Clean injection sites in Canada

Clean needle exchange for drug users has proven repeatedly to slow the spread of AIDS in one of the marginalized populations in the world: injection drug addicts. The controversial question of who should pay for needle exchange programs came up in section last night. Vancouver has taken "safe" injection drug use a step further, by offering its residents a safe injection site. At Insite, nurses hand out clean needles and condoms, help users find veins, provide gynecological and STD exams, and treat overdoses. There have been over 1,000 overdoses at Insite, and no one has died. The program appears to be stopping AIDS spread in its tracks.

The second major focus of the Canadian program is to identify injection drug users, test them for HIV, and provide antiretroviral drugs early on in the infection. Since antiretrovirals lower the viral load in the blood, they decrease the infectiousness of an HIV-positive person. Because Canada's medical system is socialized and has a focus on public health, doctors are aggressive about finding and treating HIV cases in order to prevent further spread. By contrast, in the US doctors often wait until HIV-positive people have lowered CD-4 counts to start treatment because of the unpleasant side-effects of the antiretroviral drugs. Treatment here is more single-patient oriented and less focused on public health.

The success of Canada's clean injection site program stems from recognizing the reality of the conditions in which many drug users live. While Vancouver's Downtown Eastside has a needle exchange, the 20-30 minute wait can sometimes be too long for addicts to tolerate. And female users are often assaulted and robbed, necessitating protection by men which they pay for in sex. And desperate drug users sometimes resort to really really unsafe practices, which I won't describe here, that lead to endocardial infections. All this can be prevented by having nurses observe drug users as they inject. Narcotics laws are suspended within the walls of Insite. The only thing the nurses can't do is push the plunger.

And now for the more familiar part of the story:

"Insite opened when the Liberal Party was in power. The Conservative-led government that came to power in 2006 has sued to shut it. Local courts have refused to close it, accepting the city’s argument that an addict’s need for opiates is like a diabetic’s for insulin and that a citizen’s right to health — recognized in Canada’s version of the Bill of Rights — outweighs narcotics law."

New York Times Article