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Living and Dying With and Without Harm Reduction

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I had the unusual experience of having been, within the last couple of weeks, in a room depicted in The New York Times webcast, which covers three stories around the world each day. This was the injection room in Vancouver. The New York Times followed this webcast with a Science Times article about the substantial benefits of this program, called Insite, in terms of reduction in HIV infection and increased follow-up medical treatment of addicts.

PHS (the Portland Hotel Community Services Society) invited me to present my vision of addiction and its treatment. PHS is the overseeing body for the Insite injection room and related facilities (in that same building are detox and a drug-free halfway house -- PHS also runs 30-plus residences for addicts, a bank and a number of businesses where addicts are employed). I know PHS through its executive director, Liz Evans, whom I met in Liverpool when I spoke at the International Harm Reduction Association conference last year. Liz is as remarkable a person as you will find anywhere.

I stand in awe of Liz. How do you obtain and upgrade all those residences and find and supervise staff to run them? How do you start a bank where addicts and others can safely deposit their checks? How do you deal with the power structure in creating residences and an injection site for addicts?

Stateside, providing a place for addicts to shoot drugs -- as well as to live, eat and receive medical care -- is considered sinful. And make no mistake about it, the 12-step model of treatment partakes of that notion of sinfulness. The ironclad rule of absolute abstinence in the 12 steps is not the result of scientific discovery or based on sound medical knowledge or treatment practices. It is beyond questioning. It is a religious and a moral precept.

So there is no shooting room in the United States. There is no provision of medically supervised narcotics -- well, that's not counting all those Oxycontin and Vicodin prescriptions. But in the U.S. you need medical coverage and a person with a prescription pad to get narcotics. PHS deals with poor people who provide their own narcotics. The PHS shooting room does not supply the drugs, only clean paraphernalia and a place that people can take them safely and under loose supervision of trained counseling and nursing staff. (Hmm, I wonder where they get the drugs -- aren't those illegal?)

"But what if something goes wrong?" people often ask. "You don't know what the hell they have in those packets they're shooting -- they don't know."

Actually, I don't have the guts for something like that. I have a private abstinence-oriented treatment program in the U.S. -- and several people have questioned me about the gap between it and my views that life improvement is what licking addiction is about. I won't go into my answer here, but I will repeat what I said above -- I stand in awe of Liz Evans and her group.

The Times article reports:

Insite, situated on the worst block of an area once home to the fastest-growing AIDS epidemic in North America, is one reason Vancouver is succeeding in lowering new AIDS infection rates while many other cities are only getting worse.

By offering clean needles and aggressively testing and treating those who may be infected with H.I.V., Vancouver is offering proof that an idea that was once controversial actually works: Widespread treatment, while expensive, protects not just individuals but the whole community.

In addition, Darwin Fisher -- Insite's manager -- describes in the video accompanying the article how addicts are spawned and maintained by an environment that rejects them and denies them any access to not only shelter and health care, but opportunities to improve their lots through work and education, as PHS does. In other words, isn't PHS the embodiment of compassionate -- and effective -- Christianity?

Why, then, is there no chance such a program will ever be implemented here?

You tell me.

P.S. (April 18, 2011):

From the Partnership, not generally thought of as a harm reduction operation:

A government-sanctioned facility in Canada that medically supervises the injection of illegal drugs has reduced fatal overdoses, according to a new study in the journal The Lancet. The researchers say their findings indicate the facility should be used as a model in other areas where illegal drug use is prevalent.

The facility, called Insite, provides clean needles to heroin and cocaine users, who inject themselves with their own drugs while they are supervised by a nurse, Reuters reports. The study found that Insite reduced drug overdose deaths by 35 percent in a neighborhood that has one of Canada's highest rates of drug addiction.

Insite is funded by the province of British Columbia. Reuters notes that Canada's Supreme Court is preparing to hear a lawsuit over the Canadian government's attempt to close Insite. Critics of the facility argue that it promotes illegal drug use. The article adds that local health officials and police want to keep it open.