Safe Injecting Facilities - Term Paper Example

?Safe injecting facilities Introduction Safe injecting sites are an approach to harm reduction in which people can go to a safe place to inject drugs and connect with a variety of services. "Safe injection" remains controversial, as people question whether this is the right approach to tackling the problem of drug use in communities. These Safe injections sites also known as drug consumption rooms (DCRs), safe injection rooms, and supervised injection sites/facilities/centers, began in Europe in the 1980s. They now exist in cities in Switzerland, Germany, the Netherlands, Spain and Australia. The first safe injection site in North America, Insite, began operating as a pilot project in Vancouver, BC in 2003, and was recently given the go-ahead to remain open after a Supreme Court battle with the federal government (Keen, 2003). Injection drug use continues to be associated with an array of significant health and social consequences throughout North America. These consequences are tied directly to the consumption of illicit drugs of unknown potency and composition, and the sharing of contaminated injection equipment; and indirectly, through unprotected sex with drug injectors, and through injectors’ immersion in black-market pursuits that result frequently in violent exchanges with criminals and the police. Keen (2003) states that in the United States, injection drug use accounts for approximately 25% of all cumulative AIDS cases nationwide, but closer to 50% of all cases in several northeastern States. The number of new HIV infections reported nationwide among injectors increased 300% in the 1990s, from 6,474 new infections in 1993, to 13,969 in 1995, 17,344 in 1998 and 18,882 in 1999. Disease Injectors also suffer from very high rates of hepatitis C infection – 90% of people who have injected for 5 years or more are infected - and from endocarditis, an acute infection of the heart valves that is not commonly seen among young adults. Fatal and nonfatal drug overdose (OD) is also a prevalent medical problem among injectors, and hospital emergency rooms throughout the country attend to ODs virtually everyday. Emergency room (ER) visits involving heroin alone doubled from 33,900 in 1990 to 70,500 in 1996. Some medical experts have recently declared that the United States is in the midst of another heroin epidemic. On the other hand, injectors are known to use primary care services erratically and only after they are very sick, which drives up health care costs (Drug Policy expert Committee, 2000). The argument for safe injection sites Several research studies have shown that safe injection sites have advantages for drug injectors and for the community including reduction in many of the harmful aspects of drug use on the individual (spread of infections, risk of overdose) and to society (drug-related crime, public exposure to drug injecting paraphernalia), as well as positive benefits (increase in education about safety among injectors, more drug users accessing treatment and other services). Extensive research has been conducted at Insite in Vancouver, with positive results. The argument against safe injection sites Critics have argued against the introduction of safe injection sites largely based on the principle that drug addiction is wrong, and should not be condoned in any way. The political focus on reducing harm to drug users deflects the focus from where it belongs, which is on the prevention and treatment of drug abuse. Introducing safe injection sites is seen as a step towards drug legalization, and undermines law enforcement principles and practices. Researchers conclude that police surveillance may end up scaring away the very people North America's first sanctioned safer injecting facility is intended to help. While there have been methodological criticisms of the evaluation studies supporting safe injection sites, and Insite in particular, critics on the other side argue that there is no substantial basis for these criticisms. Ultimately, the strong views on both sides appear to be driven by political ideology, and depending on whether the person expressing the view approves or disapproves of harm reduction in principle. Insite is the only legal supervised injection site in North America, located at 139 East Hastings Street, in the Downtown Eastside (DTES) neighborhood of Vancouver, British Columbia. The DTES had 4700 chronic drug users in 2000 and has been considered to be the centre of an "injection drug epidemic". The site provides a safe and health-focused location for injection drug use primarily heroin, cocaine, and morphine. The clinic does not supply any drugs. Medical staffs are present to provide addiction treatment, mental health assistance, and first aid in the event of an overdose or wound. In 2009, the site recorded 276,178 visits (an average of 702 visits per day) by 5,447 unique users; 484 overdoses occurred with no fatalities, due to intervention by medical staff. Health Canada has provided $500,000 per year to operate the site, and the BC Ministry of Health contributed $1,200,000 to renovate the site and cover operating costs (Drug Policy Expert Committee, 2000). In light of the continuing threat posed by HIV, HCV, and other drug injection related health problems in both the United States and Canada, there is a clear need for further development of innovative interventions for injectors for disease prevention, reduction of drug-related deaths, and for increasing the number of injectors enrolled in drug treatment and other health care programs. Harm reduction Harm reduction is a proactive approach to reducing the damage done by alcohol, drugs, and other addictive behaviors, as well as addressing broader health and social issues such as HIV transmission (Single, 1999). The term harm reduction can be used to describe the philosophical beliefs that underlie strategies and programs or it can be used to describe the strategies and programs on which it is based. Often, harm reduction strategies are used in conjunction with other approacheswhich require abstinence. A common misconception about harm reduction is that it condones or encourages drug use. Many advocates of harm reduction also support the goal of people working towards abstinence from alcohol, drugs and addictive behaviors, but recognize that for many people, this process takes time and in the interim period while the person is still drinking, using drugs, or engaging in other addictive behaviors, both they and the people around them are vulnerable to harm (Single, 1999). While it is well known that even small amounts of alcohol can affect people's ability to drive safely, driving and driving laws allow drivers to have a small amount of alcohol in their bloodstream. The focus is not on eliminating alcohol use from drivers completely, but setting a limit over which the greatest risk of causing a serious accident is defined. Injecting drugs such as heroin is illegal yet harm reduction advocates for clean needles to be provided to drug users free of charge. This is because there is more harm caused to individual drug users, the health care system, and society as a whole if injection drug users pass HIV and hepatitis to each other through sharing needles (Denning & Glickman, 2004). Needle exchange programs do not encourage drug use. In fact, they are usually the first point of contact for drug users to access addiction treatment services. But they accept the fact that many people will inject drugs whether they have clean needles or not, and prefer that they do not get ill and die as a result of infection. Safe injection facilities Safe injection sites go a step further than needle exchange services by providing a safe space in which people can inject drugs, clean needles and injection equipment, and supervision of the injection process by medical staff. In addition to the harm reduction goals of needle exchange services, such as reducing transmission of HIV, hepatitis and other infections, and damage caused by unclean equipment being used for injecting, safe injection rooms offer a safe space and immediate help if an overdose occurs. Fischer (2000) observes that Safe injection facilities do not encourage drug use -- they provide a connection between the most vulnerable drug users and treatment services, such as detox. And they save lives that would otherwise be lost to drugs. Sex can be an addictive behavior, and it can lead to unplanned pregnancy, but the main reason that free condoms are sometimes provided as a harm reduction service is to reduce the transmission of STDs, specifically HIV. Free condoms are not distributed to encourage people to have sex. Programs that distribute them recognize that people have unprotected sex for many different reasons, and that factors such as embarrassment and poverty may get in the way of purchasing condoms. They prevent a lot of illness and problems associated with unprotected sex (Fischer, 2000). Law enforcement Law enforcement agencies in the United States and Canada vigorously pursue illicit injectors, dealers, traffickers and producers. However in many municipalities throughout North America, law enforcement agencies have also entered into a “hands-off” relationship, working in collaboration with public health programs for injectors (Fry et al, 2006). They have agreed, sometimes under court pressure, to curb their surveillance and arrest efforts of injectors utilizing health services such as needle exchange, and to not interfere with outreach workers attempting to access injectors for the purpose of disseminating health education and risk reduction materials. Legally, what SIFs need is the same working agreement that the police already honor for the clients and staff of needle exchange programs, street-based outreach services, HIV test counseling centers, drug treatment facilities, and other public health programs. Local government Community implementation of safe injection facilities requires the knowledge and endorsement of local governmental officials, especially from the offices of the major, city council, city attorney, zoning and planning, health department, and relevant task forces. Officials need to be informed sufficiently about the public health implications of a proposed SIF in order to explain it to others, and to defend its goals and operations. Ideally, officials should be integrated into the development and implementation of an SIF, including deciding where it will be located, the range of services it will offer, its operational procedures, and the composition of its staff (Miller & Munoz, 2005). In addition, it will be incumbent on officials to work out the legal framework within which safe injection facilities (SIF) can operate. This legal framework will articulate the rights and obligations of an SIF’s sponsoring agency and staff, and circumscribe its potential liabilities. By rights, we mean the program staff’s authority to specify and enforce the SIF’s rules of operation and code of conduct for clients and staff. Obligations include the staff’s “duty to care” for eligible clients, and the protocols staff members will be expected to follow in conducting business, and in responding to problems and emergencies (Fry et al, 2006). Finally, agencies that receive government funding at least in the United States are required to certify that they provide a “drug-free” workplace for their employees. For example, they are required to notify “employees that the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violation of such prohibition”. Rationale The idea behind the safe injection sites is to reduce the collateral damage from drug abuse. Proponents argue that since addicts have begun to use the safe injection sites, the crime rates have fallen, and that the rates of HIV and hepatitis have declined because clean needles have been made available. Because nurses can keep an eye on addicts after they shoot up in the facility, they say that deaths by overdose will decline, since ambulances can be called more easily than if drug users were shooting up alone in a darkened alley (Denning & Glickman, 2004). They further claim that the needle exchange program can allow users to remain healthy until they get help for their substance abuse problem. While drug addiction certainly puts a major dent in human freedom, it would be false to conclude that an addict can't make choices. The only reason there is any hope left for an addict is because he still has a small and diminishing space of freedom that he can act on, allowing him to decide whether or not to begin a new journey. He can choose to take the first step along the road leading away from addiction towards rehabilitation. Our public strategy for dealing with drug addiction must always show great sensitivity towards that tiny space of freedom that remains in each individual struggling with addiction. After all, it is precisely this freedom that sets us apart from our animal counterparts. Public policy should not contribute to shrinking that space of freedom even further through approaches that enable destructive behaviors and greater addiction. Thus the scientific criteria is not inherently better than the moral criteria. References Denning, P., Little, J. & Glickman, A. (2004). Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. New York: Guilford. Drug Policy Expert Committee. (2000). Drugs: Responding to the issues, engaging the community. Melbourne: Government of Victoria. Fischer, B. (2000). Injection drug use and preventive measures: A comparison of Canadian and Western European Jurisdictions over time. Canadian Medical association journal, 162(12), 1709-1713. Fry, L, Hall W, Ritter A, & Jenkinson R. (2006). The ethics of paying drug users who Participate in research: A review and practical recommendations. Journal of Empirical Research on Human Research Ethics, 1(4):21–36. Miller, W. & Munoz, R. (2005).Controlling Your Drinking: Tools to Make Moderation Work For You. New York: Guilford. Keen, J. (2003). Does methadone maintain treatment based on the new national guidelines primary setting? British Journal of General Practice 53(491). Single, E. (1999). A harm reduction framework for drug policy in British Columbia. Penultimate draft of a discussion paper prepared for the British Columbia Harm Reduction Working Group. Melbourne: Government of Victoria. Read More