Monday, October 08, 2007

Track Marks

There's a place in Vancouver, British Columbia, Canada where injection drug users (IDUs) can go to shoot up in a supervised setting, without fear of arrest. Depending on your point of view, that represents enabling illicit drug use or smart public health policy.

Estimates place the number of Vancouver residents who inject heroin or other drugs around 12,000. About 4,000 of the IDUs are clustered in one neighborhood, Downtown Eastside, where the supervised injection site - Insite - operates.

If you think, given those numbers, that Insite enables drug use, you're wrong.

That many IDUs were in Vancouver before Insite was created in 2003 to address the unique issues IDUs face. Specifically, an estimated 30% of Downtown Eastside's IDUs are HIV+ and 90% have Hepatitis C. They die at a rate 14 times higher than other area residents. Half live in substandard housing or are homeless.

Given those numbers, Insite can't be considered anything other than smart public health policy.

About 600 people visit Insite daily, where they have access to sterile injection equipment and harm reduction instruction. (They supply their own drugs.) Between 2004 and 2006 Insite provided over 6,000 nursing interventions, 1,600 referrals to addiction counseling and 2,400 other treatment referrals. Insite also handled 453 overdoses without a single fatality.

Given those numbers, Insite can't be considered anything other than smart public health policy.

And, indeed, evaluations conducted to date to determine Insite's effect on IDUs and the surrounding community have been largely positive. Nevertheless the program's future is in question.

That's because Canadian Conservatives are pushing a US-type war-on-drugs policy which is at odds with the harm reduction philosophy embodied by Insite. The former - which can hardly be called successful, based on US results to date - has 'zero tolerance' for drug use, while the latter acknowledges that some people will use drugs regardless and, thus, seeks to ensure they do so as safely as possible.

Insite operates under an exemption from Canadian drug statutes. Due to expire soon, the exemption was recently extended an additional six months. That means Insite can continue to operate through June 30, 2008. After that - even though the numbers show Insite can't be considered anything other than smart public health policy - who knows?

"An extensive evaluation [of Insite] has produced very positive results for thousands of users. Normally such strong evidence documenting the successes of such a program, and the medical and public health significance of these positive outcomes, would be the basis for celebration and moves to expand the model and provide similar services elsewhere in Canada. Instead, there is a distinct possibility that Insite will be closed by the newly elected Canadian Prime Minister [Stephen] Harper – a conservative who has traveled to the US to visit George W Bush and come back antagonistic to harm reduction in all its forms." Ernest Drucker, Harm Reduction Journal
All stats from Insite website
News articles 1, 2
Blogs 1, 2
More about harm reduction
More about US war on drugs [PDF]

This week's word was track.
The track to related posts starts here.

This concludes this test of the emergency be-serious system. We now return to our regularly-scheduled caustic mockery.

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