Injection Sites, Canadian Drug Policy Seeks a Fix 

Injection Sites, Canadian Drug Policy Seeks a Fix 
Posted by CN Staff on August 01, 2003 at 20:19:50 PT
By DeNeen L. Brown, WP Foreign Service
Source: Washington Post 
Vancouver, B.C. -- Her fingers travel up and down her arm, feeling for a good vein. Lori-Kim Veenstra opens a $7 bag of methamphetamine and pours some of the crystals onto a clean spoon. She opens a tiny blue bottle of sterile water and fills the spoon, waiting for the chemical to dissolve. Sometimes junkies use water from puddles to break down their drugs, sometimes soda pop or toilet water. Sometimes they use their own blood.
Not here. Veenstra, 40, is in a clinic at the Dr. Peter Centre, where junkies who test positive for HIV can shoot up safely under supervision. This is one of the first of what are called "safe injection sites" in North America. Soon to be sanctioned by the provincial and federal governments, it is an example of a new policy in Canada, known as harm reduction, to address a pervasive drug problem plaguing Vancouver and other major cities. In the past year, Canada has drastically shifted its approach to dealing with drug users, going from punishing them to instituting the policy of harm reduction. This program makes sure junkies are safe while they are shooting up instead of sending them to jail. "Before I knew about this room, I used to go outside and shoot in the back alleys," Veenstra says. She ties a blue rubber tube around her left arm and pulls it tight with her teeth. She takes a clean syringe and draws up the liquefied drug, sucking it through sterile cotton, hoping the cotton will capture the impurities in the addictive stimulant, made of substances she is unsure of -- her crystal meth could be cut with drain cleaner, baby laxatives or asbestos. The syringe is full now. She steadies the needle and points it at her best vein. "The only thing I ask of you," she says, looking up, "is don't talk to me and don't ask me if I'm okay. Okay?" The needle punches her vein. There is a slight hissing sound, as if her body is issuing a faint protest when the drug enters her system. She drops the needle. But there is no hurry. She is not on the street. There is no fear that another junkie might attack and stab her, then run off with her drugs. There is no concern of an overdose. All the time, a registered nurse is watching her, guiding her, making sure she uses sterile water and cotton and a clean needle, and that she inserts the needle correctly, following instructions. "Go flush with the skin," a nurse, Patti Zettel, instructs. "Then up. Once in the vein, release the tourniquet. Look, she has good blood flow." At Odds With U.S. Approach  Throughout the country, officials are considering radical changes in Canada's approach to drugs, rejecting the tendency in the United States to push for law enforcement solutions. In so doing, officials are taking up the stance of several other countries, including Germany, the Netherlands, Switzerland and Australia, where there are various programs for decriminalization, clean needles and free methadone clinics. The Vancouver-based Harm Reduction Action Society, which advocates changes in drug laws, reported that drug overdoses in Frankfurt, Germany, decreased from 147 in 1991 to 26 in 1997 with the creation of safe injection sites. In Switzerland, the organization said, drug overdoses also decreased, and there was a marked increase in the number of people registering for methadone and other treatment programs. U.S. officials have angrily criticized the Canadian policy of harm reduction. "The very name is a lie," John Walters, the White House drug policy director, said in a telephone interview. "There are no safe injection sites." Walter said the United States would continue to treat drug abuse as a "deadly disease that shortens lives." "It can't be made safe," Walters said. "We believe the only moral responsibility is to treat drug users. It is reprehensible to allow people and encourage people to continue suffering. That is why we don't make this choice and we don't believe we ever will." Canada also faced criticism from the United States in May when it proposed decriminalizing possession of small amounts of marijuana. Canadian officials said their approach is intended to combat HIV -- rampant among drug users -- and to decrease overdoses. Officials in Canada's largest cities, Toronto, Montreal and Vancouver, are also debating whether supplying heroin to addicts will save lives and combat criminal behavior. The Dr. Peter Centre, where Veenstra was using her crystal meth, does not yet have legal sanction to run its safe injection program, but officials and police are allowing it to operate without interference. The provincial government has approved a three-year, $1.1 million pilot program, to be run by the Vancouver Coastal Health Authority, for a safe injection clinic in the city's drug-ridden Downtown Eastside district. This includes exemption from prosecution under the Controlled Drugs and Substances Act. Part of the pilot program involves gathering information on whether addicts will be more likely to seek treatment, and whether the number of drug overdoses and cases of infectious diseases decrease. "Somebody said, 'Why are we helping addicts?' " said Viviana Zanocco, a spokeswoman for the Vancouver Coastal Health Authority. "The question is: Why shouldn't we? Are we only supposed to help heart patients?" The program also makes good economic sense, Zanocco said. "When we get somebody with HIV, it costs $150,000 Canadian [about $107,000] to treat over a lifetime. Some people say you are enabling addicts, but you can point also to the health care system. If we can prevent 10 people from contracting HIV, the safe injection site pays for itself." 'No Nurse, No Fix' Even before formal approval, the city of Vancouver is allowing operation of a safe injection clinic in Downtown Eastside, where a public health emergency was declared two years ago. Officials said poverty and cheap heroin and cocaine prices combined to create the largest open-air drug market in North America. Junkies raced into the illegal clinic at a storefront building one recent evening. Outside, some of the district's more than 12,000 intravenous drug addicts were wandering about. Officials estimate that about 90 percent of the addicts have hepatitis C and 30 percent are HIV positive. It is a zone of intense poverty, minimal housing and high unemployment. The addicts rushed past the coffee machine and into a back room. Beyond the door were signs that read, "If you are not injecting or using the bathroom, stay out," and, "No nurse, no fix." "It's good to come here," said a drug addict who identified herself as Corky. She was dressed in thigh-high boots, black fishnet stockings and a tiny black dress. Corky had just finished taking a hit of heroin. "Being a working girl, it's safe. You don't have to worry about guys jacking you up for your dope," she said. "Maybe it allows for self-esteem, maybe in the long run people will get off and you start to feel more normal and get a semblance of respect." All the while, Meagan Oleson watched the addicts. "This is a user-run safe injection site," said Oleson, a nurse. "Users decide what goes on here. My role is to supervise injections and to support them in doing that." The site is run by volunteers; the space is donated. "People die every day -- people shooting alone," Oleson said. "They don't have access to sterile supplies. People are using water out of alleys to mix dope with." The official clinic is scheduled to open in September in another storefront that will look no different from other businesses in the area. Addicts will receive syringes and other gear for their fixes. "Then they would move into a post-injection room to make sure they don't overdose or there are no adverse reactions," Zanocco said. Peer counseling and treatment options also will be available. "They'll have to purchase the drugs on their own. They can possess drugs and not be arrested inside," Zanocco said. She said police were still trying to determine "how close they can be to make sure people don't stand on the doorstep and sell drugs on the doorstep. That is something the police will work out." Constable Sarah Bloor of the Vancouver police department said, "The Vancouver police is supportive of the effort to provide treatment and health initiative in the community." Bloor said the drugs would still be illegal but people using them inside supervised injection sites would be exempt from being arrested for possession. Bloor said police tried to focus most of their efforts on traffickers. "We don't currently go after users," Bloor said. "We believe users are individuals that require treatment. We don't see them as criminals. They are individuals that have an addiction." Courts in Vancouver generally do not prosecute users for simple possession, which Bloor said was about "one point of a gram, or basically a hit. "Basically someone with a flap of heroin or cocaine, a minimum amount, you typically don't see the courts wanting to proceed to trial process for that amount."  'Ethical Work' Inside the Dr. Peter Centre, Zettel is watching Veenstra, the addict. "It's the most ethical work I've ever done as a nurse and human being, because addicts are Canadian citizens with a health problem," Zettel says. "We as a society have reinforced their marginalization. They have a poor sense of self-esteem and value. We have reinforced that. That to me is criminal. "Lori is an IV drug user. If she wasn't here, she would be out there. Where is it safe? Where is it better? In front of me or in an alley? . . . Doing it here, I have the ability to teach and teach." Clay Adams, of the Vancouver Coastal Health Authority, said the government would provide medical liability coverage to employees working at the site. "We understand the reality of the potential for overdoses," Adams said. "The risk is there. We are not ignorant of the risks." Currently, addicts must sign an agreement before using the injection room, a small space much like a doctor's office in the clinic. The room has three chairs, a sink, and a cabinet full of supplies. On a round table are clean syringes, boxes of sterile water, cotton and rubber tubing. On the wall are posters with photographs and text telling addicts how to achieve "The Safer Fix." Veenstra says her arms are healthier with the supervised injections, although there are still deposits of crystal meth beneath her skin. She says she is proud of the improvement. Veenstra also says she has started to cut down on the amount of drug she uses each day, leaving a little more in the needle after each fix. This day, as she fixes her fix, she talks about how she ended up here. "Most users are trying to hide the hurt," she says. Her mother, she says, left when she was 6 months old. Reared by her father, she ran away at 10 and never looked back. She met a guy named Paul who asked if she was hungry, and he took her back to his house. "He was a heroin addict. He did a hit. He was all happy. He was nodding out," Veenstra says. She wanted to be just like Paul. "I've been using since I was 10. I lied to my first heroin dealer. I told him I already used." Heroin was her mother for 30 years, she says, adding that she has no guilt for being a junkie. As Veenstra waits to shoot up, she sorts through her briefcase, which is stuffed with pamphlets on treatment programs. She has stocked up on them; nobody in the center pushes the information on her, she says. Zettel says she wants to come across as nonjudgmental with addicts. "I can't push my agenda. If Lori is interested in detox treatment, it is about what Lori wants when she wants it," Zettel says. Veenstra says Zettel has simply shown her the options. "She opened the doors and windows," Veenstra says. "If I want to walk through that door, I can." But not today, Veenstra says as she gathers her equipment for another fix. Source: Washington Post (DC)Author: DeNeen L. Brown, Washington Post Foreign ServicePublished: Saturday, August 2, 2003; Page A15 Copyright: 2003 Washington Post Contact: letterstoed washpost.comWebsite: Related Articles:Eliminating Death Penalties for Drug Use Up Legally Up North Safe-Injection Site Wins Police Immunity To Take New Approach for Addicts
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