Vision: The Idea That Drug Addicts Should Be Treated, Not Locked Up, Is Making Waves

Hundreds of doctors, politicians, researchers and frontline workers met with drug users and ex-users in Austin, Texas, in December to openly talk about drug use. But instead of reaffirming their commitment to the decades-long war on drugs, the eighth National Harm Reduction Conference will feature discussions on opening needle exchanges, legalizing and regulating the drug trade, and overdose prevention methods.

"What we do in (the United States) is make drugs as unsafe as they possibly can be, and we do that through laws, which means that, if you get busted with drugs, you go to prison for a long time. And that's designed as a deterrent to make people stop using drugs, which obviously it isn't," said Allan Clear, executive director of the Harm Reduction Coalition, which runs the national conference. "We do things like take syringes out of circulation, which has caused epidemics of hepatitis and HIV. So harm reduction is a way of trying to make drug use safer for people who use drugs, without demanding that they stop using drugs."

Harm reduction can include a range of services from needle exchanges and condom distribution to safe consumption sites and access to addiction services such as methadone and buprenorphine treatments and detox facilities.

Supported by the United Nations and over 93 countries worldwide, harm reduction remains controversial. While over half of the 158 countries where drug use has been reported say they support harm reduction, only 82 countries have needle exchanges, just 73 provide opiate substitution therapies like methadone, and a measly eight countries have safe drug consumption facilities. There are only two safe consumption facilities in North America, both in Vancouver, British Columbia, Canada.

"Insite" into harm reduction

"We were coming to work and people were overdosing and people were dying, and at its height it seemed like it was happening every day, and it just seemed unnecessary. If people were dead, there was no chance of detoxing," said Mark Townsend, executive director of the Portland Hotel Society, which runs Insite, one of the two safe consumption sites in North America, open since 2003.

"(Insite opened) because lots of people worked hard to make it happen, including the mayor - all the different mayors - and (Premier) Gordon Campbell."

Insite is located in the city's Downtown Eastside, often referred to as Canada's Poorest Postal Code. Injection drug users in that area have a mortality rate 14 times higher than the rest of B.C., with an HIV rate of 4 in 10, and a hepatitis C rate of 9 out of 10 users.

The facility consists of 12 safe-injection booths, monitored by nurses, where clients are provided with clean syringes, cookers, filters, water, and tourniquets, as well as education on safe injection practices that limit the spread of diseases like HIV and hepatitis C. Injection drug use is illegal in Canada, but Insite applied for and received an exemption from the federal government to run the site, though the current government is trying to shut the facility down.

There are approximately 12,000 registered clients at Insite, but in 2009 only 5,447 used the clinic, with an average 491 injections per day. Four-hundred-and-eighty-four overdose interventions were performed that year, with no fatalities - in fact, no one has died at Insite since it opened, but the long lines mean some people walk away without injecting.

Because the local health authority funds it, Insite acts as a gateway to other medical services, such as treating infections and diseases and referrals to mental health treatment. In its second year alone, Insite made 2,000 referrals to outside services, including 800 to addiction counseling. There is also a detox center called Onsite located upstairs if people want to quit.