Vancouver's Radical Approach to Drugs: Let Junkies Be Junkies

By Vince Beiser, Miller-McCune Magazine. Posted November 18, 2008.

All told, some 8 percent of Americans over age 12 -- about 20 million people -- use illicit drugs, according to the most recent estimates from the U.S. Department of Health. That's a higher rate than the same agency found in the early 1990s. More than 1 in 3 Americans -- including, by their own admissions, Sarah Palin and Barack Obama -- have tried some kind of illicit substance at least once.

Meanwhile, tens of thousands of people in the U.S. are infected with HIV or hepatitis C every year thanks to shared needles. And according to the Centers for Disease Control and Prevention, nearly 20,000 people died of drug overdoses in 2004 -- the most recent year for which statistics are available -- way up from the 12,000 reported fatal ODs in 1999.

No surprise, then, that there is a small movement pushing for more harm-reduction-based policies. Voters in California, Arizona and Maryland have passed initiatives in recent years mandating treatment instead of incarceration for first-time drug offenders. Not long ago, needle-exchange programs were banned everywhere; now there are nearly 200 such programs in 38 states.

The liberal, forward-operating base of San Francisco is at the vanguard of these efforts. Surging overdose deaths among the city's estimated 16,000 intravenous drug users spurred the city to officially embrace harm reduction in 2000. "We've tried to take drug addiction from being seen as a moral issue to being seen instead as a chronic disease," says Barbara Garcia, deputy director of the San Francisco Department of Public Health.

Today, a welter of programs hands out more than 2 million clean syringes every year, more than in any other city. At one storefront needle exchange in the notoriously skivey Tenderloin district, for instance, visitors can choose from three different sizes of syringes; speed shooters and junkies with narrow veins prefer smaller hardware. They can also pick up little metal cups and tubes of sterile water to cook the drugs in, hand wipes and alcohol swabs to clean their skin before stabbing it and other handy accessories, including tourniquets and crack-pipe mouthpieces.

One recent evening, Ian Johnson, a veteran local drug user dressed in pinstriped slacks, a soiled white shirt with a neatly knotted tie and a stained double-breasted jacket two shades darker than his pants, came in for another service: overdose prevention training. A friend had recently died from a too-big shot of heroin, he explained, and he didn't want to see that again. A volunteer trainer sat Johnson down with a torso-and-head CPR mannequin and showed him how to inject a dose of Narcan into someone's shoulder. Satisfied that Johnson had the simple procedure down, the trainer passed him along to a nurse who wrote a prescription making it legal for Johnson to walk out with a little black plastic box containing two needles and a vial of Narcan.

More than 1,200 people have been trained to administer Narcan this way, and trainees have used it at least 260 times to intervene in potentially fatal overdoses, according to the Harm Reduction Coalition, a nonprofit group that runs the trainings for the city. San Francisco also puts up the money to give methadone to about 5,000 people a year and to train dozens of "peer counselors" -- current and former speed users -- to advise their drug buddies on basics like remembering to eat while on multiday meth binges. There's even talk of opening a supervised injection site.

Outside of New York, Baltimore, Chicago and a few other places, though, harm reduction is a tough sell in the United States. Congress forbids federal dollars from funding needle exchanges. In many jurisdictions, it's illegal to possess a syringe without a prescription, making widespread needle distribution impossible, no matter who funds it. Federal drug czar John Walters has denounced Vancouver's Insite program as "state-sponsored suicide" and harm reduction in general as a Trojan horse for the goal of legalizing drugs outright.

Even in Canada, the Vancouver experiment is under pressure. The country's ruling Conservative Party has denounced the safe injection site and is pushing for a tougher line against drugs nationwide. "Allowing and/or encouraging people to inject heroin into their veins is not harm reduction," said Health Minister Tony Clement at a recent AIDS conference. "We believe it is a form of harm addition."

At first blush, the proposition that making drug use easier for addicts will benefit everyone does seem a bit far-fetched. As many critics have pointed out, it seems to send the message that hard drug use is all right, as long as you're careful about it. It's a message that, critics insist, could lead more people to experiment with narcotics and leave fewer addicts inclined to seek treatment.

Though the "wrong message" idea makes intuitive sense, the overwhelming preponderance of research on the subject does not bear it out. Over and over again, studies find that measures like needle exchange and even supervised injection sites do not promote drug use and do help curb some of the damage it causes.

See more stories tagged with: drug reform, drug addiction, vancouver

Vince Beiser is a Miller-McCune contributing editor based in Los Angeles. He has hunted down stories from the Balkans to the Middle East on assignments for Harper's, Wired, The Los Angeles Times Magazine, The Village Voice, The New Republic, The Nation and Rolling Stone.

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