Vancouver To Take New Approach for Addicts

Vancouver To Take New Approach for Addicts
Posted by CN Staff on June 09, 2003 at 21:09:00 PT
By Jonathan Martin, Seattle Times Staff Reporter
Source: Seattle Times
Vancouver, B.C.  The cops are outside the door, but a junkie named John is in no hurry to get his fix. The war on drugs is not waged in here, after midnight in a health clinic in the city's freewheeling downtown Eastside slum. John patiently scours both arms for one last good vein as he cracks jokes with a supervising nurse. "For the liberal government of B.C., I'd like to thank you for this opportunity," said John, and he drops the plunger on a needle full of cocaine and heroin. 
It's no wonder addicts are unafraid of arrest. Drug laws here, which are already pliable by U.S. standards, are easing yet again, propelling Canada toward European-style tolerance. As the Canadian Parliament debates making possession of small amounts of marijuana the equivalent of a traffic ticket, Vancouver, the vanguard of Canadian cities, is taking the widely adopted idea of a needle exchange even further. It plans to dispense prescription heroin to hundreds of chronic addicts and to replace the clinic visited by John with a state-of-the-art, federally sanctioned facility. From the Canadian perspective, that John shot up with a clean needle, and in a clinic where he can get information on treatment, is more important than making an arrest. But what Canada calls progressive, the Bush administration has called "immoral," and has warned of slowdowns at the border should marijuana be decriminalized. Without the threat of arrest, addicts won't seek treatment and will only expand a drug market that spills across the border, U.S. authorities say. Vancouver is the nexus of the debate. The province is the namesake for marijuana  B.C. bud  so potent and valuable it is traded with U.S. smugglers kilo-for-kilo for cocaine. The city is so awash in heroin that a 100-kilogram seizure by police in 2000 didn't dent the street price. The city also has one of the highest rates of HIV/AIDS infection in North America. The unusually open drug market of the downtown Eastside, where almost a third of the 16,000 residents are IV drug users, has helped make overdoses the city's leading cause of death for men ages 30-49 for five years running, according to research from the University of British Columbia. The U.S. criticism rankles Vancouver, which just elected as mayor a former drug cop campaigning for the injection site. "There is no doubt the American drug problem is the biggest in the world," said Donald MacPherson, head of drug policy in Vancouver. "People here say, 'Go home and fix your own problems.' " Following the Swiss  The day after Welfare Wednesday, when government checks arrive, ambulance sirens scream out of the downtown Eastside neighborhood with overdose cases. The $368,000 (U.S.) annual cost of such trips  and the estimated $100,000 (U.S.) spent annually on each new HIV case  helped sway voters toward a more liberal approach. Canadians view drug addiction pragmatically, in part, because the socialized medical system bears much of the cost, said Philip Handrick, acting director of the Canadian Studies Centre at Michigan State University in Lansing. "Canadians tend to be very deferential to authority, and if the medical authorities say this is the way we should approach it, there is a deference to that opinion," he said. There is consensus  from the Canadian Senate to the Vancouver police chief  that arrests alone won't solve the problem. Instead, Canadians have looked to Europe for cures to social ills. Vancouver, in particular, latched onto a Swiss model called the "four pillars" that gives equal weight to safe injection sites and incarceration. In one study published in the British Medical Journal, Swiss heroin addicts reported working more and relying far less on income from criminal activity when prescribed heroin at government clinics. A group of current and former drug addicts campaigned for Vancouver Mayor Larry Campbell, and now are pressuring him to follow through on his pledge of an injection site. An astonishingly high 15 percent of the city's IV drug users have AIDS, compared with 1 percent in Pierce County, home to the U.S.'s first needle-exchange program. "This will go down in history as a time when we saw thousands and thousands of people die" of HIV/AIDS and overdoses, said Anne Livingston, project coordinator for the Vancouver Area Network of Drug Users, which operates the site visited by John, who agreed to be interviewed if his last name was withheld. The group is now frustrated that Campbell has been slower than expected opening a site, even as rates of HIV/AIDS and other diseases related to IV drug use hover at epidemic levels. "The younger activists use the words like murder" to protest the delay, Livingston said. "I want people to stop dying, not just to be right."  Decriminalization As politicians and epidemiologists have looked to Europe for answers, Canada's courts have gnawed at the foundation of marijuana-possession laws. A judge in Ontario this year ruled the country's laws for personal possession of marijuana were a violation of the country's version of the Bill of Rights. B.C. courts, according to police, routinely give no jail time  and scant probation  for possession arrests. Acknowledging that police rarely make such arrests now, the Canadian Parliament introduced a law last month that decriminalized possession of the equivalent of 15 joints, while stiffening criminal penalties for big pot growers and narcotics trafficking. On the streets in Vancouver, Police Sgt. Bob Usui watches red-eyed tourists drift out of the Amsterdam Cafe, one of the downtown Eastside clubs where pot is bought and smoked openly. Usui, who grew up nearby, is part of a beefed-up unit deployed last month to clean up the neighborhood's open-air drug market. It's widely believed that the show of force is linked to the city's bid for the 2010 Winter Olympics. Although marijuana is estimated to be one of the top three cash crops in Western Canada, worth an estimated $2.8 billion (U.S.) in B.C. alone, police are more concerned now about a burgeoning crack-cocaine market, Usui said. While heroin addicts shoot up two or three times a day, crack addicts can go through 30 needles daily, increasing risk of infection. "Do you really want to ruin someone's life for a few joints? Usui said. "We don't have the resources anyway, not like the Americans." The U.S. rate of incarceration for all crimes is at least five times higher than the rate in Canada, according to the Canadian National Parole Board.  Border slowdowns? U.S. drug-policy officials critical of Canada's direction have used Vancouver as a poster child for liberal drug laws. U.S. drug czar John Walters called the downtown Eastside slum the worst he has ever seen during a tour there earlier this year and said the country's direction on marijuana may force more rigorous checks at the border. "Nobody wants to punish Canada, but we have to take reasonable security measures as the threat increases," he told The New York Times recently. U.S. Border Patrol agents at the Blaine crossing have seen a 350 percent increase in illicit drug seizures in the past three years. The trade goes both ways, border agents say, with high-grade pot traded for cocaine to fuel Vancouver's booming cocaine market. Dave Murray, a researcher for Walters' office, said the Canadian approaches are based on sketchy research. Looser laws would fertilize drug markets, spilling even more pot into the United States, he said. "The philosophy is that there's nothing wrong with what you're doing, so where is the incentive to change behavior," Murray said. "If there is not a criminal-justice sanction, as we've learned in the U.S., they won't go to treatment." Washington Gov. Gary Locke's criminal-justice adviser, however, said he sees no reason to enhance border security to respond to the Canadian proposals because a crackdown would hurt trade. "I just don't understand the logic of that," said Dick Van Wagenen. "The Canadians don't advise us about our own policy much, and we try to extend that courtesy."  Treatment The B.C. Centre for Excellence in HIV/AIDS is expecting to get a federal waiver from heroin-importation and -possession laws sometime this summer to open an injection site in the downtown Eastside neighborhood and begin prescribing heroin to 470 addicts. The neighborhood is home to an estimated 5,000 IV drug addicts. But two unauthorized clinics already are open, including one at an HIV/AIDS treatment center connected to Vancouver's largest hospital. The Dr. Peter Centre debated supervising injections in 2001, after a patient told a nurse he planned to use his own blood as a solution to mix his drugs in and shoot up in the shrubs outside. That put the nonprofit clinic in an ethical quandary, Executive Director Maxine Davis said. The clinic's nurses live by the Hippocratic oath, but they also didn't want to get arrested. Nor did the clinic want to lose financial donors. The clinic got the police's pledge to not raid it, and no donors canceled checks after the injections were made public. About 15 patients a day shoot up in a room plastered with appropriate injection technique and information on treatment. "This is the most ethical work I've ever done," nurse Patti Zettel said. "It's simply unrealistic to think we can prosecute this away. It's impossible to fund, and it's not working. And it's just not right." But the clinic has had trouble getting addicts into treatment. Addicts must call daily for eight to 10 days before getting into detoxification beds and often wait a month for inpatient treatment. Murray, of the U.S. drug czar's office, said the underfunded treatment is perhaps the biggest problem with Canada's direction on drug policy. "Without treatment, you have a kind of euthanasia by heroin injection," he said. Complete Title: Vancouver To Take New Approach with Legal Injection Site for AddictsSource: Seattle Times (WA)Author:  Jonathan Martin, Seattle Times Staff ReporterPublished:  Monday, June 09, 2003 Copyright: 2003 The Seattle Times CompanyContact: opinion seatimes.comWebsite: Articles:Canadian Mayor Pushes for Treatment Centers Laws Need Massive Overhaul: Committee
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