Safe Shooting Rooms

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Last summer, activists erected 2,000 wooden crosses in a park in downtown Vancouver. The crosses symbolized the number of injection-drug users who have overdosed and died in British Columbia since 1992.

In the near future, organizers might have to plant even more crosses; according to a report issued last fall by the Vancouver-based Harm Reduction Action Society (HRAS), roughly 23 to 30 per cent of the city's estimated 10,000 heroin addicts are HIV-positive. Nearly nine out of ten have hepatitis C.

Vancouver, in fact, has the highest rate of HIV infection in western world. Media pundits refer to the shabby downtown east side, where most of the city's addicts live, as the "killing fields."

The situation in cities such as Montreal and Toronto, while not quite as apocalyptic, is still pretty grim.

A study by the Centre for Addiction and Mental Health (CAMH) suggests that nearly 10 per cent of Toronto's estimated 15,000 heroin addicts are HIV-positive. In Montreal, the infection rate is about 20 per cent.

Drug addicts contract HIV by using dirty needles. Needle-sharing - a common practice among junkies - further spreads the disease.

There is a way to stem the rate of HIV/AIDS among injection drug users: give addicts clean needles, a safe place to shoot up and medical supervision, so they can be revived if they overdose.

Such locales are called safe - or supervised - injection sites.

The HRAS report defines them as, "controlled health-care settings where drug users inject drugs under supervision and receive health-care, counselling, and referral to health and social services, including drug treatment."

A growing number of high-ranking officials would like to open safe injection sites in Canada's biggest cities. Some of these officials sit on a federal taskforce that has been convened to investigate the idea.

While still a revolutionary concept in North America, safe shooting rooms are relatively common in Europe.

Since they were launched in Germany, Holland and Switzerland in the 1980s and 1990s, supervised injection sites have been credited with reducing overdose deaths, the spread of disease and petty crime. The main negative impact of such places is that they tend to attract drug dealers, who try to peddle their wares among the clientele.

Nonetheless, injection rooms are becoming an increasingly popular option among policymakers around the world; authorities in Australia opened a safe shooting site a few months ago, while Spain is planning to establish similar venues soon.

Vancouver Mayor Philip Owen would also like to open a safe shooting room. The mayor has become a firm supporter of a so-called "four pillar" approach to that city's terrible HIV problem. This approach puts equal emphasis on enforcement, prevention, treatment and harm reduction, and might include injection rooms.

Councillor Kyle Rae has taken a similar position in Toronto. He represents the downtown core and has long lobbied for drug-law reform initiatives, including safe shooting rooms. He even visited a pair of supervised injection sites during a visit to Frankfurt, Germany a few years ago.

"It was interesting watching people shooting up right in front of you," notes the counsillor.

According to Rae, Frankfurt's injection rooms were opened at the behest of local police, who saw little point in pursuing failed "zero tolerance" strategies, and business merchants, who disliked having addicts hanging around their premises.

The federal government is also interested in safe shooting rooms: Ottawa launched a taskforce in the spring to look into the feasibility of setting up injection sites in Canada.

The task force is headed by Catherine Airth, acting director of the Office of Canada's Drug Strategy, a branch of Health Canada, and Dr. Perry Kendall, chief medical officer for B.C. Rounding out the taskforce are health, justice and police officials, as well as treatment specialists, such as Shaun Hopkins, manager of Toronto's needle exchange program.

Hopkins says the taskforce's research will be included in a draft report on needle-drug use that will be presented at a meeting of provincial health ministers in the fall.

Even if the ministers are okay with the idea, the federal government would have to change the Criminal Code before opening any safe injection sites, says Hopkins. At present, laws against possession rule out the possibility of creating such places.

In the end, a concern about the bottom line might be the main factor that pushes the feds to make the change.

According to the report "HIV, AIDS and Injection Drug Use," which was written by a Health Canada taskforce in the late 1990s, the average lifetime cost of treating a single HIV patient runs to over $100,000.

That's the kind of figure likely to bring around diehard opponents of safe injection rooms, who are otherwise unmoved by the sight of countless crosses in a park.

Nate Hendley is a freelance journalist who lives in Toronto. He has written extensively for This Magazine, the National Post and eye weekly, among other publications.

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