A CONTROVERSIAL EXCHANGE

The Needle Exchange Program In The Downtown Eastside Treats
Intravenous Drug Users With Respect, Not Contempt

When I went looking for the needle exchange van, I expected to find
something big. A big vehicle, with big wheels perhaps, giving off big
noise. I tend to assume that controversial things are big and
imposing. Otherwise, why all the fuss?

I had phoned before for directions. Get off the bus at Main &
Hastings. Walk west on Hastings, past the Carnegie Centre, past the
Regent. Walk a little past the Brandiz Hotel, and stop just before you
get to Columbia. Wait there until 6:15pm.

Fine. I found the Brandiz Hotel, Pub and Disco, passed it, and came
across a long wall covered with graffiti, several metres from
Columbia. I stood next to a series of sombre black and white faces,
spray-painted onto the brick. I could see crowds of people gathered up
near Carnegie and the Regent, but down where I was standing there were
only a few people milling around. Was I in the right place?

When a small, inconspicuous, grey minivan pulled up to the side of the
curb and parked, I was unfazed. My eyes kept searching the street for
the needle exchange van. It was only when the driver turned on the
lights in his car, and rolled down the passenger-seat window that I
started to put two and two together. A few of the men and women on the
street walked over to the van and formed a polite line-up. The first
man stuck his head in the window, said a few words to the driver and
threw a handful of needles into a bin on the passenger seat of the
car. In exchange, he received a handful of plastic-wrapped syringes.
The man nodded his head in thanks and walked away.

This is Vancouver's needle exchange. From 6:15pm to 6:45pm, and then
again from 8pm to 9pm, the needle exchange van, owned and operated by
the Downtown Eastside Youth Activities Society (DEYAS), exchanges
clean needles for dirty ones, seven days a week, from this exact spot
on East Hastings street. No payment is required. No questions are
asked. There is only one stipulation: that patrons be intravenous drug
users.

DEYAS owns and operates two needle exchange vans. Besides stopping on
Hastings St, the vans drive through all the major streets in the
Downtown Eastside, as well as a number of streets in the downtown core
and several alleyways. The vans also make stops at the Portland Hotel,
a low-cost housing project on West Hastings. Between 1pm and 7:30am,
at least one van will be out on the road at any given moment. During
the mornings, intravenous drug users can exchanges needles at the
DEYAS office at 221 Main St.

Again, I had thought the needle exchange office, which DEYAS staff
call the 'fixed site,' would be big and instantly recognisable. But if
the building hadn't been numbered, I would never have found it. The
fixed site is a tiny room directly facing Main St. with red metal bars
covering the windows. Inside is a wealth of pamphlets and flyers on a
variety of subjects-how to inject heroin properly, where to find a
free meal, what to expect off of a hit of crack and why you never want
to contract Hepatitis C.

"THERE IS NO SUCH THING AS PURE HEROIN HERE" reads a message on the
large dry-erase board on the right-hand side of the room. Drugs in the
Downtown Eastside are renowned for their impurity and users are lucky
if they can find heroin that is 50 per cent pure. I ask Thomas
Wheeler, one of the staff at DEYAS, what kind of things are found in
impure heroin. "Oh it can be anything," he says. "A lot of stuff we
see is mixed with gasoline."

Thomas stands in front of a clear plastic bin filled with used
needles. While we talk, a steady stream of men and women stops by to
exchange needles. "Eight please, Tom," one man asks. Thomas nods, and
picks out eight plastic-wrapped syringes from a box of hundreds. "Do
you want water with that?"

He doesn't mean water for drinking. The fixed site and the vans give
out small plastic vials of clean water to clean out rigs. Since many
drugs users continue to share needles, DEYAS provides them with the
means to reduce the risk of infection when re-using. In several
illustrated pamphlets, DEYAS shows users how to rinse used syringes
with bleach and clean water to disinfect the rig.

Even if users don't re-use needles, they still expose themselves to
many potential health risks by injecting. Over time, many users lose
the ability to inject into the veins of their arms and resort to
injecting into veins On the neck and the groin-a practice which is
very dangerous because of the risk of hitting an artery or nerve. It
is also very common for users to develop abscesses and other
infections around the area of the injection. For these reasons,
showing users how to find veins and how to inject safely is part of
the job for the DEYAS staff.

This is one the reasons that Judy McGuire, the manager of the needle
exchange program, likes to hire ex-users. "Ninety-five per cent of our
staff are ex-users. They know the issues and if they've been using in
the area they'll know the people," she says.

DEYAS is responsible for creating the needle exchange program in
Vancouver, but it was the drug users that created the demand for the
service. DEYAS's founder, John Turvey, began handing out needles as
early as 1988, after his clients began asking for them. "Most users
take responsibility for their addictions," Judy explains.

DEYAS developed the exchange program to confront the drastic increase
in HIV infection rates during the late 1980s, and consulted with the
community through an advisory committee to develop the program's
mandate. It was important for DEYAS to confront the popular
misconception that a needle exchange program would increase the level
of drug use in the community. The experiences of other communities
which have adopted similar programs, DEYAS said, show that this is
simply not the case.

The needle exchange program has three specific goals: maximising
access to clean syringes, bleach, condoms and similar products for
intravenous drug users; educating users on the proper use of equipment
to prevent the transmission of HIV and other infections; and
recovering contaminated needles as quickly and completely as possible
to prevent their re-use, while minimising the number of used syringes
discarded in public places.

To an outsider, there may appear to be something missing from the
objectives of the program. Nowhere is there any mention of decreasing
the level of drug use in the Downtown Eastside. If the community is
facing such a drastic problem with drug use, shouldn't the program
encourage users to think about healthier lifestyle choices?

"No," says Judy, "that's not the point at all. We're here to support
users in their choices."

The exchange program is not meant to reduce drug use. The exchange
staff aren't out to promote healthy lifestyle alternatives. The needle
exchange program is a harm reduction initiative.

So what is 'harm reduction?' I ask Judy this very question, and she
rolls her eyes and laughs. It is as easy to define harm reduction as
it is to define morals and ethics. She thinks for a while. "I suppose
harm reduction consists of strategies that reduce harm to an
individual that results from particularly harmful behaviour, without
these strategies causing further harm for others," she says decidedly.

'Harm reduction' is a popular topic in the Downtown Eastside, and not
only amongst outreach organisations. It is one of four pillars, along
with Prevention, Treatment and

Enforcement, of A Framework For Action, the City of Vancouver's most
recent strategy for combating drug problems in Vancouver. In the
over-80-page report, 'harm reduction' is defined as a "pragmatic
approach that focuses on decreasing the negative consequences of drug
use for communities and individuals."

According to A Framework for Action, an initiative must meet five
criteria in order for it be classified as a harm reduction initiative:
It must not cause harm; it must respect the basic human dignity of
persons who use drugs, it must maximise intervention options; it must
focus on the harm caused by drug use, rather than drug use per se; and
it must have appropriate outcome goals.

A lot of different outreach services might or might not be thought of
as reducing harm. Drug and alcohol counselling is commonly thought of
as a form of harm reduction. So is methadone treatment. Some argue
that safe infection sites are as well. These sites provide a clean and
safe place where users can inject and be in constant contact with
health care staff. Cities such as Frankfurt and Amsterdam, facing drug
problems similar to the ones in Vancouver, have shown that safe
injection sites reduce the number of deaths due to overdose.

Some even argue that legalising drug use outright is the ultimate harm
reduction initiative. Legalisation would eliminate the stigma
associated with the use of crack and heroin, and would allow users to
focus on using safely.

Four blocks away from the needle exchange office, Dr Kevin Rowan toys
with the idea of legalising narcotics as a solution to the drug
problem in Vancouver.

"Maybe we should install vending machines on every corner, and fill
them with free heroin and crack, along with clean syringes and
instructions on how to inject properly," he says.

Rowan isn't serious when he suggests this, but he sees it as a way of
confronting prostitution, which is the problem that bothers him the
most.

Rowan, a UBC graduate, is a part of the Community Health Initiative by
UBC Students (CHIUS), which operates Wednesday through Saturday out of
a drop-in health clinic on Cordova St. During specific hours on these
days, a doctor and a handful of medical students make themselves
available to anyone who needs medical care, counselling or just
someone to talk to. Working with CHIUS has given Rowan insights into
addiction that he says he would never have had before.

"There is a lot more to addiction than the chemical component. There
is a huge social component," he says.

April Halliday, a second-year Medicine student at UBC,
agrees.

"We're all susceptible to addiction," she says. "I've met users in
this clinic who are PhDs."

Halliday speaks highly of her experiences at the clinic. What she
enjoys most are the relationships she forms with patients, many of
whom are struggling with substance abuses. Some of her patients have
gone into recovery while she has known them. Most relapse, which
Halliday admits is disappointing, but she points out that it takes the
average drug user seven times to quit a habit. For this reason, she
says that harm reduction initiatives such as the needle exchange and
safe injection sites make sense.

CHIUS participants do not exchange needles themselves, but by forming
relationships with patients and providing referrals, they are actively
reducing the potential for users to meet harm, whether self-inflicted
or inflicted by others.

The needle exchange program is a small part of a far larger project:
allowing drug users to make choices for themselves, and helping them to act
safely regardless of what choices they make. It's not about big vans, or big
offices or even big ideals. It's about respect.