25/03/08

Vancouver’s needle exchange is homeless

Drug use and homelessness go together in many cities around the world. The Canadian city of Vancouver, for many years a shining example of sensible drug policy, is no exception. Now, however, it’s the city’s much-vaunted needle exchange programme that is being thrown onto the streets according to Cindy Harnett of the Times Colonist.

The Vancouver needle exchange is especially well known among HIV researchers; it was among the first to show that giving out sterile injecting equipment prevents the spread of HIV, and among the first to eat its claims as HIV rose steeply even among needle exchange clients. It a long and interesting story (see shamless plug at the bottom of this post), but most public health officials agree that needle exchanges help keep people alive and disease-free, while making it more likely they’ll get into treatment and off drugs.

Public health officials are one thing, the Public is another. Many Canadians, including an increasingly conservative government spurred on by international police bodies, are uncomfortable about treating addiction as a health issue. So when the needle exchange was evicted from its current spot and decided to set up together with an array of other social services, there was a predictable outbreak of footstamping. It didn’t help that the proposed site was across the street from a primary school, and that there didn’t seem to have been a whole lot of consultation. More fulminating.

The irony of this is that what the punters object to is the idea that they are paying to maintain people in their addiction. Which takes us back to the addiction and homelessness thing. Homelessness and lack of access to basic social services make it more difficult for people to kick their addictions. Putting the needle exchange in a single centre with those other services will make it easier for junkies to access services that help them stop being junkies. Giving out needles just makes it more likely that Canadian taxpayers won’t have to pay for a lifetime supply of expensive anti-retorviral drugs for people once they stop shooting up. Making the needle exchange homeless is bad for junkies, but it is also bad for people who would like to see less addiction and lower public spending in Vancouver.

Shameless plug: You’ll be able to read more about the Vancouver needle exchange controversy in The Wisdom of Whores, which will be published by Penguin Canada in May, 2008.

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This post was published on 25/03/08 in War on drugs.

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  1. Comment by Local Pedant, 27/03/08, 07:11:

    I believe that your post refers to the city of Victoria–which is the city mentioned in the first, third, and fourth links–not the city of Vancouver. Victoria is the capital of British Columbia, separated from Vancouver by about 70 km and a body of water called the Straight of Georgia. Since you mention that there is more about this controversy in your forthcoming book, I’m hoping that you have the details correct there.

    I used to work less than a block from the location of the current needle exchange. I can attest to the effect of the exchange on the character of the neighborhood. Despite the negatives that everyone discusses, perhaps there is something positive that results from having the needle exchange centrally located: increased community awareness. The scope of the problem would be less visible to “the punters” if the exchange were to be pushed to a remote location or forced into a mobile service. I wonder if it might be useful for people to be confronted daily with the impact of addiction, homelessness, and the issues around access to social services. Unpalatable, but useful in terms of creating awareness and the momentum for evidence-based strategies that address the real health issues.

  2. Comment by Lee Rudolph, 29/03/08, 03:17:

    Two comments.

    (1) A few years ago in my small Massachusetts town, the Board of Selectmen (5-person popularly elected executive branch of the government) were persuaded one day to OK the set-up of a regional needle-exchange center (permitted by Massachusetts law, but barely instantiated anywhere in the state). My mostly rural town lies between two cities (adjoining one, separated from the other by a much tonier, much more “suburban” town); the site of the proposed center was on the state highway joining the cities, in a slightly residential but overwhelmingly commercial district (mostly used-car lots, peppered with a few failing mini-malls and the like; miles and miles from any of the town schools, churches, etc.). In practical terms, access by the clients would have been almost exclusively by regional mass transit bus (the state highway is the one part of town served by the bus, and that only because of the cities it runs between) or (much less likely, I think) by private car. That is, even assuming the worst stereotypes of the needle exchange’s prospective clients, there would have been a negligible chance that out-of-town clients would be wandering around the neighborhood wreaking havoc to any extent greater than they might already be. Nonetheless, there was an immediate public outcry against the Board of Selectmen for their decision: public pressure forced them to reverse it nearly immediately; they were condemned by great numbers of the townspeople at the next Town Meeting (legislative branch of town government; in our town it’s not representative–any citizen of town can attend and vote); and at the next election three of the four who had supported the exchange were voted out of office. Some of the reaction was (I am sure) orchestrated by people who had other axes to grind, and some was based (rightly, though unfortunately) on procedural errors in the original decision. But most of the reaction was blind hysteria, including willful blindness of the townspeople-at-large to the numbers of injectors *in town*. I don’t in fact think that anything approaching rationality even as remotely as “I object to paying to maintain people in their addiction” was significantly in play–I think almost all the (non-procedural) objections came down to “I’m afraid of junkies, they’re ICKY, keep them away from me!!!”

    (2) A new epidemiological study relating Parkinsonianism with pesticide use has been published in BMC Neurology, as reported today by the BBC at news . bbc . co . uk / 2 / hi / health / . stm (let’s see if spacing out the U R L gets it past the blog’s filter). I have serious (though purely amateur) methodological quibbles about the study, but I’m really bringing it up here only because of a pharase it contains, in a quotation attributed to the lead researcher. “What we noticed in our research was that recreational pesticide use in the home and garden was more of a source of exposure than occupational use.” OMG, recreational pesticide users!

    Elizabeth comments: I knew there was a reason I hated gardening. URL for the full text of the study in the (wonderful, open-access) BMC Neurology is: http://www.biomedcentral.com/content/pdf/1471-2377-8-6.pdf.
    Re: Icky junkies. I think you town’s reaction is pretty common. It’s really hard to think of a way to “destigmatise” drug injection, because the truth is that junkies can be pretty icky, when they are in your life, your family, your wallet. (So can most teenagers.) The point for me is that junkiedom does not generally last for ever or even for very long. I’d rather people emerged from it without a fatal disease.
    Perhaps what we need is for more former injectors and former addicts to come out of the closet, so people can see that people who are now icky can turn into valuable members of society, and even get elected to the highest offices. Not that those two things are synonymous, of course.

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