our city."
But conservatives also argue that the positive results of harm-reduction
programs overseas may not translate across different cultures or cityscapes. "I
think there are far more serious difficulties with the Swiss model than have
been acknowledged," David Murray of the U.S. Office of National Drug Control
Policy, a social anthropologist by training, told the Vancouver Sun in May. "My
impression is that the presumed benefits will turn out to be illusory."
Enabling addicts to pursue their habit, conservatives say, will inevitably
boost neighborhood crime and deepen urban decay.
"It is possible safe-injection sites are a good idea," says UCLA's Kleiman. He
points to the success of needle exchange programs in promoting drug use
abstinence, though he stops short of the controversial heroin distribution
plans that the U.K. and others have tried, with mixed success, in the past.
"But purely from an economist's point of view," he says, "a safe-injection site
makes being a drug user easier, and one would expect that to lead to more
people becoming drug users and staying drug users."
"This isn't a game I'm playing where we win or lose, it's peoples' lives," says
Mayor Campbell. "If it doesn't work, we'll try something else, but we know that
pure enforcement doesn't work. Remember, I'm an ex-narc and I have many friends
in the DEA and FBI. The fact of the matter is, the most compelling reason to do
this is the U.S. system -- just take a look at your jails. Prisons are a growth
industry in the United States, and a vast majority are in there for drugs, of
some form or another." Indeed, more than 70,000 inmates, or roughly 55 percent
of the U.S. federal prison population, are currently locked up for drug
offenses, according to the Federal Bureau of Prisons. "People don't come out
rehabilitated, and the drug and health problems aren't dealt with," says
Campbell. "We're simply trying to move beyond outdated laws."
Evan Wood of University of British Columbia further points to a study published
by his colleague Dr. Mark Tyndall in the April 2003 scientific journal of the
International AIDS Society, which concludes that jailing addicts actually
worsens the HIV epidemic.
Tyndall's study shows that Vancouver injection drug users incarcerated over the
prior six months faced nearly triple the risk of HIV infection. "We know HIV
spreads very rapidly among addicts in prison, where they're sharing rigs," says
Wood, affirming that illicit drug use on the inside is indeed commonplace. "I
go to many [international] public health conferences ... and my understanding
is it's no different in the U.S."
Standing in the pleasant salt breeze of the city's trendy Yaletown
neighborhood, former Vancouver Mayor Philip Owen explains why he defied all
expectations and made harm-reduction policy a hallmark of his nine-year career
in office.
Owen served from 1993 with the backing of the conservative Non-Partisan
Association until the party dumped him from its 2002 election ticket. He was
instrumental in setting the four-pillar drug strategy in motion in 1997. Owen
says his perspective began to shift when a wave of crack cocaine hit the
streets in 1996, and he made several trips to the Eastside to observe the
growing problem. "I got to know some of the people there. It was quickly
obvious: The user is sick and the dealer is evil," he says. "What are you going
to do? Lock up a 16-year-old girl who's selling her body because she needs
dope? You have to lock up the dealers and treat the addicts."
Dressed in a crisp button-down shirt and khakis, the now-retired Owen is more
diplomatic than polemical -- until the discussion shifts to Washington. "In the
State of the Union address, George W. said his approach to the narcotics
problem is to prevent importation, and to treat those who are addicted." Owen
claps boisterously. "Wonderful! Then do it! The problem is, the U.S. hasn't
done it for 30 years and it's just bullshit to cloud over a serious issue like
this. They haven't stopped the importation -- they can't -- and the consumption
is rampant as can be. So that's just fine: Keep flying your planes over
Colombia, Turkey and Afghanistan, and burning crops and blowing planes out of
the sky," he fumes. "It isn't working and we can't wait at the city level
because we've got destruction here. And it's in Seattle and Portland and San
Francisco and New York. We have to deal with this at the street level, so don't
come here and criticize us."
UCLA's Kleiman offers a bit more tempered advice for a displeased Bush
administration.
"A really sensible U.S. government might say to Canada, 'We think this is a
really dangerous experiment, but if you're crazy enough to try it in your
neighborhood, God bless you, and we'll watch,'" he says. "A scientific view of
drug policy would say, 'Here's an opportunity for us to learn something.' Of
course, that's not what I expect to see from Washington."
For Megan Oleson, such debate is almost beside the point.
A little before 1 a.m., Oleson and I are sitting on a bench in Pigeon Park, a
dreary cement strip on the corner a half block from 327 Carrall. The street
hustle is going strong: people dealing, smoking, drinking and using, several
homeless people sleeping on the pavement. "A lot of institutions and healthcare
workers claim they understand harm reduction," Oleson says, "but in the end
you're challenging a lot of stigmas.
You get these people parachuting into ghettos, who don't really care what
people's health needs are."
Still, it seems dubious to assume all these despairing people could rescue
themselves.
When we walk back inside 327 Carrall the relative calm is striking, though it's
still plenty busy an hour before closing time: addicts drinking coffee or
nodding off; a couple of others pacing, anxious to get through the door into
the back room.
It's not hard to imagine the look on John Ashcroft's face, were he to walk
inside this place.
Yet not one person has died here since the site opened over four months ago --
even as a couple of people per week are pulled off the nearby streets in body
bags.
"I'm here because I hate seeing my friends inject in the alley," Oleson says.
"I hate going to fucking memorial services because people go to their hotel
room and OD because they're alone."
She heads for the fixing room, pausing to greet a couple of familiar faces
before she gets back to work.
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