Sunday, July 30, 2006

July 22, 2006

The latest survey on the habits of street-level injection drug users in the Capital Region is a grim little reminder of all the things we don’t yet get about addiction.
Since the last assessment in 2003, the only bright spot in the most recent survey is a two per cent decrease in the HIV rate. Virtually all other indicators - rates of hepatitis-C, amount of needle-sharing, condom use - have gone in the wrong direction.
As is our wont, we’ve talked and talked for years about addiction and drug use. If words were all it took, we’d be living in a drug-free paradise by now.
But we’re not. The Vancouver Island Health Authority’s newly released report on needle users in the downtown is most definitely proof of that.
Almost three-quarters of the 250 needle users surveyed by VIHA at two downtown social agencies last year tested positive for hepatitis-C, an increase of more than five per cent from the 2003 survey. Forty-two per cent reported sharing needles, also a five per cent increase.
Meanwhile, the number of needle users who had sex in the previous month without using a condom jumped 10 per cent between 2003 and 2005, to 65 per cent. The news gets even worse for the sex partners of those surveyed: almost a quarter of users with HIV or hepatitis-C hadn’t known they were infected prior to being tested as part of the VIHA study.
All of this is unfolding in a region that gives the appearance of working hard to combat the ravages of addiction. We’ve provided free access to clean needles and condoms for many years, and launched countless high-profile campaigns aimed at reducing risk behaviours.
More recently, we’ve sent the mayor to Europe to check out safe-injection sites, and debated in council meetings whether to install drop boxes around the city for users to dump their dirty needles. If ever there was a time and a place to attempt to be a “safe” and responsible needle user, here and now in the Capital Region is pretty much as good as it gets anywhere in Canada.
And such efforts are laudable. Consider how the stats might look by now had we continued to do nothing at all. As bad as things are among street-level needle users, they’d be significantly worse at this point if not for needle exchanges and other harm-reduction strategies. Ninety-two per cent of those surveyed in the VIHA report ( use local needle exchanges, and most said they’d frequent a safe injection site as well if the region had one.
But the problems of addiction won’t be dealt with as simply as making it easier and safer to use drugs. Addiction is what happens when hurting people with susceptible genetics discover something that takes the pain away. Drug use at that level is a complex behaviour far removed from the act that it appears to be on the surface.
On the streets, where the only “good times” are the brief moments before and after injecting, sharing needles can be the way people express friendship and trust. It can also be the way they express self-loathing, something of which they’re all very familiar with.
For one young needle user I know, it’s all about getting the drugs into her body as quickly as possible, before she has to think about it. If that means sharing a needle, or shooting herself up in the neck or straight through her filthy pant leg despite having been cautioned against both acts dozens of times, so be it.
There are ways to help her, and others as well. But they don’t exist in the Capital Region. Small wonder, then, that problems are worsening.
Clean needles and safe places to use drugs are just one piece of the puzzle. If we’re ever to get a handle on addiction, we need to rethink our entire strategy.
Family support. A place to live. A sense of belonging. Sober and happy pregnancies. Drug treatment. Mental-health care. Hope for the future. It all matters.
The VIHA report, done in conjunction with the Public Health Agency of Canada, barely scratches the surface around the full impact of substance abuse.
With surveys conducted only at Streetlink and the downtown needle exchange, any of the region’s 1,500 to 2,000 injection drug users who don’t use street services were automatically excluded. Women were also underrepresented, again because of the survey sites (most of Streetlink’s clients are male).
So as troubling as the VIHA survey is, it’s still just a partial picture. There’s a firestorm coming, and somebody’s going to have to do something about that.

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