As Bexar prepares to pilot needle exchange, Vancouver CA models the future of harm reduction

One of the more interesting presentations I saw last week in New Orleans at the Drug Policy Alliance conference centered on implementing ground-level harm reduction strategies, a topic that interests me especially as Bexar County prepares to launch Texas' first legal needle exchange operation in San Antonio. (Last I heard, Bexar officials hoped their county's needle exchange pilot program will begin early next year.)

Vancouver launched its needle exchange programs, said the city's Drug Policy Coordinator Donald MacPherson, because of a spike in overdose deaths in the late 1990s topping 200 per year at its height. Like similar programs elsewhere, Vancouver saw a decline in both overdoses and HIV transmissions among injection drug users after implementing needle exchange, and more addicts referred to treatment.

Observing these successes, MacPherson said, the city took the idea one step further, creating a "supervised injection site" where addicts can use illegal drugs in a clean environment under nurses' supervision. The facility teaches addicts how to protect themselves from disease transmission and encourages them to enter drug treatment. According to this brochure from the Vancouver program, called "insite," more than 7,000 people have used the facility to inject drugs since its inception.

people using insite are more likely to enter withdrawal management (detox) programs, and people using insite who also talk with addiction counselors are even more likely to enter detox. In fact, one in five regular visitors to insite began a detox program, showing that insite is a proven entry-point for the Downtown Eastside’s highest risk injection drug users. Detox programs are an important marker of addiction treatment system use, as most addiction treatment programs first require people to complete a detox program.

This notion may seem radical from where Texas sits now, but from all appearances the idea (which was imported from Switzerland) works surprisingly well at reducing both drug use and the harms associated with it. "It hasn’t been difficult to convince injection drug users that insite offers a safe, clean place to inject drugs," reports the insite brochure. Overall program results were analyzed in a study published in the Canadian Medical Association Journal, reported CBC News, finding that

the three-year-old Supervised Injection Site in the Downtown Eastside has been a great success.

The injection site, which drew about 5,000 users in its first year of operation, is a place where people can safely go to inject illegal drugs while being supervised by nurses.

"By all criteria, the Vancouver facility has both saved lives and contributed toward the decreased use of illicit drugs and the reduced spread of HIV infection and other blood-borne infections," Mark Wainberg, the director of the McGill University AIDS Centre in Montreal, wrote in a commentary published alongside the study.

The study — conducted by Dr. Evan Wood, a professor of epidemiology at the University of British Columbia, and his colleagues — found that drug users who visited the site at least once a week were more willing to enter detoxification programs.

These data make me optimistic about San Antonio's legislatively approved pilot program to exchange clean needles, which I see as an important first step toward implementing policies to reduce drug demand and the harms associated with addiction. Prison, by contrast, does neither of those things.

Vancouver's experience shows that not only do harm reduction principles work but they can be expanded beyond just needle swapping, and indeed may be the best available method for convincing serious addicts to seek treatment.

Vancouver's model demonstrates that its possible to scale up harm reduction strategies to demonstrably reduce deaths and addiction in a major city. Indeed, the idea of a safe injection site strikes me as the epitome of the harm reduction model - a much more civilized, humane, and rights respecting mentality than Texas' current "trail 'em, nail 'em, and jail 'em" approach. Every major Texas city has thousands of addicts who inject illegal drugs, and if all society offers them is prison, they're more likely to remain in the shadows.

In closing, I found these data interesting about the Vancouver supervised injection site, and was especially encouraged to see that 453 overdoses at the site occurred during a two year stretch with no fatalities. By contrast, that many overdoses out on the street or in some run-down shooting gallery would be much more likely to result in morbid outcomes. Here are some other statistics worthy of note for those interested the Vancouver supervised injection site:

Other research results show*:

• 7,278 unique individuals registered at Insite
• Women made up 26 per cent of clients
• Aboriginal people made up 18 per cent of clients
• Heroin was used in 41 per cent of injections
• Cocaine was used in 27 per cent of injections
• Morphine was used in 12 per cent of injections
• 453 overdoses resulted in no fatalities
• 4,084 referrals were made with 40 per cent of them made to addiction counselling
• Referral to withdrawal management: 368
• Referral to methadone maintenance: 2 per week
• Daily average visits: 607
• Average number of visits per month, per person: 11
• Busiest day: May 25, 2005 (933 visits in 18 hours)
• Number of nursing care interventions: 6,227
• Number of nursing interventions for abscess care: 2,055

*All totals or averages are for the two-year period from April 1, 2004 to March 31, 2006.