Drugs

Helping those who can’t help themselves

  The safe injection site in the downtown eastside must turn away those who, by physical disability, cannot safely inject themselves. The result is needlessly heightened risk of HIV and AIDs among those already disabled  

By Alex Tegart

On January 3, 2003, Health Canada made an exemption under the Controlled Drugs and Substances Act (CDSA) so that intravenous drug users would be legally permitted to self-administer their drugs in a safe and controlled environment. Nine months later, the supervised injection site, known as InSite, located on Hastings Street East in Vancouver’s notorious Downtown Eastside, was born.

InSite is a pilot program implemented by the Vancouver Coastal Health Authority and the Portland Hotel Society. It is operated with the help of nurses, social and public health workers, and local volunteers.

At InSite, clients can show up to the supervised injection site with their drugs and receive sterile needles to inject them in a clean and safe environment. The problem is that users who can’t physically do the job alone can’t get any assistance with injecting. Their only option is to use needles they manage to scrounge up on the street, risking exposure to Hepatitis C, HIV, overdose, and poor injection technique. Without a further exemption allowing nurses to help those users who need help to inject their drugs, the site would be considered illegal under the CDSA for doing so.

The federal minister of health does have the power to get around this restriction if there are certain conditions that he thinks could reduce harm associated with injection drug use. These exemptions all have to be for scientific research purposes. For example, as outlined in the exemption noted in Section 56 of the Act, trafficking of drugs is not permitted at the site. “Trafficking” is a term not to be taken lightly. It can be defined in variety of ways, such as to sell, give, transfer, transport, send, or deliver the substance, to sell an authorization to obtain the substance, or most importantly, in this case, to administer a substance.

Allowable reasons for the minister to consider an exemption are whether a resulting project would help minimize the risk to health, safety, and security of research subjects, staff members, and local communities.

Helping clients who can’t help themselves could be a good enough reason for the minister to consider an exemption, but it hasn’t happened so far. Saving users from unnecessary wounds inflicted by bad injecting techniques shouldn’t be a crime.

But matters become complicated when nurses take the needles into their own hands and actually push the plunger for the clients. The idea of nurses injecting an unknown substance into a client’s body exposes the nurses to a huge liability that the clinic and the nurses would share.

A similar site has operated in the past in a less formal setting in Vancouver. In April 2003, a guerrilla site was organized at 327 Carrall Street in the Downtown Eastside by the Coalition for Harm Reduction. The unsanctioned supervised injection site was the precursor to InSite, now operating on East Hastings. The coalition at this site was made up of health care practitioners and several community-based groups who supported marginalized people in the Downtown Eastside.

They were responding to the municipal government’s failure to open a supervised injection site as was promised in 2002. The site was overseen by a registered nurse and volunteers who were trained in CPR, first aid, safer injecting technique, and dealing with conflict.

Over the 181-day period it was open, data was collected by Dr Thomas Kerr, Megan Oleson, and Dr Evan Wood. Oleson was the registered nurse on site. There were no rules that prohibited the sharing of drugs or assisting injections. The volunteers at the site supervised over 3,000 injections until the site was closed in October 2003 by the supervised injection site council. According to the report, they had little financial support or support from local health-care workers, and the volunteers were getting tired. By this time, InSite had opened and the majority of volunteers from the Carrall Street location were employed at InSite.

InSite now serves approxi-mately 600 clients a day, which is about half of the population of users in the Downtown Eastside. The site focuses on safe injection technique education, the treatment of wounds and abscesses, addiction counselling, withdrawal management, and opiate replacement therapy.

From September 2004 to August 2005, there were 197 treated overdoses among 116 clients at the supervised injection site. None of them resulted in death. Research on the site’s impact on the city and on issues surrounding health in the Downtown Eastside are being conducted with the help of the BC Centre For Excellence in HIV/AIDS.

In September 2005, a study on injection drug users in the Downtown Eastside was produced by Dr Wood and Dr Kerr. The researchers recruited intravenous drug users from the Downtown Eastside over six-month intervals to evaluate the relationship between intravenous drug users requiring help injecting and HIV infection. Participants were given an interviewer-administered questionnaire and were asked to provide blood samples. Results showed that users who needed help injecting were more likely to share needles with other users. When sharing the needles, the users were more likely to be exposed to HIV and Hepatitis C. Out of the 1,013 users who participated in the study, 41.3% needed help injecting during the time period of six months.

If almost half of the participants in this study needed help with injecting, it’s safe to say that a lot of users in the Downtown Eastside are not getting the proper aid that they require.

The solution to the problem is as simple as slightly changing the definition of the one elusive term: “trafficking.” But with such slight alterations come huge implications for the ethical and professional responsibilities of health care practitioners and political leaders, and their obligations to their professions, their constituencies, and to the downtown eastside population.