SIX MONTHS LATER, NEEDLE EXCHANGE STILL OVERDUE
The benefits of such a facility are clear, so why are the city and VIHA waiting?
Six months have passed since the closing of Victoria's only fixed-site needle exchange. What has happened in that time? Have things improved? Where will we be six months from now?
All attempts to re-establish a new location for needle exchange and support services have failed. The biggest failure was the rejection of the plan to locate the services in the old St. John's Ambulance building due to criticisms from a nearby school and neighbours.
Reports on the mobile needle exchange reveal that while the service provided by the vans is vital, it is also dangerously inadequate.
Vancouver Island Health Authority reports indicate that fewer needles are being handed out. Even more distressing is that the percentage of needles being returned is significantly lower than before closure of the fixed-site exchange.
The fact that fewer needles are being collected indicates increased risk of harm. Individuals could be sharing needles, leading to increased transmission of HIV and hepatitis C; individuals could be reusing old needles, resulting in abscesses and increased ER use; and individuals could be disposing of needles elsewhere.
The most recent reports from the B.C. Centre for Communicable Diseases indicate that the rate of new HIV infections on south Vancouver Island has not significantly decreased and the targets for reduction in HIV infections outlined by VIHA in its strategic plan are not being met.
The current situation is not sustainable. In this first year since the release of the report of the Mayor's Task Force on Breaking the Cycle of Mental Illness, Addictions and Homelessness, we have not moved forward on the recommendation to "strengthen harm reduction services to help mitigate public health and public order issues."
Instead we've actually cut harm reduction services in our community.
The situation defies all available evidence and fails to account for the clear recommendations contained in multiple reports over the past seven years to enhance needle-exchange services and develop supervised consumption sites.
Simply stated, we have closed a harm reduction service that has proven effective in reducing the transmission of disease as well as reducing other negative consequences associated with drug use, and replaced it with an ad hoc mobile service that cannot match the previous level of services.
It is time for a new "four pillars" approach to addressing the harms related to drug use, based on housing, health care, income and supports. The best safe consumption site is a home. But Housing First requires more than ACT teams. It requires access to essential health services and addressing poverty.
There must be a six-month strategy. We need to ensure that one year after the closure of the Cormorant Street facility, we can be assured that Victoria is better served than when it closed.
VIHA and the city need to spend less time on appeasing neighbourhood associations and private schools and much more time and resources replacing the inadequate Cormorant facility with the implementation of comprehensive primary health care services for those affected by drug use and poverty.
There is overall consensus to not simply replace the old Cormorant facility with the same services in a new location. We have heard support for the development of multiple, integrated safe consumption services from the city, the police, the provincial health officer, service providers and drug users. The feasibility study for such services was commissioned by the city and VIHA, completed by Benedikt Fisher in April and hopefully not shelved.
Since the needle exchange was closed, a court decision regarding Insite in Vancouver has provided a legal argument that would assert that adequate harm reduction services must be offered in order to protect the fundamental rights of individuals with an addiction.
Similarly, provincial and national nursing associations have confirmed that providing supervised consumption services is very much in their scope of practice and in compliance with standards that strive to provide competent, evidence-based and ethical care.
The newly elected Victoria council, the established Coalition to End Homelessness and VIHA must make firm commitments to the general population and to those individuals and families most affected by drug use.
What services will be in place by May 31, 2009, a year after the closure of the Cormorant Street needle exchange?