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Reducing the Risk to Public Health While Minimizing the Harms of Drug Use

Victoria Permanent Needle Exchange Site Faces Delay Due to Safety Concerns

According to an August 24, 2009 article in Canada's Globe and Mail, the "[a]pproval of a permanent needle exchange for Victoria continues to be held up because drug users say the site is in a violent area and not close enough to the inner city." The article ("Drug Users Say New Needle Exchange Site Too Dangerous") explains that the owner of a house on Princess Street, "an industrial part of Victoria bordering downtown, offered the property to the Needle Exchange Advisory Committee [...] to replace a controversial downtown [needle exchange site] that closed in May, 2008." However, drug users and their advocates - primarily the Society of Living Intravenous Drug Users (SOLID) - remain concerned about the house's location not just because they consider the area unsafe but also because it may be too far away for some addicts who previously relied on the older site.

According to Jill, a spokesperson for SOLID, the "proposed house, which requires renovations, is in a part of town where buildings are run-down and gang activity punctuates the street scene." The Victoria Police Department, however, disagrees. "We were suprised to hear that," Sergeant Grant Hamilton told the news outlet. Hamilton also contends that the new site "is only a five-minute walk from the former exchange." The Sergeant also "questions the need for a brick-and-mortar needle exchange;" as he told the Globe and Mail, "I haven't heard people on the street complain that they can't find needles." Indeed, the article suggests that Hamilton may be opposed to the program altogether, and Hamilton himself at least partially blames the region's "soft on crime" drug policies for the "high number of drug addicts in Victoria."

Hamilton "suspects that the only needle exchange SOLID will accept is on Pandora Avenue, near Our Place, a non-profit society that provides food, shelter, and counselling for Victoria's sizeable street population," which is "estimated at 1,500" people. Indeed, Shannon Turner, the Needle Exchange Advisory Committee's chairperson, who met with SOLID members on August 12, agreed with Hamilton's assessment of SOLID's wishes. However, that site sits "kitty-corner to a Catholic elementary school and up the street from the Victoria Conservatory of Music" and "has been firmly off the table since last spring" when parents and nearby business owners "swamped the advisory committee" with complaints upon hearing that the needle exchange would be located in their backyards (though, according to the article, "a 2008 phone survey of 500 Victoria-area residents found that 69 per cent supported needle-exchange programs"). Downtown Victoria does supply drug users with needles through "at least two mobile needle exchanges" and "two social-service providers that supply clean needles downtown," but SOLID and other harm reduction and AIDS prevention advocates are adament about establishing a new, permanent site in their preferred locale.

The Globe and Mail article provides numerous reasons why residents and officials would prefer a less central location for the permanent needle exchange. However, it glosses over - and refuses SOLID with the chance to make its case regarding - the many reasons that make the downtown site desirable. For example, why shouldn't drug users in Victoria's street population be able to access the social services provided by Our Place without also having to travel an unspecified distance to obtain clean needles? Does it not make sense that many of the services provided by Our Place might overlap with or compliment those offered by SOLID? And if Our Place already operates to the satisfaction of residents and business owners, how drastically will the area's landscape change if a needle exchange site moves in next door? Moreover, if needle exchanges aim to keep drug users safer, why should intravenous drug users have to trek into an unsafe part of town to obtain what they need to most effectively reduce the harms associated with their addictions? One positive readers can glean from the article: at least Victoria's drug users have some say in the negotiations.

Minnesota's Sole Remaining Needle Exchange Center Closes

According to an August 3, 2009 Minnesota Independent article ("State's Only Needle-Exchange Program Shuttered by Economy, Anti-Drug Policies,"), "Minnesota's only needle exchange drop-in center closed its doors last week after more than a decade of helping drug users find treatment and prevent disease." The article provides an in-depth discussion of the center, dubbed Access Works!, which started out as "Women with a Point," a two-person operation designed to "reach women who were using needles to inject drugs." The program soon expanded - offering not just clean needles but "conduct[ing] HIV and Hepatitis C testing, [teaching] overdose prevention, [holding] support groups and connect[ing] users with chemical dependency treatment experts."

Unfortunately, economic woes and "federal anti-drug policies" converged to close the clinic in August. As the article states, "Despite its apparent success, however, Access Works! went into hibernation on July 24. They will maintain their nonprofit status and website, but the needle exchanges and the services are discontinued."

The program's executive director, Lauri Wollner, "says the organization got hit hard in the economic downturn." She told the paper that "All the private funders we used to get money from are all broke," and although "[g]overnment funding is great, [...] it only pays for overhead." Wollner remains skeptical that the possible repeal of federal funding for needle exchange programs will or could have helped the center - primarily because of tight restrictions on placement and the somewhat slim chance that it will pass.

Fortunately for Minnesotan drug users, however, Wollner says that there "are a few smaller exchanges starting up." But they aren't as easily accessible as Access Now! "People just have to know to call around and ask friends," Wollner laments.

House Needle Exchange Funding Amendment Raises Questions, Senate Version Retains Ban

As previously reported by Common Sense for Drug Policy, the U.S. House of Representatives recently passed an appropriations bill that, for the first time in over 20 years, does not include the notorious ban on federal funding of needle exchange programs. However, a July 31, 2009 Washington Independent article exposes flaws in the House amendment and warns of possible trouble ahead ("Congress Looks to Lift Two-Decade Ban on Federal Needle Exchange Funds"). As the article states, "ban critics cheered [the legislation's passage] as a long step toward curbing the spread of blood-borne diseases like HIV. Yet the proposal moving through Congress, according to many health and human rights advocates, has been diluted to the point that it won't help the same urban areas most afflicted by those illnesses." Additionally, the version of the bill circulating in the Senate "retains the needle-funding ban."

Despite his best intentions, House Appropriations Committee Chairman and bill sponsor David Obey (D-Wis.) felt obligated to include a restriction in the funding ban repeal that "prohibits [needle exchange programs] from operating within 1,000 feet of schools, daycare centers and other areas where children are likely to congregate," including "pools, parks, video arcades 'or any event sponsored by any such entity,'" and universities - a particularly puzzling inclusion, as most people who attend those institutions are legal adults. According to the Independent, Obey "included the restriction, not because he supports it, but to appease conservative critics who might have killed the entire provision otherwise." However, "needle exchange supporters argue" that the provision renders the bill near-entirely unworkable in urban areas because "the geographic restraints are so expansive that they'll neuter most benefits that would come with allowing funding of clean needle programs."

Allan Clear, who serves as the Harm Reduction Coalition's executive director, summarized needle exchange advocates' concerns most succinctly: "'It's too restrictive,' [he] said [...]. 'You couldn't open a program in Washington, D.C. - or most any urban area - with these restrictions." According to William McColl, political director for advocacy group AIDS Action, "If the bill is enacted as it stands, [...] 'it would preclude the use of needle exchange in the areas that need it most." Human Rights Watch's Rebecca Schleifer elaborated, stating that "As a practical matter, you won't be able to have needle exchange in the city [where] there are schools and daycare centers everywhere." She concluded by telling the Independent that the restrictions "make the bill 'meaningless as a practical matter, even if it's important as a symbolic matter."

However, the Independent provides harm reduction advocates with a glimmer of hope. After briefly discussing the Senate's decision to leave the funding ban intact, the article notes that "Needle exchange supporters on and off Capitol Hill are hoping to remove the geographic restrictions when the two chambers meet to hash out the differences between the two bills." Hopefully, the Senate will concur with the House's decision, and perhaps the two chambers could design a proposal that protects both public safety and needle exchange programs' ability to effectively operate in areas that need their services most direly. But, according to the article that "process [...] won't arrive until September, at the earliest." While harm reduction proponents would like to see the ban repealed more quickly, the delay does provide citizens, health and human rights groups, and other interested parties ample time to contact their representatives, organize events and demonstrations, and generally push their perspectives into public view.

UK Drug Policy Commission Suggests Harm Reduction Measures

A report released by the UK Drug Policy Commission, released on July 30, 2009 and discussed here by the British Press Association, found in their survey of law enforcement officers that "[n]ine out of 10 of those questioned said it was 'unlikely' UK drugs markets would be eradicated in the near future." The study did not limit itself to law enforcement but also addressed drug markets and drug dealers themselves. For example, the Commission found that "drug dealers were often able to avoid having their operations shut down by police" and were "quick to adapt" when avoidance was not possible.

But the Commission did not limit itself to simple observations. Instead, it used its findings to make recommendations regarding how and where law enforcement should distribute its resources. As the Press Association states, "the authors suggested targeting law enforcement efforts at reducing the harm caused by illegal drugs." The study suggested such practices as "moving drug dealers from residential neighbourhoods to different areas where they would cause less harm" and "measuring success" based on something other than "arrests and seizures," which the report characterized as having "limited value." Indeed, the Commission suggested that "[e]ven successful police operations can sometimes have negative consequences if, for example, they create a turf war between rival gangs." The Commission seems to have discovered what drug policy reformers have known for over a decade.

Alan Campbell, minister for UK governing body Home Office, told the Press Association that "Tough enforcement is a fundamental part of our drug strategy, and the police continue to make real progress in tackling the supply of illegal drugs and in reducing the harm they cause. As the report states, harm reduction underpins every element of our approach to tackling this complex issue." However, a July 31 Bolton News article claims that, despite the think tank's recommendations, UK police plan to stick with their "zero tolerance" policies ("Police Vow to Continue Zero Tolerance in Drug Crime Fight"). The Bolton article thus raises questions regarding the extent to which police will take the study's findings into account and, most pecularliarly, leads informed readers to wonder if law enforcement agencies even know what "harm reduction" means.

House Passes Appropriations Bill with Needle Exchange Funding Ban Repeal In Tact

Despite his best efforts to continue the ban on federal funding for syringe exchange programs, Rep. Mark Souder (R-IN) failed to convince the majority of his colleagues to remove an amendment that sought, as AP reported on July 25, 2009 ("House Permits Needle Exchange Programs"), to allow communities to use federal funding for needle exchange programs. The vote was close - 218 to 211 - but harm reduction advocates ultimately prevailed on the controversial measure, even after sitting through a "brief but passionate debate on [the] amendment [added] by [Souder] to keep the ban in place."

Souder argued that "HIV is spread chiefly through sexual activities and that needle exchange programs don't have a proven record of success." He added that "providing needles acts as a way for drug users to sustain their intravenous drug use and does not address the primary illness of the drug addiction." However, fellow Representatives like Lucille Roybal-Allard (D-CA) rebutted, saying "the scientific evidence is indisputable and that needle exchange programs put addicts into contact with social service agencies, opening the door for them to seek treatment." As mentioned above, Roybal-Allard's argument proved more convincing, and for the first time since 1988, the federal government will monetarily support syringe exchange programs in regions that wish to establish them.

Victoria to Distribute "Crack Kits" to Users

According to a July 13, 2009 article in the Nanaimo News Bulletin ("Victoria Accepts 'Crack Kit' Distribution"), Victoria "is impatient to get [...] crack kits flowing" to addicts despite opposition from surrounding cities. The kits, which are also distributed - though differently - in Prince George and Toronto, "include a mouth piece and a push stick," which advocates say could help reduce "the transmission of communicable disease[s]" like Hepatitis C; as the Bulletin states, "research has shown that crack pipes can carry hepatitis C-positive blood." The kits will be distributed "through the same agencies distributing needles for drug injection" and can be provided at a negligible cost to taxpayers. Moreover, the Bulletin notes, "unlike needles," crack kits "could be reused by drug addicts several times." Victoria should be applauded for approving this laudable idea that not only assists crack users in ingesting the drug more safely but also expands upon the success of harm reduction measures more typically associated with heroin users.

Syringe exchange programs moved one step closer to having access to federal funding following the House Appropriations Subcommittee on Labor, Health, and Human Services' removal of the long-standing ban. Chairman of the House Committee on Appropriations David Obey wrote in a July 10 press release that "Scientific studies have documented that needle exchange programs, when implemented as part of a comprehensive prevention strategy, are an effective public health intervention for reducing AIDS/HIV infections and do not promote drug use." Obey also stated that the Subcommittee felt the time had come to "lift this ban and let State and local jurisdictions determine if they want to pursue this approach."

However, as Philadelphia City Paper blogger Isaiah Thompson ("House Subcommittee Removed Ban on Needle Exchange Programs") reminds readers, "This isn't the end, [and] the measure still has to be approved by the Senate" and the full House itself. But, if recent protests in both Philadelphia and Washington, D.C. are any indication, concerned citizens are looking to Congress to, as Philadelphia activist Jose De Marco put it in a press release ("AIDS Activists Take Over Capitol Rotunda to Demand Action on AIDS from Obama and Congress") issued by Health GAP, "show real courage where the President has not."

For more on this historic deletion, stop by David Borden's blog post on the issue here.

Maryland's Democratic Representative Donna Edwards introduced the Drug Overdose Reduction Act into the House in June of 2009 "[i]n response to a rapid increase in the number of drug overdose fatalities," the Drug War Chronicle reports ("Overdose Prevention Bill Introduced, Study Released"). The bill seeks to assist "cities, states, tribal governments, and nonprofits" in implementing harm reduction strategies aimed at curbing overdose deaths by providing dispersing $27 million among the various entities each year.

Edwards proposed the legislation "in conjunction with a new report from the Drug Policy Alliance" (DPA), entitled "Preventing Overdose, Saving Lives: Strategies for Combating a National Crisis." DPA's report "lays out a number of ways in which the overdose toll can be reduced," including expanding prevention education, improving "monitoring, research, outreach, and coordination to build awareness of the overdose crisis [...] and public health approaches to reducing it," trying out "supervised injection facilities," and "[p]romot[ing] 911 Good Samaritan immunity law reform."

For more information, view DPA's report for yourself here.

New Yorkers Host Conference on Safe Injection Facilities in Effort to Expand City's Harm Reduction Services

On May 22, 2009, a coalition of 17 New York City harm reduction and syringe exchange advocacy groups - the Injection Drug User Health Alliance (IDUHA) - hosted a "day long forum on the science, politics, and law of safe injection facilities (SIFs) as part of a budding movement to bring the effective but controversial harm reduction measure to the Big Apple," the Drug War Chronicle reports ("Effort to Bring Safe Injection Facility to New York City Getting Underway"). Their discussions "targeted not only harm reductionists but public health advocates and officials, law enforcement, service providers, and the general public" in an attempt to "create public awareness of SIFs, provide evidence that they are cost-effective, and start developing a plan for implementing SIFS [sic] in New York." The conference took place at John Jay College of Criminal Justice and boasted over 150 attendees.

The Chronicle provides a thorough and informative write-up not just of the conference but of the history and current state of similar programs in such places as Vancouver and Switzerland, on which the activists at least partially based their plans. Readers can also view the the conference program in PDF form via the Harm Reduction Coalition's website.

Friar Clarifies Differences Between Substance Use and Substance Misuse

An Ireland Friar speaks out for a harm reduction framework regarding substance use. According to the Irish Examiner October 29, 2008 article, ("We Must Distinguish Between Drug Use And Misuse") "Fr McVerry said adults should take a 'long and critical' look at their own drug use, namely alcohol and prescription drugs, such as valium. 'It is hypocritical to expect our young people to stay away from drugs, when we adults won't,' he told the conference, organised by the Addiction Training Institute. He said adults had fostered a culture of consumerism and individualism, which did not value young people for what they were and destroyed their sense of community. The Jesuit priest, who has worked with homeless young people for 30 years, said he had seen the 'devastation' caused by illegal drugs, particularly heroin and cocaine. But he said there was a massive difference between drug user per se and drug misuse."

The article states, "I do it along the lines of alcohol. Many people use alcohol but it doesn't have any dire consequence for themselves or for anybody else and people can use drugs without it having any dire consequences for themselves or anyone else, whereas the misuse of drugs is where drugs have consequences for oneself, one's family or one's community.' He said 98% of those who experiment with drugs do not go on to misuse them. 'lIf you want to find out why young people take drugs, go into any pub any night of the week and ask the adults why they take alcohol. The reasons are the same. Adults would say we take alcohol in order to relax, as a focus for socialising, in order to escape from the pressures of life and to alter our moods. We take alcohol because we enjoy it. Young people take drugs for exactly the same reasons."

The article adds, "He said Ireland's response to illegal drugs has been a predominantly criminal justice approach, which he was 'particularly inappropriate' for drug users, who should be helped by way of prevention and education. He said criminal justice responses should be secondary in dealing with drug misusers, who should be first helped from a social and medical point of view. Fr McVerry said public discussion of drugs was dominated by either a climate of fear or a moral climate."

The first legal syringe exchanges in the state of New Jersey began operation recently.

The Philadelphia Inquirer reported on Jan. 30, 2008 (Getting Out the Word on Needle Exchange") that "In the two weeks since it launched, only seven people have signed up for the Camden Area Health and Education Center syringe-exchange program, in a city with more than its share of intravenous drug users. Camden County ranks among the top in the state for drug abusers, with 1,516 heroin and opiate users alone seeking help in 2006, according to the New Jersey Substance Abuse Monitoring System. The state had more than 22,053 people who sought treatment for heroin abuse that year. The city of Camden ranks ninth among New Jersey municipalities for residents infected with HIV/AIDS, which is commonly transmitted among intravenous drug users by sharing needles. As of June 30, 2005, there were 1,384 cases in the city, according to the New Jersey Division of HIV/AIDS Services. Newark leads the state with 12,720. Camden's is the second syringe-exchange program to open in New Jersey since passage of legislation last year aimed at reducing the spread of blood-borne diseases among intravenous drug users. The state was the last in the country to legalize needle exchanges. Philadelphia already offers the service."

According to the Inquirer, "In Atlantic City, a needle exchange opened in a drop-in HIV counseling center in November and has already registered 170 people in a state-mandated database. Exchanges are also set to open in Paterson and Newark. Part of the Atlantic City program's allure is that it is run by an established treatment facility. That exchanges are made indoors and there are free coffee and doughnuts doesn't hurt, either. In Camden, the service is run out of a van and offers only the warm hearts of workers and fresh needles."

The Inquirer noted that "In Camden, the program has drawn much less scrutiny than a proposal to move a methadone clinic from near Cooper University Hospital to a site just a few hundred yards from the needle-exchange van. On Monday, members of Camden's Sacred Heart Church gathered to oppose the relocation of the Parkside Recovery Methadone Clinic. But they had little to say about the exchange. 'The exchange is run very well and can save lives,' said Msgr. Michael Doyle of Sacred Heart, who has been in Camden for 40 years. 'This is where the drug people are,' he said, explaining that the exchange saves lives, but that he believed methadone clinics perpetuate addiction. He said he thought that moving the methadone clinic would concentrate the problems of all of Camden County in an area of the city that has struggled for years to remake itself."

The Texas state legislature authorized creation of the state's first legal needle exchange, as a pilot project, in San Antonio. Local officials are blocking the plan and now harm reduction workers involved in a needle exchange there have been arrested.

The Los Angeles Times reported on Jan. 28, 2008 ("His Needle Plan Has Touched A Nerve") that "Bill Day doesn't fancy himself an outlaw -- and with his Mr. Rogers demeanor, he definitely doesn't look the part. But soon the 73-year-old lay chaplain could spend up to a year in jail for breaking a law that he considers immoral. Day hands out clean needles to drug addicts on some of the seediest streets in this south Texas city. He does it because he's convinced that it reduces human suffering by curtailing the spread of HIV, a view that has been supported by medical research for more than a decade. However, Day's actions are illegal in Texas -- the only state that has not started a needle-exchange program of some kind. So when a San Antonio police officer spotted him swapping syringes with prostitutes and junkies this month, he was arrested on drug paraphernalia charges."

According to the Times, "Neel Lane, a high-powered San Antonio lawyer who agreed to defend Day for free after learning about his case through their church, St. Mark's Episcopal, said it was time for the Lone Star State to admit it was behind the times. 'When you're the only state that doesn't have [a needle-exchange program], you're either the 2% smartest or 2% dumbest in the country,' Lane said. Though Texas is the only state that has not begun at least a pilot needle-exchange program in any city, lawmakers last year authorized one -- for San Antonio. Bexar County public health officials are studying whether to launch it, but Dist. Atty. Susan Reed has warned that she could prosecute anyone who distributes needles because she considers the act illegal. 'I'm telling [local officials], and I'm telling the police chief, I don't think they have any kind of criminal immunity,' Reed said in August, according to the San Antonio Express-News. Reed has not explained why she opposes the program, and her office did not return requests for comment. But at the request of a state lawmaker, Texas' attorney general is reviewing the dispute. Day and two associates, cited with him on Jan. 5, initially faced Class C misdemeanors, which are punishable by a fine of up to $500. But Reed's office and police plan to increase the charges to distributing drug paraphernalia, a Class A misdemeanor, which carries a possible one-year jail sentence."

The Times noted that "Day's supporters say they are outraged that police and prosecutors are treating the activists as criminals. 'How silly to arrest senior citizens who are trying to stop the spread of HIV in their community,' said Jill Rips, deputy executive director of the San Antonio AIDS Foundation, which provides HIV testing and runs a hospice. 'Don't police have something better to do?' Day said he accepted the arrest as part of a process that his community must go through before it could begin a healthy debate about reducing the spread of AIDS by addicts."

Legislation recently signed by the President contained a provision lifting the ban on local funding for syringe exchanges in the District of Columbia. The New York Times reported on Dec. 27, 2007 ("New law Allows Needle Exchanges in Washington") that "Since 1999, the nation's capital, which reports having the highest rate of AIDS infection of any major city in the country, has been the only city barred by federal law from using municipal money for needle exchanges. A recent report by the city showed that intravenous drug users' sharing of needles was second only to unprotected sex as a leading cause of H.I.V. transmission. Congress controls local government here, and for nine years members of the House, expressing concerns about worsening drug abuse, had inserted into the bill approving the city's budget a provision to prohibit financing needle exchange programs. But with Republicans' loss of Congressional control to Democrats, this year's bill, signed by Mr. Bush on Wednesday, reversed the ban."

According to the Times, "Officials of the District of Columbia Health Department said that with the ban lifted, they would allocate $1 million for such programs in 2008."

The Times noted that "'For too long, Congress has unfairly imposed on the citizens of D.C. by trying out their social experiments there,' said Representative Jose E. Serrano, the New York Democrat who heads the House Appropriations subcommittee that handles the city's budget. 'The ban on needle exchanges was one of the most egregious of these impositions, especially because the consensus is clear that these programs save lives.'"

San Francisco Considers Establishing Safe Injection Site

The Tenderloin, a notorious San Francisco dwelling of injection drug users, is an obvious choice for a city-funded, legal center where intraveneous drug users can receive free needles and consume drugs in a safe environment according to an October 19, 2007 San Francisco Chronicle article ("S.F. Injection Center Idea Draws Support and Doubt"). The Chronicle reported that 'Momentum for such a center seems to be gaining strength among drug reform advocates and some public health workers, who say it will help stop the spread of HIV and hepatitis C, prevent deaths from drug overdoses and keep dirty needles off city streets.Supporters include the San Francisco AIDS Foundation, the Mission Neighborhood Resource Center, the Harm Reduction Coalition and San Francisco General Hospital's Opiate Treatment Outpatient Program. But so far, no San Francisco politician appears ready to champion the cause."

According to the Chronicle, "It took 10 years of community organizing for the Vancouver center to go from idea to reality, said Sarah Evans, the center's program coordinator, who spoke Thursday at the San Francisco symposium. Insite, which opened four years ago, is North America's only injection drug center, though many exist in Europe. Insite is a rather bland, sterile place used by 800 intravenous drug users every day. They bring their own drugs - most often heroin, crack, cocaine and crystal methamphetamine - but are given free needles by the center's staff. The center hands out and collects 2 million needles a year. Despite a lot of initial skepticism, the Vancouver center now has the backing of the majority of the public, the mayor, the police chief and local merchants, Evans said."

The Chronicle noted that "The center has proven it can help stop the spread of disease and prevent deaths from overdoses, said Dr. Thomas Kerr, an HIV/AIDS researcher at the University of British Columbia. He has studied Vancouver's injection facility since its inception, and spoke at Thursday's event. Kerr said 800 overdoses have happened at the facility, but they have resulted in no deaths because trained professionals are right there. Without the center, overdoses would happen in back alleys or single-room-occupancy hotel rooms where there would be no help, he and other supporters of the facility said.' It's really been studied to death - it's time to move on,' Kerr said. 'It's obvious this is something that works."

The ban on funding for syringe exchanges in Washington, DC, imposed by the US Congress years ago, may soon be lifted. The Associated Press reported on June 6, 2007 ("Needle Exchange Ban Lifted From DC Budget") that "A congressional subcommittee has voted to lift a ban on the use of local tax money for a needle exchange program in the District. Members of the House Subcommittee on Financial Services and General Government voted Tuesday to remove the prohibition from an appropriations bill governing the D.C. budget. The measure has been included as a rider each year since 1998."

According to AP, "The District has one of the worst rates of HIV/AIDS infection in the country. Officials said intravenous drug users account for a third of new AIDS cases, reported each year. A nonprofit group has operated a limited needle exchange program in the city for several years."

The AP noted that "The District budget is still subject to a series of votes in the House and Senate before it is sent to the White House for President George W. Bush's signature. D.C. Mayor Adrian Fenty has said he would provide local funding for a needle exchange program if the ban is removed."

A survey of Canadian citizens in several major cities showed strong support for use of sanitary consumption facilities similar to the Insite project in Vancouver, British Columbia. The Edmonton Sun reported on May 30, 2007 ("Safe Injection Site Supported") that "A recent Canada West Foundation survey found 47% of Edmontonians think safe injection sites are a good or very good idea. The survey polled Canadians in seven major cities -- six in the west, plus Toronto. It found support for safe injection sites ranged from a low of 42% in Winnipeg to a high of nearly 55% in Vancouver."

According to the Sun, "Darren Grove, supervisor of Edmonton's park ranger unit, said while he doesn't have any hard numbers, he figures workers are picking up 1,000 to 1,500 discarded needles in the river valley each year. The last time the city had hard numbers was in 2005, when officials collected 497 needles from park areas, most of them around homeless camps. 'Absolutely there is a concern,' Grove said. 'We don't want to have someone stumble across them and accidentally get struck with a needle.' Marliss Taylor, who speaks for Streetworks, said while the group isn't pushing for a safe injection site, it would welcome one. 'We're not hopeful it will happen here at this time,' she conceded, noting the federal government appears opposed to the concept."

The Sun noted that "However, when respondents were asked to rank potential responses to illegal drug activity, safe injection sites ranked well below increased law enforcement and increased programs for addicts."

Research published in the journal Addiction shows that use of a sanitary consumption facility by drug users in Vancouver, BC, is leading some drug users to enter detox and eventually drug treatment. The Vancouver Sun reported on May 25, 2007 ("Insite Raises Use Of Detox, Report Says") that "The report, published in a London-based medical journal, says Insite has resulted in a 30-per-cent increase in the use of detoxification programs such as methadone replacement therapy, addiction counselling, or participation in Narcotics Anonymous. That higher use of detox since Insite opened in 2003 suggests, based on previous research, that the facility 'has probably helped to reduce rates of injection drug use among users of the facility,' concluded the five scientists at the B.C. Centre for Excellence in HIV/AIDS in their report, published in the June issue of the peer-reviewed medical journal Addiction."

According to the Sun, "Health Minister Tony Clement questioned whether research supported Insite last September when he refused to grant a 31/ -year extension in the facility's federal permit. Clement, noting that Prime Minister Stephen Harper's government is about to introduce a tough national drug strategy that puts more focus on enforcement and less on so-called 'harm reduction' measures like injection sites and needle exchanges, suspended Ottawa's decision on Insite's future until the end of this year. 'The government seems intent on ignoring scientific evidence to pursue an ideological agenda at the expense of lives in the Downtown Eastside,' co-author Dr. Julio Montaner said in a statement. He said the new conclusions answer Clement's questions about whether Insite is contributing to lower drug use and fighting addiction."

The Sun noted that "The new report in Addictions, summarizing results of a study funded by the federal government, said the average number of users entering detox programs increased to 31.3 from 21.6 in the year after Insite opened. While that increase represents an increase of roughly 50 per cent, the researchers adjusted the results to take into consideration other factors in coming up with the 30-per-cent figure. 'There have been many benefits of Insite in terms of public order and reduced HIV risk,' said co-author Dr. Evan Wood. 'However, the fact that it appears to be pulling people out of the cycle of addiction by leading them into programs that reduce drug use is remarkable.'"

A copy of the Addiction article, "Rate of detoxification service use and its impact among a cohort of supervised injecting facility users," is available by clicking here.

Harm reduction is a straightforward, commonsense approach to drugs. As defined by the Harm Reduction Coalition, "Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users "where they're at," addressing conditions of use along with the use itself."

Practical examples of harm reduction include Methadone and Heroin Assisted Treatment as well as Syringe Exchanges and Safer Injection Facilities.

For more information about harm reduction policies, check out:
Drug War Facts: Methadone, Buprenorphine & Heroin Assisted Treatment
Drug War Facts: Syringe Exchanges & Safer Injection Facilities
Also, check out this CSDP public service ad, US Meddling In Global AIDS Crisis: "A Triumph of Ideology Over Science."

A number of online resources exist for further information about harm reduction and harm reduction activities. Check out:
Harm Reduction Coalition
Harm Reduction Project
International Harm Reduction Association
Canadian Harm Reduction Network
Asian Harm Reduction Network
UK Harm Reduction Alliance

The state of New Mexico has enacted a law allowing drug users to report overdoses without fearing arrest as a result. The New York Times reported on April 5, 2007 ("New Mexico Bars Drug Charge When Overdose Is Reported") that "Struggling with an epidemic of drug fatalities, New Mexico has enacted a groundbreaking law providing immunity from prosecution for people who come forward to help drug users suffering overdoses. The act, signed into law Tuesday by Gov. Bill Richardson, prevents the authorities from prosecuting on the basis of evidence 'gained as a result of the seeking of medical assistance.' It also protects drug users themselves from prosecution if the process of seeking help for an overdose provides the only evidence against them. The legislation, which was popularly known as the 911 Good Samaritan bill, is the first of its kind in the nation, according to the National Conference of State Legislatures."

According to the Times, "The Samaritan bill, introduced by State Senator Richard C. Martinez, a Democrat and a retired magistrate judge from Espanola, also provides that in the event of a drug prosecution based on outside evidence, the act of seeking aid for someone suffering an overdose 'may be used as a mitigating factor' in a defense."

The Times noted that "In a statement yesterday, Mr. Richardson, who is running for the Democratic presidential nomination in 2008, said: 'I have always been committed to prevention and rehabilitation of drug users. If we can encourage people to save themselves or others from a drug-related death or trauma, then we should do that. This bill will encourage families and friends of addicts to seek medical care and prevent their loved one from dying.'"

On June 29th, the Joint United Nations Program on HIV/AIDS released a progress report on international anti-AIDS efforts. As the Guardian reported on June 28, 2005 ( "Britain Rebuffs Call To Block Anti-AIDS Needle Exchanges"), "The US is pressing the UN to block the use of needle exchange programmes in countries where drug use is driving the spread of Aids, arguing that the schemes encourage users to continue their habit. But critics, including Britain, believe that the fight against Aids in eastern Europe, central Asia and other parts of the world could be jeopardised if the US manages to water down the UN's policy. The board of UNAids, the UN agency which coordinates the fight against the pandemic, is formulating a global prevention strategy in Geneva."

According to the Guardian, "Britain opposed the US position yesterday, when Gareth Thomas, the international development minister, told the meeting in his opening statement that the UK wants to see 'efforts to intensify harm reduction strategies, including needle and syringe exchange programmes'. He said: 'We support effective harm reduction programmes, especially needle and syringe exchange and methadone substitution therapy because they have been proven to reduce HIV infection among infecting drug users and their sexual partners in many countries.' The UK, he said, had 'a different approach' from the US."

The Guardian noted that "The row is critical, because needle sharing by injecting drug users is the main cause of the soaring figures for HIV/Aids infection in many countries, and provides a gateway for the spread of infection into the heterosexual community through the partners of drug users. Drug injecting is responsible for 80% of the cases in eastern Europe and central Asia, and is also driving the epidemic in a wide range of countries in the Middle East, north Africa, south and south-east Asia and Latin America. HIV prevalence within certain populations of drug injectors exceeds 80%. Europe accepts evidence from studies which have shown needle exchanges to curb the spread of infection, but the US, which will not fund such studies domestically, does not."

This issue, of HIV/AIDS and support for needle exchanges, dramatically illustrates the gap between the UN's drug control agency and the public health & medicine sector. As the Guardian noted, "The issue has already become fraught. At a meeting in Vienna earlier this year the UN agency responsible for the policing of narcotics, the United Nations office on drugs and crime, was forced to accept the US line and oppose needle exchanges. USAid, the American development agency, is not permitted to fund or be involved with programmes that include needle exchange. Democrats are lobbying against the government's position."

(For background on the US pressure on UNODC, see UN Office On Drugs And Crime Buckles Under US Pressure.)

In expressing its support for needle exchanges, the UNAIDS report decried the lack of political will and intestinal fortitude on the part of some governments, primarily the US. According to the report, "Increased testing presents new opportunities to link people to prevention and treatment services, to supply commodities such as condoms and clean injection equipment, and to provide appropriate prevention support for people living with HIV/AIDS as part of the continuum of care."

The report continues: "Injecting drug users have specific prevention and treatment needs, including testing and counselling, needle and syringe programmes [emphasis added], drug substitution therapy and ART. While the need to implement and integrate these services for this population is becoming increasingly clear in the era of ART, political commitment is still lacking in many of the countries where these services are needed most. (p. 21)

In its World Drug Report 2005 (also issued June 29, 2005), the UN Office on Drugs and Crime avoided reference to needle exchanges. Instead, they chose to focus on the strategies of convincing injectors to quit injecting and on getting other users to quit using. As UNODC wrote:
"Despite insufficiencies of data, particularly on noninjecting drug use, there is no doubt that the use of drugs, whether injected or taken otherwise, increases the risk of becoming infected with HIV. If injected, the use of contaminated injection equipment can lead to the rapid spread of the virus in the injecting community and beyond. Certain drugs that are not injected can also increase HIV transmission due to their impact on sexual risk-taking behaviour. The sexual partners of drug users, whether drugs users themselves or not, can spread the virus to the larger community, particularly if they are commercial sex workers.
"Consequently, many researchers and analysts believe that the role of primary drug abuse prevention is widely underestimated and neglected for HIV/AIDS prevention. Also important are interventions to prevent noninjecting drug users from becoming injectors, and to encourage those who inject to consider non-injecting alternatives such as substitution treatment." (p. 161)

The United Nation's Office on Drugs and Crime plans a major shift in drug policy. The London Observer reported on Feb. 6, 2005 ( "US Cash Threat To AIDS War") that "The Bush administration opposes any programme that appears to condone the continued use of drugs, and wants the UN to seek abstention by users, combined with an end to narcotics production. Drug experts believe that if the UN shelved its so-called 'harm reduction' strategy in favour of an outright war on drugs, it could contribute to a rise in the rate of infection with HIV/Aids through shared needles and unsafe sex, as well as increasing the number of addicts."

According to the Observer, "Correspondence seen by The Observer shows that on 10 November 2004, Antonio Maria Costa, Executive Director of the United Nations Office on Drugs and Crime ( UNODC ) held a meeting with US Assistant Secretary of State Robert Charles to discuss the Bush administration's concerns about the direction the UN was taking. A leaked letter sent by Costa the next day shows him agreeing to demands to expunge references about harm reduction from UNODC literature and statements. 'On the the general issue of 'harm reduction', I share your concern. Under the guise of 'harm reduction', there are people working disingenuously to alter the world's opposition to drugs. These people can misuse our well-intentioned statements for their own agenda, and this we cannot allow. Accordingly, as we discussed in our meeting, we are reviewing all our statements, both printed and electronic, and will be even more vigilant in the future.' Costa goes on to clarify the UN agency's position on needle exchanges, where addicts are given clean injecting equipment to minimise the risk of infection from HIV and and hepatitis. In words that have caused alarm among drug treatment experts, Costa wrote: 'We neither endorse needle exchanges as a solution for drug abuse, nor support public statements advocating such practices.'"

The Netherlands-based Transnational Institute points out that this shift completely contradicts other UN policy positions as well as the scientific literature. In the TNI webpage on the UN and harm reduction, they point out that "This position taken by Mr Costa under US pressure is in direct conflict with many statements made by other UN agencies on this issue as well with statements made by UNODC representatives or in UNODC documents in the recent past. More than ever, inconsistency reigns within the UN around an issue all 191 UN Member States have pledged to achieve in the Millennium Development Goals: Halt and begin to reverse the spread of HIV/AIDS."

TNI continues:
"The General Assembly Special Session in 2001 on HIV/AIDS adopted a Declaration of Commitment [PDF document] saying that 'harm reduction efforts related to drug use,' and 'expanded access to essential commodities, including [] sterile injecting equipment' should be ensured by 2005. Both WHO and UNAIDS use the term harm reduction as a matter of course. 'The United Nations fully endorses the fundamental principles of harm reduction,' according to Catherine Hankins, associate director of UNAIDS in her opening address [PDF document] at the 13th International Conference on Drug Related Harm in Slovenia, 2002.
"The International Narcotics Control Board (INCB) has been regularly out of tune with the rest of the UN community on the issue of harm reduction. INCB president Philip Emafo, for example, considered in an interview even needle exchange to be contrary to the conventions and condemned the harm reduction policy trend as a 'crusade' to undermine them. UNODC legal experts (at the time under the name of UNDCP), however, argued in a confidential and authoritative memorandum to the INCB in 2002, Flexibility of Treaty Provisions as Regards Harm Reduction Approaches [PDF document] that most harm reduction measures are in fact acceptable under the conventions. According to the Legal Affairs Section 'it could easily be argued that the Guiding Principles of Drug Demand Reduction provide a clear mandate for the institution of harm reduction policies that, respecting cultural and gender differences, provide for a more supportive environment for drug users.'"

Indeed, as TNI points out, Mr. Costa until recently was a supporter of syringe exchange and other pragmatic harm reduction approaches:
"In his Report to the Commission on Narcotic Drugs (CND) [PDF document] in Vienna,15-22 March 2004, UNODC Executive Director Costa clarified the position of UNODC on the issue of risk reduction for HIV/AIDS prevention. 'Twenty years of research into various aspects of HIV/AIDS among injecting drug users and the experience of numerous programmes and projects indicate that HIV/AIDS epidemics among injecting drug users can be prevented, stabilized and even reversed. [..] Taking into account that drug use is a chronically relapsing condition, policies governing HIV/AIDS prevention must follow pragmatic approaches and therefore must address high-risk behaviour first before striving to achieve long-term goals such as total abstinence from drugs. Effective programmes typically include a wide variety of measures, ranging from drug dependence treatment, including drug substitution treatment, outreach providing injecting drug users with information on risk reduction and referral to services, clean needles and syringes, and condoms [..]. Thus, those injecting drug users who cannot stop injecting can be provided with clean needles and syringes, those who can stop injecting but who are not ready for abstinence-oriented treatment can be offered substitution treatment and a variety of treatment and rehabilitation options can be made available to those who have been able to stop using drugs. [..] A comprehensive package of measures also usually includes treatment instead of punishment for persons convicted of minor drug offences, since incarceration usually increases the risk of HIV transmission. The scientific evidence and the experience with such programmes strongly indicate that the above-described package is effective in reducing the risk of HIV transmission among injecting drug users and the risk of HIV diffusion from infected drug users to the general population.'
"Mr Costa reiterated that position in his address to the Bangkok International AIDS conference in July 2004: 'During the past decade, we have also learned that the HIV/AIDS epidemic among injecting drug users can be stopped - and even reversed - if drug users are provided, at an early stage and on a large scale, with comprehensive services such as outreach, provision of clean injecting equipment and a variety of treatment modalities, including substitution treatment. It is, however, a sad fact that less than five per cent, and in many high-risk areas, less than one per cent of all drug users have access to prevention and care services. In too many countries, drug users are simply incarcerated. This is not a solution; in fact, it contributes to the rapid increase in the number of people living with HIV/AIDS.'
"This gradually shifting UNODC position in the course of 2003/2004 towards the broader UN consensus on basic harm reduction practices forms the background to the current US pressure on tne agency. The combination of two resolutions seeking CND acceptance for basic harm reduction principles at March 2004 CND session, from Brazil on HIV/AIDS and the Pompidou Group on substitution treatment, plus Costa's position paper on HIV/AIDS quoted above and one on substitution treatment jointly by WHO/UNAIDS/UNODC was the prelude to the current crisis in UNODC-US relations. An angried US delegation made blunt statements during the session like that needle exchange programmes in fact might accelerate the spread of HIV instead of preventing it. Thereby denying the wisdom of their own top scientists. An analysis from the US Assistant Secretary for Health and Surgeon General, Dr David Satcher, on Evidence-Based Findings on the Efficacy of Syringe Exchange Programs had concluded that, 'After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.' As confirmed by the Leadership Statement on Injecting drug use and HIV/AIDS [PDF document] resulting from the XV International AIDS Conference in Bangkok in July 2004, saying: 'There is overwhelming, high quality evidence of very effective, safe and cost effective harm reduction strategies to reduce the negative health and social consequences of drug injection. [..] Experience of numerous programs and projects in all regions of the world indicate that HIV/AIDS epidemics among injecting drug users can be prevented, stabilized and even reversed by timely and vigorous harm reduction strategies.'"


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