Harm Reduction and Drug Regulation
Reading and Viewing List
for Prime Minister Stephen Harper
Canadian HIV/AIDS Legal Network (2007, November, 20). New anti-drug
bill likely to lead to more cases of HIV & Mandatory minimum
sentences for drug offences: Myths vs. Reality. Author.
introduced earlier today in the House of Commons by Justice Minister
Rob Nicholson will do little to reduce drug use and instead worsen
already serious public problems by resulting in increased risk of
HIV transmission, said the Canadian HIV/AIDS Legal Network. “There’s
no proof that mandatory sentences reduce drug use or the problems
associated with it. In fact, there’s evidence that it creates
more public-health problems than it solves.” said Richard
Elliott, Executive Director. “Even conservative jurists like
former U.S. Supreme Court Chief Justice William Rehnquist have said
that mandatory sentences make good politics, but result in bad policy.
Clearly, Americanizing Canada’s drug laws is not the answer.”
see a copy of Bill C-26
Cheung, Y. (2000). Substance abuse and developments in harm reduction.
CAMA, 162(12), 1697-1700.
author write: “The “drug problem” has been socially
constructed, and the presence of a moral panic has led to public
support for the prohibitionist approach. . . . The harm reduction
approach, which is based on public health principles, avoids the
extremes of value-loaded judgments on drug use and focuses on the
reduction of drug-related harm through pragmatic and low-threshold
programs. This approach is likely to be important in tackling the
drug problems in the 21st century.”
3. A Framework for Action: A Four-Pillar Approach to Drug Problems
in Vancouver (2001).
Framework for Action: A four pillar Approach to Drug Problems in
Vancouver was adopted by City Council in 2001. It recommends actions
across the four pillars of prevention, treatment, harm reduction
Fact Sheet: Facts and figures relating to illegal drugs. Compiled
by Mark Haden (2006).
author brings together facts about the economic costs of drug prohibition.
He notes that “Canada spends $2.3 billion on enforcement (police,
courts and corrections), and 1.1 billion in direct health care costs
every year, dealing with illegal drugs.” Furthermore, “Canada
spends more than $4 on enforcement for every $1 spent on the health
response in dealing with illegal drugs. ($400.3 million vs $88 million).”
5. Mathias, R. (2004) Sentenced
to Death: Canada’s Drug Users.
Richard Mathias states that “Canada’s drug laws kill
Canadians. Such a statement may seem to be hyperbole and inflammatory
but unfortunately for many Canadians it is not.” The author
reviews deaths from inadvertent overdose deaths and HIV disease.
He also examines tobacco and alcohol related deaths. He argues for
drug reform and a public health approach, one that is based on “prevention
and treatment within a human rights and ethical context.”
Canadian HIV/AIDS Legal Network (2005). “Nothing About Us
Greater, Meaningful Involvement of People Who Use Illegal Drugs:
A Public Health, Ethical, and Human Rights Imperative. Author.
booklet summarizes the main issues addressed in the Canadian HIV/AIDS
Legal Network’s paper on greater involvement of people who
use illegal drugs.
In particular, it explains why people who use illegal drugs must
be meaningfully involved in Canada’s response to HIV/AIDS,
hepatitis C (HCV), and injection drug use, and the benefits of greater
involvement. The booklet also contains a manifesto written by people
who use drugs, and describes the achievements of two organizations
of people who use drugs, the Vancouver Area Network of Drug Users
(VANDU) and the Thai Drug Users’ Network.
7. Puder, G. (2001). Recovering our honour: Why policing
must reject the “War on Drugs” Vancouver, BC: The Fraser
Institute, April 21, 1998.
Vancouver police officer, Gil Puder, writes: “My belief that
the war on drugs must end arises from the damage being done to both
policing and the society it serves. The tactics, weaponry, and propaganda
of our 20th Century narcotic prohibition have been borrowed from
a Western military model, yet in their misguided application have
generated nothing other than systemic conflict that has overwhelmed
our justice and health care systems.”
to see a copy of the Controlled Drugs and Substances Act.
8. DeBeck, K., Wood, E., Montaner, J., Kerr, T. (2006).
Canada’s 2003 Renewed Drug strategy--An evidence-based Review.
HIV/AIDS Policy and Law Review, 11 (23), 1, 5-12.
three-quarters of the resources of Canada’s Drug Strategy
are directed towards enforcement-related efforts, despite a lack
of scientific evidence to support this approach and little, if any,
evaluation of the impacts of this investment. In this article, the
authors report on a study that examined expenditures and activities
related to the Drug Strategy as renewed in 2003. The article reviews
the effectiveness of the Strategy in light of current scientific
evidence pertaining to the reduction of drug-related harm. The authors
find that although the Drug Strategy promised to remain accountable
and regularly report its progress, information pertaining to the
evaluation of the Strategy remains limited. Further, Canada’s
Drug Strategy has not seized the opportunity to promote a national
standard of care that reduces the most deadly harms associated with
illicit drug use. The authors conclude that from a scientific perspective,
Canada’s Drug Strategy should make it a priority to ensure
that federal funds are directed towards cost-effective, evidence-based
prevention, treatment and harm reduction services, and that these
services should be available to all Canadians.
understand the full impact of drug policy in the U.S. read:
PEW Center on the States (2008). One in 100: Behind Bars in America
here to see the full report:
United States has far more people in prison than any other nation
in the world. To date, 2,319,258 out of almost 230 million American
adults are in prison. Another 5 million adults are under criminal
justice control: on probation or on parole. Since the 1980s, non-violent
drug offences and “three strikes” out measures and other
sentencing enhancements have contributed to expanding prison population.
In 2007, U.S. states spent more than $44 billion on prisons.
Executive Summary of the report states:
decades of growth in America’s prison population has quietly
nudged the nation across a sobering threshold: for the first time,
more than one in every 100 adults in now confined in an American
jail or prison. According to figures gathered and analyzed by the
Pew Public Safety performance Project, the number of people behind
bars in the United States continued to climb in 2007, saddling cash-strapped
states with soaring cost they can ill afford and failing to have
a clear impact either on recidivism or overall crime.
report notes that: the “current prison growth is not driven
primarily by a parallel increase in crime, or a corresponding surge
in the population at large. Rather, it flows principally from a
wave of policy choices that are sending more lawbreakers to prison
and, through popular “three strikes” measures and other
sentencing enhancements, keeping them there longer.”
Cohen, J. and Csete, J. (2006). “As Strong as the Weakest
Pillar: Harm Reduction, Law Enforcement and Human Rights.”
The International Journal of Drug Policy 17, 101-103.
article argues that a human rights approach to injection drug use
and HIV/AIDS, one that places human dignity at its center and guarantees
an explicit range of human rights protections to injection drug
users, is more likely than a “four-pillars” type approach
to reap benefits for people who use drugs as well as for their families
Capler, R. (September, 2006). Federal Marijuana Policy Primer.
The author notes “The following policy primer is intended
to inform the Canadian public and our political representatives
about the key issues related to marijuana legislation in Canada.
This issue has been on the forefront of Canadian politics for over
30 years and is now understood by Canadians to be an issue of importance
to our social and economic well-being, our health and our sovereignty.
With an informed public debate and political leadership, we can
replace the failed policy of cannabis prohibition with a policy
that meets the needs of all Canadians.
11. Osborn, B., & Small, W. (2006). “Speaking
truth to power”: The role of drug users in influencing municipal
drug policy. International Journal of Drug Policy, 17(2), 70-72.
authors discuss how the epidemic of HIV infection and fatal overdoses
in the Downtown Eastside of Vancouver was brought to the attention
of the local health authority by drug users themselves. They make
clear the important role of drug users in shaping policy, especially
the role of the Vancouver Area Network of Drug Users (VANDU).
Vancouver Coastal Health. (2006). Saving Lives: Vancouver’s
Supervised Injection Site. Vancouver: Author.
week’s reading introduces readers to Insite, the first formal
medically supervised safer injection facility to open in North America.
Insite is located in the Downtown Eastside of Vancouver, BC. The
medically supervised safer injecting facility (SIF) is one strategy
among others to facilitate the reduction of HIV and overdose risk
and public injection drug use. For the next nine weeks the reading
list will highlight peer-reviewed research published in leading
national and international journals and publications like this one
by Vancouver Coastal Health. These articles provide evidence that
the supervised injection site reduces drug-related harm. Abstracts
obtained from the articles summarize research goals and findings.
The publications on Insite begin with the Vancouver Coastal Health
publication, Saving Lives: Vancouver’s Supervised Injection
Site. The following excerpt is drawn from their report. The full
report can be obtained from the website above.
Coastal Health recognizes that people with addictions are some of
the most vulnerable and marginalized individuals in the community.
For many, addiction is only one part of a complex set of health
problems – problems made worse by mental illness, poverty,
chronic disease and homelessness.
indicate there are more than 12,000 injection drug users living
in Vancouver, and at least one in three live in the Downtown Eastside
– the poorest neighbourhood in the city. For injection drug
users living in the Downtown Eastside, more than nine out of 10
have Hepatitis C, and three in 10 are HIV positive – a rate
that is 38 times the provincial average. Overdose deaths are not
uncommon, and the overall mortality rate for this population is
14 times that of other BC residents.Of the Downtown Eastside population,
1250 people live in substandard single room hotels; 650 people rely
on shelters; and 200 are homeless.
residents, drug user groups and activists called for an innovative
response to the high rates of infectious disease and overdose death.
Vancouver Coastal Health, in partnership with the Portland Hotel
Society, responded with an innovative program – North America’s
first Supervised Injection Site. Called Insite, it is a safe, clean
place where people with addictions can go to inject drugs and connect
with health care and addiction services. The partners were supported
by the Vancouver Police Department, City of Vancouver, Province
of British Columbia, Injection Drug Users, community groups, academic
institutions and others. Collectively, they believed the Supervised
Injection Site would have the ability to positively impact people’s
lives. Insite has been in operation since September 12, 2003and
was specifically designed to be accessible to vulnerable populations
of injection drug users – men and women who use more than
one drug; have both an addiction and a mental illness; have a history
of trauma; have sought treatment but been unsuccessful and relapsed;
live on income assistance; are Aboriginal; live in substandard housing
or are homeless.
In addition to being the first Supervised Injection Site in North
America, Insite is also the first and only site to undergo an arms
length, rigorous scientific evaluation, with all research results
published in peer-reviewed journals. The British Columbia Centre
for Excellence in HIV/AIDS received the contract to conduct the
scientific evaluation of Insite, and has been evaluating the facility
in terms of meeting the following objectives:
access to health and addiction care
Reducing overdose fatalities
Reducing the transmission of blood-borne infections like HIV and
Reducing injection-related infections
Improving public order
Research results show that Insite is:
Reaching high-risk injection drug users
Decreasing public injection
Reducing need sharing
Reducing HIV risk behaviour
Increasing use of addiction treatment
Increasing referral to community services
Reducing bacterial infections
Not increasing crime, public disorder, drug dealing, litter or relapse
Hwang, Stephen. 2007. Science and ideology. Open Medicine, 1(2),
than 130 prominent Canadian physicians, scientists and public health
professionals have endorsed” Stephen Hwang’s commentary
about science, ideology and drug policy. He states that the supervised
injection facility, Insite, has been “shown to provide a number
of benefits, including, reduced needle sharing, decreased public
drug use, fewer publicly discarded syringes, and more rapid entry
into detoxification services by persons using the facility.”
Furthermore, the opening of supervised injection facility, “was
not associated with any increase in levels of crime, public disorder,
or injection drug use.” In questions the federal government’s
lack of support of Insite and their dismissal of positive findings
published in leading peer-reviewed journals. The author explores
how efforts “to misrepresent or suppress scientific finding
for ideological purposes pose a threat . . . to the public good.”
Small, D. (2008). Amazing Grace: Vancouver’s supervised injection
facility granted six-month lease on life. Harm Reduction Journal.
should be a matter, primarily, for the Chief of Medicine rather
Chief of Police. While internationally renowned for its social kindness,
has not been without its share of disgraceful political mistakes
in the not too
distant past. Regrettably, there are many shameful events in Canada
unfolded in the name of public policy including the banishment without
treatment of Chinese Canadians living with leprosy to die on D’Arcy
and Bentinck Islands in British Columbia while European Canadians
stricken similarly enjoyed healthcare on the mainland as well as
the eternally haunting treatment of people of aboriginal ancestry
who were without full voting privileges in some parts of Canada
until 1965 and abandoned to encampments, reserves, that paralleled
South African apartheid. In due course, these public policies have
come to be understood as horrific in retrospect. Many have all met
with a remorseful fate where a future Prime Minister is held to
public account for the sad excesses of an earlier generation. With
respect to North America’s only supervised injection facility
(SIF), a medical program aimed at reducing fatal overdoses and infections
(HIV, HCV) in injection drug users, Canada’s Prime Minister
Stephen Harper holds the ability to forestall a similarly heartrending
fate in his political hands. The SIF currently has a temporary exemption
from Canada’s "Controlled Drugs and Substances Act”
in order to operate until June of 2008. As such, the fate of the
SIF is politically determined each time behind closed doors by the
Prime Minister and his ministers. Sadly, the Prime Minister appears
lost at present, content to ignore the scientific and medical evidence
on the matter of population health. In light of the vast medical
evidence accumulated on Vancouver’s SIF, the fate of injection
facilities needs to be taken out of the political realm entirely.
I am hoping that the Prime Minister will be found, see the light
of the scientific evidence, and lead the way towards to provision
of a permanent medical exemption for injection facilities from Canada’s
Controlled Drugs and Substances Act (CDSA). In so doing, the Prime
Minister would be on the brink of grace and would rescue a life
saving health program from perpetual political interference.
Wood, E., Kerr, T., Montaner, J., Strathdee, S., Kerr, T., Wodak,
A., Spittal, P., Hankins, C., Schechter, M., &Tyndall, M. (2004).
Rationale for evaluating North America’s first medically supervised
safer injecting facility. Lancet Infectious Diseases, 4(5), 301-306.
cities throughout the world are experiencing ongoing infectious
disease and overdose epidemics among illicit injection drug users
(IDUs). In particular, HIV and hepatitis C virus (HCV) have become
endemic in many settings and bacterial infections, such as endocarditis,
have become extremely common among this population. In an effort
to reduce these public health concerns, in September 2003, Vancouver
in British Columbia, Canada, opened a pilot medically supervised
safer-injecting facility (SIF), where IDUs can inject pre-obtained
illicit drugs under the supervision of medical staff. Before and
since the facility's opening, there has been a substantial misunderstanding
about the rationale for evaluating SIF as a public-health strategy.
This article outlines the evidence and rationale in support of the
Canadian initiative. This rationale involves limitations in conventionally
applied drug-control efforts, and gaps in current public-health
policies in controlling the spread of infectious diseases, and the
incidence of overdose among IDUs.
E., Kerr, T., Small, W., Li, K., Marsh, D., Montaner, J., &
Tyndall, M. (2004). Changes in public order after the opening of
a medically supervised safer injecting facility for illicit injection
drug users. Canadian Medical Association Journal, 171(7), 731-734.
researchers measured injection-related public order problems during
the 6 weeks before and the 12 weeks after the opening of the safer
injecting facility in Vancouver. They measured changes in the number
of drug users injecting in public, publicly discarded syringes and
injection-related litter. They conclude that the opening of the
safer injecting facility was independently associated with improvements
in several measures of public order, including reduced public injection
drug use and public syringe disposal.
E., Kerr, T., Buchner, C., Marsh, D., Montaner, J., & Tyndall,
M. (2004) Methodology for evaluating Insite: Canada’s first
medically supervised safer injection facility for injection drug
users. Harm Reduction Journal, 1(1): 9.
disease and overdose epidemics among injection drug users (IDUs),
in particular, Human Immunodeficiency Virus (HIV) and hepatitis
C Virus (HCV) and bacterial and viral infections, such as endocarditis
and cellulitis, have become extremely common among this population.
In an effort to reduce these public health concerns and the public
order problems associated with public injection drug use, in September
2003, Vancouver, Canada opened a pilot medically supervised safer
injecting facility (SIF), where IDUs can inject pre-obtained illicit
drugs under the supervision of medical staff. The SIF was granted
a legal exemption to operate on the condition that its impacts be
rigorously evaluated. In order to ensure that the evaluation is
appropriately open to scrutiny among the public health community,
the present article was prepared to outline the methodology for
evaluating the SIF and report on some preliminary observations.
The evaluation is primarily structured around a prospective cohort
of SIF users, that will examine risk behavior, blood-borne infection
transmission, overdose, and health service use. These analyses will
be augmented with process data from within the SIF, as well as survey's
of local residents and qualitative interviews with users, staff,
and key stakeholders, and standardized evaluations of public order
changes. Preliminary observations suggest that the site has been
successful in attracting IDUs into its programs and in turn helped
to reduce public drug use. However, each of the indicators described
above is the subject of a rigorous scientific evaluation that is
attempting to quantify the overall impacts of the site and identify
both benefits and potentially harmful consequences and it will take
several years before the SIF's impacts can be appropriately examined.
16. Wood, E., Tyndall, M., Li, K., Lloyd-Smith, E., Small,
W., Montaner, J., & Kerr, T. (2005). Do supervised injecting
facilities attract higher-risk injection drug users? American Journal
of Preventive Medicine, 29(2), 126-130.
researchers examine whether North America’s first supervised
safer injection facility was attracting injecting drug users (IDUs)
who were at greatest risk of overdose and blood-borne disease infection.
They examined data from a community-recruited cohort study of IDUs.
This study indicated that the SIF attracted IDUs who have been shown
to be at elevated risk of blood-borne disease infection and overdose,
and IDUs who were contributing to the public drug use problem and
unsafe syringe disposal problems stemming from public injection
drug use. The researchers note that the “ data suggest that
supervised safer injection facility may be effective in attracting
highest-risk IDUs and in providing a hygienic environment where
medical care and referral to addiction treatment can be provided
on site, and where emergency response is available in the event
Kerr, T., Tyndall, M., Li, K., Montaner, J., & Wood E. (2005).
Safer injection facility use and syringe sharing in injection drug
users. Lancet, 366(9482), 316-318.
injection facilities provide medical supervision for illicit drug
injections. We aimed to examine factors associated with syringe
sharing in a community-recruited cohort of illicit injection drug
users in a setting where such a facility had recently opened. Between
Dec 1, 2003, and June 1, 2004, of 431 active injection drug users
49 reported syringe sharing in the past 6 months. In contrast use
of the facility was independently associated with reduced syringe
sharing. These findings could help inform discussions about the
merits of such facilities.
Wood, E., Tyndall, M., Small, W., Stoltz, J., Zhang, R., O’Connell,
J., Montaner, J., & Kerr, T. (2005) Safer injecting education
for HIV prevention within a medically supervised safer injecting
facility. International Journal of Drug Policy, 16, 281-284.
help injecting has recently been independently associated with syringe
sharing and HIV incidence among injection drug users (IDUs) in Vancouver.
We examined IDUs who were receiving safer injecting education within
a supervised injecting facility (SIF) in Vancouver. Between May
31, 2003 and Oct 22, 2004, 874 individuals of the SEOSI cohort have
completed a baseline questionnaire, among whom 293 (33.5%) received
safer injecting education. Requiring help with an injection in the
last 6 months and sex-trade involvement in the last 6 months were
independently associated with receiving safer injecting education
within the SIF. The authors conclude that since requiring help injecting
has previously been associated with HIV incidence, it is encouraging
that this risk factor was associated with receiving safer injecting
education within the SIF. Nevertheless, prospective evaluation is
necessary to examine if receiving safer injecting education is associated
with reduced HIV risk behaviour and blood-borne disease incidence.
Wood, E. Kerr, T., Stoltz, J., Qui, Z., Zhang, R., Montaner, J.,
& Tyndall, M. (2005). Prevalence and correlates of hepatitis
C infection among users of North America’s first medically
supervised safer injection facility. Public Health, 119(12), 1111-1115.
researchers examined the prevalence and correlates of hepatitis
C (HCV) infection among a representative cohort of supervised safer
injection facility (SIF) users. Users of the Vancouver SIF were
selected at random and asked to enroll in the Scientific Evaluation
of Supervised Injecting (SEOSI) cohort. At baseline, venous blood
samples were collected and an interviewer-administered questionnaire
was performed. Participants who were HCV-positive were compared
with HCV-negative subjects using bivariate and logistic regression
analyses. Between 1 December 2003 and 30 July 2004, 691 participants
were enrolled into the SEOSI cohort, among whom 605 (87.6%) were
HCV-positive at baseline. Factors independently associated with
HCV infection in logistic regression analyses included: involvement
with the sex trade, history of borrowing syringes, and history of
incarceration. Daily heroin use was protective against HCV infection.
The researchers conclude that the SIF has attracted injection drug
users with a high burden of HCV infection and a substantial proportion
of uninfected individuals. Although crosssectional, this study provides
some insight into historical risks for HCV infection among this
population, and prospective follow-up of this cohort will be useful
to determine if use of the SIF is associated with reduced risk behaviour
and HCV incidence.
E., Tyndall, M., Small, W., Lloyd-Smith, E., Zhang, R., Montaner,
J., & Kerr, T. (2005). Factors associated with syringe sharing
among users of a medically supervised safer injecting facility.
American Journal of Infectious Diseases, 1(1), 50-54.
Canada recently opened a medically supervised safer injecting facility
(SIF) in an effort to reduce HIV and overdose risk and public injection
drug use. We sought to examine factors associated with syringe sharing
among SIF users. SIF users were randomly recruited into a prospective
cohort of SIF users known as the Scientific Evaluation of Supervised
Injecting (SEOSI) cohort. We examined the prevalence and correlates
of used syringe borrowing among baseline HIV-negative participants
and used syringe lending among baseline HIV-infected participants.
Between 22 March 2004 and 22 October 2004, 479 baseline HIV-negative
subjects and 103 baseline HIV-infected participants were recruited
into the cohort. For baseline HIV negative participants, syringe
borrowing was positively associated with public drug use and requiring
help injecting, whereas exclusive SIF use was inversely associated
with syringe sharing. For baseline HIV-infected participants, syringe
lending was positively associated with daily cocaine injection and
shooting gallery use. Although ongoing injection-related HIV risk
behavior was reported among some SIF users, rates of syringe sharing
were substantially lower than the rate observed previously in this
community and it is noteworthy that exclusive SIF use was associated
with reduced syringe sharing.
M., Kerr, T., Zhang, R., King, E., Montaner J., & Wood, E. (2006).
Attendance, drug use patterns, and referrals made from North America’s
first supervised injection facility. Drug and Alcohol Dependence,
America’s first government sanctioned supervised injection
facility (SIF) was opened in Vancouver in response to the serious
health and social consequences of injection drug use and the perseverance
of committed advocates and drug user groups who demanded change.
This analysis was conducted to describe the attendance, demographic
characteristics, drug use patterns, and referrals made during the
first 18 months of operation. As part of the evaluation strategy
for the SIF, information is collected through a comprehensive on-site
database designed to track attendance and the daily activities within
the facility. All users of the SIF must sign a waiver form and are
then entered into a database using a unique identifier of their
choice. This identifier is used at each subsequent visit to provide
a prospective record of attendance, drug use, and interventions.
From 10 March 2004 to 30 April 2005 inclusive, there were 4764 unique
individuals who registered at the SIF. The facility successfully
attracted a range of community injection drug users including women
(23%) and members of the Aboriginal community (18%). Although heroin
was used in 46% of all injections, cocaine was injected 37% of the
time. There were 273 witnessed overdoses with no fatalities. During
just 12 months of observation, 2171 individual referrals were made
with the majority (37%) being referred for addiction counseling.
Vancouver’s SIF has successfully been integrated into the
community, has attracted a wide cross section of community injection
drug users, has intervened in overdoses, and initiated over 2000
referrals to counseling and other support services. These findings
should be useful for other settings considering SIF trials.
18. Kerr, T., Stoltz, J., Tyndall, M., Li, K., Zhang, R.,
Montaner, J., & Wood, E. (2006). Impact of a medically supervised
safer injection facility on community drug use patterns: a before
and after study. British Medical Journal, 332(7535), 220-222.
paper highlights findings from a study of 871 injecting drug users
recruited from the community in Vancouver, Canada. The study examines
rates of relapse into injected drug use among former users and of
stopping drug use among current users. Local health authorities
established the Vancouver supervised injecting facility to provide
injecting drug users with sterile injecting equipment, intervention
in the event of overdose, primary health care, and referral to external
health and social services. Analysis of periods before and after
the facility’s opening showed no substantial increase in the
rate of relapse into injected drug use and no substantial decrease
in the rate of stopping injected drug use. Recently reported benefits
of supervised injecting facilities on drug users’ high risk
behaviours and on public order do not seem to have been offset by
negative community impacts.
E., Tyndall, M., Qui, Z., Zhang, R., Montaner, J., & Kerr, T.
(2006). Service uptake and characteristics of injection drug users
utilizing North America’s first medically supervised safer
injecting facility. American Journal of Public Health, 96(5): 770-773.
average number of daily visits to the supervised safer injection
facility (SIF) in its first week of operation was approximately
200; an approximate average of 500 visits per day has been consistently
observed since the 2 months after the facility's opening. During
the latest 6 months for which data are available from the SIF database
(March 1, 2004, to August 31, 2004). The average breakdown of substances
injected per month included heroin (42%), cocaine (32%), and other
substances (26 %): there were an average of 104 visits with the
addictions counselor per month, and there were an average of 19
responses to potential overdoses per month. Key findings: the medically
supervised injection site staffed by nurses has been well accepted
among injection drug users (IDUs) in the community. Homelessness,
which is commonly a factor in public injection drug use, was associated
with frequent use of the SIF. Daily SIF use was associated with
several risk behaviors that have been linked to elevated rates of
HIV transmission in this community. Including frequent cocaine injection.
Prospective follow-up of SIF users will be valuable to examine blood-borne
disease incidence and uptake of medical care and addiction treatment.
E., Tyndall, M., Zhang, R., Stoltz, J., Lai, C., Montaner, J., &
Kerr, T. (2006). Attendance at supervised injecting facilities and
use of detoxification services. New England Journal of Medicine,
short article speaks to concerns related to unfounded fears that
safer injecting facilities may lessen the likelihood that injection-drug
users will seek addiction-treatment services. Study findings provide
reassurance that supervised injection facilities are unlikely to
result in reduced use of addiction-treatment services.
Wood, E., Tyndall, M., Lai, C., Montaner, J., & Kerr T. (2006).
Impact of a medically supervised safer injecting facility on drug
dealing and other drug-related crime. Substance Abuse Treatment,
Prevention, and Policy, 1(1), 13.
America's first medically supervised recently opened in Vancouver,
Canada. One of the concerns prior to the safer injecting facility’s
(SIF) opening was that the facility might lead to a migration of
drug activity and an increase in drug-related crime. Therefore,
we examined crime rates in the neighborhood where the SIF is located
in the year before versus the year after the SIF opened. No increases
were seen with respect to drug trafficking (124 vs. 116) or assaults/robbery
(174 vs. 180), although a decline in vehicle break-ins/vehicle theft
was observed (302 vs. 227). The SIF was not associated with increased
drug trafficking or crimes commonly linked to drug use.
T., Tyndall, M., Lai, C., Montaner, J., & Wood, E. (2006). Drug-related
overdoses within a medically supervised safer injection facility.
International Journal of Drug Policy, 17(5), 436-441.
The researchers sought to examine the incidence and characteristics
of overdose events at the supervised safer injection facility (SIF).
The Vancouver SIF evaluation involves a comprehensive database within
the SIF and the Scientific Evaluation of Supervised Injection (SEOSI)
cohort consisting of 1046 SIF users. We examined the incidence and
features of overdoses at the SIF and the responses made by SIF staff.
Between 1 March 2004 and 30 August 2005, there were 336 overdose
events at the SIF. The most common indicator of overdose was depressed
respiration (60%), and the most common intervention involved the
administration of oxygen (87%). In total, 90 SEOSI participants
had an overdose at the SIF during the study period. Factors independently
associated with time to overdose included fewer years injecting,
daily heroin use, and having a history of overdose. The researchers
conclude that there have been a large number of overdoses within
the SIF, and it is noteworthy that none of these overdoses resulted
in a fatality. These findings suggest that SIF can play a role in
managing overdoses among IDU and indicate the need for further evaluation
of the impact of SIF on morbidity and mortality associated with
E., Tyndall, M., Montaner, J., & Kerr T. (2006). Summary of
findings from the evaluation of a pilot medically supervised safer
injecting facility. Canadian Medical Association Journal, 175(11),
medically supervised safer injection facility (SIF) was granted
a legal exemption by the Canadian government on the condition that
a 3-year scientific evaluation of its impacts be conducted. In this
review, we summarize the findings from evaluations in those 3 years,
including characteristics of IDUs at the facility, public injection
drug use and publicly discarded syringes, HIV risk behaviour, use
of addiction treatment services and other community resources, and
drug-related crime rates. Vancouver’s safer injecting facility
has been associated with an array of community and public health
benefits without evidence of adverse impacts. These findings should
be useful to other cities considering supervised injecting facilities
and to governments considering regulating their use.
20. Tyndall, M., Wood, E., Zhang, R., Lai, C., Montaner,
J., & Kerr, T. (2006). HIV seroprevalence among participants
at a medically supervised injection facility in Vancouver, Canada:
Implications for prevention, care and treatment. Harm Reduction
Journal, 3(1), 36.
December 2003 and April 2005, a representative sample of 1,035 supervised
safer injecting facilities (SIF) participants were enrolled in a
prospective cohort that required completing an interviewer-administered
questionnaire and providing a blood sample for HIV testing. HIV
infection was detected in 170/1007 (17%) participants and was associated
with Aboriginal ethnicity, a history of borrowing used needles/syringes,
previous incarceration, and daily injection cocaine use. The SIF
has attracted a large number of marginalized injection drug users
and presents an excellent opportunity to enhance HIV prevention
through education, the provision of sterile injecting equipment,
and a supervised environment to self-inject. In addition, the SIF
is an important point of contact for HIV positive individuals who
may not be participating in HIV care and treatment.
S., Kerr, T., Tyndall, M., Zhang. R., Montaner, J., & Wood,
E. (2007). Injection drug users’ perceptions regarding use
of a medically supervised safer injecting facility. Addictive Behaviors.
recent years, there has been increased interest in supervised safer
injecting facilities (SIF) as a strategy to reduce the harms of
illicit drug use; however, little work has been done to assess drug
users' satisfaction with this service. This study was undertaken
to explore injection drug users' experiences and opinions regarding
North America's first SIF in Vancouver, Canada. Injection drug users
(IDU) were randomly recruited from within the Vancouver SIF and
invited to enroll in the Scientific Evaluation of Supervised Injecting
(SEOSI) cohort. For the present study, participants were then surveyed
regarding their experiences and beliefs regarding the SIF. The study
finds that of 1082 IDU surveyed, 809 (75%) reported that their injecting
behavior had changed as a result of using the SIF. Among these individuals,
80% indicated that the SIF had resulted in less rushed injecting,
71% indicated that the SIF had led to less outdoor injecting and
56% reported less unsafe syringe disposal. The three most common
features always or usually limiting IDU's use of the SIF were: travel
to the SIF (12%), limited operating hours (7%), and waiting times
to access the SIF (5%). When asked in what ways the SIF might be
improved, the three most common suggestions were: longer hours of
operation (53%), addition of a washroom (51%), and reduced waiting
T., Tyndall, M., Zhang, R., Lai, C., Montaner, J., & Wood, E.
(2007). Circumstances of first injection among illicit drug users
using a medically supervised safer injection facility. American
Journal of Public Health. 97(7), 1228-30.
have been concerns that safer injecting facilities may promote initiation
into injection drug use. We examined length of injecting career
and circumstances surrounding initiation into injection drug use
among 1065 users of North America's first safer injecting facility
and found that the median years of injection drug use were 15.9
years, and that only 1 individual reported performing a first injection
at the safer injecting facility. These findings indicate that the
safer injecting facility's benefits have not been offset by a rise
in initiation into injection drug use.
21. McKnight, I., Maas, B., Wood, E., Tyndall, M., Small,
W., Lai, C., Montaner, J., & Kerr, T. (2007). Factors associated
with public injecting among users of Vancouver’s supervised
injection facility. American Journal of Drug and Alcohol Abuse.
researchers evaluated factors associated with public drug injection
among a cohort of injection drug users (SEOSI) originally recruited
from within Vancouver’s supervised injecting facility (SIF).
Between June 2004 and July 2005, 714 IDU were followed up as part
of SEOSI. In multivariate analyses, factors associated with public
drug injection included homelessness, syringe lending, requiring
help injecting, and reporting that wait times affected frequency
of SIF use. The researchers note that persistent public injection
was independently associated with elevated HIV risk behaviors, as
well as programmatic factors that limit SIF use. SIF program expansion
may further help to reduce persistent risk behaviors and the community
concerns related to public injection drug use.
E., Tyndall, M., Zhang, R., Montaner, J., & Kerr, T. (2007).
Rates of detoxification service use and its impact among a cohort
of supervised injecting facility users. Addiction, 102(6), 916-9.
suggest that the supervised safer injecting facility does not help
injection drug users reduce their drug use. However, this study
demonstrates that there was an increase in the uptake of detoxification
services the year after the SIF opened and detoxification was associated
with elevated rates of methadone initiation and other addiction
J., Wood, E., Small, W., Li, K., Tyndall. M., Montaner, J., &
Kerr, T. (2007). Changes in injecting practices associated with
use of a medically supervised safer injection facility. Journal
of Public Health, 29(1), 35-9.
drug users (IDUs) are vulnerable to serious health complications
resulting from unsafe injection practices. We examined whether the
use of a supervised safer injection facility (SIF) promoted change
in injecting practices among a representative sample of 760 IDUs
who use a SIF in Vancouver, Canada. Consistent SIF use was compared
with inconsistent use on a number of self-reported changes in injecting
practice variables.More consistent SIF use is associated with positive
changes in injecting practices, including less reuse of syringes,
use of sterile water, swabbing injection sites, cooking/filtering
drugs, less rushed injections, safe syringe disposal and less public
22. Kerr, T., Small, W., Moore, D., & Wood, E. (2007).
A micro-environmental intervention to reduce the harms associated
with drug-related overdose: Evidence from the evaluation of Vancouver's
safer injection facility. International Journal of Drug Policy,
drug overdose prevention strategies have been criticised for failing
to address the macro- and micro-environmental factors that shape
drug injecting practices and compromise individual ability to reduce
the risks associated with drug-related overdose. This in turn has
led to calls for interventions that address overdose risks by modifying
the drug-using environment, including the social dynamics within
them. Safer injection facilities (SIFs) constitute one such intervention,
although little is known about the impact of such facilities on
factors that mediate risk for overdose. Semi-structured qualitative
interviews were conducted with fifty individuals recruited from
a cohort of SIF users in Vancouver, the Scientific Evaluation Of
Supervised Injecting (SEOSI). Audio recorded interviews elicited
injection drug users’ (IDU) accounts of overdoses as well
as perspectives regarding the impact of SIF use on overdose risk
and experiences of overdose. Interviews were transcribed verbatim
and a thematic analysis was conducted. The researchers note that
50 IDU, including 21 women, participated in this study. The perspectives
of participants suggest that the Vancouver SIF plays an important
role in mediating various risks associated with overdose. In particular,
the SIF addresses many of the unique contextual risks associated
with injection in public spaces, including the need to rush injections
due to fear of arrest. Further, SIF use appears to enable overdose
prevention by simultaneously offsetting potential social risks associated
with injecting alone and injecting in the presence of strangers.
The immediate emergency response offered by nurses at the SIF was
also valued highly, especially when injecting adulterated drugs
and drugs of unknown purity and composition. The researchers state
that the perspectives of IDU participating in this study suggest
that SIFs can address many of the micro-environmental factors that
drive overdose risk and limit individual ability to employ overdose
prevention practices. Although challenges related to coverage remain
in many settings, SIFs may play a unique role in managing overdoses,
particularly those occurring within street-based drug scenes.
J., Wood, E., Miller, C., Small, W., Li, K., Tyndall, M., Montaner,
J., & Kerr, T. (2007). Characteristics of young illicit drug
injectors who use North America’s first medically supervised
safer injecting facility. Addiction Research and Theory, 15(1),
study examined whether North America’s first medically supervised
safer injection facility (SIF) attracts young injection drug users
(IDUs) who are at high risk of health-related harm. Prevalence of
SIF use was determined based on data obtained after the SIF’s
opening. Predictors of initiating future SIF use were determined
based on behavioral information obtained from the participant’s
study visit immediately preceding the SIF’s opening. The median
duration between the acquisition of pre-SIF opening behavioral data
and the more recent interview, where SIF use was measured, was 16
months. Characteristics of IDUs who did and did not subsequently
initiate SIF use were statistically compared. Data from the 6-month
period prior to the SIF’s opening showed that youth initiating
SIF use were significantly more likely to have been in jail, to
use heroin daily, to have overdosed, to have binged on drugs, to
have loaned needles, and to have been homeless. The study suggests
that among IDUs 29 years of age or younger, those who used the SIF
were at higher risk than those who were not.
23. Final Report of the Commission of Inquiry into the Non-medical
use of Drugs. Ottawa (The LeDain Report, 1973): Information Canada.
Libraries and Archives, Canada states that “The Commission
of Inquiry Into the Non-Medical Use of Drugs was established under
Order in Council P.C. 1112, 29 May 1969, under Part I of the Inquiries
Act (R.S.C., 1952, c.154) and on the recommendation of the Minister
of Health and Welfare. The Commission was mandated to inquire into
and report upon the factors underlying or relating to the non-medical
use of the drugs and substances, with particular reference to: (a)
the data and information comprising the present fund of knowledge
concerning the non-medical use of sedative, stimulant, tranquillizing,
hallucinogenic and other psychotropic drugs or substances; (b) the
current state of medical knowledge respecting the effect of the
drugs and substances referred to in (a); (c) the motivation underlying
the non-medical use referred to in (a); (d) the social, economic,
educational and philosophical factors relating to the use for non-medical
purposes of the drugs and substances referred to in (a) and in particular,
on the extent of the phenomenon, the social factors that have lead
to it, the age groups involved, and problems of communication; and
(e) the ways or means by which the federal government can act, alone
or in its relations with government at other levels, in the reduction
of the dimensions of the problems involved in such use. The commissioners
were Gerald Le Dain, Chairman; Ian Lachlan Campbell; Heinz E. Lehmann,
J. Peter Stein and Marie-Andrée Bertrand. André Lussier,
an original member of the Commission, resigned on 25 June 1969 and
Marie-Andrée Bertrand was appointed to replace him (Order
in Council, P.C. 1961, 10 October 1969). The secretary was James
J. Moore. After Moore's resignation, in the fall of 1972, his duties
were carried out by Frederick Brown and C. Michael Bryan.
response to the concern over the use of illicit drugs and the need
to obtain more information about some of them, the federal Minister
of Health and Welfare, John Munro, announced in the House of Commons,
on 1 May 1969, the appointment of a commission of inquiry into the
non-medical use of drugs.
particular, the commission was to examine those psychotropic drugs
having sedative, stimulant, tranquillizing or hallaucinogenic properties.
According to the Commissioners, their most important task was to
determine the motivation for the non-medical use of drugs and to
place its occurrence in a suitable social and philosophic context:
is necessary to consider not only the effects, extent and causes
of such use, but the range of social response and attitudes which
such use has elicited from government, other institutions and individuals.
For non-medical drug use and the social response to it are interacting
and mutually conditioning phenomena." (See Interim Report of
the Commission of Inquiry into the Non-Medical Use of Drugs, Ottawa:
Queen's Printer, 1970; and Order in Council, P.C. 112, 29 May 1969.)
of the commission were held in all 10 provincial capitals of Canada
and in Saint John, Moncton, Sackville, Trois Rivières, Sherbrooke,
Lennoxville, Montreal, Sept-Iles, Baie Comeau, Ottawa, Kingston,
Sudbury, London, Thunder Bay, Hamilton, Windsor, Saskatoon, Calgary
and Vancouver from 16 October 1969 to 20 November 1970 and 19 February
1971. These included informal sessions held at several universities
and at coffee houses in Montreal, Toronto and Vancouver.
addition, private hearings were held with the Royal Canadian Mounted
Police, the Addiction Research Foundation, the Canadian Bar Association,
the Canadian Medical Association and other associations. The commission
also received valuable assistance from a number of organizations
and individuals in the field of the non-medical use of drugs, including
law enforcement, officials and officials in treatment centres, in
Canada, the United States, Great Britain and other countries.
commission received 507 formal submissions and numerous letters.”
Among other recommendation, in their final report they recommend
drug policy reform especially regarding marijuana possession. Marie-Andree
Bertrand recommends a policy of legal distribution of cannabis.
Cain, J. (1994). Report on the Task Force into Illicit Narcotic
Overdose Deaths in British Columbia. Victoria, BC: Ministry of the
1994, Chief Coroner of British Columbia, Vince Cain, released a
broad analysis of drug use in the province in response to increasing
numbers of drug overdose deaths. The Cain Report states that vast
amounts of money are being spent on the drug problem within the
criminal justice system with little or no effect. The report calls
for policy makers to recognize that the misuse of heroin, cocaine
and other drugs is primarily a health issue. The report makes clear
that a high percentage of deaths of heroin users had also ingested
alcohol. The Cain Report also recommends: “the feasibility
of decriminalizing the possession and use of specified substances
by people shown to be addicted to those substances.” It concludes
that serious inquiry is needed into “the merits of legalizing
the possession of some of the so-called “soft” drugs,
such as marijuana.” The report recommends providing heroin
Policy For The New Millennium: Working Together To Redefine Canada’s
Drug Strategy. Interim Report of the Special Committee on Non-medical
use of Drugs (2002).
May 17, 2001, the House of Commons created the Special Committee
on Non-Medical Use of Drugs based on a motion brought forward by
Randy White, M.P. (Langley—Abbottsford) and gave it a very
broad mandate to study “the factors underlying or relating
to the non-medical use of drugs in Canada” and to bring forward
recommendations aimed at reducing “the dimensions of the problem
involved in such use.” A House of Commons Special Committee
issued in November 2002 a report on the Non-Medical use of Drugs
in Canada. The report highlighted a number of important areas in
this field, including: the use and harmful use of substances, dependence
in Canada, Canada's drug strategy, research and knowledge, public
health issues, substance use and public safety, international treaties
and legislative reform, as well as drug policies abroad.
26. Nolan, P., & Kenny, C. (2003). Cannabis: Report
of the Senate Special Committee on Illegal Drugs
special committee of the Canadian Senate brought together in 2001
examined the scientific literature on cannabis, including reports
from 23 internationally renowned scientists and testimony from more
than 200 witnesses, from experts to ordinary citizens, and discussion
groups. In their final report the special committee asks if it is
“appropriate that such considerable resources be funneled
into the war against drugs in Canada to the detriment of other important
government programs such as the reform of our health care system,
education, job creation, and improving the competitiveness of the
Canadian economy. . . . [T]he Auditor General’s 2001 annual
report reveals, over 95% of [Canada’s Anti-Drug Strategy]
is spent applying the criminal law.” The special committee
recommends a legal system of regulated access for cannabis and an
amnesty for any person convicted of possession of cannabis under
current or past legislation.
MacPherson, D., Mulla, Z, Richardson, L, & Beer, T. (2005).
Preventing Harm from Psychoactive Substance Use.
a Framework For Action: A Four Pillar Approach to Drug Problems
in Vancouver was adopted by City Council in 2001, “Vancouver
committed to developing a comprehensive plan based on the best evidence
available to address harmful drug use in the city. In public meetings
across the city, citizens called for a more focused, coordinated
and sustained approach to addressing drug related issues. . .
is no magic prevention bullet, no inoculation that allows us all
to avoid harmful substance use from developing. Instead, this plan
draws on a number of approaches to prevention – ranging from
population health models to community-based, legal and regulatory
approaches – and recommends strategies that have shown the
strongest evidence for success. The plan recognized that factors
such as adequate housing and employment are as important to keeping
people healthy as is access to health care systems.”
28. Health Officers Council of British Columbia. 2005, October.
A Public Health Approach to Drug Control in Canada. Victoria, BC:
Officers Council of British Columbia (2008). Regulation of Psychoactive
Substances in Canada. Victoria, BC. Authors.
Health Officers Council of British Columbia (2011). Public Health Perspectives for Regulating Psychoactive Substances: What we can do about Alcohol, Tobacco, and Other Drugs. Click here for report. Click here for a summary report.
See the 2005 and 2008 reports at:
authors summarize their 2005 report: “Drug control policies
could be crafted to reduce harmful use of substances, minimize negative
health effects to the individual, and limit secondary drug-related
harms to society. A spectrum of policy approaches exists for drug
control. In Canada, tobacco and alcohol exist towards one end of
the spectrum in a legal, for profit economy. Illegal drugs such
as marijuana, heroin and cocaine exist towards the other end of
the spectrum in a criminal-prohibition, black-market economy. The
types of harms created by each of these frameworks are reviewed.
We argue for a more centrist public health approach to currently
illegal drugs, where policies are set to minimize harms. The balance
point for determining public health policies for currently illegal
drugs would be that which minimizes the prevalence of harmful use
and negative health impacts, and also minimizes any indirect or
collateral harms to society from regulatory sanctions. Studies support
public health harm reduction strategies, but their implementation
is hindered by the criminal status of drugs in popular use. Current
conditions are right to enter into serious public discussions regarding
the creation of a regulatory system for currently illegal drugs
in Canada, with better control and reduced harms to be achieved
by management in a tightly controlled system. The removal of criminal
penalties for drug possession for personal use, and placement of
these currently illegal substances in a tight regulatory framework,
could both aid implementation of programs to assist those engaged
in harmful drug use, and reduce secondary unintended drug-related
harms to society that spring from a failed criminal-prohibition
approach. This would move individual harmful illegal drug use from
being primarily a criminal issue to being primarily a health issue.
A review of Canadian reports, articles and poll results on these
issues indicates a readiness to explore new approaches. A comprehensive
public health approach for drug control should be adopted by the
Federal, Provincial, and Municipal governments in Canada.
A. Reform Federal and Provincial laws and international agreements
that deal with psychoactive drugs.
B. Devise pan-Canadian, public health based strategies to manage
C. Improve capabilities to closely monitor and provide information
about the health and social consequences of psychoactive drugs and
drug control strategies.
D. Develop comprehensive services and a balanced investment for
prevention, harm reduction, treatment, rehabilitation, and enforcement.
Haden, M. (2008). Controlling illegal stimulants: A regulated market.
Harm Reduction Journal, 5, 1.
author states: “Prohibition of illegal drugs is a failed social
policy and new models of regulation of these substances are needed.
This paper explores a proposal for a post-prohibition, public health
based model for the regulation of the most problematic drugs, the
smokable and injectable stimulants. The literature on stimulant
maintenance is explored. Seven foundational principles are suggested
that could support this regulatory model of drug control that would
reduce both health and social problems related to illegal stimulants.
Some details of this model are examined and the paper concludes
that drug policies need to be subject to research and based on evidence.”
Alexander, A. 2006. “Beyond Vancouver’s “Four
Pillars”: An Historical Analysis.” International Journal
of Drug Policy, 17(2), 118-123.
Bruce Alexander argues that a historical analysis of the roots of
addiction suggests that it will also be necessary to go well beyond
the Four-Pillar Approach if society is to bring addiction under
control. The author explores the relationship between free market
economies, dislocation and addiction and suggests that until we
look at the roots of addiction our drug policy is limited.
read another article by Bruce Alexander, The Roots of Addiction
in Free Market Society, click here:
Boyd, S., & Marcellus, L. (2007). (Eds.). With child: Substance
use during pregnancy: A woman-centred approach. Halifax: Fernwood
book provides practitioners and researchers with information about
maternal drug use, harm reduction, best practices and policy by
bringing together a number a number of contributors who are directly
involved in providing services for pregnant women and mothers. The
editors conclude: “Moving towards harm-reduction, health,
and human rights models and a regulated market will significantly
reduce the harms associated with drugs to both the individual and
society. It will also lessen the vulnerability of safe and effective
individual programs. Woman-centred harm reduction programs and practice
have much to offer; yet we recognize they are not a panacea. It
is important to recognize that women’s drug use is shaped
by social factors such as poverty, inter-personal and structural
violence, colonization, drug laws, neoliberal policy and restructuring
(at the local, national, and global levels), and inequalities of
race, class, sexuality, and gender. It is impossible to expect that
harm-reduction initiatives will counter all social oppressions.
Yet, harm-reduction, woman-centred programs can provide a momentum
– a shift in perspective and practice –that brings social
factors to the foreground while providing compassionate care.”
Spittal, P., et al. (2002). Risk factors for elevated HIV incidence
rates among female injection drug users in Vancouver. Canadian Medial
Association Journal, 166(7), 894-898.
Canada, roughly 39 percent of “all new HIV infections in 2000
were related to injection drug use.” As early as 1997, it
was noted that in Vancouver, women injection drug users had a higher
prevalence of HIV seroconversion than their male counterparts. In
the Downtown Eastside of Vancouver, poor women and Aboriginal women
are vulnerable to infection. Many women do not inject themselves,
relying on their partners to do so; thus they are “second
on the needle” and often times more at risk for blood-borne
researchers note that “HIV incidence rates among female injection
drug users [IDUs] in Vancouver are about 40% higher than those of
male injection drug users. Different risk factors for seroconversion
for women as opposed to men suggest that sex-specific prevention
initiatives are urgently required.” They conclude: “Our
data demonstrate that an elevated risk of incident HIV infection
exists among female IDUs in Vancouver. These findings further demonstrate
the urgent need for sex-specific programs involving needle exchanges,
safe injection sites and street nurses that can better accommodate
the challenges and concerns of female IDUs.”
33. Maher, L. (2002). Don’t leave us this way: Ethnography
and injection drug use in the age of AIDS. Internal Journal of Drug
Policy, 13, 311-325.
from ethnographic research, Dr. Lisa Maher explains that for many
poor and visible injecting drug users “HIV and other blood-borne
viruses are just one of many risks to be negotiated on a daily basis:
the risk of arrest, death, withdrawal, overdose, being attacked,
robbed or ripped off, losing your children, losing a limb and losing
your dignity. These are not individual and isolated but rather,
connected and cumulative.”
34. Robertson, L., & Culhane, D. (Eds.). (2005). In
Plain Sight: Reflections on Life in Downtown Eastside Vancouver.
Vancouver: Talon Books.
award winning collection of seven life stories from Vancouver’s
Downtown Eastside, “sets out to create a space for the voices
of women who are seldom heard on their own terms—the words
of people who are publicly visible yet who, due to the blur of preconceptions
that surround the inner city, remain unseen. To man, these women
who offer their stories here are “people without history,”
defined only by belonging to a neighbourhood branded by layers of
stigma. Their diverse histories are rarely included in the clichés
of media depictions of urban poverty: the “drug problem,”
prostitution” or statistics on crime and violence. . . . These
women share their stories of their complex pathways from childhood
into and out of the Downtown Eastside, through periods of addiction
and recovery, strength and illness, affluence and povery. They confront
and challenge the familiar stereotypes applied to drug users, to
“wayward women,” and to those who live with disease
and or mental illness.
Tupper, K. (in print). Teaching Teachers to Just Say “Know”:
Reflections on Drug Education. Teaching and Teaching Education.
Tupper writes: “Psychoactive substance use by students is
common in many countries, obliging schools to deliver drug education.
However, some jurisdictions do not prepare teachers for engaging
their students in honest, knowledge-based education. This article
looks at the history and queries the purposes of contemporary drug
education. It compares current approaches to drug education with
those of other ‘‘vice’’ issues addressed
in the history of public schools, such as sex education and temperance
education. It critically challenges the question of knowledge definition
and production related to psychoactive substances. Finally, some
of the theoretical groundings on which to base teacher education
for drug education are considered.”
Amar, M. (2006). Cannabinoids in medicine: A review of their therapeutic
potential. Journal of Ethnopharmacology, 105, 1-25.
researcher explains that “in order to assess the current knowledge
on the therapeutic potential of cannabinoids, a meta-analysis was
performed through Medline and PubMed up to July 1, 2005. The key
words used were cannabis, marijuana, marihuana, hashish, hashich,
haschich, cannabinoids, tetrahydrocannabinol, THC, dronabinol, nabilone,
levonantradol, randomised, randomized, double-blind, simple blind,
placebo-controlled, and human. The research also included the reports
and reviews published in English, French and Spanish. For the final
selection, only properly controlled clinical trials were retained,
thus open-label studies were excluded. Seventy-two controlled studies
evaluating the therapeutic effects of cannabinoids were identified.
For each clinical trial, the country where the project was held,
the number of patients assessed, the type of study and comparisons
done, the products and the dosages used, their efficacy and their
adverse effects are described. Cannabinoids present an interesting
therapeutic potential as antiemetics, appetite stimulants in debilitating
diseases (cancer and AIDS), analgesics, and in the treatment of
multiple sclerosis, spinal cord injuries, Tourette’s syndrome,
epilepsy and glaucoma.”
Lucas, P (2008, January).Regulating compassion: an overview of Canada's
federal medical cannabis policy and practice. Harm Reduction Journal
The author states: “This critical policy analysis is an evidence-based
review of court decisions, government records, relevant studies
and Access to
Information Act data related to the three main facets of Health
Canada's medicinal cannabis policy - the Marihuana Medical Access
Division (MMAD); the Canadians Institute of Health Research Medical
Marijuana Research Program; and the federal cannabis production
and distribution program. This analysis also examines Canada's network
of unregulated community-based dispensaries . . . .
is a growing body of evidence that Health Canada's program is not
meeting the needs of the nation's medical cannabis patient community
and that the policies of the Marihuana Medical Access Division may
be significantly limiting the potential individual and public health
benefits achievable though the therapeutic use of cannabis. Canada's
community-based dispensaries supply medical cannabis to a far greater
number of patients than the MMAD, but their work is currently unregulated
by any level of government, leaving these organizations and their
clients vulnerable to arrest and prosecution. . . . Any future success
will depend on the government's ability to better assess and address
the needs and legitimate concerns of end-users of this program,
to promote and fund an expanded clinical research agenda, and to
work in cooperation with community-based medical cannabis dispensaries
in order to address the ongoing issue of safe and timely access
to this herbal medicine.”
The Nature of Things: Dealing with Drugs, New Options (1991/1997).
In the first of two films produced for the Nature of Things, hosted by David Suzuki, this documentary from 1991 examines illegal drug use and policy in four cities, Amsterdam, Liverpool, New York and Toronto. The documentary examines the impact of law enforcement and innovative health practices and harm reduction.
is a follow-up to the 1991 documentary,
Dr. David Suzuki examines the war against illegal drugs. Drug policies
in North America, Great Britain and Holland are explored. In addition,
the drug scene in Vancouver, BC is examined. Dr. Bruce Alexander
is interviewed and the Portland Hotel in Vancouver is highlighted
as an alternative to criminal justice initiatives for drug offences.
The benefits of public health and harm reductions initiatives and
the futility of punitive drug laws and imprisonment are vividly
expressed in the film.
Fix: The Story of an Addicted City (2002).
documentary produced by Vancouverite Nettie Wild, highlights the
efforts of Vancouver activists to make public the increasing number
of drug overdose and AIDS related deaths to the attention of Mayor
Phillip Owen and City Hall. The necessity of a safe injection site
is highlighted. The Vancouver Area Network of Drug Users (VANDU)
is central to the story.
Bevel Up: Drugs, users & outreach nursing (2007).
Up is a unique educational kit (including a DVD, subtitled in French,
with special features and a bilingual Teaching Guide) created to
share knowledge not found in nursing schools and teaching hospitals.
It shows how registered nurses working with the BC Centre for Disease
Control's Street Nurse Program provide health care to the people
living in the alleys and hotels of Vancouver's Downtown Eastside.
and produced by the street nurses themselves in collaboration with
community members, Bevel Up offers instructors and students access
to the experience of an entire community of health care practitioners
who work with drug using populations.
educational kit is a co-production of the Street Nurse Program of
the British Columbia Centre for Disease Control and the National
Film Board of Canada with financial support from Health Canada and
the BC Nurses Union. Created in collaboration with Canada Wild Productions
Damage Done: The Drug War Odyssey. (2007). Director, Connie Littlefield
Viewing this film may change your answers to these questions: Should
law enforcement officers be expected to enforce laws that don't
make sense? What happens if the police don't believe in the laws?
What if nobody believes in them? Does drug prohibition actually
do more harm than drug use?
primary characters, all current or former law enforcement officers,
say that as much as 80% of all felony crime is caused by drug addiction
prohibition. "Legalize, regulate and tax" is their mantra
now. Our heroes believe that all illicit drugs should be under the
control of government, not left in the hands of criminals.
How I got Busted (2007).
directors state that “Ten million Canadians have tried it
at least once in their lives. Six hundred thousand, the less fortunate,
have criminal records for smoking, growing or possessing it. How
I got busted is a social documentary with an unusual take on a phenomenon
that puts so many ordinary people at odds with our justice system.
In a remarkably frank conversation, five good people talk for the
first time about their history with marijuana, the pot bust in their
past, and what it means to be an otherwise exemplary citizen with
a criminal record.”
The Prince of Pot (2007).
2007 Vancouver International Film Festival summarizes director Nick
Wilson’s documentary about Vancouver pot activist, The Prince
of Pot: “Call him what you want: egotist, criminal or martyr,
what matters most to Marc Emery is that you know what he stands
for: the decriminalization and legalization of British Columbia's
most famous shrubbery. In 2005 the United States' Drug Enforcement
Agency asked that Mr. Emery and two of his employees be extradited
to the US to face drug trafficking charges for sending his seeds
south of the border. Nick Wilson's candid documentary asks: Are
we as Canadians willing to send one of our own to a US prison for
the rest of his life for something that our law enforcement won't
even fine him for?”
The Union (2007).
Adam Sorgie, the director of The Union, asks: Ever wonder what British
Columbia’s most profitable industries are? Logging? Fishing?
Tourism? Ever think to include marijuana? If you haven’t,
think again. No longer a hobby for the stereotypical hippie culture
of the ‘60s, BC’s illegal marijuana trade industry has
evolved into a seemingly unstoppable business . . .Commanding upwards
of $7 billion Canadian annually.” The filmmaker asks: “Whey
is marijuana illegal? What health risks do we really face? Does
prohibition work? What would happen if we taxed it? Medicine, paper,
fuel textiles, food, etc. Are we missing something here?”
Adam Sorgie interviews experts from around the world, including
“growers, clippers, police officers, criminologists, economists,
psychologists, medical doctors, politicians and pop culture icons.”
Anderson, J. (2001). What to do about “much ado” about
drug courts? International Journal of Drug Policy, 12, 460-475.
first drug court emerged in Canada in 1998 in Toronto, Ontario,
which was funded by the federal government as a four-year pilot
project. Researcher Dr. John Anderson asks how the proposed drug
court in Vancouver (which is now running) will address the needs
of users there. He asks how drug courts will address the needs of
Vancouver’s illegal drug users in The Downtown Eastside of
Vancouver where many are homeless, unemployed and inject heroin
and cocaine, which places them at the risk of contracting HIV and
hepatitis C and of taking a lethal overdose. He argues that “there
is no evidence that drug courts are effective at reducing the incidence
of either of these serious health problems.”
Nolan, J. (2002). (Ed.). Drug courts in theory and in practice.
New York: Aldine de Gruyter.
Dr. James Nolan brought together the first book about drug courts.
He and other chapter contributors examine how drug courts have spread
dramatically throughout the United States and elsewhere since 1989
even though there is little evidence to suggest that they are effective.
In the U.S., drug treatment money is now being funneled through
the criminal justice system and treatment is no longer voluntary.
Dr. James Chriss, a chapter contributor, ask who gains from diverting
federal funds into drug courts? He states that funding is diverted
from voluntary drug treatment to coerced treatment. He and others
question the lack of due process and the “psychotherapeutic
ethos” that imbues the drug court. Chriss also argues that,
in the U.S., “a whole new group of citizens –most of
whom are nonviolent marijuana” users are constructed as “sick”
or “ill” needing intervention.
and others conclude that drug courts are portrayed as a more humane
and cheaper option than traditional criminal justice proceedings
and incarceration. However, drug courts are not cost effective and
they are quite punitive. Over 50 percent of U.S. drug treatment
participants will ultimately be sent to prison, and those who do
complete the program are under criminal justice supervision for
far longer than most non-incarcerated offenders.
drug courts in Canada are run differently than drug courts in the
U.S., these research findings are significant. Canada’s Bill
C-26, which introduces mandatory minimum prison sentences for cannabis
offences, includes a clause where sentencing can be delayed in order
to enable offenders to participate in a drug treatment program.
Boyd, S. (2006). Representations of women in the drug trade. In
G. Balfour & E. Comack (Eds.), Criminalizing women (pp. 131-151).
author provides a brief overview of the roots of Canada’s
drug laws, contemporary representations of drug traffickers, and
the lives of women convicted of drug trafficking and importing.
She concludes with an examination of Canadian criminal justice responses
and two drug courier cases, R. v. Hamilton.
Women, Chapter 5: PDF
The Senlis Council: Security and Development Policy Group (2007,
June). Poppy for Medicine: Licensing poppy for the production of
essential medicines: an integrated counter-narcotics, development,
and counter-insurgency model for Afghanistan. London. Author.
Senlis Council states that “Resolving Afghanistan’s
illegal opium crisis is the key to the international community’s
successful stabilization and development of the country. Yet, by
over-emphasizing failed counter-narcotics strategies such as forced
poppy eradication, the United States-led international community
has aggravated the security situation, precluding the very reconstruction
and development necessary to remove Afghan farmers’ need to
on extensive on-the-ground research, The Senlis Council has developed
a Poppy for Medicine project model for Afghanistan as a means of
bringing illegal poppy cultivation under control . . . “
The Ottawa Citizen January 23, 2008 article, What about the opium
trade?, by Dan Gardner.
Gardner critiques John Manley’s report, Independent Panel
on Canada’s Future Role in Afghanistan. He concludes, “The
Manley report could have identified the Afghan dilemma squarely.
It could have shown how international drug policy helped create
that dilemma. It could have called on the Canadian government to
work with European governments and others disenchanted with the
war on drugs to turn the UN’s 2008 review into a serious re-examination
of drug policy from top to bottom. It could have challenged us all
Steve Rolles’, Information Officer, Transform Drug Policy
Foundation, Guardian editorial on Afghanistan and poppy for medicine
(September 6, 2007).
R., & South, N. (2004). (Eds.). “Drug use and Cultural
Contexts ‘Beyond the West.’” London: Free Association
researchers Ross Coomber and Nigel South state: “As this book
shows (and there are numerous other examples that we are unable
to include here) there are forms of drug use that simply ‘do
not fit’ the supposedly progressive, western notion of all
drug use as essentially damaging. In fact, rather than understanding
drug use as undermining of individuals, communities and societies,
some of the examples presented here are better understood as illuminating
positive, integrative and functional contributions of drug use to
the social-health of particular communities of people. For many
of the various communities described in this book, use is integrated
into many facets of everyday life as well as having ceremonial or
ritual meaning, often central to spiritual or religious activity.
For these peoples, drug use is normal and rather than causing inevitable
harm in fact contributes to group solidarity and reaffirmation of
traditional roles and community structures. Yet the pressure of
international conventions weighs down upon this kind of positive
drug use just as much as it does on the prevalence of more destructive
use in the urban developed nations – the problem that really
lies at the hear to the anxieties of western drug control warriors.”
summary on the back cover of Drug use and Cultural Contexts ‘Beyond
the West’ concludes: “What is clear is that not all
drug use that is demonized in the West can be shown to necessarily
produce the same problems elsewhere. As the chapters in this volume
demonstrate, the problems that do emerge are as much about the influence
of western politics, economic and definitions as they are about
the dangers inherent within the use of any particular drugs. However
little is known about the use of drugs in non-western societies
and this lack of comparative knowledge hinders a broader understanding
of drug use, the way problems are attached to it and the nature
of inappropriately applied social and regulatory policies.”
Haden, M. (2008, February). Sound bytes for change: Questions and
Answers on the issue of a regulated market for currently illegal
Haden provides a detailed question and answer paper that addresses
many of the concerns and queries that Canadian’s express about
drug regulation and change.
conclusion, I have chosen the words of poet, Bud Osborn, and the
principles of post-prohibition drug control, created by Creative
Resistance (founded by Bud Osborn and Dave Diewert) for the final
reading. They provide us with hope and the principles to guide us.
Osborn, B. (2005). A New Day. In Bud Osborn (poetry) and Richard
Tetrault (prints), Signs of the Times (pp. 42-43). Vancouver: Anvil
Osborn read his poem, A New Day, at the opening in 2003 of North
America’s first official supervised injection facility in
New Day in word.
Resistance (2008, February). Principles of Post-Prohibition Drug
members of Creative Resistance, a Vancouver-based social justice
movement dedicated to ending drug prohibition, created principles
of post-prohibition drug control.
Resistance Principles in word
have just learned of this innovative and fanciful idea and I thoroughly
just came across your website, and think it's an excellent initiate.
January 31, 2008
all the debate has centered around marijuana laws these past few
years, why isn't reducing harmful chemicals associated with smoking
combustible material a concern to the government?
Marijuana for medication is a blessing for those of us who are
unable to use any conventional meds.
February 1, 2008
site! Let's hope Mr. Harper and others learn something.
Thank you so much for setting it up.
idea, I hope you are copying the opposition so they can ask relevant
read in the Georgia Straight that you would be sending the PM
weekly readings. I thought it would be some new stuff, not the
old status quo harm reduction material. I don't think the PM will
bother to read it.
Harm reduction had its chance, it is clear now with all the money
that was thrown at it in Vancouver it didn't help at all. Things
are a lot worse now than before all the HR nonsense started.
February 16, 2008
saw the article in the Georgia Straight (http://straight.com/article-131203/activist-aims-to-school-harper-in-drug-policy?#)
and I think what you're doing is fabulous. . . .
April 8, 2008
Am loving your website!
Thank you for your important activism.
April 27, 2008
I've just learned of your efforts from an article in the times Colonist and want to thank you. I have a son struggling with recovery from cocaine addiction. He has been actively working at recovery for a year now and it continues to be difficult. The treatment programs he has participated in just aren't long enough. He has a loving and supportive family - my heart goes out to the other men who have gone through treatment with him, wanting to change, but without adequate support or safe housing to go home to. What a collosal waste of money and people. Rather than have people go through residential treatment 3 & 4 & 5 times we need to spend the money on long term treatment, such as the Narconon Treatment program in Trois Rivieres.
Your efforts have prompted me to write to my MP, Harper and the other leaders. Thank you again.
April 27, 2008
This web site is an excellent resource and your initiative is worth every moment devoted to it.
"First they ignore you, then they ridicule you, then they fight you, then you win." – Ghandi. Keep up the good work.