Insite: The Battle over Supervised Injection Sites
In the 1990’s there was an epidemic of HIV outbreaks in the Downtown Eastside of Vancouver. Injection drug users were found to be the leading cause of this, and a public health emergency was declared (Fafard, 2012). The “mortality and morbidity” resulting from this increasing injection drug use became a major political issue. This resulted in the adoption of harm reduction by the government as one of their four pillars of their drug strategy (Fafard, 2012). Harm reduction “is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use” (Boyd, 2013). In September 2003 Insite, North Americas first harm reduction supervised injection site,
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There was also no increase of users relapsing into injection drug use, nor did it negatively influence those seeking to stop drug use (Kerr et al., 2006). The research shows that Insite has not promoted increased illicit drug injection, but rather it has attracted individuals with histories of injection drug use.
Another claim put forth by the Conservatives is that SISs are harmful to communities. They believe SISs create public nuisances, and threaten public safety (Broadhead, Kerr & Alice, 2002). Research on the other hand argues that SISs can address issues related to public. Since Insite opened the public has noticed less public injections, less syringe droppage, and less complaints about drug user nuisances (Potier et al., 2014). It also cleans up public environment such as streets and alleyways. Drug use is still an illicit activity and it takes place in unsterile environments such as behind dumpsters and shooting galleries. SISs provide sterile environments for users and are a lot safer than shooting up in the streets. This leads to less public injection and a better community environment (Potier et al., 2014). Local police data was also evaluated and there has been no increase in crime, violence, or drug trafficking around Insite. There were no significant statistical changes in rates of drug trafficking. There were 124 incidents in the year before and 116 incidents after. There were 147
Although these clients will still be abusing illegal substances, Sheon (2004) indicated that any reduction of harm is a step in the right direction, and the amount of success is measured by the client’s quality of life and well-being (as cited in Brown et al., 2005). “Harm reduction is about being respectful in somebody else’s world” (Georgina Perry, Service manager and co-author, England as cited in Cusick et al., 2010). By not respecting somebody else’s choices, the clients feel they must lie about their unhealthy lifestyles, which prevents the clients from getting assistance because they were trying to protect themselves from the real situation (Georgina Perry, Service manager and co-author, England as cited in Cusick et al., 2010). A way to reduce the harm from illegal substance abuse is clean needle exchange, and teaching clients how to properly inject themselves (Brown et al., 2005). The needle exchange is a program where clients exchange their used needles for clean ones, which helps reduce the spread of diseases such as HIV/AIDS (Brown et al., 2005). With continuation of these programs the harm from abusing illegal substances is reduced and the spread of life threatening diseases, such as HIV,
Vancouver Injection Drug User Study (VIDUS) is a project that gives a prospective study and has over 1500 IDU 's enlisted to assist since 1996 and gathers data on drug use, health, sexual activity, etc. Some of the topics discussed included: prison culture, availability and price of drugs and equipment, drug use, VIDUS shows that the risk of HIV infection indicated that incarcerated injection drug users were associated with a greater risk of 2.7 times (Small, Kain, Laliberte, Schechter, O 'Shaughnessy & Spittal, 2005).
Using injection sites that not only provide the individual with the instruments but also the knowledge of same practices would be very beneficial investment for Canada, thus the previously stated example of how Canada has already enabled and succeeded with this method within Vancouver British Columbia. If Canada were to take on more of these harm reduction initiatives then there could be more individuals benefiting from the process and as a result street crime with drugs would also be dramatically decreased. However in reality Canada has already been practicing harm reduction strategies for centuries, they have just been practiced without the label of harm reduction. “In 1987, as concerns rose in the community about the spread of HIV through injection drug use, bleach programs were started at Alexandra Park in Toronto; these developed into syringe exchange programs in 1988 and were taken over by the City of Toronto in 1989” (Cavalieri, W. & Riley, D. 2012, Harm Reduction in Canada: The Many Faces of Regression. 3). With every initiative designed to help society there will always be those who disagree with the approach. Even though there is overwhelming evidence that harm reduction techniques such as injection sites work, funding is a big issue mainly on account of these methods advertise and
Needle exchange programs have long been a controversial subject with both the general population and government lawmakers. The primary objective for needle exchange programs (NEPs) is to prevent the spread of blood-borne disease and is very successful in doing so. But, issues of morality due to the perception of drug enablement and the stigma of intravenous drug users (IDUs) and their potential effects on the decline of society are continually used as arguments for those against NEPs. It has been proven through many studies that these programs not only reduce harms associated with intravenous drug use, they are also cost effective and reduce the circulation of used syringes to the general population. Beyond epidemiological efforts, NEPs also provide a de-stigmatized center for gathering and offers health services such as HIV testing, counselling and referrals to treatment for drug addiction. This paper aims to highlight the efficacy of needle exchange programs, safe injection sites and address the social and political issues associated with them.
Vancouver is a city with multiple “claims to fame”. Known to be one of the worlds most livable, expensive, and beautiful cities, it is also well known for its large population of drug users, and the detrimental effects intravenous drugs have had on the Downtown East Side community. One of the major concerns connected to intravenous drug use is the large proportion of users who report a history of needle sharing, greatly increasing their chances of contracting HIV, Hepatitis B or C, and other injection related infections (Strike, Myers & Millson, 2004). With an estimated 15000 intravenous drug users (IDUs) currently residing in Vancouver, and up to an estimated 125000 nationally, the Canadian government has taken a proactive “Harm Reduction” stance allowing the implementation of controversial Needle Exchange Programs (NEPs) throughout most of the country (Weekes & Cumberland). Canada’s first NEP opened in Toronto in 1987, with Vancouver following suit in 1989. While it was still considered an offence to possess drugs under the Canadian Criminal Code, section S.462.2 stated that it was “not an offence […] to distribute needles to prevent the spread of HIV infection” (Weekes & Cumberland). The goal of these early NEPs was to supply IDUs with injection equipment to eliminate the necessity for needle sharing between users, operating on a strict “one for one” model. For each used needle returned, it would be replaced with a new, sterile
A safe injection site (SIS) has been placed in Vancouver’s Downtown Eastside where drug use is a challenging problem. The program is a vital piece of the cities known harm reduction approach to its serious problems with homelessness, drugs, crime and AIDS. Canada has drastically shifted its method. Going from punishing drug users to establishing the plan of harm reduction. Since 2003 when the supervised SIS opened, it has presented a safe health-focused center where drug users have access to inject illegal drugs using sterile equipment in a clean environment under the supervision of medically trained professionals. Although there are some serious concerns about the
The professors said “that addicts should not be the focus of HIV prevention efforts because they would not change their behavior.” Parker was outraged and organized meetings with IDUs to warn them of HIV transference. In one of his meetings two addicts came in with clean syringes, their actions motivated him. In 1986, Parker began distributing and exchanging needles and syringes on the streets of New Haven and Boston, Massachusetts. He has been arrested several times in eight states where it is still illegal to purchase syringes without a prescription. Because of foundational work by Jon Parker and the work in Amsterdam, in two year later the first SEP operated with a bit of community consent opened in Tacoma. In the same year, two more exchange programs surfaced, one in New York and another in San Francisco. Today, there are currently 203 exchange programs operating. Despite the “on and off” support from private state and local funding and help from activist and advocates keep the programs afloat.
Harm reduction can be defined as an approach that aims to reduce the consequences of high risk behaviours such as injection drug use on the individual and on society as a whole. Harm reduction programs provide injection drug users with access to a clean injection environment, sterile injections, drug-preparation equipment and safe disposal of contaminated material at the time of injection. Staff members in harm reduction facilities provide health teaching, anonymous HIV testing, information on addiction treatment, condoms and assist in connecting clients to social and health services (Semaan et al., 2011; Ball, 2007). Although, the benefits of harm reduction are evident through reduction of accidental drug overdose and prevention of
Canadian society has always dealt with some percentage of the population who have become addicted to intravenous drugs. Left unchecked, the ecology of IV drug use creates a number of societal issues as well as a greater burden to the already over-stretched Canadian healthcare system. Legally and financially supporting safe injection sites is just a matter of simple economics.
Several studies have shown that injection drug users lower their risk of transmitting infectious diseases when there is a needle exchange program available. There has not been a valid study of whether or not the amounts of time needles are returned to the exchange programs are harmful to communities. The Journal of Public Health, conducted surveys, evidence from needle exchange sites, jails, and institutions that needle exchange programs are effective in reducing illnesses such as HIV and AIDS (Burt & Theide, 2016). Furthermore, Reepalu, Blome, Bjork, Widell, & Bjorkman (2012), researched the same individuals for 20 years, with no breaks. Their studies concluded that injection drug use, not only heightens the risk for HIV and AID’s, there is also an increase in Hepatitis B and Hepatitis C. However, there studies showed that there is not an increase rate of cancer diagnoses due to injection drug use. In a study conducted by Bonar and Rosenberg (2014), they wanted to see if self-initiated harm strategies, such as: proper needle sterilization techniques, proper disposal of needles, and cleaning of the pre injected skin, could help improve the health of those that use drugs intravenously. Their study was conducted over an eight-month period, results showed that their
In conclusion, methadone clinics and needle exchange programs have many stigmas linked to them due to the biases that have been associated with these programs in the past. The programs are trying to create ways to encourage more drug users to use the programs available especially the needle exchange program for those who inject
Robert J. MacCoun, is an associate professor in the Graduate School of Public policy at the University of California and author of Toward a Psychology of Harm Reduction. Professor MacCoun also supports the movement towards a harm reduction approach to drugs. He explains how the harm reduction movement emerged in Amsterdam in the 1980's in response to mounting heath issues directly related to the use of drugs. Professor MacCoun illustrates that harm reduction is not a program that has been proven effective in the war on drugs, being constantly rejected as a viable option to present drug enforcement policy by the United States government. Professor MacCoun illustrates however that the policies that the U.S. presently has in place has failed in its ability to eliminate drug use thus causing the major harms of drug use in place. Professor MacCoun believes that many of the drug related problems we have today are a result of poor legislation as well as the
Safe injection sites possess many salutary benefits related to public health safety of the drug using community. Safe injection sites provide a safe place for drug users to inject drugs into their bodies so they do not have to reuse needles and can also be supervised by nurses constantly while they do so. Insite is the sole safe injection site in all of Canada and the expansion of other facilities has been fiercely contested by policy makers not due to empirical criminological evidence, but simply due to one dimensional classical conservatism inspired ideology and illogical hysteria. The fear propagated by the past Conservative government that by assisting drug users by feeding their addiction and by gathering so many law breakers in concentrated areas would correlate to an increased rate in crime. The traditionalistic ideology of the Conservative government mandated them to adamantly oppose the prospect of safe injection sites let alone their expansion into other regions and provinces regardless of the fact that there were no adverse effects for the community in terms of increased crime. Safe injection sites were introduced to Vancouver in 2003 under a special exemption under section 56 under the Controlled Drugs and Substances Act, which was granted by the Liberal government via Health Canada as a desperate means to help resolve the growing health concerns in the area. In 1998, a report by then British Columbia public health officer John Millar decried the situation in the
Supervised consumption sites are seen as an effective means of reducing harm associated with illicit opioid consumption. Generally these are sites where drug users can inject or consume drugs under the observation of trained personal. The first of such consumption sites in Canada “Insite” was established in Vancouver in 2003. So far there has not been a single reported case of overdose fatality at the site. The success of Insite as a harm reduction approach has encouraged jurisdictions across Canada to adopt or contemplate similar systems. In 2017, the federal government passed Bill C-37 with the aim of streamlining the application process for communities who wish to operate supervised consumption sites. In Alberta, there are five proposed supervised injection sites, four in Edmonton and another in Calgary.
The article called Harm reduction by a “user run” organization: A case study of the Vancouver Area Network of Drug Users (VANDU) by Thomas Kerr et al, was an interesting article to read I do not know much about the use of illicit drugs or addictions because I have not been exposed to them growing up. However, I have learned assumptions by going to school, watching television shows and through my family’s judgments. Before reading this article I did not know much about user-run organizations for harm reduction and I have now learned how beneficial it is to drug users.