Can We Be Pragmatic in the War on Drugs?

It's time to elect a new mayor here in Philadelphia, and not a day goes by without at least one candidate proposing some dynamic new policy that is sure to wipe out all social ills in one fell swoop. The strategies range from improbable (a steep toll for all cars entering Center City during peak hours) to ethically questionable (random pat downs in traditionally crime-ridden neighborhoods), but all of them are espoused in hopes of rallying the voting public and propelling the candidate into office. They are often borrowed from successful operations in other cities, but all usually make their appeal by an apparent effort to "get tough" on something. Pragmatism has never tested well in the polls; therefore no one should be surprised if the words "safe injection sites" never reach the public ear.

What is a safe injection site? U.S. residents not intimately involved with the harm reduction movement may have never heard of such a thing, but the concept is just one of many ideas centered on reducing the spread of HIV/AIDS and other diseases related to drug use. Safe injection sites are essentially government provided health facilities for intravenous drug users to inject drugs (purchased elsewhere) in a safe space under the supervision of trained professional staff. It is not an easy thing to accept, tax dollars enabling drug use (and I hope readers feel free to post thoughts, whether incensed or inspired by the idea, in the comments section), but as time passes, it is becoming more and more apparent that our country's drug problem isn't going away. The substances may change with the decade and the social class, but addiction is something that crosses all political and socioeconomic lines, from Brittany in rehab to the guy sleeping on my stoop. Until we find the cure-all that completely erases this element from society, it behooves us to treat the public health issues that it imposes. This is where these sites come in to effect. Clean needles help to prevent spread of HIV, Hepatitis C, and other diseases, protecting not only the user, but also the people that they come in contact with. Staff are given instruction on dealing with preventing overdose during use, potentially saving thousands of lives, not to mention (if you prefer to think about it economically) the millions of dollars in emergency care that are associated with overdoses.

The worth of such services are obvious when viewed from the perspective of those who use or are directly affected by the use of intravenous drugs; however, the issue is clearly much more complex than that. The United Nations recently gave warning denouncing state sponsored facilities in Canada (as well as those located in Australia, Germany, Luxembourg, the Netherlands, Norway, Spain, and Switzerland) stating that Canada is “encouraging illicit trafficking.” This is the obvious case against such practice, and there is a widely held fear of an influx of "undesirables" and, accordingly, crime to the immediate surrounding areas. It is reasonable to think that even if a city was in favor of safe injection on the whole, it would be nearly impossible to find a neighborhood that wouldn't actively oppose setting it up in their back yard.

This was certainly the case in Vancouver, B.C. prior to 2003. The city's Downtown Eastside has long been known as an area struggling to deal the presence of a large number of illicit drug users. As the problem grew, businesses in the area found fewer and fewer consumers willing to enter an area with such an openly visible drug culture. The documentary Fix: The Story of an Addicted City chronicles the fight to win the support of lawmakers and neighborhood groups to bring North America's first safe injection site to the city. Despite fierce opposition, an advocacy group made up of users and their allies was eventually able to convert a former retail space into a facility, called Insite, under an exemption of Canada's controlled substance laws.

Now, three years after its inception, Canadian officials are assessing the program's impact on the estimated 5,000 neighborhood users and the surrounding community. Research by the Vancouver Coastal Health Authority (more details can be seen here) found that the program not only took drug use off the street to the tune of 600 visits per day, but it also made it safer for the users, increased enrollment in treatment plans, and had no effect on relapse rates by former users. 456 overdoses resulted in zero fatalities. Hard numbers are difficult to produce regarding any change in the rate of blood-borne illnesses, but participants were practicing safe injection in the facility and being educated about the dangers of sharing needles in the street. Criminologists hired by the government have been quoted as saying that none of the fears voiced by the community regarding legal injection have been realized. Is this not progress?

Despite the positive health outcomes associated with the programing, widespread growth remains nonexistent. The U.N.'s scolding comes at a time when funds for Insite and other similar initiatives have been threatened to be cut. There are obvious social and political roadblocks that prevent more cities from adopting such measures, but should communities be forced to hit rock bottom before offering some solution that takes the problem for what it is? The other plans that call for more guns and more cops are going unheard in areas that can afford neither. Those that can afford to sweep drug use into the jails must remember that once an inmate is released, prison health becomes public health. Enormous steps have been taken in the fight against AIDS, but how often do we hear about the more than 4 million cases caused by unsafe injection? Across the nation, needle exchange programs are becoming more common and acceptable; safe injection sites take the next logical step to ensuring a safe environment for a very real and largely ignored portion of society.

Big city mayors, like the one who will soon take over City Hall here in Philadelphia, are in a unique position to implement cutting edge techniques where they are needed most. Concerning illicit drug use, safe injection sites may or may not be the answer, but the safety of the public warrants innovation in all areas. Let's hope that we have the presence of mind to seize ideas, no matter how personally unsettling they may be, when they present themselves.

The opinions preceeding belong solely to Beej. STH has no standard drug policy or position.