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This
is a protest and education site by drug policy researcher and educator
Dr.
Susan
Boyd in partnership with Beyond
Prohibition Coalition, a Vancouver- based
group that promotes community health, safety and drug policy reform. For each of the next 52 weeks, I will send Prime Minister Harper a letter containing educational information on harm reduction and drug regulation. These articles, as well as any reponses to these letters, will be posted below. |
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1. 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. http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=1242 Legislation 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.” Click
here
see a copy of Bill C-26 2. Cheung, Y. (2000). Substance abuse and developments in harm reduction. CAMA, 162(12), 1697-1700. http://www.cmaj.ca/cgi/reprint/162/12/1697.pdf The 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.”
http://vancouver.ca/fourpillars/pdf/Framework.pdf A
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
and enforcement. 4. Economic Fact Sheet: Facts and figures relating to illegal drugs. Compiled by Mark Haden (2006). The 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).”
Dr.
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.”
6.
Canadian HIV/AIDS Legal Network (2005). “Nothing About Us
Without Us” http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=67 This
booklet summarizes the main issues addressed in the Canadian HIV/AIDS
http://www.leap.cc/cms/index.php?name=Content&pid=16 Former 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.” Click here to see a copy of the Controlled Drugs and Substances Act.
About 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. To understand the full impact of drug policy in the U.S. read: The PEW Center on the States (2008). One in 100: Behind Bars in America 2008. Author. Click here to see the full report: http://www.pewcenteronthestates.org/uploadedFiles/One%20in%20100.pdf The 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. The Executive Summary of the report states: Three 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. The 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.”
This
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
and communities. 10. Capler, R. (September, 2006). Federal Marijuana Policy Primer. http://thecompassionclub.org/resources/Federal%20Cannabis
The
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). 12. Vancouver Coastal Health. (2006). Saving Lives: Vancouver’s Supervised Injection Site. Vancouver: Author. http://www.vch.ca/sis/docs/insite_brochure.pdf This 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. “Vancouver 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. Estimates 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. Community
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. Increasing
access to health and addiction care 13. Hwang, Stephen. 2007. Science and ideology. Open Medicine, 1(2), 99-101. http://www.openmedicine.ca/article/view/128/52 “More
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.” 14. Small, D. (2008). Amazing Grace: Vancouver’s supervised injection facility granted six-month lease on life. Harm Reduction Journal. http://www.harmreductionjournal.com/content/pdf/1477-7517-5-3.pdf Addiction
should be a matter, primarily, for the Chief of Medicine rather
than the 15. 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. Many 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. Wood, 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. The 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. Wood, 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. Infectious 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.
The 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 of overdose.
Safer 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.
Requiring 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. 17. 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. The 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. Wood, 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. Vancouver, 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. Tyndall, 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, 83(3), 193-198. North 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.
This 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. Wood, 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. The 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. Wood, 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, 354(23), 2512-2514. This
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. 19. 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. North 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. Kerr,
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. Wood, 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), 1399-404. The 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.
Between 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. Petrar, 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. 32(5),1088-1093. In 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 times (46%). Kerr, 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. There 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.
The 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. Wood, 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. Critics 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 treatment. Stoltz, 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. Injection 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 injecting.
Conventional 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. Stoltz, 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), 63–69. The 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.
http://mikan3.archives.ca/pam/public_mikan/index.php?fuseaction=genitem. In 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. In 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: "It 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.) Hearings 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. In 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. The
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. 24. Cain, J. (1994). Report on the Task Force into Illicit Narcotic Overdose Deaths in British Columbia. Victoria, BC: Ministry of the Attorney General. In
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
maintenance programs. 25. 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). http://cmte.parl.gc.ca/Content/HOC/committee/372/snud/reports/rp1032296/ On 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.
http://www.parl.gc.ca/common/Committee_SenRep.asp?Language=E A 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. 27.
MacPherson, D., Mulla, Z, Richardson, L, & Beer, T. (2005).
http://www.city.vancouver.bc.ca/fourpillars/pdf/prventingharm.report.pdf When 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. . . There 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.”
Health
Officers Council of British Columbia (2008). Regulation of Psychoactive
Substances in Canada. Victoria, BC. Authors. The
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. 29. Haden, M. (2008). Controlling illegal stimulants: A regulated market. Harm Reduction Journal, 5, 1. http://www.harmreductionjournal.com/content/pdf/1477-7517-5-1.pdf The
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.” 30. Alexander, A. 2006. “Beyond Vancouver’s “Four Pillars”: An Historical Analysis.” International Journal of Drug Policy, 17(2), 118-123. Dr. 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. To read another article by Bruce Alexander, The Roots of Addiction in Free Market Society, click here: http://www.policyalternatives.ca/documents/BC_Office_Pubs/roots_addiction.pdf
The
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.” 32. 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. In 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 infection. The 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.”
Drawing 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.”
This
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. 35. Tupper, K. (in print). Teaching Teachers to Just Say “Know”: Reflections on Drug Education. Teaching and Teaching Education. doi:10.1016/j.tate.2007.08.007 http://www.kentupper.com/resources/Teaching+Teachers+to+Just+Say+Know--T$26TE+in+press.pdf Kenneth
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.” 36. Amar, M. (2006). Cannabinoids in medicine: A review of their therapeutic potential. Journal of Ethnopharmacology, 105, 1-25. The
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.” 37. Lucas, P (2008, January).Regulating compassion: an overview of Canada's federal medical cannabis policy and practice. Harm Reduction Journal 2008, 5:5doi:10.1186/1477-7517-5-5 http://www.harmreductionjournal.com/content/pdf/1477-7517-5-5.pdf
There
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.” 38. The Nature of Things: Dealing with Drugs, New Options (1997). http://www.cbc.ca/natureofthings/ This
is a follow-up to the 1991 documentary discussed last week. Again,
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. 39. Fix: The Story of an Addicted City (2002). http://www.canadawildproductions.com/fix/ This
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. 40. Bevel Up: Drugs, users & outreach nursing (2007). http://www.nfb.ca/webextension/bevel-up/index.php?vw=1 Bevel 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. Designed 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. The
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
Ltd. 41. Damage Done: The Drug War Odyssey. (2007). Director, Connie Littlefield http://www.nfb.ca/webextension/damage-done/
Our 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.
http://www.howigotbusted.com/index.php The
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.” 43. The Prince of Pot (2007). http://www.r2r.ca/inproduction.html#PRINCEOFPOT The
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?” 44. The Union (2007). http://www.theunionmovie.com/TheUnionWeb.html Filmmaker Adam Sorgie, the director of The Union | ||||||||||||||||||||||||||||||||||||||
