accept drug addiction, we accept the state of affairs as acceptable
SAN FRANCISCO -- City health officials and addiction experts took the first steps Thursday toward opening the nation's only government-sponsored injection room that would give drug addicts a safe, clean place to shoot up.
Hoping to reduce San Francisco's high rate of fatal drug overdoses, the local public health department co-sponsored a symposium on the only such facility in North America, a 4-year-old Vancouver site where an estimated 700 users a day self-administer narcotics under the supervision of nurses.
"Having the conversation today will help us figure out whether this is a way to reduce the harms and improve the health of our community," said Grant Colfax, director of HIV prevention for the San Francisco Department of Public Health.
Organizers of the daylong forum, which also included a coalition of nonprofit health and social service groups, acknowledge that it could take years to get a so-called "safe injection site" facility up and running in the city, if it happens at all. Along with legal hurdles, such an effort likely would face political opposition.
Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, called San Francisco's exploration "disconcerting" and "poor public policy."
"The underlying philosophy is, 'We accept drug addiction, we accept the state of affairs as acceptable,"' Madras said. "This is a form of giving up, you are treatable and we will facilitate a type of behavior that leads to a destruction of yourself, your family."
Although 65 similar facilities exist in 27 cities in eight countries, no other U.S. cities have considered creating one, according to Hilary McQuie, Western director for the Harm Reduction Coalition, a nonprofit that promotes alternative drug treatment methods.
"If it happens anywhere in the U.S., it will most likely start in San Francisco," McQuie said. "It really just depends on if there is a political will here. How long it takes for that political will to develop is the main factor."
Drug overdoses represented about one of every seven emergency calls handled by city paramedics between July 2006 and July 2007, according to San Francisco Fire Department Capt. Niels Tangherlini. At the same time, the number of deaths linked to overdoses has declined from a high of about 160 in 1995 to 40 in 2004, he said.
Colfax estimated that there are between 11,000 and 15,000 intravenous drug users in San Francisco, most of them homeless men. Like many large U.S. cities, the city operates a clean needle exchange program to reduce HIV and Hepatitis C infections.
A safe injection space modeled after Vancouver's InSite program would nonetheless mark a significantly more aggressive intervention.
While it's too early to tell what the room in San Francisco would look like, Vancouver's is located on the upper floor of a low-rise building in a downtown neighborhood where open air shooting galleries thrive.
The site, exempt from federal drug laws so users can visit without fear of arrest, has 12 private booths where addicts inject heroin and other drugs with equipment and techniques provided by the staff, said Thomas Kerr, a University of British Columbia researcher who has extensively studied the program.
Kerr said that while 800 overdoses have occurred on the premises, none of them resulted in death because of the medical supervision provided at InSite. His research also has shown an increase in addicts seeking drug treatment and a decrease of abandoned syringes, needle-sharing, drug-related crime and other health threats since the clinic opened, he said.
The results indicate the idea is worth replicating, despite the hackles it may raise from the White House, according to Kerr.
"I prefer the approach of the Vancouver Police Department, which was, 'We don't like the idea of this, but let's look at the evidence and at the end of three years we will tell you either this is something we can support or it's something we cant support,"' he said.
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