Drug addicts shun mobile needle exchange

Far fewer needles handed out and returned since fixed-site exchange was closed

Victoria's mobile needle exchange is handing out far fewer needles to addicts than its fixed-site predecessor, statistics released yesterday show.

The experiences of Peter, who has used both services, might explain why.

Before the Cormorant Street needle exchange closed on May 31, Peter picked up a supply of clean needles every day.

"I had my routine of going down there," the 32-year-old cocaine and heroin addict, who declined to give his last name, said last night as he sat on the grass outside the Our Place shelter on Pandora Avenue. "Now I have to chase the mobile exchange all over the streets in a 10-block radius and I miss them sometimes and I end up going without clean needles."

Needle exchanges are promoted as a service that reduces the spread of disease among addicts by providing them with clean syringes to inject their drugs. But critics have also suggested that exchanges encourage illicit drug use.

A report released yesterday shows the number of needles supplied by the mobile exchange is down 23 per cent, from about 35,000 a month at the fixed site to 27,000 in August from the mobile unit.

Needles returned amount to just 40 per cent of those going out, a sharp drop from the 70 per cent return rate at the Cormorant Street exchange.

The figures were released by the Vancouver Island Health Authority and AIDS Vancouver Island in a summary of the first three months of the mobile service.

The Cormorant Street needle exchange closed after neighbours complained about illegal drug activity. The mobile service is supposed to be a stop-gap measure until a new permanent site can be located.

A decrease in needles coming back could indicate a number of things, said Katrina Jensen, executive director for AIDS Vancouver Island. "There are a number of factors, one is that they're disposing of them in other ways, like putting them in the garbage," said Jensen. Another possibility is that clients are keeping them and haven't used them yet, she said.

"Some clients may be taking extra syringes to keep them going for several months, and that's why we're not seeing those ones come back. It could also be that clients are using their own syringes and refusing ours."

There haven't been reports of a spike in the number of syringes discarded on the streets, said Jensen.

Aside from the syringes, clients aren't taking part in counselling services to the extent they did at the permanent site. There is no privacy and those working on the mobile service don't have the time, said Jensen.

"Due to the public nature of the mobile service a lot of clients aren't comfortable engaging in long conversations with workers. They just want to get their stuff and be gone."

Concern is mounting over how the mobile service will fare when cooler weather sends illicit drug users indoors, Jensen said.

Victoria Coun. Charlayne Thornton-Joe is concerned by the decrease in the number of needles exchanged by the mobile service.

"It concerns me that a major city does not have a fixed site," Thornton-Joe said. "It's a loss. I've always been an advocate for a fixed site which offers support and services."

Thornton-Joe has discussed the issue at meetings with the Downtown Service Providers and the clean and safe committee of the Downtown Victoria Business Association.

Thornton-Joe would like to see statistics from other local groups who hand out or take back needles. Some groups take in needles, but don't give them out, she explained.

The councillor would also like to see statistics on addicts' increased use of crack pipes, instead of needles.

"I'm hearing from street nurses that people are re-using needles and health issues are going to increase because of that," said Thornton-Joe.

Back on the grass outside Our Place, Peter pulled up his pant leg to show an abscess on his leg that became infected two weeks ago after he injected drugs with a dirty needle. The abscess required surgery at Royal Jubilee Hospital. But because he only runs into the mobile exchange service about every three days, Peter said he continues to put his health at risk.

"An hour ago, I had to use a dirty needle to suck dope out of a spoon and transfer it into another dirty needle and put it in my arm," he said.

Then by chance, five minutes before speaking to the Times Colonist, Peter ran into the mobile needle exchange and took a handful of syringes.

"Here's a lost soul looking for one right now," he said, handing a syringe to a young girl who sat down beside him. "If I don't give her one, she'll find one in the sewers."
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source: © Times Colonist (Victoria) 2008

Methadone Legal under the UN Drug Conventions, according to...the UN Drug Conventions!

Over the past week, the HR2 team has been reading through our recently arrived (and notoriously difficult to obtain) copies of the Official Commentaries on the 1961, 1971 and 1988 UN Drug Conventions, as well as the Commentary to the 1972 Protocol amending the 1961 Convention.

These four volumes, each several hundred pages in length, are the official explanatory notes from the UN itself to member states on how to interpret each of the articles in the Conventions. In essence, the Commentaries put ‘meat on the bone’ in providing detailed guidance to states on what the drug conventions mean, don’t mean and how they are to be interpreted and implemented.

Already we are finding some interesting material.

For example, the Commentary on the 1988 Convention under Article 3 (Offences and Sanctions) expressly recognises methadone as a legitimate form of treatment. To quote the Commentary:

‘The 1971 Convention and the 1961 Convention as amended by the 1972 Protocol include a provision (identical in the two texts) to the effect that when drug abusers have committed offences under the Convention, the parties may provide, either as an alternative to conviction or punishment or in addition to conviction or punishment, that such abusers undergo measures of treatment, education, aftercare rehabilitation or social integration. Paragarph 4, subparagraphs (b), (c) and (d), of the 1988 Convention, while drawing upon that earlier provision, widen the scope of application to drug offenders in general, whether abusers or not.’ (at para 3.106) [emphasis added]

Leaving aside the antiquated language of ‘abusers’, what the 1988 Commentary reiterates is the support found in all three Conventions for drug treatment instead of, or in addition to, penal sanctions for drug offences. This is not news. What is interesting, however, is where the Commentary on the 1988 Convention goes on to define what the Conventions mean by ‘treatment’.

As stated in paragraph 3.109 of the Commentary:

‘”Treatment” will typically include individual counselling, group counselling or referral to a support group, which may involve out-patient day care, day support, in-patient care or therapeutic community support. A number of treatment facilities may prescribe pharmacological treatment such as methadone maintenance, but referrals are most frequently to drug-free programmes.’ [emphasis added]

Paragraph 3.110 of the Commentary also lists 'a maintenance programme' within the definition of legitimate - and therefore legal - 'aftercare' programmes.

But the 1988 Commentary is not the only one that cites substitution treatment as a legitimate and legal intervention.

The Commentary on the 1971 Convention also lists 'medically justified "maintenance systems"' under the definition of 'treatment' (at page 332, para 3, fn 1080) and a 'maintenance programme' within the definition of 'after-care' (at page 332, para 4). The Commentary to the 1972 Protocol to the 1961 Convention similarly lists 'medically justified "maintenance programmes"' within the definition of 'treatment' (at page 84, para 3, fn 4) as well as under 'after-care' (at page 85, para 4).

So according to the official UN Commentaries, methadone maintenance is an accepted form of treatment and after-care under all three Drug Conventions, and is explicitly recognised as being legally consistent with the definition of these terms under the Conventions.

This will certainly come as news to the Russian Government, which prohibits methadone on the claim that it is illegal under the Conventions. As stated by Russia’s Minister of Internal Affairs Boris Gryzlov in 2003, the country’s prohibition of methadone was ‘not the government’s own initiative…but rather the result of our responsibility to implement the UN drug conventions of 1961, 1971, and 1988.’

Just the opposite, methadone is expressly allowed under all three Conventions according to the official Commentaries.

It might also come as news to the International Narcotics Control Board, whose record of luke-warm support for methadone is chronicled in the excellent 'Closed to Reason' report produced by the Canadian HIV/AIDS Legal Network and the Open Society Institute.

For the benefit of the Russian Government, the INCB and the many others who could benefit from access from these hard-to-find Commentaries, IHRA is currently working with Transform Drug Policy Foundation to make them available online.
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source: http://www.ihrablog.net