Excellent response by Liz Evans to the Kopala column

Liz Evans' special column in response to M. Kopala's column in the preceeding post.
[all links added]

The dead can't kick drugs

Vancouver's safe injection site isn't the whole solution to the drug problem in the Downtown Eastside -- but it has done a great deal of good

Liz Evans, Citizen Special
Published: Thursday, December 20, 2007

I was saddened by Margret Kopala's recent column, "Revoke this licence to enable" (Dec. 8). Like Ms. Kopala, I remember my first experiences in the Downtown Eastside as shocking, and I too was naive about the problems there when I left the hospital as a nurse to work in the community. It's now been almost 17 years working in the very neighbourhood Ms. Kopala describes. Addiction is clearly dreadful and tragic, but those who offer simplistic solutions offer false hope. Clearly if it were as simple as Ms. Kopala believes, there would be no debate.

Meanwhile, people suffer and die living with addictions.

Ms. Kopala's one sensible point regarding a young girl facing the tragic consequences of addiction is that she could have been her sister. Indeed, those suffering with addiction across Canada, including those helped by InSite, Vancouver's supervised injection site, are someone's sister, or brother, or son, or daughter.

I have called the parents of addicts who had overdosed to tell them their child was dead. I met one mother, at the airport, who had flown across the country to visit her dying son. She arrived too late and fell to the floor screaming in grief when she heard the news.

I was a young, inexperienced nurse. What comfort could I really offer in this tragedy? She wanted her addict son alive, addicted or not. There are things we can do. Harm reduction is one. It can keep people alive, so one day, they can enter treatment.

Harm reduction strategies buy time because not everyone is ready to enter treatment. Clean needles and condom distribution prevent the spread of disease. These are basic health interventions that are accepted across the world, from the United Nations to the medical health officers of every single jurisdiction of this
country.

InSite is neither the problem nor the solution. It is one measure designed to prevent drug overdose deaths, which it has done; reduce public disorder, which it has done; reduce the spread of HIV, which it has done; provide a doorway into the health system and into treatment, which it has also done.

Twenty-five academic papers have now been published in the world's most renowned medical journals including The Lancet, the New England Journal of Medicine, the British Medical Journal, and the Canadian Medical Association Journal. To date there has not been one single independently peer-reviewed article disputing the scientific evidence, which Health Canada paid close to $2 million to compile.

The most recent piece of research indicates that there has been a 30-per-cent increase in the number of people entering detox and methadone therapy as a result of using the injection site -- which strengthens further the argument that harm reduction is a necessary part of the health-care continuum. Making this link from the chaos of the streets to the path of recovery even stronger, OnSite opened above InSite this September, offering 30 beds to addicts wanting to detox, and escape the cycle of addiction.

The public is aware that addiction is a complex issue that requires a comprehensive strategy - one that incorporates improved enforcement, comprehensive prevention programs, and flexible and accessible detox and treatment interventions. But it also needs to include harm reduction - so people don't die unnecessarily, and parents don't continue to lose their children.

Other jurisdictions now also involve harm reduction strategies as part of their overall plans to tackle addiction. Sweden, as was mentioned by Ms. Kopala in her column, has now established needle-exchange programs in order to stop the spread of disease and comply with UN expectations, while conforming to international efforts to limit the global AIDS pandemic. Britain, where a heroin prescription maintenance
program has been in place for many years, has now expanded its addiction treatment program to include stimulant maintenance for cocaine addicts.

In no place where harm reduction approaches have been used have advocates argued they be implemented exclusive of prevention, treatment and enforcement. In every jurisdiction where harm reduction is practised, it is done so in collaboration with local police, business and residents to ensure both the individual users and the broader community equally benefit.

Since InSite opened in 2003, there has been a dramatic decrease in the number of public injections and injection-related litter. As a resident of the neighbourhood, I have witnessed a stark contrast in the livability of the Downtown Eastside since InSite opened its doors. Over the past four years of operation, InSite nurses have now supervised more than one million injections, each of which would have otherwise occurred outside, in the public view, and with a much higher risk of drug overdose death, or spreading HIV and hepatits C.

While I welcome the significant improvement to my neighbourhood for both myself and my children, the primary reason I continue to support InSite is its ongoing life-saving work. More than 900 overdose interventions have happened at InSite - each someone's child who would not be with us today if InSite nurses had not been there to take immediate action.

Like Ms. Kopala, I hope politicians like Stephen Harper [write to him here] and Health Minister Tony Clement [write to him here] think about the children when they consider public health policy relating to drug addiction. I hope desperately that resources are finally put into prevention efforts to stop kids from using drugs in the first place. But I also hope to never again explain to a crying mother why her child died from a drug overdose that could have been prevented, in a civilized country like Canada.

Liz Evans is a nurse and the executive director of the PHS Community Services Society, which operates InSite, Vancouver's supervised injection site.
© The Ottawa Citizen 2007

"The memory of April Reoch deserves better" than this article

Liz Evans' reaction to this article in the post above...

[Links in this article added by me]

08 Dec 2007
REVOKE THIS LICENCE TO ENABLE

by Margret Kopala, The Ottawa Citizen, Ottawa Citizen

The First Step to Cleaning Up Canada's Worst Neighbourhood Is to Scrap Its Abhorrent Safe Injection Site

Don't call Al Arsenault unless you are prepared to interrupt an awards ceremony. I recently tried but the retired constable was in Victoria receiving two meritorious service awards from British Columbia's lieutenant governor.

The first was awarded to Sgt. Toby Hinton, Sgt. Tim Shields (RCMP) and Arsenault for a short documentary about car theft. The second recognized Arsenault's work as a decoy in capturing thugs beating up the elderly and helpless in Vancouver's Downtown Eastside. Barely a month earlier, their company, Odd Squad Productions, had won the Excellence in Cinema for a Feature Film award at the New York Independent Film and Video Festival, this time for their most recent production, Tears For April: Beyond the Blue Lens.

For Al Arsenault, these awards are the culmination of 26 years being a beat cop in Canada's poorest, most drug-infested neighbourhood.

The 10 most recent years have been focused on making educational films about its squalid underside.

Like other Odd Squad productions, Tears for April is a matter-of-fact yet deeply affecting feature documentary about the lives of several addicts on Vancouver's Skid Row, with April Reoch as its tragic heroine writ large.

The young, part-native addict is already a mother and into drugs when she arrives on the skids at the age of 17. Despite efforts at recovery, she remains there in a downward spiral of prostitution and drug addiction for the rest of her brief life.

Beyond the foul language, weeping sores, broken teeth and needle marked body, the film reveals the addict's few shreds of dignity. April could have been your sister or mine.

The documentary was snubbed by the Vancouver Film Festival because, according to Arsenault, "They prefer ideology over art." New York picked it up but then, unlike Vancouver where decriminalization and harm reduction are the prevailing orthodoxies, New York gets it. According to the National Survey on Drug Use and Health published in September, illicit drug use in the United States among 12- to 17-year- olds has declined.

Notably, use of the initiator drug marijuana by adolescent boys is down by 25 per cent. This is good news for the United States because, as the director of the Office of National Drug Control Policy, John P. Walters reminds us, "We know that if people don't start using drugs during their teen years, they are very unlikely to go on to develop drug problems later in life." America is getting the message and so too is Britain where new laws allowing police to seize drugs and issue warnings have expedited case disposal and, according to BBC News, brought drug use to its "lowest in a decade." Then there's Sweden whose successes toward the goal of a drug-free society have been achieved in part by controversial policies such as compulsory treatment.

In Canada where marijuana use among youth is highest in the industrial world and consumption of other drugs isn't far behind, the Harper government's recently announced National Anti Drug Strategy is a promising start toward getting Canada back on the road to prevention, treatment and enforcement.

If the anti-drug budget is augmented by clearly articulated goals and a strategy for achieving them, results could soon appear.

As these unfold, mandatory minimum sentences and drug courts will affirm that possession and dealing are against the law, something even judges like Justice John Gomery seem to have forgotten.

Canada's National Anti-Drug Strategy makes no concessions to harm reduction or decriminalization measures.

Nonetheless, its biggest problem will be the decriminalizers and harm reduction crowd who have bogged the country down in controversial practices involving needle exchanges, crack pipes and safe injections even though consultation with an experienced organization like Alcoholics Anonymous would have quickly revealed that such practices merely enable the addict.

The epicentre of this approach to drug addiction is Vancouver. Here, opposition to harm reduction practices and safe injection facilities like the Downtown Eastside's Insite is routinely squashed, ignored or lambasted, though an observation that Insite seemed tantamount to "state assisted suicide" did manage to make it into the local press - -- not least because it was made by American broadcaster Dan Rather who was in town scouting out a TV special on the Vancouver Olympics.

The drug-addled stink that will rise from this issue during the 2010 Winter Olympics should alone give pause to reconsider Insite though, to thoroughly mix the metaphor, fur has already flown over its future. Contrary to the findings of
University of British Columbia studies extolling Insite's benefits, a paper published earlier this year by the Journal of Global Drug Policy and Practice challenges the harm reduction approach to drug addiction on both theoretical and practical grounds. "A Critique of Canada's INSITE Injection Site and its Parent Philosophy" by Colin Mangham argues the facility has achieved few or no reductions in the transmission of blood-borne diseases, no impact on overdose deaths, and that the facility is used only sporadically. Any reduction in public disorder, says the 20-year veteran in the drug prevention field, resulted from the injection of 60 police officers into the area when the facility opened, not safe injections at Insite.

Moreover, while the harm reduction lobby takes us on wild goose chases, the really important stuff -- the need to reduce drug use through prevention, help addicts through treatment, and reduce drug availability through law enforcement -- is marginalized even though in the cases of tobacco and alcohol, such approaches have had considerable impact.

Mangham's analysis of the harm reduction phenomenon is particularly important. As manifest in the agencies, bureaucracies and the many politicians that surround all levels of government today, he says it is "a ( libertarian ) ideology viewing drug use not only as inevitable, but as simply a lifestyle option, a pleasure to be pursued, even human right ... ( it believes ) others should only be there to help reduce the consequences of your choice until if or when you choose to choose differently." Or, as Al Arsenault recently told the Province, "... a person can have one foot in the ditch and another in the grave and they go, 'Oh, I don't want to be judgmental, here's your box of needles.'" Yet few seem to have considered that others might have something to say about an ideology that relieves the user of any personal responsibility, destroys families and communities, costs taxpayers money, and is now spilling into other formerly taboo "lifestyle" choices.

Think prostitution, for instance, where the term "sex-trade worker" is a step toward its normalization and ultimate legalization. Similarly, harm reduction is also a first step toward full legalization of drugs.

Even so, Mangham was pilloried in the west coast press though for anyone concerned about this issue, his paper is required reading.

Presumably exhausted by this battle of the experts versus front line workers like Mangham and Arsenault, few now are challenging Simon Fraser's Garth Davies whose paper "A Critical Evaluation of the Effects of Safe Injection Facilities" gathers data about safe injection sites from around the world and concludes "none of the ( positive ) impacts attributed ... can be unambiguously verified." And, certainly, no safe injection facility could have saved April Reoch, whose violent, banal and senseless death arrived not at the end of a needle, nor even at the hand of a john but as a bit of refuse on the garbage heap of humanity's lifestyle choices.

Literally.

Whether it is an academy award for Tears for April or the 2010 Olympics, the world will soon have a wide open window on Vancouver. What will it see? The festering eyesore of degraded humanity ripe for exploitation by the latest serial killer called the Downtown Eastside? Or a city where pushers and users are in treatment or in jail and whose youth are hip to the dangers of drugs?

Insite's licence to enable has been on life support since Canada's minister of health extended it last year but as a first step to cleaning up Al Arsenault's old beat, it's time to pull the plug. It's about the 14- year-olds, Minister Clement. The memory of April Reoch deserves better.

Harm Reduction, a refresher

Here's a great summary list of the main points of harm reduction from a drug policy perspective (as opposed to incorporating other harm reduction measures like drunk driving prevention programs). Prime Minister Harper obviously hasn't read it, but he should ...

from the site : Drug Policy Alliance

Reducing Harm: Treatment and Beyond
Harm reduction is a public health philosophy that seeks to lessen the dangers that drug abuse and our drug policies cause to society. A harm reduction strategy is a comprehensive approach to drug abuse and drug policy. Harm reduction's complexity lends to its misperception as a drug legalization tool.

• Harm reduction rests on several basic assumptions. A basic tenet of harm reduction is that there has never been, is not now, and never will be a drug-free society.
• A harm reduction strategy seeks pragmatic solutions to the harms that drugs and drug policies cause. It has been said that harm reduction is not what's nice, it's what works.
• A harm reduction approach acknowledges that there is no ultimate solution to the problem of drugs in a free society, and that many different interventions may work. Those interventions should be based on science, compassion, health and human rights.
• A harm reduction strategy demands new outcome measurements. Whereas the success of current drug policies is primarily measured by the change in use rates, the success of a harm reduction strategy is measured by the change in rates of death, disease, crime and suffering.
• Because incarceration does little to reduce the harms that ever-present drugs cause to our society, a harm reduction approach favors treatment of drug addiction by health care professionals over incarceration in the penal system.
• Because some drugs, such as marijuana, have proven medicinal uses, a harm reduction strategy not only seeks to reduce the harm that drugs cause, but also to maximize their
  potential benefits.
• A harm reduction strategy recognizes that some drugs, such as marijuana, are less harmful than others, such as cocaine and alcohol. Harm reduction mandates that the emphasis on intervention should be based on the relative harmfulness of the drug to society.
• A harm reduction approach advocates lessening the harms of drugs through education, prevention, and treatment.
• Harm reduction seeks to reduce the harms of drug policies dependent on an over-emphasis on interdiction, such as arrest, incarceration, establishment of a felony record, lack of treatment, lack of adequate information about drugs, the expansion of military source control intervention efforts in other countries, and intrusion on personal freedoms.
• Harm reduction also seeks to reduce the harms caused by an over-emphasis on prohibition, such as increased purity, black market adulterants, black market sale to minors, and black market crime.
• A harm reduction strategy seeks to protect youth from the dangers of drugs by offering factual, science-based drug education and eliminating youth's black market exposure to drugs.
• Finally, harm reduction seeks to restore basic human dignity to dealing with the disease
  of addiction.
  

Burnout on the frontlines

VANDU is the organization that operated InSite initially before there was a federal loophole.

Fighter for Addicts Ready to Quit
Ann Livingston of VANDU is wearied by death.
By Sarah Ripplinger
Published: December 13, 2007
TheTyee.ca

After spending the past 13 years trying to save Vancouver's poor from the filthy alleys of the Downtown Eastside, Ann Livingston doesn't have a pension plan or any significant savings, but she has decided to quit her job.

Livingston, a star of the widely shown documentary Fix, has spent the last nine years co-ordinating the Vancouver Area Network of Drug Users (VANDU), a non-profit operated by addicts. She's done a lot to help drug users get their voices heard. But she says she is tired of Vancouver's hypocrisy. While the host of the 2010 Olympics is termed the world's "most liveable city" by The Economist magazine, its poorest neighbourhood grapples with an epidemic of HIV/AIDS comparable to Botswana's.

After devoting more than a decade of her life helping people in the Downtown Eastside, Livingston says she hasn't noticed improvements in living conditions or a decrease in the demand for aid. In fact, she says, things just seem to be getting worse.

"Yeah, people did change, but then they died," Livingston remembers thinking to herself last spring. "I started to realize, I do leadership development with people who are very likely to die and there's more dead people now that I've worked with than live people."

She recalls a "critical incident" after watching a former VANDU board member try to kick in the office windows while yelling offences at her.

She found herself breaking down at red lights, rationalizing that, because of
her busy schedule, "now would be a good time to cry."

That was when she decided she had to solve her own problems before taking on everyone else's. She began imagining a new life "because I want to do something more powerful than being the crabby bitch at VANDU who yells at users." She thinks she flies off the handle so much because, for too long, she's put off grieving.

Day starts before dawn Livingston's thick grey hair sits smoothly across her shoulders. She frequently looks into the distance when she speaks. In jeans and a cotton T-shirt, she's outspoken, but her mannerisms are almost shy. She keeps a respectful distance between herself and others.

Most days, she is up checking e-mails by four in the morning. "It's mainly because I have trouble sleeping at night." She works at the computer while balancing on a blue exercise ball to ward off back pain. Then she gets her four-year-old son ready and off to daycare in time to make it to VANDU for a long day of work.

As a single mother on welfare, Livingston moved to the Downtown Eastside with her three boys (four now) in 1993, and was moved to act by the sight of people shooting up and dying on the streets. She enrolled in a four-day course on community organizing. The workshop was run by a group from Nicaragua that shared its experience of starting a literacy campaign and a campaign to collect bottles for making tomato preserves.

She co-founded VANDU in 1998, Pivot Legal Society in 2000, and was a founding member of the Eastside Movement for Business & Economic Renewal Society board in 2001. Livingston also ran for city council three times "to bring the issues of homelessness, ill and criminalized citizens to city hall."

She attends city and police meetings and sits on countless harm reduction, prostitution awareness, economic and community development boards connected with people in the Downtown Eastside.

She does it, she says, because "You never know who you're helping. It could be Christ himself." Livingston, who converted from the Unitarian to Roman Catholic Church, cannot understand how anyone could see people starving, homeless and in need, and do nothing.

Harm reduction baby steps

Livingston believes community involvement is the cure for problems of addiction, homelessness and crime in her neighbourhood. It's an absence of community that has lead to government programs that do little to address the problems of addiction and homelessness in the Downtown Eastside. Programs like the supervised injection site research project, Insite -- that provides clean needles and medical and counselling services to users, overseeing about 600 injections every day -- are really just the tip of the iceberg, she says.

There are approximately 12,000 injection drug users in Vancouver, one third of whom live in the Downtown Eastside.

Despite Vancouver's reputation as a trend setter in harm-reduction policies, Livingston says the city needs more supervised injection sites, safe inhalation sites for crack smokers, and educational programs for users on how to use drugs safely and get clean. Before Insite opened its doors, she used her own money to start her own needle exchange program, doling out thousands of needles to users on the street.

Sitting in her two-bedroom apartment filled with hand-me-down children's toys, VHS boxes and pasted-up slogans -- "Hating someone is like burning down your own house to get rid of rats" -- Livingston tells me she's planning to post her job at VANDU as a job share. Someone will get half her salary to work alongside her for a
while and eventually take over her position.

"I want to job share it first and then just ease out," she said, "because I think job sharing is the most kind thing you could do to another person. And the thing is to find another person who, in a sense, can see the redemptive quality to suffering, because there's a lot of challenges to working at VANDU."

'What do you get out of this?'

But how many people are there who want to work with drug users every day for all the right reasons?

As the only non-drug-user on the VANDU board of directors, Ann says she often feels like an outsider. "People ask: 'What do you get out of this?'"

Livingston says she is tiring of the off-based criticism, and even threats, she attracts. A recent column in The Province newspaper described her as someone who might give needle injection demos to children. She is also an outsider to other organizations that receive government funding. Unlike VANDU, these organizations are restricted from the amount of government lobbying they can do, even to the point of having their hands tied. Whereas, VANDU can lobby all it wants, but on a very tight budget.

Livingston, who is 52, is still energized by opportunities to speak to people around the world about harm reduction and affordable housing. She's still working on setting up provincial, national and international drug user groups. And she says she doesn't have any definitive plans, only a feeling that there must be another way to make a
difference. The moment has arrived, she says, to take a look at "the sort of wasteland of my life."

It's time for Livingston to rescue herself, too.

A breather

So a brief digression to kick start some creativity instead of continuing to merely regurgitate the news... Here's a walk through my neighbourhood between 4 and 5.30 pm.

Torn over at Sticky Crows has started in on 12 of 12, a photo project by Chad Darnell. The theme this month is "believe". In order to loosely link the whole thing to this blog, here's something I believe in (well, accept the scientific evidence for, but who's gonna quibble semantics):
harm reduction saves lives.
Lives like that of the person pictured here on this banner. Daily. So do lots of other people.



Pictured here: MPs Bill Siksay (Burnaby Douglas) and Libby Davies (Vancouver East) with Nathan Allen of Insite for Community Safety at a rally on Parliament Hill around Nov 12 (in keeping with the theme... this is my bonus pic anyways. Also a comparitor for the amount of snow a month later).

Right, on to the 12 of 12:

Well, it is December, and it always amazes me (in fact, I find it hard to believe) how great the Christmas cactus looks this time of year.

Well, a theme of "believe" lends itself to naturally to considering faith. We have 5 churches in a 3 block radius of our apartment. That's a whole lotta bells.

This is the Canadian Tribute to Human Rights (a.k.a. the human rights monument) by Melvin Charney (1989). Many rallies, protests, protest marches (i.e. public statements of belief) start here at the end of our block. That's city hall in the background (which, if you can believe, also has a belltower that chimes ALOT).

Right, here's something that a prairie girl like me has a hard time believing: look at all that snow! And it's only December!

The main branch of the Ottawa Public Library. Some believe it should be rebuilt, and I'd agree. There's not enough room, plain and simple. However, I hope they keep the cool fanning pages icon.

The famous five who got Canadian law to recognise women as persons. This led to sufferage.



I find it hard to believe however, that Henrietta Muir Edwards drank foamy lattes...


What may be the nicest library around.


It's got a pretty nice view too. That's Ile Victoria Island in the middle of the river.


Holiday lights at the Hill

Looking down Sparks Street through Confederation Square.

My favourite statue in Ottawa outside of the British Embassy. I believe in whimsy. Nature Girls, Laura Ford (1996). Check out these pics to see the best part: their cute lil shoes.

I'm cheating on my first time out... My personal bonus: a message from Leah. I can't believe I'm so lucky...

The power of a hand written letter

Did you know that no postage is necessary to send mail to your Member of Parliament? Did you know that

Because so few people take the time to write a letter on an issue that concerns them, politicians count each letter as representative of the views of far more citizens. A letter to a federal politician is seen as representing thousands" (Elizabeth May, MP, How to Save the World in Your Spare Time, p.90-91)?

Here's an article (below) from The Toronto Star back in Sept. that illustrates the power of letter writing. Bear in mind that since this article was written, InSite has recieved another extension to the required exemption under Section 56 of the Controlled Drugs and Substances Act. This exemption will expire in June, 2008.

Plenty of time for you to write some letters and get others to as well.

Haven from life in hell

Supervised injection site in Vancouver that has saved dozens of addicts is fighting for its life, too

Sep 15, 2007 04:30 AM

Petti Fong Western Canada Bureau Chief

Vancouver–Earl Crow is alive and surrounded by friends in the Downtown Eastside who've also managed to beat the odds.

Simply being able to survive the alleyways and streets around Main and Hastings is a major accomplishment for Crow.

"I should have been dead long ago and so many people, they're feeling the same thing," says Crow, 46, who has been on and off drugs for almost half of his life.
"This place has connected with people in this community."

What has saved Crow, and others like him, is a supervised injection facility known as Insite, where addicts can receive care from nurses and health professionals.

The injection site, the first and only one of its kind in North America, opened four years ago this month under much fanfare and support from all levels of government.

But while Vancouver and the provincial government still back the project, there are
rising concerns that Ottawa may pull its support.

The previous Liberal government granted an exemption under Section 56 of the Controlled Drugs and Substances Act that allows users to shoot up inside the facility without fear of being arrested.

When the exemption was about to expire last September, federal Health Minister Tony Clement granted a last-minute reprieve. But instead of approving the request for another three-and-a-half years, he gave an extension until only Dec. 31, 2007.

Until a decision is made, additional research is being conducted on the effectiveness of the site, and all available research will be taken into consideration when making a decision as to whether the exemption will be renewed, a spokesperson for Clement said.

Dr. Thomas Kerr, a scientist at the B.C. Centre for Excellence in HIV/AIDS, said there have been more than 25 peer-reviewed research papers published in some of the best medical journals in the world, including The Lancet and New England Journal of Medicine.

"It has shown that there has not been a harmful effect and yet we still have a government that is ideologically opposed," says Kerr.

"Minister Clement can honour the weight of the scientific evidence and recognize that there's been a number of public health and public order benefits, or he can make a decision based on ideology."

In August, a community group in Vancouver launched a volunteer-driven organization to gather signatures and letters from supporters and have been faxing the minister's office in Ottawa daily.

Nathan Allen, a co-ordinator for Insite for Community Safety, says the 4,000 letters will be boxed up and sent to the health minister next month in the hope that the stories will be enough to convince Ottawa to keep the site going.

In one handwritten letter, a user recounted the names of all the people she believes would have been saved had the facility opened earlier.

In another letter addressed to the Prime Minister, someone wrote to say the site has kept the streets cleaner and reduced the number of dropped syringes in the alleyways.

In addition to public pressure, lawsuits have been launched to force the government to keep the site open. The Vancouver Area Network of Drug Users filed an action in B.C. Supreme Court this summer against the federal government seeking a court-ordered exemption to enable Insite to stay open beyond the Dec. 31 extension date.

In another suit, two addicts, Dean Wilson, 51, and Shelley Tomic, 39, who are regular heroin users, claim that if the government doesn't provide the exemption, it will deprive them of their constitutional rights and their pursuit of "life, liberty and security."

Lawyer Monique Pongracic-Speier, who is representing the two claimants, said the suit claims that Wilson and Tomic's constitutional rights will be violated if the federal government shuts down the site. At some point, the lawsuits will probably merge, Pongracic-Speier said.

The government has responded to the lawsuits saying they are without merit.

If the lawsuits and the public pressure fail, a third option has emerged in recent weeks – cutting the federal government out of the facility and running it without support from Ottawa. The federal government funds research for the injection site, but it does not provide direct funding, which comes from the city and province.

Liberal Senator Larry Campbell, the former Vancouver mayor who opened the site in 2003, says he doesn't believe permission is needed from the government.

"I will keep it going and there are lots of people who won't let them shut this health-care facility down," he says.

"This is one of the few peaceful places in the Downtown Eastside and people's lives are being saved in that place. So there's no doubt in my mind that we will keep it open whatever way we can."

Vancouver Mayor to use Olympics lobby for a commitment to InSite

From canadaeast.com:

Vancouver mayor wants Ottawa to beef up Olympic security budget

Camille Bains, THE CANADIAN PRESS
Published Saturday December 1st, 2007

VANCOUVER - Vancouver Mayor Sam Sullivan is heading to Ottawa to ask for a beefed-up security budget for the 2010 Olympics that would include money for areas outside more high-profile zones.

Sullivan said Saturday that areas called the "Olympic domain", which will include the athletes' village and some sites for medal ceremonies, will be secured by the RCMP, but surrounding areas to be policed by municipal forces also need major protection.

"We do want to stress that security concerns for the Olympics go beyond the Olympic domain,"said Sullivan, who will leave for Ottawa on Sunday to meet with several MPs, including federal Finance Minister Jim Flaherty.

"I'd like to make the case that the municipal police forces should not be unduly taxed to handle what seems to me is clearly Olympic-related security," Sullivan said.
He said he doesn't have a figure in mind when it comes to how much money is needed for more security at the Games.

The RCMP said in an internal report leaked to the media in July that the $175-million security budget the Mounties have for the Olympics is not enough.

Sullivan said his trip to Ottawa will also include applying for $10 million in funding to construct two downtown Vancouver plazas where the public could participate in cultural events and watch various Olympic events on a big screen. He said he was in Torino for that city's 2006 Games, which included such a venue.

"You'd hear the whole crowd gasp (with) oohs and ahs as they would watch the skiing. It was a really great way for the whole community to participate in what was happening."

Sullivan said his trip to Ottawa will also include discussions with Health Minister Tony Clement about the federal anti-drug strategy and innovative treatment options for Vancouver.

He said he will speak to Clement about the need to keep North America's only safe-injection site open for drug addicts.

The facility, called Insite, began operating in 2003 and is funded by the B.C. government.

It allows people to inject their own drugs under medical supervision as a way to reduce harm connected to drug use.

But the federal government hasn't committed to keeping it open permanently, saying more research is needed into how such sites affect prevention, treatment and crime.

Last month, Ottawa gave Insite another six-month reprieve, meaning it can keep its doors open until next June under an exemption from Canada's drug laws.

"We're hoping to get a significant commitment to Vancouver's drug-addiction problems," Sullivan said. [emphasis added]

Sullivan is also to pay a visit to Toronto, where a spokesman for the mayor says he will speak to the Hong Kong-Canada Business Association on using the Olympics as a catalyst for social and economic change.

Huh. "Harm reduction saves lives" Good line. Where'd they get that idea??

You'd think the Liberals could do a bit better than this... A case of too little too late given their lack of action when actually in power. Hopefully, it is just the beginning of their action on this issue.

From the "24 Hours" free paper, Dec 2nd

Liberals' InSite mail-out panned
By BILL TIELEMAN, 24 HOURS

A federal Liberal Party mailing from leader Stephane Dion into a Vancouver riding about the controversial InSite safe drug injection site is under attack as "fear mongering" by the Conservatives, while the New Democratic Party calls it a "waste."
And the mailing, which misspells the word "minister" in referring to Prime Minister Stephen Harper, is a "rush job" and "confusing," say the two parties.

The November mailing to thousands of households in NDP Member of Parliament Libby Davies' Vancouver East riding accuses the Conservative federal government of "dithering" on renewing InSite's mandate and says "harm reduction saves lives."

But Davies says the Liberals' mailing is ironic.

"I wish they'd done a lot more on harm reduction when they were in government but they don't talk about that," Davies said in an interview, calling it a "waste."

Conservative Party spokesperson Ryan Sparrow said the Liberal mailing strategy is "confusing" and rejected its points.

"We've long been the party that delivers initiatives rather than fear mongering," he said from Ottawa.

But Liberal Party Communications Director Elizabeth Whiting told 24 hours from Ottawa that InSite is a "major issue" worthy of mailing on. Whiting said MPs can mail up to 10 per cent of a non- incumbent riding with their message, paid out of their House of Commons budget, not the party's.

InSite recently got a six-month extension to continue operating until June 2008.

Nov 26 Rally

Yesterday's leaflet:
.
On the front (in both French and English) :
.
"$ 2 million tax dollars already spent evaluating Vancouver's Supervised Injection Site. Why spend more public money trying to prove the Earth is flat? Keep Insite saving lives."
.
On the back (in both French and English):

"Canadian taxpayers have paid more than $2 Million for an extensive scientific evaluation of Vancouver's Supervised Injection Site.
.
25 research papers published in medical journals have concluded that Insite:
*prevents drug overdose deaths
*reduces the spread of HIV/AIDS and Hepatitis C
*increases access to detox and addiction treatment
.
More than 1, 000, 000 injections have taken place under the supervision of Insite nurses-- that's 1, 000, 000 injections that did not take place in streets or alleys.Why spend more trying to prove the Earth is flat?
.
Tell Stephen Harper to do the right thing--stop wasting tax dollars on more academic studies and base decisions on accepted scientific fact, not ideology.The evidence is in. The world is round and Insite saves lives.www.communityinsite.ca"



The eye-catcher was a big (like 8 feet in diametre) flat earth complete with dinosaurs, dragons and mermaidens. This was made by a local artist who donated his time. The volcano had dry ice that smoldered all afternoon. We also set up the easels and posters that we had to forgo from the other day (due to snow). Still a bit windy, but attention getters just the same.



.

One of our main problems on the day was the proximity of us to daily-protester, "Anti-everything guy" (abortion, same-sex marriage, anything he deems ungodly) with a flat earth was a pretty quick leap for most people who assumed we were together.


MP of the day was Paul Dewar (NDP, Ottawa Centre). Unfortunately, I didn't get a picture, and he didn't get a chance to talk to Nathan from InSite for Community Safety as Nathan was being monopolized (strategically?) by some anti-harm reduction guys.

.













Despite the lack of people (5-6 at any given time), we still drew attention and were able to talk to alot of people. My strategy (to create a buffer between us and anti-everything guy) was to let people get their bearings and then as they headed down the walk let them take in the leaflet and posters then tell them why we were there and did they have any questions.
.
Most disheartening response of the day (and this from a government employee):
Her: We shouldn't have people like that in our society.
Me: What do you propose we do?
Her: I don't care.
Me: Well, that's a pretty unsophisticated response.
Her: (indignant, so she cared that I called her response unsophisticated...): We shouldn't have people like that in our society...
At this point her companion broke in and pointed out that one of our French words was spelt in correctly and we were at the stairs.

.

My most heartening responses of the day (and these out numbered the negative for me, although one volunteer gave up in frustration):
.
"You're preaching to the converted!" and "We're from SanFrancisco, I hope we open one there!"

I hope you do too.

Evidence shows the Earth's not flat! Evidence shows harm reduction works!

Rally on the Hill to Support InSite, Vancouver's safe injection site

Insite for Community Safety (http://www.communityinsite.ca/)

Monday, November 26, 2007
12:00am - 4:00pm
Parliament Hill, eternal flame fountain
Wellington Street, Ottawa, ON

Rally and information distribution, physical presence on the Hill to show MPs that Canadians support InSite and harm reduction initiatives.

Imagine:

A large sculpture of a flat earth on the main walk of Parliament Hill.

*Let MPs know that evidence shows the Earth's not flat.

**25 peer reviewed journal articles and 2million dollars invested in research show that InSite's harm reduction initiatives work.

Your job: Hand out 2 million dollar bills with Stephen Harper's face on 'em (the amount of research dollars that have been invested in InSite to date) & invite others. That's it.

When: Monday November 26, 2007 8.00 am onwards
**trying to have a mass of people before question period beginning at 2.15 pm**

Nathan Allen, resident of the Downtown Eastside of Vancouver, and the Campaign Coordinator of 'InSite for Community Safety' (www.communityinsite.ca) is in Ottawa this week to raise awareness for Insite, Vancouver's safe injection site. InSite for Community Safety is a broad-based community coalition of individuals and groups from across the political spectrum, working to ensure InSite continues to save lives.

Rally Pics from Nov 19th

InSite for Community Safety campaign co-ordinator, Nathan Allen is in town this week and has been organizing rallies on Parliament Hill. The first one was held in the morning of Tues, Nov 19th.








About 30 volunteers showed up over the course of the morning and assembled giant photos of current users of the InSite facility at various stages over their lives. Volunteers handed out leaflets of the same photos to MPs and civil servants as they headed to centre block for caucus meetings. Beneath the photos on the leaflets were the taglines: "Insite Saves Them. Insite Saves Lives" and "Before they were 'junkies, they were kids"

Also in attendance were Burnaby Douglas MP Bill Siksay and Vancouver East MP Libby Davies (pictured left with Nathan Allen).

Big Events this week

Action on Parliament Hill for

InSite, Vancouver's Safe Injection Site
Come and tell the MP's that InSite saves lives.

That addicts don't live "short, miserable lives" (Stephen Harper, Oct 2007)

Where: Parliament Hill

What: Vigil and information distribution, physical presence on the Hill to show MPs that Canadians support InSite and harm reduction initiatives.

Imagine: 20 big banners of faces, faces of InSite clients in various stages of their lives.

Your job: Hand out pamphlets &/or invite others. That's it.

When: Wednesday November 21, 2007 8.00 am onwards **trying to have a mass of people between 8:30am and 10:00am**

Nathan Allen, resident of the Downtown Eastside of Vancouver, and the Campaign Coordinator of 'InSite for Community Safety' (www.communityinsite.ca) is in Ottawa this week to raise awareness for Insite, Vancouver's safe injection site. InSite for Community Safety is a broad-based community coalition of individuals and groups from across the political spectrum, working to ensure InSite continues to save lives.

ALSO:

The Alliance to End Homelessness
2007 Community Forum on Homelessness

LINKING NATIONAL RESEARCH WITH OTTAWA ACTION AND POLICY
IN HONOUR OF NATIONAL HOUSING DAY, THURSDAY, NOVEMBER 22, 2007
Location: University of Ottawa, Tabaret Hall Chapel, 75 Laurier, 1st Floor
Time: 9:00 am–3:30 pm ~ Registration Free ~ Lunch Provided

FEATURING OUR SPECIAL GUESTS
The Research Alliance for Canadian Homelessness, Housing, and Health (REACH 3), a collaborative interdisciplinary network of academic investigators and community partners in Ottawa, Vancouver, Calgary, Toronto, and Montreal.

PRELIMINARY PROGRAM
MORNING PLENARY RESEARCH PANELS
Housing Solutions
MODERATED BY AN OTTAWA REACH3 MEMBER

PANEL MEMBERS

Liz Evans, BScN, Portland Hotel Society, Vancouver
– on innovative housing programs that have been created in Vancouver.

Stephen Hwang, MD, MPH, St.-Michaels Hospital, Toronto
– on policy and program implications of some of their research

Lorraine Bentley, MA, Executive Director, Options Bytown, Ottawa
– reacting with implications for the housing situation in Ottawa.

Resident, Options Bytown, Ottawa
– providing a personal perspective on their housing difficulties in Ottawa

Youth Can Move Forward

MODERATED BY AN OTTAWA REACH3 MEMBER

PANEL MEMBERS
Elise Roy, MD, MSc, Université de Sherbrooke
– Montreal Street Youth

Bruce MacLaurin, MSW, PhD (Cand.), University of Calgary
– Calgary Street Youth

Catherine Worthington, MSc, PhD, University of Calgary
– Calgary Street Youth

Andrea Poncia, Youth Services Bureau of Ottawa
– HIV/AIDS Educator

An Ottawa youth community member
– commenting on the findings and their own experience

INFORMAL LUNCH & NETWORKING CAUCUSES — A 1½ hour opportunity to share ideas from Ottawa and ask more questions of REACH3 members.

Select your lunch then join one of the LUNCH CAUCUSES, focusing on a variety of topics, facilitated by Ottawa’s Alliance to End Homelessness members.

AFTERNOON PLENARY SESSION
The good, bad and ugly – the InSite Experience
The "how" behind linking community agencies and researchers

LED BY SARAH EVANS, LIZ EVANS AND ANITA HUBLEY

A session describing how the community and the academic's worked together on InSite, Vancouver’s legal supervised injection site.

Hear about the good, bad and ugly parts of the experience when the private, public and not-for-profit sectors, come together locally, nationally and internationally.

CLOSING ACTIVITY
WALK FOR HOUSING
Taking the need for a National Housing Program out to the community!

ALL DAY – SPECIAL EXHIBIT
A Sound & Photo Installation
Street Health Stories
How do you take care of your health when you don’t have a home?
8 Street Health Stories in large lightbox prints with headphones
The National Film Board of Canada’s Filmmaker-in-Residence presents the Street Health Stories installation which gives a human face and voice to Street Health’s statistics.
Four photographers who have experienced homelessness ~ Adrienne, Jess, Keneisha, and Meghan document the stories of 28 homeless men and women through audio recordings and portrait-photography. Katerina Cizek, a documentary-maker and the National Film Board of Canada’s Filmmaker-in-Residence at an inner-city hospital, teaming up with partners at the frontlines – doctors, nurses and patients – to create collaborative media.

CNN article that is skinny on the sensationalism...

...apart from the "watch people shoot up" link that I've left in tact (the tag is sensational, not the link itself which I encourage you to watch).

Big kudos to Lorraine Trepanier for appearing in this news peice.

I've also emphasized an import bit of demographic info that is often missed in news reports about Insite--that not all of the people using the facility are homeless and far from the Prime Minister Harper's assertion that they are living "short, miserable lives". Even this report blurs the mixed demographics by opening with the stereotyped description of tattered clothes, missing teeth, etc. and then burying the observation of older and wealthier people using the facility waaaay down in the story.


Health clinic helps addicts shoot up

By Adam ReissCNN

VANCOUVER, British Columbia (CNN) -- I didn't know quite what to expect when I entered the injection room at Insite, the world's busiest supervised drug clinic.

Similar clinics can be found at 65 locations in eight different countries.

Inside the Vancouver facility, I found more than a dozen people taking illegal drugs, such as heroin and cocaine, under the watchful eye of trained nurses. These drug users were among the more than 700 people who visit the facility every day, bringing their drugs with them.
Insite's goal is to reduce the risk of overdose and limit the spread of diseases like HIV by giving addicts clean needles and a safe place to use them.

"People need to be kept alive long enough in order to get treatment," said Liz Evans, a nurse and founder of Insite.

The clinic, which is sanctioned by Vancouver's health department, opens each day at 10 a.m. and stays open until 4 a.m. the following day. Many of the people in the clinic on the day we visited had tattered clothes, missing teeth and glassy eyes. They swayed as they struggled to keep their balance. Watch people shoot up in the Vancouver clinic »

Outside of the clinic, police patrolled the streets to keep people from buying and selling illegal drugs. Inside, patrons were given access to Insite's clean needles, injection booths and nurses. Similar facilities can be found at 65 locations in eight different countries.

San Francisco health officials recently held a day-long conference on the Vancouver drug clinic, with an eye toward possibly opening a similar one. But San Francisco Mayor Gavin Newsom said the city is unlikely to do so.

"You had a lot of health officials there that did participate in the pros and cons. But my director of the department of public health doesn't feel the city should move forward," Newsom said.
Defenders of the Vancouver clinic say more than two dozen peer-reviewed studies have shown its benefits. One study found a 45 percent reduction in public drug use as a result of the clinic; another showed 33 percent of addicts are more likely to go to detox after using Insite.
Dr. Thomas Kerr, a University of British Columbia research scientist who has studied the program, believes Insite benefits the wider community.

"In the absence of such a facility, not only would [drug users] be high out on the street, but they would be leaving their syringes in school yards, in parks and on city streets," Kerr said.

Dr. David Murray, chief scientist for the White House Office of National Drug Control Policy, opposes opening drug injection clinics in the United States. He believes they do little to help addicts overcome their additions.

"It is a cruel illusion because they are still addicted, trapped, trying to get out and dying by the virtue of the drug itself," he said.

Nurses at the Vancouver clinic say they get all kinds of people using their facility, from an old grandma who comes to inject her pain medication to men in business suits hiding their addictions from their families. [emphasis added]

At the clinic, we met Lorraine Trepanier, 50, a longtime drug user. Trepanier said she used to sell her body for drugs, but now relies on a friend to give her the $20 she uses every day to buy cocaine and heroin.

"I get up in the morning and I make sure I have one down or half a down," she said, referring to her heroin fix. Trepanier believes Insite has helped keep her alive by giving her a supervised setting in which she can take drugs.

Evans and other operators of Insite say that rather than chase addicts from corner to corner and alley to alley, it is more effective to encourage them to use their drugs in a supervised setting.

In the more than four years Insite has been open, there have been roughly 800 overdoses at the facility, but there have not been any deaths. When someone does overdose, nurses try to revive them. If the drug user is in critical condition, they are sent to a hospital.

Trepanier doesn't care what critics have to say about Insite. All she wants is a chance to get her next fix in a clean facility, until the day she finally works up the willpower to kick her addition.

"I don't want to be down here all my life," she said. "I don't want to be chasing this all my life."

Editorial from the McGill Tribune

http://www.mcgilltribune.com/

EDITORIAL: Needles in a political haystack
Issue date: 10/23/07

Political opposition to drug harm reduction centres is nothing new. Insite-a supervised injection site located in the downtown eastside of Vancouver has encountered nothing but disdain from Stephen Harper's federal government, while the UN's International Narcotics Control Board routinely condemns various harm reduction centres abroad for violating international treaties concerning narcotic drugs.

The U.S. government has also been an outspoken global critic of harm reduction projects that provide legal exemptions for drug use ever since Richard Nixon coined the term "war on drugs." Therefore, it should come as no surprise that early efforts by the San Francisco Department of Public Health to open America's first legal safe-injection site have been met by political
stonewalling and moral indignation.

The scientific evidence supporting supervised injection sites is overwhelmingly positive. Insite, the only facility of its kind in North America, has been the subject of over a dozen studies conducted by the BC Centre for Excellence in HIV/AIDS, none of which have uncovered a single negative effect of the SIS. Furthermore some of the positive effects revealed in their
peer-reviewed research are extremely encouraging: Insite has reduced the overall rate of needle sharing in the area, led to increased enrollment in detox programs and has not led to an increase in drug-related crime or intravenous drug usage.

Nurses at Insite provide care for wounds, supply users with sterile drug paraphernalia and educate users about sanitary practices that cut down on the spread of HIV and Hepatitis C. They are also on-hand for any overdoses-of which there have been over 800 at Insite. Thanks to prompt medical care, not a single overdose at the facility has resulted in a fatality and, not coincidentally, emergency room visits for intravenous drug users are down dramatically.
Unnecessary hospital visits are prevented by simple care at an SIS, saving tax-payers money and cutting waitlists at emergency rooms.

Perhaps most importantly, safe-injection sites put drug users in close contact with social workers. In fact, a recent study showed that intravenous drug users were 20 per cent more likely to enrol in a detox program after using Insite on a regular basis. The power of personal contact, something that is almost impossible to establish when dealing with users in back-alleys, is undeniable.

An SIS in the downtown eastside of Vancouver was an crucial step towards improving the community. It is estimated that the area is home to over 1,500 homeless people, as well as thousands of others living well below the poverty line. The percentage of HIV-positive men and women in the community parallels that of many third-world countries.

San Francisco has similar problems, with estimates of intravenous drug users in the city ranging from 11,000 to 15,000 people. For them, the old methods of enforcement are not working. In fact, a study published in the International Journal of Drug Study concluded that street-level arrests and confiscations only serve to exacerbate drug-related crime and prompt increased
needle sharing.

The Harm Reduction Centre here on campus is based on much of the same ideology. The centre, which became a Students' Society Service in November of last year, aims to educate students on safe alcohol and drug use and bridge the disconnect between the average student and the officials that preach on the evils of drugs. Quebec pharmacy Jean Coutu offers a kit of inexpensive needles and condoms in order to prevent the spread of disease and facilitate safe drug use and sex for low-income individuals.Yet most politicians still believe "The war on drugs" is the answer and refuse to use the formidable powers of government to offer such harm reducing services.

Ideologically it's easy to see why they have a knee-jerk reaction to anything that might seem to make drug use easier, but what they fail to realize is that supervised injection sites don't condone or legitimize drug use at all. The facts show that facilities such as Insite do not increase drug use in the community, nor cause additional relapses. The staff at safe-injection sites work
to save users' lives, while idealistic politicians stick their heads in the sand and pretend drug-busts, harsher jail sentences and preventative campaigns will rid society of the problem. They refuse to see the reality that prohibition and punishment will never completely eradicate drug use from the general population.

This sad state of affairs among our politicians was revealed, yet again, earlier this year, when Harper's government denied Vancouver Coastal Health's request for a three-year extension to Insite's operating exemption. Instead, Insite was granted an additional six months to "gather more proof of its effectiveness." Harper commented that he was "sceptical" about Insite's value,
despite the favourable studies published in over a dozen reputable medical journals such as the Lancet and the New England Journal of Medicine.

Supervised injection sites are not the be-all, end-all solution to the problem of drug usage, but rather, they are an important tool in the battle against intravenous drugs. They cost a measly $2-millon per year to operate, which is pocket-change compared to the millions spent on enforcement and education. Some object to them on moral or philosophical grounds; but the
science behind them is sound, and when morality and pragmatism meet, pragmatism should always triumph.The bottom line is that programs like Insite work.

If Mr. Harper and the politicians in California believe otherwise, then they must be high on something.

Nurses to Supervise Heroin, Cocaine Injections

Here's an article I got over at nurselink about the proposal to start a safe injection site in San Francisco. My response on the site is also reposted here below the news article. Head on over to nursingling to check out all of the naysayers too.

ASSOCIATED PRESS Oct 19, 2007
City health officials took steps Thursday toward opening the nation’s first legal safe-injection room, where addicts could shoot up heroin, cocaine and other drugs under the supervision of nurses.

Hoping to reduce San Francisco’s high rate of fatal drug overdoses, the public health department co-sponsored a symposium on the only such facility in North America, a four-year-old Vancouver site where an estimated 700 intravenous users a day self-administer narcotics under the supervision of nurses.

“Having the conversation today will help us figure out whether this is a way to reduce the harms and improve the health of our community,” said Grant Colfax, director of HIV prevention for the San Francisco Department of Public Health.

Organizers of the daylong forum, which also included a coalition of nonprofit health and social-service groups, acknowledge that it could take years to get an injection center up and running. Along with legal hurdles at the state and federal level, such an effort would be almost sure to face political opposition.

Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, called San Francisco’s consideration of such a facility “disconcerting” and “poor public policy.”

“The underlying philosophy is, ‘We accept drug addiction, we accept the state of affairs as acceptable,’” Madras said. “This is a form of giving up.”

Sixty-five similar facilities exist in 27 cities in eight countries, but no other U.S. cities have considered creating one, according to Hilary McQuie, Western director for the Harm Reduction Coalition, a nonprofit that promotes alternative drug treatment methods.

“If it happens anywhere in the U.S., it will most likely start in San Francisco,” McQuie said. “It really just depends on if there is a political will here. How long it takes for that political will to develop is the main factor.”

Drug overdoses represented about one of every seven emergency calls handled by city paramedics between July 2006 and July 2007, according to San Francisco Fire Department Capt. Niels Tangherlini. At the same time, the number of deaths linked to overdoses has declined from a high of about 160 in 1995 to 40 in 2004, he said.

Colfax estimated that there are between 11,000 and 15,000 intravenous drug users in San Francisco, most of them homeless men. Like many large U.S. cities, the city operates a clean-needle exchange program to reduce HIV and hepatitis C infections.

Advocates plan to work on building community support for a safe-injection center, including backing from Mayor Gavin Newsom and the Board of Supervisors.

The mayor’s spokesman, Nathan Ballard, said Thursday that although he does not want to discourage debate, he “is not inclined to support this program because, quite frankly, it may create more problems than it supposedly addresses.”

In Switzerland, Spain and other European countries with such programs, the sites have been placed in existing public health clinics and created as stand-alone centers, said Andrew Reynolds, a program coordinator with San Francisco’s city-run sexually transmitted diseases clinic.

Possible locations for opening one in the city include homeless shelters, AIDS clinics or drug treatment centers, he said.

“They aren’t these hedonistic dens of iniquity,” Reynolds said. “There is no buying or selling of drugs on the premises. Staff do not assist in injections.”

While it’s too early to tell what the room in San Francisco would look like, Vancouver’s InSite program is on the upper floor of a low-rise building in a downtown neighborhood where drug users shoot up in the open.

The site, exempt from federal drug laws so users can visit without fear of arrest, has 12 private booths where addicts inject drugs such as heroin, cocaine or crystal. They can use equipment and techniques provided by the staff, and then relax with a cup of coffee or get medical attention in the “chill out” room where they are observed, said program coordinator Sarah
Evans.

“It looks kind of like a hair salon,” Evans said of the bustling space. “If we were a restaurant, we would be making a profit.”

While 800 overdoses have occurred on the premises, none resulted in death because of the medical supervision provided at InSite, said Thomas Kerr, a University of British Columbia researcher who has extensively studied the program. His research also has shown an increase in addicts seeking drug treatment and a decrease in abandoned syringes, needle-sharing, drug-related crime and other problems since the clinic opened, he said.

The results indicate the idea is worth replicating, despite the criticism it may attract, Kerr said. “I prefer the approach of the Vancouver Police Department, which was: ‘We don’t like the idea of this, but let’s look at the evidence and at the end of three years we will tell you either this
is something we can support or it’s something we can’t support,’” he said.

Temple University law professor Scott Burris told the audience at Thursday’s forum that a supervised injection room would seem to run afoul of federal drug possession laws and a state statute that makes it illegal to operate a crack house or any place where drugs are used, but only if the police and federal agents enforce them.

He cited as an example California’s medical marijuana law, which has allowed pot dispensaries to flourish but at the risk of being raided by federal authorities.

“The law isn’t a barrier,” Burris said. “The issue of whether it’s legal doesn’t come up until somebody is arrested.”

My response:
There are so many reasons that this is a good idea: The first point of contact for many street-living addicts is the ER, either for an overdose or an infected abcess. Both of these are costly to the taxpayer/HMO system. If nurses can catch infections early, teach people how to inject safely, spread the word about the necessity of clean needles and clean water AND save the system money AND direct people to resources & services AND direct them to treatment, AND save their lives then the "it's illegal" argument falls a bit flat in the face of that.

It's still illegal outside of the clinic environment. By entering the clinic the user has made an
(either overt or tacit) agreement to use clean gear & stick around afterwards (at least that's the arrangement at the Vancouver InSite). Chronic drug users no longer get high from heroin or
cocaine, they need the drugs simply to remain functional and not go into withdrawl. Users then can get information on treatment programs or be put in contact with other resources while in a frame of mind where they can actually take the information in rather than while they are "jonesing" for a hit.

Just in case anyone envisoning addicts to be "merely" the homeless (although they're the ones to benefit most from this type of frontline care), 13.1% of employed Americans in 1999 were substance abusers and it's suspected that 10% of the nursing population of the US uses drugs and/or alcohol, 6-8% to the point of impairing their clinical judgement (Dunn, Substance Abuse Among Nurses, AORN Journal, Oct 2005)

Apologies, and an update (finally)

**See my post on letter writing tips in the Feb 2007 archive**

**See my post on who's who in the cabinet from the Aug 2006 archive but be careful, the cabinet has shuffled since then**

**See my fact sheet on Insite in the Aug 2006 archive**

I've been pretty remiss about posting on this blog. My apologies.

You know what finally kicked me back into gear on this issue? The recent trite remarks by the Minister of Health, Tony Clement, that "The party is over" and the simplistic and judgemental remarks of the Prime Minister, Stephen Harper about addict's "...short, miserable lives".

These, combined with a new anti-drug policy that's long on enforcement and fire & brimstone scare tactics, and short on evidence based harms-reduction strategies that actually lead to recovery and treatment for addicts.

I find it hard to believe --despite the significant chunk of the $63.8 million allocated to treatment in the get tough on drug policy announced last week-- that the government hasn't already written off addicts' "short & miserable lives" as dead in the water.

I am deeply disturbed that the Prime Minister can write off the lives of Canadians in this manner.

There is quite an avalanche of new postings here with little or no commentary--basically the opposite of how I originally invisioned this blog.

However, it remains, I think, a good repository of relevant information so that interested people can gather the necessary information to write letters to their MP or to the editors of student, local or national newspapers about Insite in particular and harms reduction in general.

From the sounds of the Speech from the Throne last night and the reactions to it today, it sounds like Canadians will be heading to the polls sooner rather than later.

Don't let harms reduction fall away as an important health care issue.

Don't let the conservatives ignore the harms reduction & treatment pillars of the 4 pillars strategy in overwhelming favour of the enforcement & prevention pillars.

Write to your MP, ask for a balanced approach for Canada: Enforcement and Prevention, yes but in conjunction with --not to the exclusion of-- Treatment and Harms Reduction

**See my post on letter writing tips in the Feb 2007 archive**
**See my post on who's who in the cabinet from the Aug 2006 archive but be careful, the cabinet has shuffled since then**
**See my fact sheet on Insite in the Aug 2006 archive**

In the Ottawa area: Community Forum on Homelessness with Plenary session by Sarah Evans, Liz Evans & Anita Hubley on Insite

The Alliance to End Homelessness
INVITATION TO REGISTER
2007 Community Forum on Homelessness

LINKING NATIONAL RESEARCH WITH OTTAWA ACTION AND POLICY
IN HONOUR OF NATIONAL HOUSING DAY, THURSDAY, NOVEMBER 22, 2007
Location: University of Ottawa, Tabaret Hall Chapel, 75 Laurier, 1st Floor
Time: 9:00 am–3:30 pm ~ Registration Free ~ Lunch Provided
~ Please Email Registration Form

download from http://www.endhomelessnessottawa.ca/events/2007CommunityForumonHomelessness.cfm

FEATURING OUR SPECIAL GUESTS
The Research Alliance for Canadian Homelessness, Housing, and Health (REACH 3), a collaborative interdisciplinary network of academic investigators and community partners in Ottawa, Vancouver, Calgary, Toronto, and Montreal.

PRELIMINARY PROGRAM
MORNING PLENARY RESEARCH PANELS
Housing Solutions

MODERATED BY AN OTTAWA REACH3 MEMBER

• PANEL MEMBERS
  Liz Evans, BScN, Portland Hotel Society, Vancouver
  – on innovative housing programs that have been created in Vancouver.
  Stephen Hwang, MD, MPH, St.-Michaels Hospital, Toronto
  – on policy and program implications of some of their research
  Lorraine Bentley, MA, Executive Director, Options Bytown, Ottawa
  – reacting with implications for the housing situation in Ottawa.
  Resident, Options Bytown, Ottawa
  – providing a personal perspective on their housing difficulties in Ottawa
  Youth Can Move Forward
• MODERATED BY AN OTTAWA REACH3 MEMBER
  PANEL MEMBERS
  Elise Roy, MD, MSc, Université de Sherbrooke
  – Montreal Street Youth
  Bruce MacLaurin, MSW, PhD (Cand.), University of Calgary
  – Calgary Street Youth
  Catherine Worthington, MSc, PhD, University of Calgary
  – Calgary Street Youth
  Andrea Poncia, Youth Services Bureau of Ottawa
  – HIV/AIDS Educator
  An Ottawa youth community member
  – commenting on the findings and their own experience
  
• INFORMAL LUNCH & NETWORKING CAUCUSES — A 1½ hour opportunity to share ideas from Ottawa and ask more questions of REACH3 members.
  Select your lunch then join one of the LUNCH CAUCUSES, focusing on a variety of topics, facilitated by Ottawa’s Alliance to End Homelessness members.
  
• AFTERNOON PLENARY SESSION
  The good, bad and ugly – the InSite Experience
  The "how" behind linking community agencies and researchers
  LED BY SARAH EVANS, LIZ EVANS AND ANITA HUBLEY
  A session describing how the community and the academic's worked together on InSite, Vancouver’s legal supervised injection site.
  Hear about the good, bad and ugly parts of the experience when the private, public and not-for-profit sectors, come together locally, nationally and internationally.
  
• CLOSING ACTIVITY
  WALK FOR HOUSING
  Taking the need for a National Housing Program out to the community!
  
• ALL DAY – SPECIAL EXHIBIT
  A Sound & Photo Installation
  Street Health Stories
  How do you take care of your health when you don’t have a home?
  8 Street Health Stories in large lightbox prints with headphones
  The National Film Board of Canada’s Filmmaker-in-Residence presents the Street Health Stories installation which gives a human face and voice to Street Health’s statistics.
  Four photographers who have experienced homelessness ~ Adrienne, Jess, Keneisha, and Meghan document the stories of 28 homeless men and women through audio recordings and portrait-photography. Katerina Cizek, a documentary-maker and the National Film Board of Canada’s Filmmaker-in-Residence at an inner-city hospital, teaming up with partners at the frontlines – doctors, nurses and patients – to create collaborative media.
  We gratefully acknowledge support from our Alliance to End Homelessness Members, United Way/Centraide Ottawa, the University of Ottawa & the Homelessness Partnering Strategy, Government of Canada.

The drug problem: Europe tolerance vs. U.S. criminalization

The drug problem: Europe tolerance vs. U.S. criminalization
RICK STEVES
918 words
16 October 2007
Guelph Mercury
Final
A9
English
Copyright (c) 2007 Guelph Mercury.

Europe has a drug problem, and knows it. But the Europeans' approach to it is quite different from the American "war on drugs." I spend 120 days a year in Europe as a travel writer, so I decided to see for myself how it's working. I talked with locals, researched European drug policies and even visited a smoky marijuana "coffee shop" in Amsterdam. I got a close look at the alternative to a war on drugs.

Europeans are well aware of the U.S. track record against illegal drug use. Since U.S. president Richard Nixon first declared the war on drugs in 1971, the United States has locked up millions of its citizens and spent hundreds of billions of dollars (many claim that if incarceration costs are figured in, a trillion dollars) waging this "war." Despite these efforts, U.S. government figures show the overall rate of illicit drug use has remained about the same.

By contrast, according to the 2007 UN World Drug Report, the percentage of Europeans who use illicit drugs is about half that of Americans. ( Europe also has fewer than half as many deaths from overdoses. ) How have they managed that -- in Europe, no less, which shocks some American sensibilities with its underage drinking, marijuana tolerance and heroin-friendly "needle parks"?

Recently, in Zurich, Switzerland, I walked into a public toilet that had only blue lights. Why? So junkies can't find their veins.

A short walk away, I saw a heroin maintenance clinic that gives junkies counselling, clean needles and a safe alternative to shooting up in the streets. Need a syringe? Cigarette machines have been retooled to sell clean, government-subsidized syringes.

While each European nation has its own drug laws and policies, they seem to share a pragmatic approach. They treat drug abuse not as a crime but as an illness . And they measure the effectiveness of their drug policy not in arrests but in harm reduction .

Generally, Europeans employ a three-pronged strategy of police, educators and doctors. Police zero in on dealers -- not users -- to limit the supply of drugs. Users often get off with a warning and are directed to get treatment. Anti-drug education programs warn people (especially young people) of the dangers of drugs, but they get beyond the "zero tolerance" and "three strikes" rhetoric that may sound good to voters but rings hollow with addicts and at-risk teens. And finally, the medical community steps in to battle health problems associated with drug use (especially HIV and hepatitis C) and help addicts get back their lives.

Contrast this approach with the American war on drugs. As during Prohibition in the 1930s, the United States spends its resources on police and prisons to lock up dealers and users alike. American drug education (such as the now-discredited DARE program) seemed like propaganda, and therefore its messengers lost credibility.

Perhaps the biggest difference between European and American drug policy is how each deals with marijuana. When I visited the Amsterdam coffee shop that openly sells pot, I sat and observed: People we re chatting; a female customer perused a fanciful array of "loaner" bongs. An older couple (who apparently didn't enjoy the edgy ambience) parked their bikes and dropped in for a baggie to go. An underage customer was shooed away. A policeman stepped inside, but only to post a warning about the latest danger from chemical drugs on the streets. In the Netherlands, it's cheaper to get high than drunk, and drug-related crimes are rare.
After 10 years of allowed recreational marijuana use, Dutch anti-drug abuse professionals agree that there has been no significant increase in pot smoking among young people and that overall cannabis use has increased only slightly. Meanwhile, in the United States, it's easier for a 15-year-old to buy marijuana than tobacco or alcohol -- because no one gets carded when buying something on the street.

The Netherlands' policies are the most liberal, but across Europe no one is locked away for discreetly smoking a joint. The priority is on reducing abuse of such hard drugs as heroin and cocaine. The only reference to marijuana I found among the pages of the European Union's drug policy was a reference to counselling for "problem cannabis use."

Meanwhile, according to FBI statistics, in recent years about 40 per cent of the roughly 80,000 annual drug arrests were for marijuana -- the majority (80 per cent) for possession.

In short, Europe is making sure that the cure isn't more costly than the problem.

While the United States spends tax dollars on police, courts and prisons, Europe spends its taxes on doctors, counselors and clinics. EU policymakers estimate that they save 15 euros in police and health costs for each euro invested in drug education and counselling.

European leaders understand that a society has a choice: tolerate alternative lifestyles or build more prisons. They've made their choice.

Rick Steves (ricksteves.com) writes European travel guidebooks and hosts travel shows on public television and radio. This commentary originally appeared in the Los Angeles Times.

From the San Francisco Chronicle

Drug injection center idea gets an airing in S.F.
C.W. Nevius
902 words
16 October 2007
The San Francisco Chronicle
5star
D.1
English
© 2007 Hearst Communications Inc., Hearst Newspapers Division. Provided by ProQuest Information and Learning. All Rights Reserved.

Two months ago I wrote about an idea for a place in San Francisco where intravenous drug users could shoot up under the supervision of trained personnel. A lot of people thought it sounded crazy.

Well, get ready to hear about it again, because the idea is gaining momentum.

On Thursday, an all-day symposium - co-hosted by the city Department of Public Health - will examine the idea of creating safe injection centers where users could bring their drugs, shoot up and leave, without fear of arrest.

The idea is to decrease overdoses, keep dirty needles off the street, and cut the risk of spreading HIV and hepatitis C. Those are all good things. It is the idea of providing addicts with their own injection clinic that riles people up.

"What's next?" a reader wrote when the first column appeared. "Giving them the drugs, too?"
No. But there's no doubt that if San Francisco ever established such a center, even as a pilot program, there would be an enormous brouhaha.

"It would be huge international news," said Peter Davidson, a researcher at UCSF in the epidemiology and biostatistics department. "It would be the first facility in the United States, and there would probably be a firestorm for a while."

You can count on that. The conservative radio talk show hosts are probably already jump-starting their tonsils. Wacky San Francisco, providing a party room for junkies.

Nor are public officials eager to jump on the bandwagon. Asked for a comment from Mayor Gavin Newsom, spokesman Nathan Ballard said, "The mayor is not inclined to support this approach, which quite frankly may end up creating more problems than it addresses."

Organizers of Thursday's conference are hardly surprised by that reaction.

"Down the road there will be a lot of strong feelings," said Hilary McQuie, Western director of the Harm Reduction Coalition, a national group that combats the adverse effects of drug use. It is organizing the event.

"It's a big topic, and we hope to start a conversation," McQuie said.

Oh, it'll start all right. But Barbara Garcia, the city's deputy public health director, asked where it will go. "We don't want to create a lot of backlash," she said.

San Francisco and the rest of the country may not be quite ready, but injection centers are
getting a lot attention in other parts of the world. Grant Colfax, director of HIV prevention for the city Public Health Department, says there are now 65 centers in eight countries.

In Vancouver, British Columbia, where an injection clinic opened in 2003, "the data ... seem to show that it is actually a benefit to the community," Colfax said.

Opening a shooting gallery benefits the community? How does that work? Well, Dr. Thomas Kerr, the University of British Columbia physician who has been involved with the Vancouver center since its inception, says it is having success treating addicts, even though they are coming to inject themselves.

"We published a paper in the New England Journal of Medicine that showed that we had a 33 percent increase in the use of detox facilities from our population," Kerr said.

But would the addicts actually use the center? McQuie says they have in other cities, and the reason may be something people don't ordinarily associate with drug users - fear.

"I think that a lot of injectors are very afraid of overdosing and dying," McQuie said. Many overdoses happen when users are alone, she said.

Then there is the question of what neighborhood would host an injection center. Davidson says he thinks the Tenderloin would be the logical place, noting that a 2003 survey in which he took part found that more than a third of the city's overdose deaths occurred within 100 yards of the intersection of Turk Street and Golden Gate Avenue.

McQuie says centers attract a certain type of user, probably one whose health is not the best and who is somewhat desperate.

"It's not for everybody," she said. "It's not the most fun place in the world."

Vancouver's center has small booths where users step in, inject and come out. With scrubbed floors and bright overhead lights, it is sterile in every sense of the word.

"They are really for the people (whose lives) are most chaotic," Kerr said. "Homeless people with mental problems who are likely to use public spaces to inject."

Exactly, in other words, those who have the worst effect on the neighborhood and community.
Ask Garcia. Not long ago she opened the front door of her house and found a man passed out on the stoop. She was able to call an ambulance in time, but he nearly died of an overdose.

"So," she says, "I am sympathetic to the dangers."

The rest of San Francisco should be, too. This is a problem that is on everyone's doorstep.

"The mayor is not inclined to support this (which) may end up creating more problems than it addresses." - Nathan Ballard,, spokesman

C.W. Nevius' column appears Tuesday, Thursday and Sunday. His blog, C.W. Nevius.blog, can be found at sfgate.com. E-mail him at cwnevius@sfchronicle.com.