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Safe injection works in Vancouver, and it can here

The Downtown Eastside of Vancouver, British Columbia, is infamous for its open-air drug markets. In recent years, heroin, the neighborhood’s traditional drug of choice, has given way to fentanyl, a cheaper and more potent substance.

More than 159 people lost their lives to drug overdoses in Vancouver last year, a majority of them to fentanyl, most of them taking drugs while alone. However, there was one place in Vancouver without a single fatal overdose, Insite; a safe consumption site where people suffering from addiction self-medicate under medical supervision. To date Insite has had 4,922 patients overdose under their supervision; not a single one has died. Credit the presence of other people who can ensure help is summoned.

As Seattle and King County move forward on what could be the first in the nation safe-consumption sites for drug users, a common refrain has been heard from critics: Won’t that lead to more crime? It is well known there are large correlations between drug use and crime, and the assumption of a causal relationship between safe consumption sites and crime rates seems reasonable at first glance. However, studies measuring crime rates around Insite suggest no such correlation between Insite and increased crime.

In fact, some research suggests such sites reduce crime, and Seattle may be even better positioned than Vancouver to capitalize on the crime reduction possibilities of safe consumption sites through our successful Law Enforcement Assisted Diversion Program (LEAD).

Two peer reviewed studies, one published by Substance Abuse Treatment, Prevention, and Policy in 2006 and another published in the Canadian Medical Association Journal in 2004 examined crime and public order in the neighborhoods directly surrounding Insite. The 2006 study compared Vancouver Police Department crime statistics for 2003, the year Insite opened, and 2004, Insite’s first full year of operation. Specifically, the study looked at drug trafficking, assaults and robberies, and car thefts and prowls. The study found no significant change in drug trafficking (124 in 2003 vs. 116 in 2004) or assaults and robberies (174 in 2003 vs. 180 in 2004). However, the study found a considerable decrease in car thefts and prowls of 25 percent (302 in 2003 vs. 227 in 2004).

Additionally, the 2004 study demonstrated a stunning improvement in the state of public order on the 10 city blocks directly surrounding Insite before and after the facility opened. The number of users self-administering in public decreased by 44 percent; the number of discarded syringes dropped by 54 percent; and the amount of injection-related litter went down 49 percent. The example of Insite suggests safe consumption sites do not correlate to an increase in crime, and have positive implications for public order in neighborhoods with existing drug use struggles.

As a public tolerance of an otherwise illegal behavior, safe consumption sites have had an interesting relationship with law enforcement. Recently, Officer Randy Fincham, a public affairs representative of the Vancouver Police Department and former Downtown Eastside patrol officer, described Insite to me as “highly complementary to the harm-reduction pillar of our work, and we support them as such. However, we do not outright endorse them.” When asked whether Insite has contributed to decreases in crime and increases in public order, he did not rule out possible influence from Insite, but qualified that it is difficult to be certain and “other factors like increasing gentrification have had an effect as well.” However, Fincham emphatically agreed that safe consumption sites have considerably decreased the number of publicly discarded needles and related paraphernalia.

Seattle has a head start on engaging law enforcement in harm-reduction strategies through the Law Enforcement Assisted Diversion Program, which diverts low-level drug offenders away from jail and into services. Fundamental to LEAD’s success is defining the role of law enforcement officers as a point of first contact with the entire system, including social services. Officers are given training to recognize eligible offenders and then offer housing and services as an alternative to incarceration. It is exactly this type of enforcement that can magnify the effect of harm reduction.

A safe consumption site can be another arrow in the quiver of Seattle’s LEAD strategy. A recent study found that LEAD participants were 60 percent less likely to reoffend after being enrolled in LEAD-sponsored services. This is an exceptionally encouraging statistic underscoring the national significance of LEAD as a great public safety program. However, we are still left with the reality that 40 percent of LEAD participants do reoffend, and that almost all LEAD participants have some type of substance abuse problem.

Safe consumption sites, therefore, are a place for the 40 percent — the population struggling with addiction who have not yet hit rock bottom and are not yet ready to seek the services they need to turn their life around. Offenders who have failed to comply with LEAD, or refuse to continue to participate in LEAD, can be referred by LEAD trained officers to safe consumption sites as an alternative to incarceration. As the example of Insite shows, such a response can reduce the amount of needles discarded in the streets, people consuming drugs in public, and, most importantly, reduce the number of people shooting up in private — where they are at the highest risk of an overdose proving fatal.

We need to meet addicts as we find them, not as we want them to be. Until addicts are ready to make the final step into treatment and recovery they are going to need a place to self-medicate. We owe that person and their family the guarantee that it can be under the watchful eye of trained medical staff and not in an alley, a public bathroom or a vacant building. It is not only the humane thing to do. It is an effective crime-reduction strategy.

The opinions expressed in this article are solely the personal views of the writer. 

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