Maybe we can punish the pushers

Maybe we can punish the pushers
Kelly Roesler
The Ottawa Citizen
901 words
16 October 2007
Ottawa Citizen
Final
A11
English
Copyright © 2007 Ottawa Citizen

'If you are addicted to drugs, we'll help you, and if you sell drugs, we'll punish you," Prime Minister Stephen Harper claimed recently in launching his drug strategy. The statement and the plan were met with a wave of derision from opposition parties, newspaper editorials and columns, and much of the general public, judging from an influx of letters to the editor.

There he goes again, they moaned, lamenting Harper's "ideological" decision to emphasize law enforcement as part of a multi-pronged strategy that includes treatment, education and prevention.

It seems Harper is being demonized for recognizing there are many drug dealers out there who don't suffer the debilitating effects of addiction, who are perpetuating the hugely profitable and pervasive drug market, and that it needs to be addressed.

But where is the rational discourse about law enforcement as a component of a comprehensive drug policy?

Before I am painted as a hard-right, ideological subscriber to the "law and order" philosophy, let me say this: I write as a passionate believer in harm reduction measures; in supervised injection sites, heroin prescriptions, dispensing of alcohol, even free crack kits. All of it.

As a young journalism student I was deeply moved by researching a story on the opening of Vancouver's Insite safe injection site. Simply put, I consider myself "progressive" on drug policy.
But "law" seems to have become a dirty word in our national discussion on drugs, and it shouldn't be. It's a vital piece of a greater plan that encompasses all players in the sad world of the drug trade. This includes addicts -- who need all the support, compassion, health and social supports we can offer -- and dealers, particularly high-level suppliers who drive the market, reap the profits, and especially those who, detached from drug addiction and operating from a business-like perspective, prey on the vulnerabilities of those who are addicted because it's easy.

I have seen this firsthand, in the face of a drug dealer I once met years ago. He was a friend of an acquaintance; a tall, well-built, clean-cut, 20-year-old from a well-to-do Kanata family. He was a reasonably intelligent man who enjoyed sports and music; he was a health nut and young father. He also happened to be a crack dealer.

I spoke to him once, horrified but curious to learn why he would engage in this gruesome trade. He didn't smoke cigarettes or drink alcohol, and he certainly wouldn't consider ingesting the poison he was dispensing to his poor, addicted customers. The conversation painted a chilling portrait of a lack of soul.

He despised the addicts he supplied, speaking of them with utter disgust and disdain. He saw himself as a businessman, making money because it was easy. And it was profitable; he wore top-of-the-line clothing and had money to burn. I never saw or heard of him again, but I'm still haunted by his image.

We can't attribute the entire scope of our drug problem to people like him, but we also can't deny they exist; a group of people who have discovered the warped economic principle of the trade: sell drugs but don't use them. Recognizing these "bad" guys -- in an even-handed, responsible way -- seems to me one part of a policy that is not ideologically based at either end of the spectrum. Isn't that what we're aspiring to?

I'm by no means saying Harper has the right answers -- he has a long way to go, especially when it comes to recognizing harm reduction as not only the logical, but humane policy. But as we work to help addicts, it's just as important to recognize the drug market is currently a criminal enterprise, and take aim at those perpetrating it; those whose addiction to the proceeds of trafficking can't be cured with a harm-reduction strategy. Surely we can distinguish them from the crack-addicted middlemen who deal to support their habits.

Does this mean implementing tougher laws, but working to stipulate they don't have the unintended, sweeping consequence of punishing addicts who need help? Maybe. Does this mean outright legalization of drugs? Maybe. I'm open to all of these ideas. Let's just talk about it.
The most vehement critics appear to condemn any plan or role for law enforcement (or some variation) in drug policy without offering alternatives, or at least acknowledging there are people at the heart of this who need to be dealt with in a different way. Do they think the "bad guys" will magically disappear as we focus solely on helping addicts? It's hard to tell; no one's talking about it.

We need to put aside our instinctual fears about any type of law enforcement propelling us to a U.S.-style war on drugs. There has to be a rational way to approach enforcement, in full conjunction with harm reduction.

We may not like all of what Stephen Harper is offering, but isn't it time to talk about what role
we think the law should play?

Kelly Roesler works on the Citizen's copy desk and as a freelance writer.

FEDERAL DRUG STRATEGY Editorial, Globe and Mail

FEDERAL DRUG STRATEGY
Editorial
How to address those addictions
424 words
9 October 2007
The Globe and Mail
A20
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

The federal government's new anti-drug strategy is not as simplistic as advance comments by the Conservatives – notably Health Minister Tony Clement's silly “the party's over” declaration – might have led one to believe. It does not merely ape the failed “War on Drugs” strategy employed by the United States. Rather than treat addicts as criminals, it is sympathetic to their plight, devoting two-thirds of the program's $64-million in funding to treatment and prevention. But it would stand a much better chance of success if it were not undermined by a rigid single-mindedness.

From Prime Minister Stephen Harper's perspective, fighting the evils of drug use is entirely about getting Canadians to stop taking drugs. He rejects the ideas behind harm-reduction programs such as the Insite safe injection facility for heroin users in Vancouver.

“I remain a skeptic that you can tell people that we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use but somehow we will keep you addicted but reduce the harm just the same,” he said in announcing the new strategy last week. “If you remain a drug addict, I don't care how much harm you reduce, you are going to have a short and miserable life.”

Nobody will dispute the fact that it is better to avoid drug use entirely than to use drugs more safely. But it's not as easy as it sounds. Some potential drug users might be swayed by prevention campaigns, and some addicts will voluntarily enter rehabilitation. Yet all the available evidence shows that no efforts by governments will get the most hardened addicts to kick their habit. That leaves two options: abandon those people altogether or attempt to limit the health and social costs of their illness.

The harm-reduction programs rejected by Mr. Harper do much in that regard. Insite reduces needle-sharing in the community, limiting the spread of disease. It saves lives by preventing addicts from dying of overdoses. It reduces the number of people injecting drugs in public places and leaving needles behind. Far from endorsing drug abuse, it encourages treatment. According to research, one in five regular visitors enlists in detoxification programs.

Instead of abandoning such efforts, the government should be expanding them. A sensible anti-drug strategy would do so. Unfortunately, Mr. Harper appears under the misguided impression that prevention and harm reduction are mutually exclusive.

FEDERAL DRUG STRATEGY Editorial, Globe and Mail

FEDERAL DRUG STRATEGY
Editorial
How to address those addictions
424 words
9 October 2007
The Globe and Mail
A20
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

The federal government's new anti-drug strategy is not as simplistic as advance comments by the Conservatives – notably Health Minister Tony Clement's silly “the party's over” declaration – might have led one to believe. It does not merely ape the failed “War on Drugs” strategy employed by the United States. Rather than treat addicts as criminals, it is sympathetic to their plight, devoting two-thirds of the program's $64-million in funding to treatment and prevention. But it would stand a much better chance of success if it were not undermined by a rigid single-mindedness.

From Prime Minister Stephen Harper's perspective, fighting the evils of drug use is entirely about getting Canadians to stop taking drugs. He rejects the ideas behind harm-reduction programs such as the Insite safe injection facility for heroin users in Vancouver.

“I remain a skeptic that you can tell people that we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use but somehow we will keep you addicted but reduce the harm just the same,” he said in announcing the new strategy last week. “If you remain a drug addict, I don't care how much harm you reduce, you are going to have a short and miserable life.”

Nobody will dispute the fact that it is better to avoid drug use entirely than to use drugs more safely. But it's not as easy as it sounds. Some potential drug users might be swayed by prevention campaigns, and some addicts will voluntarily enter rehabilitation. Yet all the available evidence shows that no efforts by governments will get the most hardened addicts to kick their habit. That leaves two options: abandon those people altogether or attempt to limit the health and social costs of their illness.

The harm-reduction programs rejected by Mr. Harper do much in that regard. Insite reduces needle-sharing in the community, limiting the spread of disease. It saves lives by preventing addicts from dying of overdoses. It reduces the number of people injecting drugs in public places and leaving needles behind. Far from endorsing drug abuse, it encourages treatment. According to research, one in five regular visitors enlists in detoxification programs.

Instead of abandoning such efforts, the government should be expanding them. A sensible anti-drug strategy would do so. Unfortunately, Mr. Harper appears under the misguided impression that prevention and harm reduction are mutually exclusive.

Nursing focus in an excellent Globe & Mail article: The inside story of Vancouver's safe injection site

PUBLIC HEALTH AND DRUG ABUSE
National News

The inside story of Vancouver's safe injection site; Supporters work to convince opponents that Insite saves lives, still fearing for the facility's long-term future

IAN BAILEY
2549 words
6 October 2007
The Globe and Mail
A3
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

VANCOUVER -- Using heroin and cocaine can be a dirty business. That means Bethany Jeal sometimes has a lot to do as a nurse helping addicts at North America's first safe injection site.
The 28-year-old says she isn't shy about strolling off the nursing platform in the injection room of the Insite operation in the city's Downtown Eastside and going up to clients in one of Insite's 12 booths.

Each booth is brightly lit so addicts can find good veins into which to plunge a syringe's needle. But there are also mirrors, which allow nurses from across the room to get an idea of what addicts are doing – whether, for example, they are using alcohol swabs.

“We can see everything that's going on,” said Ms. Jeal, who added “there's a lot of unclean practices with regard to drugs.”

She explained that users do not always wash their hands. The drugs themselves, bought on the street are not sterile. (Insite allows the use of drugs, but does not provide them.) And people do not always use alcohol swabs before plunging needles into their flesh.

“I will definitely walk over to them, and if I don't know them, introduce myself and say, ‘Hey. There's a great way to do this. Why don't you use an alcohol swab first?' ” Ms. Jeal said in an interview.

Ms. Jeal, who has been a nurse for three years, once worked full time at Insite.

Now she pulls the occasional shift in the operation, which opened in 2003 with support from the province, city and Vancouver Police Department, among others, as a means of dealing with disease, overdoses and other problems related to injection drug use, largely in the poverty-stricken Downtown Eastside.

However, many Insite supporters now fear for its future because federal Health Minister Tony Clement this week agreed to only a six-month extension in the Controlled Drugs and Substances Act exemption that allows illegal drugs in the facility without legal sanctions. Insite opened with a three-year exemption granted by the then-Liberal government.

Some say the federal Tories want the issue of Insite's future off the table with the possibility of a fall election, especially since the operation is popular in B.C. – with Premier Gordon Campbell and, according to polls, with the public as well.

B.C. Health Minister George Abbott says Insite represents a practical approach to issues of injection drug use.

“The challenge we have is that for drug-addicted individuals, at least until they resolve to try to move beyond their addictions, they are going to be using. When they use, we want to minimize the public health hazards that are associated with intravenous drug use,” he said.

“No one is saying drug addiction is a good thing. It is clearly a very bad thing. It's how we manage those addictions in a thoughtful and humanitarian way that is the key to understanding Insite.”

INSIDE THE SITE
Insite is open 18 hours a day and, in a rare look at its inner workings, The Globe and Mail had a recent opportunity to visit during working hours.

Despite its unusual business, the injection room was subdued and quiet. The exception was one client, who came in on his bicycle and rode it back and forth, within a range of about a metre. (The man likely kept his bike with him, one observer noted, because it would be stolen if he left it on the street.) There were seven men and one woman, largely focused on taking out their drugs, preparing them and using them under nursing supervision.

A poster on the wall warns: “Take care Of your veins. Avoid abscess, dirty hits, embolism and edema. Avoid injecting particles.”

With its track lighting, black tile and white walls, the injection room has the disconcertingly elegant feel of a furniture showroom in a slick Vancouver shopping district. But as they arrive, clients can pick up clean syringes, little aluminum plates for cooking their drugs, a match or lighter and tourniquet.

“We wanted it to be as calm as it could be, and simple,” said Mark Townsend, manager with the Portland Hotel Society that runs the facility with the Vancouver Coastal Health Authority, explaining the design.

Ms. Jeal was not on duty this day. She spoke about Insite during an interview at a café up the street from the injection site, which is laid out on one floor behind a storefront-style facade on East Hastings, the main street in the Downtown Eastside neighbourhood that is home to about 4,000 injection drug users.

During her shifts, she said, she tries to constantly walk around the injection room, interacting with clients. “That's how we get to know people, get a rapport with people, find out what their thoughts are. Maybe they have an infection going. Or maybe they really want to get into detox.”
The point is to head off unsafe practices that can lead to HIV or hepatitis C, or to direct addicts to detox programs. Sanctioning injection-drug use within Insite also allows for a quick response to overdoses that occur on site as nurses look on, sending them into a scramble of sudden treatment and calls to ambulances. There were no fatalities among 453 overdoses reported between April, 2004, and March, 2006, the last period for which statistics are available.

“You can read through the protocol and study what to expect, but you never really know until you experience it,” Ms. Jeal said on the overdose issue, recalling she was “scared shitless” six weeks into her work at Insite when a man fell off his chair after shooting up. With treatment, he
recovered.

The Burnaby-raised nurse, who never came to the Downtown Eastside in her youth, said Insite is no doubt necessary.

“It's not so much sanctioning drug use. The whole basis of harm reduction is accepting that people use [drugs],” she said. “It's not saying it's a good thing. It's not saying it's a bad thing, or marginalizing people who use drugs. It's saying they do use drugs and taking means to prevent harm that might come from using. It's a moral obligation to do that.”

But the federal government has its doubts. Prime Minister Stephen Harper, announcing a $63.8-million national drug strategy in Winnipeg this week that balances prevention and treatment, said he remains a skeptic about Insite, calling it a “second-best strategy at best.”
The Prime Minister stated, “If you remain a drug addict, I don't care how much harm you reduce, you're going to have a short and miserable life.” He said his government will continue studies on Insite, en route to a conclusion about its value.

The B.C. government provided an initial $1.2-million in capital funding for Insite, plus $2-million for first-year operating costs. Since then, the Vancouver Coastal Health Authority has covered the $2-million annual cost, drawing on its funding from the province. Health Canada provided $1.5-million over Insite's first three years to cover the research aspect. And Ottawa has a key power over its fate because of the controlled-substances exemption.

“I would have preferred a longer extension but I will tell you this. It certainly is better than not having any extension,” Mr. Campbell said.

“I think it's important that the extension has been made and what we will do now is continue to work with, not just the city, but with the federal government to ensure an even further extension.”

Mr. Campbell, a former Vancouver mayor, acknowledged that people will have questions about whether Insite is working. “We believe it is making a difference. We think it is effective. So our job is to continue to work on behalf of the province, the health-care system and patients in this regard.”

The current mayor, Sam Sullivan, said that city council would like the exemption extended for at least 3½ years, and that he plans to continue to make the case for Insite with federal officials. “It's a great achievement to have an exemption,” he said. “I look forward to getting a further exemption.”

POLITICAL BATTLE
Insite has its critics. The Canadian Police Association and the RCMP have criticized the operation for, among other things, creating an enabling environment.

Although there have been a number of studies endorsing Insite for steering addicts into detox and addiction programs and encouraging safe injection practices, other studies have not been so enthusiastic. One, by the Drug Prevention Network of Canada that was released in the Journal of Global Drug Policy last May, said positive findings about Insite had been overstated while negative findings were not given prominence.

In an interview, Mr. Clement said he is awaiting more research on how supervised injection sites affect prevention, treatment and crime before a decision would be made on Insite's fate. Six contracts have been put to tender. Successful bids have been accepted for three.

Mr. Clement, who opposed safe injection sites when he was an Ontario health minister years ago, insisted that his government has yet to make a final decision on Insite's fate, and dismissed the allegations of critics that the six-month extension was intended to put Insite beyond debate in an election.

“When we have decided something, we will certainly let everybody know, but we have not made that decision,” he said when asked about the required federal exemption.

Mr. Clement, who toured Insite last year, said it isn't yet clear how the facility fits into the tough drug strategy announced in Winnipeg. The government's posture this week is all about research, he said.

“The researchers said, ‘We need more time in order to do proper research for you and for Canadians,' and we gave them more time. There's nothing more sinister than that,” Mr. Clement said.

Mr. Abbott, B.C.'s Health Minister, said Ottawa deserves some credit for continuing with exemptions for Insite that were launched by a previous Liberal government. But he said Insite is a key to B.C.'s goals on injection drug use.

“I have always made it clear to Tony that I am supportive of this facility, that we believe it is a valuable part of the continuum of care for the drug addicted, and have always made clear to him we're prepared to assist in providing whatever information they believe they need to support the extension of their support for this facility.”

Mr. Abbott would not speculate on what Victoria will do if Mr. Clement eventually rules out an extended exemption for Insite, saying he was reluctant to consider hypothetical questions.
“We'll cross that bridge if and when we get to it. I would like to think that over the next six months, we will be able to provide them with the evidence that would support what they need
to get their support for this,” he said.

But Insite's operators are thinking about a Tory-engineered demise for Insite, and Mr. Townsend of the Portland Hotel Society says the situation looks bleak. “I believe if the PM does the wrong thing, we will have no choice but to keep the site open,” he said. “We would try our best to carry on as we could.”

But, he said, it wouldn't be easy. “It's hard to run a medical facility, a hospital or a supervised injection site with volunteers. You can't run these things with bake sales.”

Letters have been written to the Prime Minister's Office, and there is a talk of a protest visit to Parliament Hill. Mr. Townsend's society and a pair of drug addicts even filed a statement of claim in B.C. Supreme Court arguing the closing of Insite would violate their Charter rights to “security of the person.”

A PERSONAL STORY
One of those addicts, Shelly Tomic, warmly recalls the support she has received from Insite since its first day as she grappled with a hunger for heroin, cocaine, speed and meth. She is now in recovery, but visits Insite when she feels the need to inject heroin.

Ms. Tomic, who has tested positive for hepatitis C and is disabled and unemployed, said she once had a heart attack at Insite – nurses called 911 when they noticed she was in distress. She said the site is better than the alleys and bar bathrooms she once used to shoot up.

“In Insite, you've always got clean rigs every single time, and even if you could get clean needles before Insite, you didn't necessarily have a sterile place to do it,” said Ms. Tomic, 39.

“You have got clean rigs. You don't have to rush to get it into you for fear of being arrested, or somebody taking [your drugs] from you or [being] mugged for it. And if you overdose at Insite, you have got medical staff right there to help you.”

She added: “[Insite] is sort of like the show Cheers, for Norm,” she says. “That's how I feel about Insite. I go in. Everybody knows me.”

Milestones in Insite's history
*******
November, 2002
Larry Campbell, Vancouver's newly elected mayor, promises to move quickly on the creation of a safe injection site, acting on debate over the issue that has been under way for years.

September, 2003
Insite opens as North America's first safe injection site, bolstered by $1.2-million in capital funding from the B.C. government, plus $2-million for first-year operating costs. (Since then, the Vancouver Coastal Health Authority has covered the $2-million annual cost of the operation, drawing on its funding from the province.) Health Canada allots $1.5-million over three years to cover research costs.

September, 2006
Federal Health Minister Tony Clement approves a 16-month extension in an exemption to Section 56 of the Controlled Drugs and Substances Act that allows Insite to operate. He rules out considering applications from other municipalities for such sites until the review is completed. Vancouver police salutes the minister's decision, noting the department “congratulates the federal government for making a very difficult decision on a complex issue.”

Oct. 2, 2007
Mr. Clement announces a six-month extension of the exemption to June 30, 2008, to allow for more research on issues around supervised injection sites.
Ian Bailey

Insite client data collected from April, 2004, to March, 2006 (the most recent statistics available):
CLIENT GENDER Female: 30% Male: 70%

CLIENT INJECTIONS, BY DRUG
Other: 20% Morphine: 12% Cocaine: 27% Heroin: 41%

CLIENT NUMBERS
There were 453 overdoses and no fatalities.
4,084 referrals were made with 40% to addictions counselling.
The busiest day was May 25, 2005, with 933 visits in 18 hours.
There were 6,227 nursing care interventions with 2,055 for abscess care.

SOURCE: VANCOUVER COASTAL HEALTH AUTHORITY, INSITE, B.C. CENTRE FOR EXCELLENCE IN HIV/AIDS

'Serious time for serious crime'; Opposition pans Harper's $63.8M national anti-drug strategy as U.S.-style war on drugs

'Serious time for serious crime'; Opposition pans Harper's $63.8M national anti-drug strategy as U.S.-style war on drugs
Meagan Fitzpatrick
CanWest News Service
849 words
5 October 2007
Edmonton Journal
Final
A3
English
Copyright © 2007 Edmonton Journal

The federal government will introduce legislation this fall that would require mandatory minimum jail sentences for people convicted of "serious" drug crimes, Prime Minister Stephen Harper said Thursday.

"Currently there are no minimum prison sentences for producing and trafficking dangerous drugs like methamphetamines and cocaine," Harper told a news conference. "But these are serious crimes; those who commit them should do serious time."

But in launching the government's long-awaited, $63.8-million national anti-drug strategy in Winnipeg, Harper also promised to be compassionate toward people hooked on illegal drugs. In particular, the prime minister said he is concerned about rising drug use among youth. He also noted that drug use takes an expensive toll on the health-care system and fuels crime.

"Narcotics destroy lives. They rob young people of their futures, they tear families apart, they make our streets less safe and they lay waste to our communities."

Harper said the government's response will be two-pronged, focusing on drug addicts on one hand and on drug producers and dealers on the other.

"Drugs are dangerous and destructive. If drugs do get hold of you, there will be help to get you off them," Harper promised. "But if you sell or produce drugs, you will pay with prison time."

"Our two-track approach will be tough on the dealers and producers of drugs and compassionate for their victims."

He underlined that tough new anti-drug laws will be a major component of the government's plan, but confirmed that two-thirds of the funding will go toward the prevention and treatment of illicit drug use. The plan also includes a major national public awareness campaign aimed at youth and their parents.

"Interdiction by itself is not going to be enough," said Harper, flanked by Public Safety Minister Stockwell Day and Health Minister Tony Clement. "Our government recognizes that we also have to find new ways to prevent people from becoming enslaved to drugs and we need new laws to free them from drugs when they get hooked."

Other details unveiled by Harper about the plan included funding for the provinces and territories for drug abuse programs, modernizing treatment services and making them more widely available, financial support for youth intervention programs, more money for police agencies to investigate and prosecute drug crimes, ramping up the RCMP's drug unit programs, and increased funding for the Canada Border Services Agency.

Some details of the plan were in the last federal budget, including a breakdown of the overall funding to distribute about $10 million to prevention initiatives, $32 million for treatment for drug addicts, and $22 million to crack down on production and dealers.

"Solving Canada's drug problem will require a huge effort. We won't get clean overnight but we will put our country on the road to recovery," said Harper.

Even before it was made public, the government's plan drew darts and laurels from all sides of the drug debate. Liberal and New Democratic Party critics said the government is embracing a U.S.-style "war on drugs" that treats drug abuse as more of a criminal matter than a health issue. Liberal MP Keith Martin, a physician, and NDP MP Libby Davies both said in interviews earlier this week that the government should focus more on harm-reduction programs, such as
safe injection sites and needle exchanges.

The Vancouver safe injection site, Insite, was in danger of closing after its exemption from federal drug laws was scheduled to end at the end of this year. This week, however, the government gave the facility a six-month reprieve, extending its exemption to June 30, 2008.
Prime Minister Harper admitted on Thursday that he remains skeptical about the program and said that even if it's effective, it's a "second-best strategy at best."

"If you remain a drug addict, I don't care how much harm you reduce, you're going to have a short and miserable life," said Harper. He pledged to continue to study the program and gather the facts on it, but noted that his government's "tentative conclusion" is that safe injection sites, if allowed to operate, should operate in concert with other programs that aim to treat addicts.
Critics of the government said the reprieve for the Vancouver site was just designed to get the controversy over harm-reduction policy off the table in time for Harper's drug strategy announcement.

The Canadian Police Association, meanwhile, has expressed support for the government's get-tough approach to drugs. The organization has called for stronger legislation and a new system of graduated consequences to prevent and deter drug use. The group's president, Tony Cannavino, has called the government's promise to crack down on illegal drug use and dealers "a cornerstone, because a lot of violence is related to drugs."

A $64-MILLION STRATEGY

A $64-MILLION STRATEGY
National News
Harper takes aim at drug culture
GLORIA GALLOWAY
623 words
5 October 2007
The Globe and Mail
A4
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

Canada has become too drug-friendly and it's time for a culture change, Prime Minister Stephen Harper said yesterday as he laid out his government's get-tough strategy for reducing the use of illegal substances.

Police and others fighting the battle against drug abuse are up against a culture that “since the 1960s” has done little to discourage drug abuse and “often romanticized it – romanticized it or made it cool, made it acceptable,” Mr. Harper said.

“As a father I don't say all these things blamelessly. My son is listening to my Beatles records and asking me what all these lyrics mean. It's just there, it's out there. I love these records and I'm not putting them away. But, that said, there has been a culture that has not fought drug use and that's what we're all up against.”

Mr. Harper, flanked by Health Minister Tony Clement and Public Safety Minister Stockwell Day, announced his new two-year, $64-million anti-drug strategy at a Salvation Army building in Winnipeg.

Two-thirds of that money will go to prevention and treatment programs and the rest will be used to beef up enforcement, including the introduction of new mandatory minimum sentences for an unspecified slate of drug crimes.

The Conservatives say they will create an awareness campaign targeted at young people and their parents, fund new treatment services and launch a national youth intervention program to divert young drug users into assessment and treatment programs instead of detention.
On the enforcement side, they plan to direct resources at identifying and closing down grow-ops, pay for more enforcement measures at the border and ramp up the RCMP's Proceeds of Crime Program.

Gone are any musings, such as those of the previous Liberal government, about decriminalization of so-called softer drugs such as marijuana.

Critics have ripped apart the government's strategy on many fronts, especially Mr. Harper's unwillingness to embrace harm-reduction measures such as those offered at Insite, Vancouver's safe-injection site. It allows addicts to safely inject illegal dugs and connect with health professionals who can direct them toward treatment.

The government this week extended funding to that program but only for six months so it can be further studied.

“I remain a skeptic that you can tell people that we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use but somehow we will keep you addicted but reduce the harm just the same,” Mr. Harper said of the Insite program. “If you remain a drug addict, I don't care how much harm you reduce, you are going to have a short and miserable life.”

But Thomas Kerr, a professor in the University of British Columbia's Department of Medicine who has studied Insite and its effect on the prevention of the spread of HIV-AIDS, said Mr. Harper is ignoring the facts.

“The government continues to misrepresent the science around harm reduction. In the case of Insite we have shown that there has been a 33-per-cent increase in the rate of entry into detox programs,” Dr. Kerr said. “In no way is the facility perpetuating addiction. In fact, it's helping people quit drug use.”

Leon Mar of the Canadian HIV/AIDS Legal Network said education programs, such as the one proposed by the government, have previously proved ineffective. Health Canada's own review of the Drug Abuse Resistance Education program implemented widely across Canada, he said, has shown that the program does not prevent or delay drug use.

Vancouver safe-injection site can operate until June under six-month extension

Vancouver safe-injection site can operate until June under six-month extension
BY STEPHANIE LEVITZ
CP
1116 words
2 October 2007
19:56
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.

VANCOUVER _ Ottawa's six-month reprieve for Vancouver's safe injection site simply allows the government to shelve the issue until after a possible fall election, leaving a suffering community in limbo, supporters of the site said Tuesday.

Though they applauded the announcement from the federal government that Insite can remain open until next June, doctors, community activists and opposition politicians said they are frustrated that a health issue has become a political football.

Health Canada announced Tuesday it would extend the exemption from Canada's drug laws that allows Insite to operate. The exemption was set to run out at the end of the year.

``I think what this is an indication of is that the government is currently really trying to sit out the issue of Insite rather than making a decision one way or another that inevitably would offend a lot of people on one side or another,'' said Benedikt Fischer, director of the Illicit Drugs, Public Health and Policy Unit at the Centre for Addictions Research of B.C.

``That problem is postponed but not resolved.''

The former storefront provides a place for addicts to safely inject themselves with their own heroin under the supervision of medical staff.

A spokeswoman for Health Canada said the exemption will allow further research.

``It's for the purposes of research into the impact of such sites on prevention, treatment and
crime,'' said Jirina Vlk, acting head of communications for the department.

Reams of research have been done on Insite since it opened in Vancouver's beleaguered Downtown Eastside in 2003.

The studies examining the centre have included results showing drug addicts who used the program were more likely to enrol in detox programs, more likely to start methadone replacement programs and reduce their number of monthly visits to shoot up.

In August, a group of 130 prominent doctors, scientists and public health professionals endorsed a commentary published in the journal Open Medicine that said the injection site was being judged by a different standard than other health measures.

``Harm reduction has now been shown to be effective _ Insite in particular _ on a variety of fronts and I think that the real issue is when are we going to finally agree to expand the role of Insite both in terms of the hours of operation and the number of people we can serve,'' Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS in Vancouver, said Tuesday.
The centre has led many studies into the centre's work.

``The federal government at this time has taken the strategy, if you want, of giving us a piecemeal licence to operate and the latest effort, let's be clear, sounds a lot like a political effort to get this issue off the table in case an election be called. We cannot accept this kind of behaviour.''

When the site was approved in 2003, Vancouver officials applied for an exemption from the Controlled Drugs and Substances Act, which makes the use of heroin illegal.

The site was granted a three-year exemption for the purposes of a pilot study on the site's impact.

Federal Health Minister Tony Clement had announced in September 2006 the exemption would be extended until December of this year to allow for further study.

The Vancouver Coastal Health Authority had requested an extension for three and a half years.
Former Vancouver mayor Larry Campbell, now a Liberal senator, said he doesn't even believe the exemption is needed because he said it's unclear how the law would be enforced without the exemption.

``I realize that the Conservative government has a difficult time because they can't seem to find any substantiated evidence that would back their Neanderthal response,'' he said.

``The fact is that this is a health-care facility and it should be left open and expanded in many places across Canada.''

Clement also said in 2006 that a new National Drug Strategy would need to be in place before the government considered allowing any other supervised rejection sites to open in Canada.
The minister said in an interview with The Canadian Press last week that strategy is expected this week.

Mark Townsend, of the Portland Hotel Society which runs Insite, called Tuesday's announcement depressing and a distraction from the real problems facing addicts on the Downtown Eastside.

``We've got people that are sick, people that are dying, mentally ill people living in crummy hotels,'' said Townsend.

``There's loads to do and the supervised injection site is important but really they just need to accept that the evidence is in and they do the right thing.''

Back in April, Health Canada put out a request for proposals for further study connected with Insite, asking for input on health issues, public order and safety issues and similarities and differences between Vancouver and other Canadian cities.

Townsend said several noted researchers in the field declined to apply for the grants because of a gag order that would prohibit them from talking about their findings unless given approval from the government.

``The prime minister is out there trying to find a researcher that will tell him the world is flat, so he's got an excuse to cut it,'' Townsend said.

A Simon Fraser University criminologist who was told last week that he won one of the grants said his work will examine the impact of the site on crime in the Downtown Eastside.

``We're going to be doing interviews, detailed interviews, with a sample of police, residents, business owners in the vicinity and social service agencies,'' Prof. Neil Boyd said.

``We're also hoping to use police data, calls for service and arrest data, to determine whether there have been changes in activity over time at the site.''

His research will be submitted to the government in February.

Vancouver Mayor Sam Sullivan welcomed the government's announcement, which came on the same day that the city was considering a report on substitution treatment for people with drug addictions in the city.

The 34-page report looks at the use of opiate replacement drugs, like methadone, and also a North American study being carried out in part in Vancouver that prescribes legal opium to addicts.

The report also outlines five clinical trials the city would like to run in conjunction with the Inner Change Society and Chronic Addiction Substitution Treatment program announced earlier this year.

The report was approved by city council and the mayor plans to ask the federal government to fund the studies under the new National Drug Strategy

Fate of safe-injection site remains up in the air

SIX-MONTH REPRIEVE
National News
Fate of safe-injection site remains up in the air
IAN BAILEY
490 words
3 October 2007
The Globe and Mail
A4
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

VANCOUVER -- The federal Health Minister has cleared Vancouver's safe-injection site to operate for another six months, but critics say the decision announced yesterday does nothing to clear up uncertainty about the fate of the controversial operation that provides a safe place for drug addicts to use heroin or cocaine.

In a terse statement, Tony Clement said he would allow Insite a continued exemption under Section 56 of the Controlled Drugs and Substances Act that allows the use of otherwise illegal drugs by clients at the facility in the poverty-stricken Downtown Eastside.

The extension runs until June 30, 2008. “[It] will allow research on how supervised injection sites affect prevention, treatment and crime to be continued for another six months,” the statement said.

The minister was not available for comment. His press secretary, Laryssa Waler, would only refer to the statement's point about additional research when asked for further comment.
Perry Kendall, B.C.'s provincial health officer, said he thought enough research had already been done on Insite, which opened in 2003.

Insite has been credited with helping to reduce overdoses and drug-related disease. Clients bring their own drugs to the site with a freedom allowed by the exemption Mr. Clement has renewed for the second time. The B.C. government finances the program.

In comments that reflect a broad consensus of support, Premier Gordon Campbell earlier this week urged the Tories to maintain Insite, calling it “part of the solution” to issues of drug addiction.

Mark Townsend, a community worker for the Portland Hotel Society, which operates Insite in partnership with the Vancouver Coastal Health Authority, said the uncertainty is a stress for clients, staff and medical officials working with the operation.

“It's like constantly debating the same tiny speck of dust,” Mr. Townsend said. “It's stressful on the ground for the human beings, the doctors and nurses involved with it. It's stressful for the people who work in the bureaucracy and care about people on the ground and are trying to put together programs that help people.

“The clients do get stressed about it as well. It's like you're constantly about to be fired from your job.”

Mr. Townsend echoed the view of many observers, including NDP and Liberal MPs in Vancouver, that the Tories are reluctant to shut down Insite while an election is possible, so they have put the issue on ice for now.

Libby Davies, NDP MP for Vancouver East, said the Tories are “playing politics” with an important community asset, central to helping protect drug users from disease, overdoses and other harm. Insite is located in Ms. Davies's riding.

She predicted a community fight to save the facility. “People know they will have to gear up for another campaign to keep Insite going,” she said.

DRUG POLICY Editorial The wrong way to go

DRUG POLICY
Editorial
The wrong way to go
413 words
3 October 2007
The Globe and Mail
A20
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

‘The party's over,” federal Health Minister Tony Clement intoned this past weekend. Mr. Clement was talking about drug users, but it wasn't entirely clear which ones. It might have been otherwise law-abiding citizens who occasionally smoke marijuana. Or perhaps it was all those partiers suffering from debilitating addictions to hard drugs such as heroin and crack cocaine. Either way, Mr. Clement appears to have borrowed his rhetoric from the 1980s. To go with it, he appears set to borrow the disastrous “War on Drugs” strategy from south of the border.

This week, the federal government is set to unveil a new $64-million anti-drug strategy. Some of its anticipated components, including more money for treatment programs and a crackdown on drug smuggling at the border, are worthwhile. But the government is also reportedly set to shift away from harm-reduction programs. In their place, it is expected to launch both an anti-drug messaging campaign targeting teenagers and a crackdown on illegal drug use – presumably meaning more criminal charges against both hard- and soft-drug users.

All the available evidence suggests that this will be a waste of time and money. Worse, it could cost some lives and ruin others. The overwhelming body of research shows that harm-reduction strategies such as Insite, the Vancouver safe-injection site for heroin users, succeeds in limiting the health and social costs of addiction, preventing deaths from overdose and disease and directing addicts toward treatment. Yet rather than expand such programs, the government is reluctant even to keep Insite going; it announced yesterday that the site will be allowed to operate through June of next year, but refused to confirm its long-term future. As much of the rest of the world recognizes addiction for the disease it is, the Conservatives appear poised to revert to treating it like a crime. Meanwhile, rather than continue with the previous government's plan to decriminalize possession of small amounts of marijuana for personal use, they will ensure that more Canadians are saddled with criminal records for indulging in a substance no more harmful than alcohol or tobacco.

This new strategy may play well with some members of the Conservatives' base. But as evidenced by what has transpired in the United States, it will do absolutely nothing to reduce drug use. Its only effect will be to make the effects of substance abuse all the more painful.

Ottawa adopting failed U.S.-style "war on drugs"

Ottawa adopting failed U.S.-style "war on drugs"
533 words
1 October 2007
09:30
Canada NewsWire
English
Copyright © 2007 Canada NewsWire Ltd. All rights reserved.

TORONTO, Oct. 1 /CNW/ -- New National Anti-Drug Strategy plays politics with people's lives

TORONTO, Oct. 1 /CNW/ - The new National Anti-Drug Strategy to be officially unveiled this week by federal Health Minister Tony Clement is a huge step backward for Canada's response to HIV/AIDS, said the Canadian HIV/AIDS Legal Network today.

The new strategy funds law enforcement, prevention and treatment programs - three of the four so-called "pillars" common in many drug strategies. But the fourth pillar, harm reduction - which includes needle exchanges, methadone clinics and safe-injection facilities - has been eliminated.

"The federal government is ignoring widely published scientific evidence on the value of investing in harm reduction programs," said Richard Elliott, Executive Director. "It seems clear that the new drug strategy is based on ideology instead of evidence, and from every angle - human rights, public health, or use of taxpayers' dollars - that's irresponsible and unacceptable."
Even worse, Minister Clement is sowing confusion by claiming that other measures, such as law enforcement, constitute harm reduction in their own right.

"This is just smoke and mirrors," said Elliott. "The reality is that some people can't or won't stop using drugs. Harm reduction pragmatically and realistically acknowledges this fact by providing evidence-based programs and services to lessen the harms associated with drug use. Arresting and imprisoning people can't be considered harm reduction."

The new drug strategy apes the failed U.S. approach of treating drug addiction primarily as a criminal matter, rather than a matter of public health. But despite spending billions of dollars on its "war on drugs," not a dent has been made in reducing either drug supply or drug consumption in the United States. Rather, the establishment of "get-tough" criminal approaches to drug addiction has filled U.S. prisons with non-violent, often small-scale offenders.

Relying on criminal law inevitably also leads to increased fear, stigma and discrimination. As a result, many people hide their drug use, which usually means avoiding the public health and harm reduction programs that could help treat them. Insite, Vancouver's safe injection facility, is one such program.

"The facts speak for themselves: Insite has lowered the rates of syringe-sharing and deaths from overdoses, reduced the risk of HIV and hepatitis C transmission, and increased the chances of directing drug users to addiction treatment services," said Elliott. "Instead of mounting a public misinformation campaign, Minister Clement and his government should be sharing these facts with Canadians to explain why funding harm reduction programs like Insite is a responsible investment in public health."

About the Canadian HIV/AIDS Legal Network
The Canadian HIV/AIDS Legal Network ( www.aidslaw.ca ) promotes the human rights of people living with and vulnerable to HIV/AIDS, in Canada and internationally, through research, legal and policy analysis, education, and community mobilization. The Legal Network is Canada's leading advocacy organization working on the legal and human rights issues raised by HIV/AIDS.

OTTAWA'S NEW SUBSTANCE-ABUSE STRATEGY

OTTAWA'S NEW SUBSTANCE-ABUSE STRATEGY
National News
Get-tough plan on drugs doomed, experts say; Liberal MP calls Tories' policy a triumph of ‘ideology over science,' urges medical, not moral, approach to issue
ANNE McILROY
SCIENCE REPORTER
647 words
1 October 2007
The Globe and Mail
A4
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

Canada's war on drugs is about to escalate. But as the federal Conservative governments prepares to unveil a new strategy that cracks down on illicit drug users, critics say they are ignoring a mountain of research that shows the get-tough approach doesn't work.

“This is a failed approach. The experiment is done. The science is in,” says Thomas Kerr, a researcher at the University of British Columbia and member of the university's faculty of medicine.

The $64-million anti-drug strategy, to be announced in the next few days, is expected to include stiffer penalties for drug offenders and more money to stop drugs getting across the border. There will also be a massive campaign to warn young people not to use drugs.

It is not expected, says Liberal MP Keith Martin, to include money for what experts call “harm reduction.” These are programs such as Vancouver's controversial safe injection site, where heroin addicts can shoot up in a sterilized, supervised setting.

The idea behind harm reduction is to reduce the health effects of drug use without requiring people to beat their addiction. Experts compare it with smokers using a nicotine patch; people still get their fix, but it is vastly preferable to smoking a pack a day.

A study published by Dr. Kerr and his colleagues last year found that the Vancouver supervised injection site, known as Insite, reduced the risk of overdoses and encouraged more users to seek treatment. It did not increase crime in the neighbourhood, nor lead to increased drug use.

But Prime Minister Stephen Harper has said he does not think the site should receive federal health money, and Health Canada must make a decision about the future of Insite by the end of the year.

Dr. Martin, a physician from British Columbia, says the Conservatives' approach is a triumph of “ideology over science.” While he supports more money for police to go after drug dealers or
organized crime, Dr. Martin says substance abuse needs to be treated as a medical problem, not a moral one.

That's the approach taken in many European countries that have much lower rates of illicit drug use than Canada, he said.

Erik Waddell, a spokesman for Health Minister Tony Clement, said yesterday that the minister was travelling and would not be available for an interview.

Mr. Waddell said he couldn't discuss the details of the new strategy either. But earlier this year, he told The Globe and Mail that the Conservatives disagreed with the Liberals' approach. “In every poll, when Canadians are asked whether they want more law enforcement or less, they want more. So the bottom line is that Canada's new government will be taking a different approach.”

The Liberals had put forward a bill to decriminalize the possession of small amounts of marijuana, but the Conservatives did not reintroduce it after taking office in early 2006.
But the Liberals were also harshly criticized – by academics, doctors and the federal auditor-general – for focusing too much on enforcement.

The current drug strategy, which was renewed in 2003, devotes almost three- quarters of its resources to enforcement. Only 3 per cent of the annual $245-million goes to prevention, and another 3 per cent to harm reduction.

Barney Savage, director of public policy at the Centre for Addiction and Mental Health in Toronto, says law enforcement is extremely important, but so is prevention, treatment and harm reduction. “You have to balance the law enforcement perspective with the health perspective.”

The Canadian Association of Chiefs of Police also advocates a balanced approach in dealing with drug abuse and addiction issues.

Harper government to unveil get-tough national drug strategy CP

Harper government to unveil get-tough national drug strategy
BY TERRY PEDWELL
CP
822 words
29 September 2007
15:35
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.

OTTAWA _ Health Minister Tony Clement will announce it's anti-drug strategy this week with a stark warning: ``the party's over'' for illicit drug users.

``In the next few days, we're going to be back in the business of an anti-drug strategy,'' Clement told The Canadian Press.

``In that sense, the party's over.''

Shortly after taking office early last year, the Conservatives decided not to go ahead with a Liberal bill to decriminalize small amounts of marijuana.

Since then, the number of people arrested for smoking pot has jumped dramatically in several Canadian cities, in some cases jumping by more than one third.

Toronto, Vancouver, Ottawa and Halifax all reported increases of between 20 and 50 per cent in 2006 of arrests for possession of cannabis, compared with the previous year.

As a result thousands of people were charged with a criminal offence that, under the previous Liberal government, was on the verge of being classified as a misdemeanour.

Police forces said many young people were under the impression that the decriminalization bill had already passed and were smoking up more boldly than they've ever done before.

Clement says his government wants to clear up the uncertainty

``There's been a lot of mixed messages going out about illicit drugs,'' Clement said in an interview Saturday after a symposium designed to bring together Canada's arts and health communities to combat mental health issues.

There's also a health-care cost element to suggesting to young people that using illicit drugs is OK, the minister said.

``The fact of the matter is they're unhealthy,'' Clement said.

``They create poor health outcomes.''

For too long, Clement argues, governments in Canada have been sending the wrong message about drug use. It's time, he says, to take a tougher approach to dealing with the problem.

``There hasn't been a meaningful retooling of our strategy to tackle illicit drugs in over 20 years in this country,'' Clement said.

``We're going to be into a different world and take tackling these issues very seriously because (of) the impact on the health and safety of our kids.''

The Conservatives' wide-ranging $64 million anti-drug strategy is expected to combine treatment and prevention programs with stiffer penalties for illicit drug use, and a crackdown at the border against drug smuggling.

Justice Minister Rob Nicholson and Public Safety Minister Stockwell Day will join Clement in announcing the plan as part of a range of initiatives to be unveiled by the Tories surrounding next month's throne speech.

Clement said treatment and prevention programs were his key priorities for the health element of the drug strategy.

``Yes, there's a justice issue to that,'' he said.

``But there's also a treatment issue, there's also a prevention issue.''

Clement has suggested in the past that he opposes so-called harm reduction strategies for combating illegal drug use, including safe-injection sites where nurses provide addicts with clean needles and a safe place to use drugs.

At a Canadian Medical Association meeting last month, he was quoted saying ``harm reduction, in a sense, takes many forms. To me, prevention is harm reduction. Treatment is harm reduction. Enforcement is harm reduction.''

The following day, a petition signed by over 130 physicians and scientists was released, condemning the Conservative government's ``potentially deadly'' misrepresentation of the positive evidence for harm reduction programs.

Vancouver's Insite safe injection clinic is facing a December 31 deadline for the renewal of a federal exemption that allows it to operate.

Critics of the Conservative government's approach to illicit drug use say the federal government would be making a serious mistake by failing to renew the exemption.

``I think there's very little chance that Mr. Clement will extend the safe injection site's permit to continue,'' says Dr. Keith Martin, a British Columbia Liberal MP and former substance-abuse physician.

``But in doing that they will be essentially committing murder.''

Advocates say safe-injection sites help to prevent the spread of serious diseases, including AIDS and Hepatitis by preventing users from sharing needles while opponents say the sites simply promote illegal drug use.

Martin says he's all for increasing penalties for people who sell illegal drugs, including gangsters, but wonders why the Tories would want to target users when he says similar strategies in other countries haven't worked.

``I can't understand why the Conservatives are embracing a war-on-drugs approach that has proven to fail,'' he said.

``By all means, go after the pushers. By all means, absolutely go after the organized crime gangs that are the real parasites in this situation,'' he added.

``But for heaven's sake, treat the user as a medical problem and adopt the solutions that have proven to work in other countries.''

The other point of view: Canada's Shooting Gallery

Some journalism biased in the other direction...

Canada's Shooting Gallery
By Mary Anastasia O'Grady
1165 words
27 August 2007
The Wall Street Journal
A10
English
(Copyright (c) 2007, Dow Jones & Company, Inc.)

Vancouver, British Columbia -- Early on a cool, rainy morning here last week, I decided to walk from my hotel in the most fashionable quarter of this fashionable West Coast metropolis to the "Downtown East Side." I was going to see an old friend, who in his retirement years has joined a Catholic ministry dedicated to outreach among the prostitutes in this notoriously seedy area. I wanted to visit the neighborhood where he works, in part, because it also happens to be where provincial authorities have set up a "safe injection site" for drug addicts. Many of the young women on the streets are hooked on opiates.

When I asked for directions from the hotel concierge, her eyebrows went up and she asked me what time of day I would be going. "As long as it's early and you stick to Pender Street, you should be OK," she said, tracing a path for me on a map.

Her advice, I later realized, was another way of saying, "stay off East Hastings Street," the epicenter of life for drug users here and the location of "InSite," North America's only legal, government-sponsored, injection clinic. Later that morning, as my friend showed me around the neighborhood in his car, I saw why. The sidewalks in front of the clinic were lined with addicts, and for blocks in both directions, all humanity looked sick, drawn, impoverished and defeated. In the gloom of a drizzly, cloud-covered Sunday morning, I felt I had entered one of Dante's inner circles of suffering.

Like most wealthy societies, Canada struggles with the problem of drug addiction. Prohibition was supposed to limit the supply of evil weeds, and thus the temptation to experiment with addictive chemicals. Yet decades of drug laws have had little effect, if any, on the availability of mind-altering substances and their corrosive effects on some part of the population.

While the benefits of prohibition are hard to discern, the cost of the war on drugs is quite clear. Inside the borders of rich countries, the large profits make vigorously pushing illegal substances worth the risk. Children, even in rural areas, are an especially attractive target under the black-market pricing structure. Addicts have to pay dearly; yet, like all intelligent vendors, dealers offer "introductory prices" for beginners. For criminals, prohibition profits make weapons, information technology and bribery of law-enforcement officials easily affordable.

These days Canadians are all too familiar with the price of the drug war outside their borders. Their military is now engaged in some of the heaviest fighting in Afghanistan, where reports from the field suggest that what is making the mission so difficult, at least in part, is the fact that the bad guys have enlisted support from the poppy growers who serve the heroin trade.
Organized crime is also flourishing in the Western Hemisphere. Colombian society has been shredded by drug cartels and, more recently, by narcotrafficking left-wing guerrillas and right-wing paramilitaries. The U.S. effort to block Caribbean transit routes sent the traffickers into Central America and Mexico. Since taking office in July 2006, Mexican President Felipe Calderon has made defeating the drug lords a priority. The Calderon crackdown has produced a spike in violence in the past year, claimed the lives of numerous Mexican law-enforcement officials and, if reports from the border are true, is now having a spillover effect in the Southwestern U.S. Yet the drugs keep coming, answering the demand.

This record suggests that attacking supply as a way to reduce demand is fighting a losing battle. Sophisticated economists -- most notably the late Milton Friedman -- have argued that the power of the market is just too great and that the unintended consequences are bound to cause both more bloodshed and more corruption.

Yet even though the war on drugs has been an obvious failure, Canada's experimental approach is hardly a promising alternative. Vancouver's InSite is simply horrifying in different ways. I didn't venture inside the clinic itself, but someone who has describes "bright white lights and a cold clinical setting," with the obligatory "absolutely no smoking" sign hanging at the entry. The idea is that junkies are going to use anyway so the state should help lower the risk, being careful, of course, not to pass judgment. The drugs are illegal, but in the interest of "harm reduction," the state will provide sanitary injection services. "Come right in, get your fix. There, you feel better, don't you?"

This is like something out of Aldous Huxley's novel, "Brave New World." Utilitarian big government discovers a low-cost, efficient method of getting the dregs of society out of everybody's hair. All it takes are sterile needles and mind-numbing drugs supplied by the addicts themselves. Leaving aside the quaint notion that putting oneself in a perpetually medicated state may not be the best way to reach one's human potential, the clinic's approach is hugely problematic. Even the most pro-legalization libertarians would have to agree that a government that engages in drugging the citizenry is pretty far removed from the classic definition of the modern liberal state.

Canada is now debating this issue. A group of 130 Canadian scientists and doctors recently published a statement arguing that InSite has been successful because there has been "reduced needle sharing, decreased public drug use, fewer publicly discarded syringes, and more rapid entry into detoxification services by persons using the facility." But last week Health Minister Tony Clement suggested that other studies have drawn far less happy conclusions. Critics of "harm reduction" programs say that despite free needles, junkies tend to share anyway and that addicts continue to sell sex and spread disease. They also note that signing up for "detoxification" is a far cry from rehab and it's not the least bit clear that needle clinics are paths to treatment.

There is another problem as well with the nanny province getting into the drug injection business: It adds to what one British Columbian described to me as "the growth of the poverty industry" in Vancouver. The bureaucracy that exists to "serve" the drug-dependent community has little interest in seeing the problem go away and, with it, their jobs. Here, as in many other arenas, there is a normal bureaucratic impulse to expand, broadening the state's subsidization of dependency. Viewed in this light, a state-sponsored shooting gallery is good for business.
Something is also very wrong when society officially winks at its own prohibition laws. Indeed, InSite demonstrates that encouraging drug use through the welfare state while at the same time attempting prohibition is not just illogical. It also produces the worst of all worlds.

(See related letters: "Letters to the Editor: Down in the Trenches in a War That Can't Be Won" -- WSJ Aug. 30, 2007)

Safe-injection site adding detox beds and housing

Safe-injection site adding detox beds and housing
Canadian Press
152 words
27 August 2007
Guelph Mercury
Final
A5
English
Copyright (c) 2007 Guelph Mercury.
VANCOUVER

Addicts who shoot up their own drugs at the city's safe-injection site will soon have a place to start getting clean as the facility expands to include detox beds and short-term housing.

As of mid-September, IV drug users at the supervised injecting facility called Insite won't have to wait for detox beds elsewhere, but can instead go directly into detox on the second floor of the same building where they've been getting their fix.

The detox floor will include 12 rooms, each with its own bathroom, a common area, kitchen and exam room, where professionals will assess users and provide counselling.

Those who are homeless or don't want to go back to living in an unsafe place where people are using can then move up to the third floor for temporary shelter.

Editorial, Globe and Mail, SAFE INJECTION SITES

SAFE INJECTION SITES
Editorial
Renew Insite's licence
626 words
27 August 2007
The Globe and Mail
A14
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

Speaking to the Canadian Medical Association last week, federal Health Minister Tony Clement was non-committal on the future of Vancouver's safe injection site. But he seemed to be leaning against extending Insite's licence when it expires at year's end, telling doctors that recent research has cast doubt on the pilot project's usefulness.

Where is Mr. Clement getting his information? He hasn't said. Most likely it is from a well-publicized article published this past spring in the Journal of Global Drug Policy and Practice. The report was authored by Colin Mangham, the director of research for the Drug Prevention Network of Canada, a hard-line organization. Last year, former Reform MP Randy White, the then-head of the network, lauded what he saw as the Conservative government's tough approach on drugs. “A new National Drug Strategy, mandatory minimum prison sentences and large fines for marijuana grow operations, a nationwide awareness campaign, withdrawal of support for injection sites, a crackdown on drug crime and no marijuana decriminalization legislation is a breath of fresh air for Canadians, as well as a reflection of real leadership we have not seen in decades in Canada,” he enthused.

Unsurprisingly, much of the report put out by Mr. White's research director reads more like a rant against the “ideology” of harm-reduction and its alleged infiltration into society than a scientific study. It contains no first-hand research; the bulk of its findings consist of simplistic efforts to poke holes in the litany of more serious studies demonstrating Insite's benefits.
Indeed, virtually all serious research suggests that the program has had considerable benefits with little downside. Reports in reputable medical journals such as The Lancet and the BMJ (British Medical Journal) have shown that Insite reduces needle-sharing in the community, reducing the spread of disease. While 500 users overdosed at Insite over a two-year period, onsite medical assistance prevented a single one from dying – something that would never have been the case on the street.

Far from encouraging drug use, as its opponents claim, Insite has encouraged addicts to kick their habits. Over a one-year period of study, it made 2,000 referrals, 40 per cent of them to addiction counselling. One in five regular visitors to the site enlisted in detoxification programs – resulting, said a recent report in the British medical journal Addictions, in a 30-per-cent rise in the number of local addicts making use of such services. Similar findings were reported last year in the New England Journal of Medicine.

Last week, a group of 134 prominent Canadian doctors and health professionals endorsed a commentary by Dr. Stephen Hwang in the journal Open Medicine calling for Insite to be continued on the basis that it “provide[s] a number of benefits, including reduced needle sharing, decreased public drug use, fewer publicly discarded syringes, and more rapid entry into detoxification services by persons using the facility.” And while the RCMP has been critical of Insite, Vancouver's police department – which is on the ground and thus aware that harm reduction makes the streets safer – has endorsed it.

Unfortunately, it appears that no amount of evidence will convince the Conservatives, skeptical since the project was launched in 2003, of Insite's value. Desperate, local activists and drug users are going to court to argue that closing Insite would violate addicts' Charter rights. That seems a dubious proposition; ultimately the government will likely be free to decide whether or not to keep the program. But if Mr. Clement resists any urge to cherry-pick his information and looks at the overwhelming body of evidence, it should not be a difficult decision.

Illegal drug study says number of deaths high in Downtown Eastside

Illegal drug study says number of deaths high in Downtown Eastside
CP
723 words
23 August 2007
16:42
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.
VANCOUVER (CP) _ Residents of the poverty-riddled Downtown Eastside have seven times the provincial rate of drug-induced deaths, says a report on drug use in Vancouver.
The report from the Canadian Community Epidemiology Network on Drug Use says deaths from illicit drug use were down in Vancouver and the rest of British Columbia for 2006.
Downtown Eastside residents have a 33 per cent higher death rate than the rest of the province.
The report released Thursday says Vancouver's rate of newly diagnosed hepatitis C cases declined from 2006 and new cases of HIV were down from 2005 in connection to intravenous drug use.
The report also says the volume of ecstasy seized by police in 2005 was more than 40 times that seized in 2002.
``This document provides a unique snapshot of the state of drug use in the city,'' Dr. Jane Buxton, Vancouver site co-ordinator, said in a news release.
``Our hope is that we can empower people with a basic understanding of some of the issues involved so that they can begin to do something about it.''
The group says the study was done to provide policy makers and community leaders with better information to help develop harm reduction and prevention techniques to reduce drug use.
The report found the life expectancy for men in the Downtown Eastside, ``the centre of the injection drug use epidemic in Vancouver,'' is nine years less than for Vancouver overall and three years less for women.
In 2006, there were 131 illicit drug deaths in British Columbia, 42 of them in Vancouver, compared with 146 deaths in B.C. and 46 deaths in Vancouver the previous year.
``There has been a dramatic decline in the number of illicit drug deaths in both Vancouver and B.C. since 1998,'' the report said.
Since 2003, the number and proportion of First Nations people to die from illicit drug use has increased to an average of 17 a year or 10 per cent of deaths.
In the 2001 census, 4.4 per cent of B.C. residents identified themselves as aboriginal.
The Downtown Eastside has a higher rate of tuberculosis than Vancouver or British Columbia.
``Challenges to TB control include unstable housing, mobile populations (including populations moving back and forth between the Downtown Eastside and their rural or reserve home communities), and addictions, co-morbidities and non-compliance to TB treatment.''
Studies in top international journals, including the Lancet and British Medical Journal, suggest Vancouver's safe-injection site, where users are given clean needles to inject their drugs, reduces the chance of people passing along infections such as HIV.
But in order to allow the safe-injection site to operate the federal government must grant an exemption from the Controlled Drugs and Substances Act.
The clinic's current exemption lasts until the end of the year and Health Minister Tony Clement has said he wants comprehensive research on the clinic before giving the further operating approval.
The report says between December 2003 and March 2005 4,764 people used the safe injection site.
Insite ordered 1.2 million sterile needles between April 1, 2006, and Feb. 15, 2007.
``It is important that harm reduction programs attract high-risk users, as the contact presents an opportunity to inform users about safer drug use practices and connect them to health services and drug treatment,'' the report says.
Between March 2004 and August 2005 the drugs most often used at Insite were heroin (40 per cent) and cocaine (28 per cent), as well as morphine, dilaudid, oxycodone, crushed crack cocaine, crystal methamphetamine and Talwin-Ritalin.
A study done before and after the site opened found ``significant reductions in the mean number of injection drug users injecting in public and publicly discarded syringes.''
Vancouver police department statistics indicated there was no increase in drug trafficking, assaults or robberies.
The report said said crack cocaine is one of the commonly used drugs in Vancouver's Downtown Eastside.
``While people of all socio-economic backgrounds use crack people who are homeless, street involved or otherwise living in poverty have high rates of use and experience profound negative health consequences.
``There have been few harm reduction initiatives in Vancouver that specifically target the harms associated with crack use.''

130 scientists urge Ottawa to base Insite decision on science, not ideology

130 scientists urge Ottawa to base Insite decision on science, not ideology
CP
228 words
21 August 2007
10:58
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.


TORONTO (CP) _ A group of 130 prominent doctors, scientists and public health professionals is calling on the federal government to use scientific evidence, not political ideology, when deciding whether to extend the life of Vancouver's safe injection site.

The group has endorsed a strongly worded commentary on the issue published by Open Medicine, an online medical journal.

In the commentary, Dr. Stephen Hwang says that if government refuses to accept the scientific evidence backing the Insite program it should be transparent about the basis for its objections.
Hwang says the health of the nation is placed in peril if leaders ignore crucial research findings simply because they run counter to a policy agenda driven by ideology or fixed beliefs.

Hwang, a researcher in the Centre for Research on Inner City Health at Toronto's St. Michael's Hospital, says the federal government seems to be judging the safe injection site program by an entirely different standard than it would other health measures.

An exemption that allows the safe injection site to operate expires at the end of this year.
Signatories to the commentary include Dr. Robert Brunham, head of the British Columbia Centre for Disease Control; Dr. Richard Lessard, Montreal's director of public health; and leading HIV-AIDS researcher Dr. Mark Wainberg

The question of charter rights

Does anyone know the outcome of this court action? It presents an interesting question

Addicts, operator of BC safe-injection site go to court to keep facility open
BY BY CAMILLE BAINS
CP
918 words
17 August 2007
13:30
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.

VANCOUVER (CP) _ Two drug addicts and a group that runs Canada's only safe-injection site have launched court action, saying any effort by the federal government to close the place would violate addicts' Charter rights.

Shelly Tomic and Dean Wilson, along with the Portland Hotel Society which helps operate the facility, filed a statement of claim in B.C. Supreme Court on Friday.

They want the court to declare the operation of Insite, as the facility is known, the exclusive jurisdication of the province and that the federal government shouldn't play any role in its future.

Closing it would be a violation of Tomic's and Wilson's right to ``security of the person,'' the court documents say.

Insite opened four years ago as a pilot project in the Downtown Eastside for IV drug users to inject their own heroin and cocaine with clean needles under the supervision of a nurse.
Addicts who get their fix at the site -- instead of in back alleys and the area's single-room hotels -- can also access referrals to detox and rehabilitation services.

But the future of Insite is currently in Ottawa's hands because in order for the facility to operate, it needs the federal government to grant it an exemption from the Controlled Drugs and Substances Act.

The exemption is set to expire Dec. 31 and federal Health Minister Tony Clement has been noncommital about whether it will be renewed.

``Should Insite close due to the revocation of the exemption. . . Wilson, Tomic and other users will face risk of death or serious harm to their physical and mental health,'' the court documents say.

``In particular, Wilson and Tomic will face increased risks of overdose, infection, decline in their mental and psychological well-being and other health-related complications from drug use.''
The documents go on to say the services provided at Insite are health-care matters and are therefore ``within the exclusive jurisdiction of the province of British Columbia.''

Mark Townsend, director of the Portland Hotel Society, said the ongoing uncertainty is no way to operate a health service for vulnerable people.

``It's not even funded by the federal government, it's 100-per-cent funded by the province, yet they get to give us an extension here and there to create this endless kind of worry,'' Townsend said.

``We'd rather not be in court on this issue but what we really need is just to get the clarification that, really, this is about health care,'' he said.

The site, known as Insite, is the only facility of its kind in North America.

Tomic, a 39-year-old addict with a long history of addiction issues, said she got involved in the legal action because she's seen its positive effects first-hand

``A lot of people will end up dying if they shut it down because with the fear of the police picking them up, they start (injecting) too much just to get it in them before they're caught,'' said Tomic, who was one of the first to use the facility.

Tomic said she's been taking methadone for about 10 months as part of her treatment to withdraw from heroin. And despite staying clean so far, she said she still visits Insite to talk to the staff on days when she feels like relapsing.

Dean Wilson, the other addict named in the statement of claim, credited Insite for keeping him and his two sons alive.

``This is gold-standard medicine,'' Wilson said. ``Addiction is a health issue.

``This is a life-saving measure down here. It may not be a life-saving measure in (Toronto's) Rosedale or Mount Royal in Montreal but in the Downtown Eastside, it is a life-saving measure.''
The court documents note Wilson has been addicted to herion for about 38 years, contracted hepatitis C in 1969 and has had several close calls with overdoses.

The suit says before Tomic and Wilson began getting treatment for their addictions, they stopped in at Insite to inject about six times a day for Tomic and 15 times a day for Wilson.
Dr. Evan Wood, an epidemiologist at the B.C. Centre for Excellence in HIV/AIDS, said 24 studies have pointed to Insite's benefits.

Since 2003, research published in top journals has stated the site reduces public injections, overdose fatalities and the transmission of blood-borne infections like HIV and hepatitis C, Wood said, adding crime hasn't increased in the area despite initial fears by some in the community.

``From a scientific perspective, I believe this is a health issue,'' Wood said, adding he agrees with the court action.

``(Prime Minister) Stephen Harper has failed to show any leadership on this issue and the fact that it's going to the courts now is not surprising,'' he said.

``If the facility closes and somebody contracts HIV or dies of an overdose and has a compelling argument that this wouldn't have happened to them had the federal government not removed this service, then I think that raises legal issues as well.''

Monique Pongracic-Speier, one of three lawyers working on the case for free, said her clients are merely asserting their constitutional rights regarding the use of a facility that's helped them stay alive.

``After all, Insite is about saving lives. That's the bottom line.''

Kerr, Tyndall, Ahang, Lai et al, American Journal of Public Health

Circumstances of First Injection Among Illicit Drug Users Accessing a Medically Supervised Safer Injection Facility
Kerr, Thomas; Tyndall, Mark W; Zhang, Ruth; Lai, Calvin; Et al
2867 words
1 July 2007
American Journal of Public Health
1228
Volume 97; Issue 7; ISSN: 00900036
English
© 2007 American Journal of Public Health. Provided by ProQuest Information and Learning. All Rights Reserved.

There have been concerns that safer injecting facilities may promote initiation into injection drug use. We examined length of injecting career and circumstances surrounding initiation into injection drug use among 1065 users of North America's first safer injecting facility and found that the median years of injection drug use were 15.9 years, and that only 1 individual reported performing a first injection at the safer injecting facility. These findings indicate that the safer injecting facility's benefits have not been offset by a rise in initiation into injection drug use. (Am J Public Health. 2007;97:1228-1230. doi:10.2105/AJPH.2006.086256)

Medically supervised safer injection facilities, where injection drug users can inject preobtained illicit drugs, have been implemented in various cities to reduce the public health effects of illicit drug use.1 Although evidence suggests that safer injecting facilities reduce overdose deaths,2 HIV risk behavior,3 and public disorder,4 this intervention remains highly controversial,5-7 largely because of concerns that the provision of a legal place to inject drugs may encourage initiation into injection drug use.8,9 Preventing initiation into injection drug use is a key public health priority,10 and it is noteworthy that fears regarding potential increased rates of injection drug use were among the reasons for the US federal ban on funding for needle exchange programs.9

In the light of concerns regarding the potential of safer injecting facilities to promote initiation into injection drug use,11 we examined length of injecting career and circumstances surrounding initiation into injection drug use among a cohort of users of a safer injecting facility in Vancouver, British Columbia. The Vancouver safer injecting facility-known as Insite-opened in September 2003 as part of a 3-year pilot study.

The Scientific Evaluation of Supervised Injecting (SEOSI) cohort has been described previously.12 In brief, the SEOSI participants were a representative sample of users of the Insite safer injecting facility derived through random recruitment at the Insite facility. During study visits, blood samples for HIV and hepatitis C virus testing were drawn and a questionnaire was administered to elicit demographic and other information, including drug use and HIV risk-associated behavior.

METHODS
First, we examined length of injecting career. To avoid the potential bias resulting from participants' potential unwillingness to report that their first injection was within the safer injecting facility, we calculated duration of injection drug use by subtracting each participant's age at first injection from the participant's current age rather than asking this question directly. Later in the interview, we assessed the circumstances surrounding initiation into injection drug use among SEOSI participants. Variables of interest included injection by someone else during first injection, injection with a used syringe during first injection, and location of first injection (including within the safer injecting facility). As a subanalysis, we compared the overall rate of initiation into injection drug use among SEOSI participants since the safer injecting facility had opened with the expected rate of initiation among local street youths during a similar follow-up period.

RESULTS
Overall, 1065 participants completed surveys from December 1, 2003, to October 21, 2005 (Table 1). The median age of the participants was 39 years (range= 19-64 years); 312 (29%) participants were women. The median number of years of injection drug use was 15.9 (interquartile range=8.6-25.9). High levels of HIV risk-associated behavior at the time of initiation into injection drug use were reported: 213 (20%) participants reported that their first injection was performed with a used syringe, and 796 (75%) participants reported that they were injected by someone else during their first injection. One man reported performing his first injection within the safer injecting facility. On die basis of the difference between age at first injection and current age, we calculated that an additional 14 individuals had initiated injection drug use since the opening of Insite, all of whom did not report performing their first injection within the facility. When these data were extrapolated to the entire population of safer injecting facility's users (i.e., approximately 5000 individuals),13 the estimated number of injection drug users who may have initiated injection drug use inside and outside the safer injecting facility were 5 (95% confidence interval [CI] =2, 12) and 70 (95% CI= 55, 80), respectively.

For comparison purposes, we estimated the rate of initiation into injection drug use that might be expected among the estimated 1250 Vancouver street youths during a single year.14,15 On the basis of published estimates of the annual incidence of first injection among Canadian street youths (8 per 100 person-years),16 one can estimate that approximately 100 (95% CI=81, 122) Vancouver street youths initiate injection drug use each year. This rate is higher than the rate observed among users of safer injecting facilities overall, and street youths represent only a small fraction of the local population that is at risk for initiating injection drug use on an annual basis. The 14 individuals who initiated injection drug use outside of the safer injecting facility likely did so completely independently of the existence of the safer injecting facility. Thus, the values that are most relevant for comparison are likely the estimated rate of initiation among street youths (100; 95% CI=81, 122) and the estimated rate of initiation within the safer injecting facility (5; 95% CI=2, 12).

DISCUSSION
Our findings indicated that most users of the safer injecting facility were long-time injection drug users, and we found no evidence to suggest that the safer injecting facility prompted elevated rates of initiation into injection drug use in the community. In fact, the median years of injection drug use among users of safer injecting facilities were greater tìian the median years of injection drug use (10; interquartile range=4-20) among participants in another cohort study of local injection drug users (the Vancouver Injection Drug Users Study).17 Although 1 individual reported performing his first injection at the safer injecting facility, even when we included individuals who initiated injection drug use outside the safer injecting facility, the overall rate of recent initiation into injection drug use among users of the safer injecting facility was markedly lower than the estimated background community-level rate of injection initiation.16,18
The negligible number of new injectors observed in the Vancouver safer injecting facility compares favorably with the proportions observed in European safer injecting facilities.11 Our findings also may reflect rules that prevent first-time injectors from using the safer injecting facility. More specifically, the staff members at the safer injecting facility ask all new visitors to the facility to sign a waiver indicating that they have injected previously, and it is known in the community that first-time injectors are prohibited from using the facility.

The findings pertaining to risky behavior during first injections were consistent with those of previous studies19 and indicated the need for interventions to prevent initiation into injection drug use and programs that promote safer injecting practices among new injectors. Given the high rates of syringe borrowing and assisted injection during the first injections reported among participants in this study, rules preventing first-time injectors from using the safer injecting facility should potentially be reevaluated. For example, perhaps first-time injectors could inject at the safer injecting facility if, after a careful assessment, an addiction counselor determined that the individual was unlikely to act on referrals to abstinence-based treatments and remained highly likely to initiate injection drug use.

This study relied on self-reports that may have been susceptible to socially desirable reporting. Although studies indicate that injection drug users may underreport undesirable behaviors, participants were blinded to this eventual use of the data, and therefore, we have no reason to believe that our estimates were biased. This assumption was further supported by the fact that our primary outcome was calculated by subtracting the age at first injection from the participant's current age rather than asking directly about years of injecting. However, we recognize tìiat socially desirable responding may have biased our estimates of the number of first injections performed at the safer injecting facility among the 14 individuals who initiated injection drug use after the safer injecting facility opened. Regardless, even if we assume that all of these individuals initiated injection drug use at the safer injecting facility, the rate of initiation into injection drug use among users of safer injecting facilities still would be lower than the rates that have been reported among similar at-risk populations.

Also, even though we generalized the rates observed in the SEOSI cohort to the overall cohort of users of the safer injecting facility, we thought that this was justifiable because SEOSI was based on a random sample and because previous comparisons between the SEOSI cohort and the overall cohort of users of the safer injecting facility have shown the 2 populations to be statistically similar.12 A further potential limitation of our study pertains to our comparison of rates of initiation into injection drug use from other settings and from previous years. We recognize that contextual and temporal differences may have limited the appropriateness of these comparisons, but local estimates were unavailable.

We found that the Vancouver safer injecting facility is used by individuals with long injecting careers and that users of the safer injecting facility were almost universally long-term injectors. Together, these findings indicate that the reported benefits of the safer injecting facility on HIV risk-associated behavior and public disorder were unlikely to have been offset by negative effects of increased rates of initiation into injection drug use.

References
1. Kimber J, Dolan K, van Beek I, Hedrich D, Zurhold H. Drug consumption facilities: an update since 2000. Drug Alcohol Rev. 2003;22:227-233.
2. Poschade S, Hoger R, Schnitzler J. Evaluation of the Work of the Drug Consumption Rooms in the Federal Republic of Germany [in German]. Final Report on Behalf of the Federal Ministry for Health. Baden-Baden, Germany: Nomos; 2003.
3. Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005;366:316-318.
4. Wood E, Kerr T, Small W, et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ. 2004;171:731-734.
5. Strang J, Fortson R. Supervised fixing rooms, supervised injectable maintenance clinics- understanding the difference. BMJ. 2004;328:102-103.
6. Wright NM, Tompkins CN. Supervised injecting centres. BMJ. 2004;328:100-102.
7. Capozza KL. U.S., Canada spar over anti-drug policies. United Press International. September 16, 2003.
8. Vancouver's heroin users get safe-injection site. Canadian Broadcasting Corporation September 15, 2003.
9. Vlahov D, Des Jarlais DC, Goosby E, et al. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. Am J Epidemiol. 2001;154(12 suppl):S70-S77.
10. Vlahov D, Fuller CM, Ompad DC, Galea S, Des Jaríais DC. Updating the infection risk reduction hierarchy: preventing transition into injection. J Urban Health. 2004;81:14-19.
11. Hedrich D. European Report on Drug Consumption Rooms. Lisbon, Portugal: European Monitoring Centre for Drugs and Drug Addiction; 2004.
12. Wood E, Kerr T, Lloyd-Smith E, et al. Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users. Harm Reduct J. 2004;1:9.
13. Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. Attendance, drug use patterns, and referrals made from North America's first supervised injection facility. Drug Alcohol Depend. 2006;83:193-198.
14. Poulin C, Fralick P, Whynot EM, et al. The epidemiology of cocaine and opiate abuse in urban Canada Can J Public Health 1998;89:234-238.
15. Wood E, Stolte J, Montaner J, Kerr T. Evaluating metharnphetamine use and risks of injection initiation among street youth: the ARYS study. Harm Redud J. 2006;3:18.
16. Roy E, Haley N, Ledere P, Cedras L, Biais L, Boivin JE Drug injection among street youths in Montreal: predictors of initiation. J Urban Health. 2003;80:92-105.
17. Kerr T, Marsh D, Li K, Montaner J, Wood E. Factors associated with methadone maintenance therapy use among a cohort of polysubstance using injection drug users in Vancouver. Drug Alcohol Depend 2005;80:329-335.
18. van Ameijden EJ, van den Hoek JA, Hartgers C, Coutinho RA. Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users. Am J Epidemiol. 1994;139:1153-1163.
19. Fuller CM, Vlahov D, Latkin CA, Ompad DC, Celentano DD, Strathdee SA Social circumstances of initiation of injection drug use and early shooting gallery attendance: implications for HIV intervention among adolescent and young adult injection drug users. J Acquir Immune Defic Syndr. 2003;32:86-93.

Abstract
Medically supervised safer injection facilities, where injection drug users can inject preobtained illicit drugs, have been implemented in various cities to reduce the public health effects of illicit drug use.1 Although evidence suggests that safer injecting facilities reduce overdose deaths,2 HIV risk behavior,3 and public disorder,4 this intervention remains highly controversial,5-7 largely because of concerns that the provision of a legal place to inject drugs may encourage initiation into injection drug use.8,9 Preventing initiation into injection drug use is a key public health priority,10 and it is noteworthy that fears regarding potential increased rates of injection drug use were among the reasons for the US federal ban on funding for needle exchange programs.9 In the light of concerns regarding the potential of safer injecting facilities to promote initiation into injection drug use,11 we examined length of injecting career and circumstances surrounding initiation into injection drug use among a cohort of users of a safer injecting facility in Vancouver, British Columbia. In fact, the median years of injection drug use among users of safer injecting facilities were greater tìian the median years of injection drug use (10; interquartile range=4-20) among participants in another cohort study of local injection drug users (the Vancouver Injection Drug Users Study).17 Although 1 individual reported performing his first injection at the safer injecting facility, even when we included individuals who initiated injection drug use outside the safer injecting facility, the overall rate of recent initiation into injection drug use among users of the safer injecting facility was markedly lower than the estimated background community-level rate of injection initiation.16,18 The negligible number of new injectors observed in the Vancouver safer injecting facility compares favorably with the proportions observed in European safer injecting facilities.11 Our findings also may reflect rules that prevent first-time injectors from using the safer injecting facility.

Copyright American Public Health Association Jul 2007 Thomas Kerr, PhD, Mark W. Tyndall, MD, ScD, Ruth Zhang, MSc, Calvin Lai, MMath, Julio S.G. Montaner, MD, and Evan Wood, PhD About the Authors All authors are with the British Columbia Centre for Excellence in HIV/AIDS, Vancouver. Thomas Kerr, Mark W. Tyndall, fulio S. G. Montaner, and Evan Wood are also with the Faculty of Medicine, University of British Columbia, Vancouver. Requests for reprints should be sent to Thomas Kerr, PhD, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 (e-mail; tkerr@cfenet.ubc.ca). This brief was accepted August 16, 2006. Contributors T. Kerr and E. Wood originated and designed the study, supervised all aspects of study implementation, drafted the article, and incorporated reviewer suggestions. T. Kerr, R. Zhang, and C. Lai conducted the statistical analyses. M. W. Tyndall and J. S. G. Montaner made significant contributions to the formulation and design of the analyses, interpretation of the data, and drafting of the article. All authors helped to interpret findings and review drafts of the article. Acknowledgments The safer injecting facilities evaluation has been made possible through a financial contribution from Health Canada, the Michael Smith Foundation for Health Research, and the Canadian Institutes for Health Research. We wish to thank the staff of the Insite Safer Injecting Facility, the Portland Hotel Society, and Vancouver Coastal Health (Chris Büchner, David Marsh, Heather Hay). We also thank Aaron Eddie, Suzy Coulter, Megan Oleson, Peter Vann, Soni Thindal, Dave lsham, Daniel Miles Kane, Steve Gaspar, Cristy Power, Carl Bognar, Jo-Anne Stolte, and Deborah Graham for their research and administrative assistance. Note. The views expressed in this article are those of the authors and do not represent the offical policies of the study's sponsor. Human Participant Protection The evaluation received ethical approval from the University of British Columbia/Providence Health Care Clinical Research Ethics Board and from Health Canada