Accessibility links

Controversial Vancouver Program Aims to Reduce HIV Infection - 2002-11-30

Vancouver, the seaport city on the west coast of Canada, has one of the most serious drug problems in North America. On Monday, December 2, a new mayor will take over the city government. One of the first things he promises to do is implement what are known as "safe injection sites" for the area's drug addicts.

For years, drug dealers and addicts have populated the downtown Eastside of Vancouver. Within a few short blocks, they openly deal and inject drugs on the sidewalks and back alleys. Nearly all businesses have deserted the area, leaving behind blocks of boarded up buildings.

Recent studies and social agencies say that about 90 percent of active intravenous drug users in the downtown Eastside area test positive for Hepatitis C, and over a quarter are infected with HIV or AIDS.

In 1997, public health officials declared a state of emergency in the area because of its high number of HIV and tuberculosis cases.

In an effort to reduce the risk of infection and move drugs off the streets, the city is developing what it calls a "four pillars approach," involving treatment, prevention, harm reduction, and enforcement. The pillar drawing the most attention is harm reduction, which includes providing specific sites where addicts can inject drugs such as crack cocaine and heroin, under medical supervision.

Vancouver Mayor-elect Larry Campbell, a former high-profile coroner and inspiration for a popular Canadian TV series, made the four pillars approach a central part of his recent election campaign.

Mr. Campbell says the injection sites will be established in early 2003, but not before the other three pillars are developed, involving detoxification and treatment. "We're going forward with it as quickly as we can. And working in a cooperative manner. I want it as quickly as possible, but I don't want it unless we have treatment of detox and treatment beds," he said. "I don't want it unless that's in place because it's not going to do us any good. I don't want it until we have all, we know what we're doing with enforcement or prevention. I mean, all of these pillars have to work together."

Among those opposed to the "safe injection sites" is the Vancouver Board of Trade. Chief economist Dave Park says too much attention has been paid to the issue. The business group favors other aspects of the new drug strategy, but Mr. Park feels providing a place for addicts to "shoot up" is misguided. "We are certainly opposed to the adoption of that particular part of the strategy. Moreover, it is becoming increasingly irrelevant, " he said. "The amount of the numbers of heroin addicts that would use it are relatively small compared with the total population, as we understand it. The drug of choice is now cocaine and we understand it is probably moving to crystal meth (methamphetamine)."

Less than a week after Mr. Campbell's election as mayor, Vancouver's Board of Trade called on the White House director of drug policy, John Walters, to outline the Bush administration's opposition to such things as safe injection sites.

Greater Vancouver near the U.S. northern border and is less than a three-hour drive from Seattle (192 km). The White House drug policy chief would not comment when asked about the possibility of U.S. drug users moving north to Vancouver to take advantage of the sites. However, he says that instead of treating the problems associated with drug use, it is better to directly fight the addiction. Still, Mr. Walters concedes, the supervised sites could save some lives.

"Certainly if you have people who overdose and they're more closely connected to medical personnel," he said. "But again, my argument from our policy point of view, and I'm not telling you what to do, I'm telling you from my point of view which is my responsibility, the issue is why not save people from the fatal disease of addiction and not just from the fatal opportunity for an overdose at some sort in time. Why would you want, if you had a choice, to continue to let people throw away their freedom and allow them become slaves to a drug when in a democracy one of the fundamental things that we want as a freedom is the freedom to direct our own lives and not be enslaved to a substance."

Outgoing Vancouver Mayor Phillip Owen, who is credited with helping to create the four pillars drug strategy, says addicts cannot be forced into treatment.

He says that when drug users have refused rehabilitation and are still struggling with addictions, the best option is to provide them with other forms of help, including safe injection sites where medical help is nearby. Mr. Owen says this will also remove drugs from being used in public.

"Now you've go to help them with their addiction, to care for them and their neighborhood and not allow the consumption of drugs in the public realm, shooting up in the public realm."

The next step for Vancouver's proposed drug policy will be after the inauguration of the new city council and mayor on Monday, December 2.

After taking office, Mayor Campbell will organize a committee to oversee the initiative and find a location for the first "safe injection site."