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Harm Reduction in Vancouver

I'm headed to Vancouver for a few days off this week, so this seems particularly appropriate. From a Salon article on efforts to create safe fixing sites for drug addicts in that city:

It's 11 o'clock on a busy Wednesday night inside 327 Carrall St.... in the smaller back room, two or three junkies at a time inject heroin or crack cocaine into their veins using sterile swabs and fresh needles under the watchful eye of a registered nurse. In here they can also receive advice on vein care, skin infections and detox programs...

The... operation is illegal, but the mayor's office has looked the other way since it opened on April 7; the guerrilla safe-injection site running here every night from 10 p.m. to 2 a.m. insures junkies have sterile gear to shoot up with, and discourages them from fixing alone -- a main contributing cause of overdose... The site is the de facto vanguard of an evolving "harm-reduction" strategy that the city of Vancouver hopes will help clean up the streets and halt a decade-long illicit-drug catastrophe that's killed more than 2,000 via overdose and infectious disease.

Essentially, the situation here has been so bad for so long that the government is willing to help addicts plunge illegal drugs into their veins if it means stemming the greater tide of destruction. If the city's official plan stays on track, by mid-September street junkies will be able to walk into a storefront at nearby 135 East Hastings St. almost any time of day and get high in a safe, clean facility administered by the provincial Vancouver Coastal Health Authority. It's a prospect that's angered conservatives from Ottawa to Washington.

So far, so good. Rather than continuing with an interdict-and-punish strategy that has never worked, Vancouver politicians have realized they have to try something different. But wait -- there's a problem. The US government doesn't like what Vancouver is doing:

Vancouver's bold strategy has provoked the expected ire of conservatives -- especially south of the border, where Washington has recently watched Canada sanction gay marriage and close in on federal decriminalization of marijuana. The prospect of government-backed hard-drug use next door has the White House palpably unsettled: As soon as Vancouver's planned site gained Canadian federal approval in late June, U.S. drug czar John Walters went off. "It's immoral to allow people to suffer and die from a disease we know how to treat," he told the Associated Press. "There are no safe-injection sites," he added, calling the policy "a lie" and "state-sponsored personal suicide." David Murray, special assistant in the U.S. Office of National Drug Control Policy, told the Vancouver Sun on May 2 that likely "unintended consequences" of the safe-injection site could force the U.S. to tighten border controls to prevent increased drug trafficking. That could, of course, negatively impact trade of all sorts.
This is offensive and stupid. It's offensive because we're telling a sovereign nation -- one consistently ranked as having a higher quality of life and better social services than do we -- how to run their country, and threatening them with consequences if they don't do things our way. It's stupid because we've had a "War on Drugs" for decades now and haven't achieved anything except a soaring prison population, yet somehow our leaders feel competent to tell others how to handle their drug problems.

The mayor of Vancouver seems highly pragmatic:

"This is a health problem, not a criminal problem," says Vancouver Mayor Larry Campbell. Like many other Canadian officials, Campbell appears unfazed by Washington's rhetoric. "We have conservatives in Canada, too, and they won't look at fact or reason either," he says flatly. "I've been to Zurich [Switzerland] where they had a problem way worse than ours, and I've seen the results." The harm-reduction component of the widely endorsed plan -- Mayor Campbell was voted into office in 2002 promising to implement it -- is modeled after programs in Europe and Australia, which have dramatically reduced overdose deaths and the spread of disease.
The reality is that supply reduction simply doesn't work:
[Drs. Evan] Wood and [Martin] Schechter... cite a 2001 United Nations report indicating that only 5 percent of the global illegal drug flow is successfully thwarted by law enforcement. Still, the problem isn't on the enforcement front lines. "The responsibility lies with the politicians and policymakers who continue to direct the overwhelming majority of resources into failing supply-reduction strategies, despite the wealth of scientific evidence demonstrating their ineffectiveness," they write. "Our strong consensus [is] that curbing HIV and overdose epidemics requires a shift toward prevention, treatment and harm reduction." ...

According to the latest Vancouver drug use epidemiology report, injection drug use was the predominant mode of HIV transmission in B.C. from 1994 to 2000. A 1997 study of more than 1,400 Vancouver needle users revealed an HIV infection rate of 18 percent -- the highest level anywhere in the developed world...

Conservatives, [nurse Fiona] Gold... points out, should be equally invested in the harm-reduction strategy -- especially those who are fiscally conservative. Every HIV-infected addict dropped into the healthcare system costs the Canadian government an average of $150,000 in long-term care; the cost of 12 such patients would pay for the new site to run for a year, she says.

Once again, we find that no one wants to experiment with social policy when it goes against their dogma. Liberals are willing to allow children to rot in failing schools rather than experiment with privatization and school choice. Conservatives are willing to allow drug users to die rather than experiment with safe-injection sites and other harm reduction programs.

"It's certainly reasonable to expect that if this is successful in Canada, that some people will want to imitate it here," says UCLA's [Professor Mark] Kleiman. The prospect of entering uncharted legal waters may be another reason Washington conservatives are sounding a defiant note... "There's no doubt that those who want to keep U.S. drug policy very supply-reduction focused feel threatened by this." ...

But conservatives also argue that the positive results of harm-reduction programs overseas may not translate across different cultures or cityscapes. "I think there are far more serious difficulties with the Swiss model than have been acknowledged," David Murray of the U.S. Office of National Drug Control Policy, a social anthropologist by training, told the Vancouver Sun in May. "My impression is that the presumed benefits will turn out to be illusory." Enabling addicts to pursue their habit, conservatives say, will inevitably boost neighborhood crime and deepen urban decay...

"This isn't a game I'm playing where we win or lose, it's peoples' lives," says Mayor Campbell. "If it doesn't work, we'll try something else, but we know that pure enforcement doesn't work... The fact of the matter is, the most compelling reason to do this is the U.S. system -- just take a look at your jails. Prisons are a growth industry in the United States, and a vast majority are in there for drugs, of some form or another." Indeed, more than 70,000 inmates, or roughly 55 percent of the U.S. federal prison population, are currently locked up for drug offenses, according to the Federal Bureau of Prisons. "People don't come out rehabilitated, and the drug and health problems aren't dealt with," says Campbell. "We're simply trying to move beyond outdated laws." ...

UCLA's Kleiman offers... advice for a displeased Bush administration.

"A really sensible U.S. government might say to Canada, 'We think this is a really dangerous experiment, but if you're crazy enough to try it in your neighborhood, God bless you, and we'll watch,'" he says. "A scientific view of drug policy would say, 'Here's an opportunity for us to learn something.' Of course, that's not what I expect to see from Washington."

Sensible, pragmatic viewpoints and a willingness to try new ideas when the old ideas aren't working -- I don't expect to see that from any politician in the US. It's not just sad; in this case, at least, it's tragic.


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It is tragic. It's tragic to know that our country was founded on sensible and pragmatic viewpoints. The point isn't even to *try* new methods if you're not comfortable with them, it's to stand back and learn something which lately has been impossible for our country.

Great write up. I subscribe to Salon but it's been hard for me to keep up.

Hey Pal, let me guess… you are still pissed that Bush “stole” the election,

And every “green’ cause is good, huh?

Oh, and it was just sex w/ Clinton,

I know ... Democrats are good, Republicans are bad… ... so intellectual.

Your diatribes are pathetic, and worst yet, predictable. Blah blah blah.

Same old 60’s rhetoric. People like you make me vote libertarian.

Do me a favor – read something other than Mother Jones…


I am not a Republican, but neither am I a Democrat or a Green. As I once wrote on this blog, "I belong to no political party because no political party represents my beliefs."

I don't believe that Bush "stole" the election. From what I have seen, the best available evidence indicates that the vote count in Florida in 2000 was simply too close to ever know who won that state. I note that Bush lost the popular vote, but through the Electoral College, the US Consitution allows for such events, so that can't be considered theft.

The silliest thing about your comment is when you wrote, "People like you make me vote libertarian." In fact, the Libertarian Party is strongly in favor of the decriminalization of drugs. In other words, any true Libertarian would be in favor of a harm reduction policy such as Vancouver's.

My beef is not just that the Republicans won't experiment with different drug policies -- it's that no one seems to want to experiment with anything. As I wrote:

Liberals are willing to allow children to rot in failing schools rather than experiment with privatization and school choice. Conservatives are willing to allow drug users to die rather than experiment with safe-injection sites and other harm reduction programs.
By the way, I don't read Mother Jones. I do read the Wall Street Journal, the New York Times, and the Economist. Do you?

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