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December 31, 2007 - Victoria Times-Colonist (CN BC)

Column: The Dead Can't Kick Drugs

Safe Injection Sites Aren't The Entire Solution to Addiction, but They Do a Great Deal of Good

By Liz Evans, Times Colonist

Return to Drug War News: Don't Miss Archive

I remember my first experiences in the Downtown Eastside as shocking, and I too was naive about the problems there when I left the hospital as a nurse to work in the community.

It's now been almost 17 years working in that very neighbourhood.

Addiction is clearly dreadful and tragic, but those who offer simplistic solutions offer false hope.

Meanwhile, people with addictions suffer and die.

Those suffering with addiction across Canada, including those helped by InSite, Vancouver's supervised injection site, are someone's sister, or brother, or son, or daughter.

I have called the parents of addicts who had overdosed to tell them their child was dead. I met one mother who had flown across the country to visit her dying son at the airport. She arrived too late and fell to the floor screaming in grief when she heard the news.

I was a young, inexperienced nurse. What comfort could I really offer in this tragedy? She wanted her addict son alive, addicted or not. There are things we can do. Harm reduction is one. It can keep people alive, so one day they can enter treatment.

Harm-reduction strategies buy time because not everyone is ready to enter treatment. Clean needles and condom distribution prevent the spread of disease. These are basic health interventions that are accepted across the world, from the United Nations to the medical health officers of every single jurisdiction of this country.

InSite is neither the problem nor the solution. It is one measure designed to prevent drug overdose deaths, which it has done; reduce public disorder, which it has done; reduce the spread of HIV, which it has done; provide a doorway into the health system and into treatment, which it has also done.

Twenty-five academic papers have now been published in the world's most renowned medical journals including The Lancet, the New England Journal of Medicine, the British Medical Journal, and the Canadian Medical Association Journal. To date, not one single independently peer-reviewed article has disputed the scientific evidence, which Health Canada paid close to $2 million to compile.

The most recent piece of research indicates there has been a 30 per cent increase in the number of people entering detox and methadone therapy as a result of using the injection site -- which strengthens further the argument that harm reduction is a necessary part of the health-care continuum.

Making this link from the chaos of the streets to the path of recovery even stronger, OnSite opened above InSite this September, offering 30 beds to addicts wanting to detox and escape the cycle of addiction.

The public is aware that addiction is a complex issue that requires a comprehensive strategy -- one that incorporates improved enforcement, comprehensive prevention programs and flexible and accessible detox and treatment interventions.

But it also needs to include harm reduction -- so people don't die unnecessarily, and parents don't continue to lose their children.

Other jurisdictions now also involve harm-reduction strategies as part of their overall plans to tackle addiction. Sweden has now established needle-exchange programs in order to stop the spread of disease and to comply with UN expectations, while conforming to international efforts to limit the global AIDS pandemic.

Britain, where a heroin prescription maintenance program has been in place for many years, has now expanded its addiction-treatment program to include stimulant maintenance for cocaine addicts.

In no place where harm-reduction approaches have been used have advocates argued they be implemented exclusive of prevention, treatment and enforcement. In every jurisdiction where harm reduction is practised, it is done so in collaboration with local police, businesses and residents to ensure the individual users and the broader community equally benefit.

Since InSite opened in 2003, there has been a dramatic decrease in the number of public injections and injection-related litter. As a resident of the neighbourhood, I have witnessed a stark contrast in the livability of the Downtown Eastside since InSite opened its doors.

Over the past four years of operation, InSite nurses have now supervised more than one million injections, each of which would have otherwise occurred outside, in the public view, and with a much higher risk of drug overdose death or spreading HIV and hepatitis C.

While I welcome the significant improvement to my neighbourhood for both myself and my children, the primary reason I continue to support InSite is its ongoing life-saving work. More than 900 overdose interventions have happened at InSite -- each someone's child who would not be with us today if InSite nurses had not been there to take immediate action.

I hope politicians like Prime Minister Stephen Harper and federal Health Minister Tony Clement think about the children when they consider public health policy relating to drug addiction. I hope desperately that resources are finally put into prevention efforts to stop kids from using drugs in the first place.

But I also hope to never again explain to a crying mother why her child died from a drug overdose that could have been prevented in a civilized country like Canada.

Liz Evans is a nurse and the executive director of the PHS Community Services Society, which operates InSite, Vancouver's supervised injection site.

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