For more than a decade, harm-reduction programs in Europe have produced compelling results. In Zurich, Switzerland, many streets that were once needle-littered and crime-ridden are no longer so forbidding. And since the country's first safe-injection site opened in 1986, there hasn't been a single fatal overdose at any of the 13 sites operating across three Swiss cities, according to the U.S.-based advocacy group Drug Policy Alliance. Frankfurt, Germany, a city with population and drug-user demographics similar to those of Vancouver, opened five sites beginning in 1994; fatal overdoses there declined from 147 in 1991 to 26 in 1997, and the spread of HIV among drug users declined dramatically as well.
Studies of the European programs show less clear results, however, in battling long-term addiction. Though conservatives often denounce harm-reduction policy in strictly moral terms, such mixed results may be enough to arm the policy's opponents with a more practical argument: that chronic junkies pose a greater criminal threat than a public health one.
"To many harm-reduction advocates, heroin use is a practical [health] problem, but that's not a plausible view if you live in a neighborhood where drug addicts steal your television set," says Mark Kleiman, a drug policy expert and professor of public policy at University of California Los Angeles. "Ask people living in those neighborhoods if they want a safe-injection site next door, and they will say -- perfectly reasonably -- no." In fact, notes Kleiman, many harm-reduction supporters themselves get caught up in an ideological battle against the conservative crusade. "As a result," he says, "I don't think they take into account all the possible consequences of harm-reduction measures."
But the Canadian federal government appears convinced of the potential benefits; it's promised $1.5 million to fund research at the pilot site, and if the site proves effective, several more could follow in the Vancouver area and in other cities facing illicit-drug problems, including Winnipeg and Toronto.
Urban hard-drug havens in the U.S. could be next. According to a New York Times report on Aug. 11, New York City is estimated to host a staggering 200,000 heroin addicts -- more than 16 times the number in Vancouver, and 20 percent of the nearly 1 million addicts living in the U.S.
"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 Kleiman. The prospect of entering uncharted legal waters may be another reason Washington conservatives are sounding a defiant note. "It's unclear to me whether or not current federal law would forbid a safe-injection site," says Kleiman. "It's not at all obvious to me that it would, because the site does not provide illicit drugs. There's no doubt that those who want to keep U.S. drug policy very supply-reduction focused feel threatened by this."
Mayor Larry Campbell, who first saw the Vancouver drug crisis blooming while working as a narcotics officer three decades ago, says that becoming B.C. chief coroner in 1996 galvanized his view of harm-reduction policy. "When you're going into a room every day and there are two people dead with needles still in their arms, you know the status quo isn't working," he says. "I went from being an enforcement officer to one whose major job was to prevent death. Hopefully this policy will do that, and prevent disease, and will give us back the heart of our city."
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.
"It is possible safe-injection sites are a good idea," says UCLA's Kleiman. He points to the success of needle exchange programs in promoting drug use abstinence, though he stops short of the controversial heroin distribution plans that the U.K. and others have tried, with mixed success, in the past. "But purely from an economist's point of view," he says, "a safe-injection site makes being a drug user easier, and one would expect that to lead to more people becoming drug users and staying drug users."
"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. Remember, I'm an ex-narc and I have many friends in the DEA and FBI. 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."
Evan Wood of University of British Columbia further points to a study published by his colleague Dr. Mark Tyndall in the April 2003 scientific journal of the International AIDS Society, which concludes that jailing addicts actually worsens the HIV epidemic. Tyndall's study shows that Vancouver injection drug users incarcerated over the prior six months faced nearly triple the risk of HIV infection. "We know HIV spreads very rapidly among addicts in prison, where they're sharing rigs," says Wood, affirming that illicit drug use on the inside is indeed commonplace. "I go to many [international] public health conferences ... and my understanding is it's no different in the U.S."
Standing in the pleasant salt breeze of the city's trendy Yaletown neighborhood, former Vancouver Mayor Philip Owen explains why he defied all expectations and made harm-reduction policy an emblem of his nine-year career in office. Owen served from 1993 with the backing of the conservative Non-Partisan Association until the party dumped him from its 2002 election ticket. He was instrumental in setting the four-pillar drug strategy in motion in 1997. Owen says his perspective began to shift when a wave of crack cocaine hit the streets in 1996, and he made several trips to the Eastside to observe the growing problem. "I got to know some of the people there. It was quickly obvious: The user is sick and the dealer is evil," he says. "What are you going to do? Lock up a 16-year-old girl who's selling her body because she needs dope? You have to lock up the dealers and treat the addicts."
Dressed in a crisp button-down shirt and khakis, the now-retired Owen is more diplomatic than polemical -- until the discussion shifts to Washington. "In the State of the Union address, George W. said his approach to the narcotics problem is to prevent importation, and to treat those who are addicted." Owen claps boisterously. "Wonderful! Then do it! The problem is, the U.S. hasn't done it for 30 years and it's just bullshit to cloud over a serious issue like this. They haven't stopped the importation -- they can't -- and the consumption is rampant as can be. So that's just fine: Keep flying your planes over Colombia, Turkey and Afghanistan, and burning crops and blowing planes out of the sky," he fumes. "It isn't working and we can't wait at the city level because we've got destruction here. And it's in Seattle and Portland and San Francisco and New York. We have to deal with this at the street level, so don't come here and criticize us."
UCLA's Kleiman offers a bit more tempered 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."
For Megan Oleson, such debate is almost beside the point. A little before 1 a.m., Oleson and I are sitting on a bench in Pigeon Park, a dreary cement strip on the corner a half block from 327 Carrall. The street hustle is going strong: people dealing, smoking, drinking and using, several homeless people sleeping on the pavement. "A lot of institutions and healthcare workers claim they understand harm reduction," Oleson says, "but in the end you're challenging a lot of stigmas. You get these people parachuting into ghettos, who don't really care what people's health needs are."
Still, it seems dubious to assume all these despairing people could rescue themselves.
When we walk back inside 327 Carrall the relative calm is striking, though it's still plenty busy an hour before closing time. Some addicts sit drinking coffee, some nod off. A couple of others are pacing, anxious to get through the door into the back room.
It's not hard to imagine the look on John Ashcroft's face, were he to walk inside this place. Yet, not one person has died here since the site opened over four months ago -- even as a couple of people per week are pulled off the nearby streets in body bags.
"I'm here because I hate seeing my friends inject in the alley," Oleson says. "I hate going to fucking memorial services because people go to their hotel room and OD because they're alone."
She heads for the fixing room, pausing to greet a couple of familiar faces before she gets back to work.
About the writer
Mark Follman is an editorial fellow at Salon.
Story finder (3 ways to search Salon)
Salon Directory (browse by topic)