http://www.cbc.ca/stories/2003/09/15/safe_injection030915

Vancouver's heroin users get safe-injection site
Last Updated Mon, 15 Sep 2003 14:14:48

VANCOUVER - Vancouver is the first North American city to provide heroin users with a safe medical environment to take their drugs.

The supervised, safe-injection site, which will cost $2 million a year to operate, opened on Monday. It is expected to stop the spread of HIV and Hepatitis C from intravenous drug use and reduce the number of heroin deaths.

The safe-injection site, located in the Downtown Eastside, will operate 18 hours a day under the supervision of nurses. The neighbourhood is home to an estimated 4,000 injection drug users and a high number of people with HIV and Hepatitis C.

Up to 800 drug users are expected to visit the Vancouver site each day.

There are currently 47 safe-injection sites operating in Europe, many of them in existence for more than a decade.

Safe injection sites, which operate under the supervision of medical staff, typically offer drug addicts sterile needles, spoons, water and access to detox and treatment programs and free counselling.

Safe-injection sites have been criticized by high-profile individuals such as U.S. drug czar John Walters as being havens that will encourage heroin use. The Vancouver site is seen as a welcome neighbourhood service by the city's former mayor, Philip Owen and current mayor, Larry Campbell.

In 2000, Owen pushed for a safe-injection site that would provide out-reach services to the city's heroin users.

"It's pretty obvious you can't incarcerate your way out of the drug problem. You can't liberalize your way out of it and just give anybody the drugs they want, " he says. "You can't ignore it. So you manage it," said Owen.

Another dissenting voice comes from Thomas Kerr, a Canadian HIV/AIDS Legal Network researcher who said that rigid rules and the presence of eight police officers at the site will likely scare away drug users from entering the site.

A recent study showed that 92 per cent of Vancouver's drug users initially said they would use the safe-injection site, but when they learned about the bureaucratic complexities they would face at the safe-injection sites, the number dropped to 31 per cent.

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i honestly don't know what to think about this idea. it seems that it could be promising in deterring/treating some users but things like this never seem to go quite as efficiently as planned, especially when the government is involved. and i wonder how many heroin users care enough about getting HIV and Hepatitis C to voluntarily go to one of these sites?

Wow..I don't know what to think. Sign of the times?

i applaud this move.

when someone says "drug problem" what do they really mean? often they are talking about the crime and disease that are factors in illegal drug use. the crime comes from people being too poor to afford their drugs, because drugs are illegal and cost far more than they are worth, on the black market. the disease comes from them being unable to access safe, clean places to get their "works" from and use in. at least vancouver is taking steps to help combat the latter problem.

I believe they have something like this in Europe somewhere. I'd be interested in seeing their stats on how effective it is. I agree with Kreeli. Pushers will use an old needle, trying to clean it out best they can, rather than do without one at all. If they have a choice between an old dull one that someone else used or a new fresh one, they'll choose the latter. I believe this should lessen the chances of getting a blood born diseases such as Hep or HIV.

I believe they have something like this in Europe somewhere.
There are currently 47 safe-injection sites operating in Europe, many of them in existence for more than a decade.

but yes, i'd certainly like to see some stats on this. and i still question how many users will actually use this kind of site, and more importantly, stick with it. heck, i'm always telling myself i'm going to get off the computer in 30 mins but my actions often say otherwise. 92% of users said they would use this site, which then dropped it to 31% - and of this 31%, how many will follow through with their words? and of that number, how many will still be going in 3 months?

Hmm, I have to look into this. I assume it is a provincial thing and not a federal gov't thing. I would absolutely be pissed off if even one of my tax dollars for the healthcare system were placed into a program to fund any drug program for addicts.

I'm for just about anything that will keep syringes off of the street. Heroin abuse is a large problem in Baltimore, MD US (home). I quit walking my dogs because of the frequency with which I would come across a needle, a vial, a baggie, a burnt spoon or burned up soda can bottom. I'm not encouraging drug use or abuse, particularly heroin, but keeping needles off the streets and out of general population where a contaminated one might accidentally be stumbled on by a child or ANYONE else is a worthwhile endeavor.

those are good questions, stonecrest, and i do think the police presence will be a big deterrant for most users. for all intents and purposes i am an upstanding law-abiding citizen and even i don't like hanging out in a room full of cops, so i can just imagine how it would make a user feel.

imo, the safe injection site should have a couple of security guards...not official cops.

How sad this makes me.....thinking about those that are addicts. Maybe someone who takes advantage of the counseling through the site will be able to overcome their addiction. I hope so. I'm all for helping them in any way, even if it costs me money. Addiction is incredibly painful for everyone involved. Bless them.

I'd have no problem in the access to detox and treatment programs and free counselling, and would haveno problem in some of my tax dollars going to help these people wanting to get clean. But no way I'd support giving these addicts spoons and needles. All that does is make taking the drugs a bit safer, but does nothing to help the addict get clean. I'm more than willing to help those willing to help themselves, but they have to want help first.

I'm absolutely for teaching drug-injectors how to inject safely, and to use alternate routes of taking their drug (such as intranasally), and to supply them with safe drugs at normal retail cost (so that legal sellers can make a reasonable profit, compete with illegal sellers, and put illegal sellers out of business), as well as safe needles, syringes, etc, all of which should be affordable -- these are not expensive items if sold legally.

Then drug users won't have to steal as much to support their habit, and we can save money on law enforcement, courts, and jails.

Let them have whatever drugs they want and ruin their own lives -- not the lives of others by stealing from them.

I'm absolutely for teaching drug-injectors how to inject safely, and to use alternate routes of taking their drug (such as intranasally), and to supply them with safe drugs at normal retail cost (so that legal sellers can make a reasonable profit, compete with illegal sellers, and put illegal sellers out of business), as well as safe needles, syringes, etc, all of which should be affordable -- these are not expensive items if sold legally.

Then drug users won't have to steal as much to support their habit, and we can save money on law enforcement, courts, and jails.

Let them have whatever drugs they want and ruin their own lives -- not the lives of others by stealing from them.

soilman has it right. :)
another aol-esque "me too!" post from yours truly...

ebola
np: arovane

Nice post, Soilman!

I'm wondering exactly what the idea is behind these safe-injection centers. Do people bring their own drugs into them, or do they have to pay to get drugs at the center? Are these centers here to ween people off drugs, or can you just stop in every day for the rest of your life?

Bit confused.

mikie, the centers are designed to be a clean, safe place for users to get clean works from (needles and syringes) and inject in. the users bring their own drugs. they may come every day for the rest of their lives, as long as the center is still funded and being operated.

I think they are usually associated with a "harm reduction" program. This is a program that is designed to minimize how much harm the drug user does to herself, without necessarily getting her completely off drugs. They first focus on clean needles, then the focus on what the person wants to do next. Do they want to get completely off the drug, do they want to take as much as they can fit into their veins, or do they want to try and reduce how much they take, perhaps to a level that makes them functional, but still taking enough drugs to avoid withdrawal symptoms, or the physical pain, or emotional pain that perhaps they might be taking the drug for. Most drug rehabilitation programs have a goal of either getting the person completely off drugs, or on methadone instead of heroin, if they were taking heroin. A "harm reduction" program has that as only possible goals. A "reduce your dose to a safer level" goal is an alternative goal instead of these other 2. They take the same view regarding alcohol -- they don't, like alcoholics anonymous, say you have to completely quit drinking to remain in the program. One might have a goal of simply drinking less, or even staying the same but minimizing how much harm you do as a result.

Another possibility for "harm reduction" for heroin users, would be switching to another opioid, but not necessarily methadone. It might be a legal or illegal opioid, but one that is less disruptive of one's ability to function than the gigantic doses that some heroin users my habitually take, seeking euphoria. Illegally acquired opium may be a step toward less harmfulness than illegally acquired heroin. A legal opioid like legally prescribed morphine, oxycodone, hydrocodone, or codeine, may be a step toward a less harmful habit.

Soilman, yes, but Alcoholics Anonymous is not paid for by the tax payers to the extent that they provide clean drinking glasses to those who wish to drink.

Like I said, I have no problem with some tax dollars going to help those who WANT to get clean, but I am absolutely opposed to giving even a single tax dollar to supply junkies with the tools they need to get high.

Robert I'm not necessarily opposed to the compromise of charging the drug user a reasonable fee for needles and syringes. If the user can afford to buy drugs, they can afford the $1.29 for the syringe and the $0.79 for the needle -- and the center could probably make a profit selling needles and syringes at this fee. In fact i tend to think this would be a good idea.

also, a certain percentage of "junkies" are taking their drug not to get high, but to relieve actual physical pain or emotional pain. They don't even get high. They just found it difficult to prove to a doctor that they have pain because they have a condition that doesn't show up on scientific diagonostic tests (as I do, by the way) and they haven't convinced a doctor that they have legit pain, and in addition, most doctors are quite reluctant to describe adequate opioids for legit pain that does show up in tests or x-rays.

But I think we have to consider that we are not only helping the intravenous drug user by giving her a needle, free or at reasonable cost, but we are helping the population in general, by reducing the spread of aids and other diseases. The money saved by the government in treating indigent AIDs patients would be much more than the really really trivial amount spent on needles. And people could feel safer about shaking hands with strangers, or talking on telephone after someone else talked on it and maybe got a little saliva or mucus on it. It's worth the trivial expense for needles and syringes.

well, an alcoholic can't get or transmit HIV, AIDS or hep C via a dirty drinking glass, robert. there is a big difference there. and since AIDS, HIV, and hep C are reaching epidemic proportions around the world, it only makes sense to try and stem the tide by doing what we can to help those in high risk situations.

I think it would also be less tax dollars, to give iv drug users needles and syringes, than to put them in a methadone program, where the salary of an md has to be paid, or an abstinance program where counselors are paid large salaries to counsel iv drug users on how to quit. The cost of hiring an unskilled person to hand out the needles and syringes, taking a few seconds for each iv drug user, would be much less. Less salaries have to be paid. And volunteers can do this -- hand out needles and reorder more when the supply get low and keep track of inventory and expenses.

If that's the case, Kreeli... then I think I'm with Robert on this one. :surprised

Like I said, I have no problem with some tax dollars going to help those who WANT to get clean, but I am absolutely opposed to giving even a single tax dollar to supply junkies with the tools they need to get high.

Another possibility for "harm reduction" for heroin users, would be switching to another opioid, but not necessarily methadone. It might be a legal or illegal opioid, but one that is less disruptive of one's ability to function than the gigantic doses that some heroin users my habitually take, seeking euphoria. Illegally acquired opium may be a step toward less harmfulness than illegally acquired heroin. A legal opioid like legally prescribed morphine, oxycodone, hydrocodone, or codeine, may be a step toward a less harmful habit.

Methadone is starting to get a bad rap in England because it has a higher rate of negative side effects than clean morphene or heroine and may even be more dangerous. It's really a tough call made even more difficult by the fact that research on treatment methods that use a maintenance level of a controlled substance or even the use of other drug therapies to fight addiction are practically supressed. Another case where this puritanical approach to drug addiction comes in with tobacco. There are forms of snuff that provide the same high as tobacco use but offer minimal cancer risks. However, don't expect to see safer tobacco products in the U.S. in the near future.

kirkjobsluder writes:
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Methadone is starting to get a bad rap
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It is starting to get a bad reputation, among pain relief professionals, in the US also, for having more central nervous system effects than morphine or oxycodone or codeine. (some pain relief patients have been getting methadone). It doesn't seem to do organ damage that I am aware of. the problem is effects like sudden, unpredicatable drowsyness or even blackouts. Making it more dangerous for driving and use of machinery.

The main reason for its use is it is long-acting, and cheap to make. I'm all for giving drug users morphine, oxycodone, codeine, or even fentanyl patches, instead of methadone.

I'm not so sure heroin is a good idea either as it has extreme ups and downs within 2 or 3 hours. So you have to take frequent doses, and if you don't want to be "falling asleep on the job" it is hard to estimate the dose that will keep you comfortable, but not make you drowsy. And you have to take frequent doses. Morphine, oxycodone, and codeine are much more "even" from minute to minute. You don't go flying up and crashing down like on a rollercoaster. Morphine users who take the right amount report complete relief from pain with minimal to no effects on consciousness.

>>Methadone>>

I've done a bit of reading, and it also seems that some of the synthetic opiates, methadone and demerol in particular, may be slightly neurotoxic when taken for extended periods...this is NOT good. :)

There is a new treatment out there which employs the use of a mixed agonist-antagonist at opiate sites. I forget the name of it...starts with a "b"..."buper..."...anywho, it prevents dope-sickness, but allows the user to more easily transition away from opiate-dependent neurochemistry.

ebola
np: quake soundtrack

im wondering about this...

so its legal for people to shoot up inside this place...

but could they be arrested for posession outside?
are police going to be tracking some of the users to arrest dealers?

also is the medical staff going to provide medical care if their drugs are bad and they get sick?

do the people get to shoot up in private? can they do non IV drugs there as well?

i dont understand the whole setup of it... people come in, they get clean needles and whatever, they go to a room, they get high.... and then what? do they get to hang around? do they get kicked out?