Building a healthier society, one needle at a time

As the AIDS Committee of Newfoundland and Labrador announces a significant surge in the demand for clean needles by injection drug users for the second consecutive year, a local documentary opens a window to the humanism of drug addiction and harm reduction efforts in St. John’s.

It may seem ludicrous at first, even antithetical, to give needles and syringes to a person with a drug addiction. But in the first part of 2013 the AIDS Committee of Newfoundland and Labrador (ACNL) has distributed a record number of needles to people who use intravenous drugs.

On Monday, Fran Keough of the ACNL’s Safe Works Access Program (SWAP) told The Independent the demand for clean needles within the province is continuing to surge.

“Between January and May 2012 we gave out 121,000 (needles). As of the first five months of this year we gave out 156,000,” she explained. “So we’ve had an increase in distribution of 28 per cent, and we’ve had an increase in the numbers we’re getting back – returns have increased by 48 per cent.”

Last August, ACNL Executive Director Gerard Yetman announced the organization had exhausted its government-funded annual budget barely more than half way through the year after distributing 185,000 clean needles through SWAP’s needle exchange service, primarily in Corner Brook and St. John’s.

The growing demand for clean needles prompted the province to fund a province-wide ACNL-led needs assessment research initiative, the results of which Keough says will be made public later this year.

She said the growing demand is likely a result of an increase in the number of people using injection drugs in the province and a greater awareness of, and trust in, the needle exchange services.

“I think there is more drug use but I think more people are more comfortable coming to us and are now aware of us, so are using our service.”

According to the Department of Health and Community Service’s monthly Community Disease Surveillance report for Dec. 2012, last year eight people in the province tested positive for Human Immunodeficiency Virus (HIV) and 66 for hepatitis C virus (HCV), though it’s estimated about a quarter of people who are HIV-positive do not know they have the disease.

Needle sharing among injection drug users is one of the primary means of contracting and transmitting both HCV and HIV.

Harm reduction and ideological opposition

Needle and syringe programmes (NSP) are a form of harm reduction, and harm reduction is a philosophy and approach to public health that aims primarily to reduce the negative consequences of risky behaviour. Needle exchanges like those offered by ACNL usually administer clean needles and syringes in exchange for used ones as a means to help minimize the number of dirty needles discarded in public places. They are supported by substantial evidence as an effective means to reduce the risk of HIV and HCV transmission among people who use injection drugs.

With pragmatism and humanism as its core values, harm reduction frames drug addiction as a health issue rather than criminal or legal matter. Given the deep and complex roots of addiction and substance abuse – including social and economic inequality, childhood abuse, stress, and depression, among other things – it assumes all people have equal human rights, that stigmatisation and stereotyping further marginalise people already suffering from a disease and that abstinence is not always an option for all people who are addicted to drugs, and therefore that incremental and willful improvements to one’s own health is a more realistic expectation.

Building relationships on trust and confidentiality, harm reduction workers are often better suited than doctors, nurses, and police officers to reach out and offer support and guidance to those who voluntarily contact them when they are ready to seek treatment or other help.

The more liberal approach to public health, however, stands in stark contrast to the current anti-drug (or “war on drug”) policies of the Canadian and American governments, who in recent years have pushed hard to criminalize drug addiction.

Canada’s first national drug strategy was introduced in 1987 and featured a working policy framework for prevention, treatment and reduction of the harms associated with substance use. By 1998, with evidence that needle exchange programs in several Canadian cities were proving effective, it included harm reduction as one of its four pillars, the others being education and prevention, treatment and rehabilitation, and enforcement and control.

Vancouver's Downtown Eastside is home to the Insite supervised safe-injection facility. Photo by SqueakyMarmot via Flickr (CC BY 2.0).
Vancouver’s Downtown Eastside is home to the Insite supervised safe-injection facility. Photo by SqueakyMarmot via Flickr (CC BY 2.0).

In 2003 the Government of Canada committed $245 million to Canada’s Drug Strategy over five years. A 2006 study showed, however, that 73 per cent of the money allocated to reduce the harms of illegal drug use was in fact spent on law enforcement. In 2007, led by Prime Minister Stephen Harper and the Conservative Party of Canada, the government renamed Canada’s Drug Strategy the “National Anti-Drug Strategy”, removed Health Canada as the lead agency overseeing the policy initiative by bringing the Department of Justice and Public Safety Canada into the fold, and introduced three new pillars on which the strategy would operate: preventing illegal substance use, treating people with illegal drug dependencies, and combating production and distribution of illegal drugs.

Harm reduction was not part of the new plan.

The federal Conservatives’ ideological opposition to harm reduction is epitomized by its efforts to halt funding to Vancouver’s Insite, North America’s only legal supervised safe-injection site created in 2003 to deal with the intravenous drug epidemic overwhelming the city’s Downtown Eastside, which has one of the highest HIV prevalence rates in the Western world. Insite had been operating on funding granted by the Government of British Columbia and with a special exemption of Section 56 under the Controlled Drugs and Substances Act granted by the Paul Martin federal Liberals in 2003.

In 2007 a constitutional challenge was launched by the Portland Hotel Society – the group that runs Insite – and two people with drug addictions who claim the facility and services offered there saved their lives. In response to the federal government’s plans not to extend the legal exemption which allowed Insite to operate, they argued to a B.C. Supreme Court judge that the facility’s closure would constitute a violation of the right to “security of the person” – under the Canadian Charter of Rights and Freedoms – against people who avail of Insite’s services. The judge ruled in favour of keeping Insite open, saying sections of the Canadian Criminal Code which prohibited drug trafficking and possession contravened the Charter. He also indefinitely exempted Insite from federal drug laws that would otherwise prevent it from operating legally.

The federal government appealed the court’s decision with no success, then appealed to the Supreme Court of Canada, which in 2011 upheld the B.C. court’s ruling.

Insite remains a model for other cities in North America working to establish supervised safe-injection sites and other harm reduction services. Portland Hotel Society staff physician Gabor Maté has written and spoken extensively about the importance of supervised safe-injection sites and harm reduction in general.

The Needle and The Damage Undone: inside the world of injection drug use in St. John’s

In the 1990s, long before Insite’s time, Paul Burton of Shea Heights walked into the recently formed AIDS Committee’s office downtown St. John’s and asked for a few dollars to buy some clean needles at the Woolworth Pharmacy so he could shoot up without the risk of contracting a communicable disease. The unexpected request posed an ethical dilemma for ACNL worker Tree Walsh and her colleagues, but in the end they decided to loan Burton the money. He got his needles, used them, and a few days later returned to pay back the money. Though unofficial, Newfoundland and Labrador’s first needle exchange program was born.

Burton, Walsh, Keough and others are featured in a new documentary that sheds light on the dark world of addiction and injection drug use in St. John’s. Written and directed by Mark Hoffe of Mad Mummer Media, The Needle and The Damage Undone avoids burdening the viewer with facts, statistics and preachy talking heads. Instead, the St. John’s-based filmmaker, who got his start with the Newfoundland Independent Film Cooperative (NIFCO) a decade ago and now doubles as president of the Nickel Independent Film Festival, sought out the humanity in the words and personalities of his interview subjects.

“I think it’s all about faith in human beings. You’re a human being, you made some different choices in your life that really suck,” Walsh told Hoffe in an interview that appears in the film. “So why can’t you turn that around? When someone comes to a needle exchange, it’s often their first step toward taking care of themselves in any way, shape or form.”

Speaking to The Independent on Sunday, Hoffe said he chose harm reduction and needle exchange as the subject for his first documentary because he “didn’t think the population in our province knew much about it.

Photo courtesy Mad Mummer Media.
“When someone comes to a needle exchange, it’s often their first step toward taking care of themselves in any way, shape or form.” – Tree Walsh in ‘The Needle and The Damage Undone’. Photo courtesy Mad Mummer Media.

“Rather than hit people over the head with facts and statistics, we wanted it to be a human story first,” he explained. “So the aim from the beginning was to find out how these people are, why they’re doing what they’re doing, and why they feel it’s important that other people know about harm reduction and the state of injection drug use in our province.”

Provincial NDP leader Lorraine Michael also spoke in the film.

“It’s not healthy for us to have people who are in serious situations of addiction – it doesn’t make for a healthy society,” she said. “So it is a societal problem whether we like it or not. … [W]e don’t start saying, ‘Well, you shouldn’t have got the disease – we can’t help you.’ Unless we fully understand what addiction is about and we’re non-accusatory and we don’t have prejudices, then we’re not going to have adequate programs to deal with addiction.”

Burton, who speaks openly in the film about the life experiences that drove him to substance abuse, including being a childhood victim of sexual abuse, said harm reduction is the difference between “life or death” to him.

“That’s basically what I believe. It could save your life. And people have to understand that if it wasn’t for the needle exchange program here in St. John’s, Newfoundland, there would be a hell of a lot more people infected with Hepatitis C and HIV than there is right now.”

Once he got a glimpse inside the lives of Burton and others who suffered from addiction, as well as those working on the front lines of harm reduction, Hoffe said he was forced to overcome “an engrained perception of people who use drugs” and confront “the stigmas and discrimination that I grew up with (to see) them for who they are – a human with a disease, right?” he said. “And trying to understand why their life took a turn toward drug use.

“I think once you sit down and you meet a person and you listen to their story, I would say 90 per cent of the time you’re going to understand why they are where they are and not just judge them on the street as a ‘skeet’, as I hear many people say on social media sites and whatnot. So I think just trying to get over our sense of self-importance and assuming you’re better than somebody because you choose not to do drugs was the biggest challenge.”

Meanwhile, the budding filmmaker acknowledged the situation in his home province seems to be worsening, even with growing support for SWAP’s harm reduction initiatives.

“I  think once you sit down and you meet a person and you listen to their story, I would say 90 per cent of the time you’re going to understand why they are where they are and not just judge them…”  – Mark Hoffe

“It’s really hard to nail down statistics because…people aren’t willing to openly talk about their problems with this, because they face so much discrimination over it,” he said. “So to say how many people in Newfoundland and Labrador are using drugs is almost an impossibility – you can’t find that statistic anywhere. But the AIDS committee has certainly seen a rise in the need for the service, they’ve certainly seen more needles coming in and going out every year – whether that’s more education being done and more people being aware of the service, or whether it’s a rise in the problem, it’s hard to say.

“In boom economies like this, the divide between those who have a lot of money and those who don’t gets wider,” he continued, “and with poverty comes increased drug use in general, and crime. So I think that’s contributing to it. But another important thing to remember is it’s not just people without money who do drugs, it’s everybody.”

Keough also noted the link between economic inequality and social problems like substance abuse.

“We see it right across the board – right across the country (and) globally,” she said. “When there is more money, you don’t get one without the other.”

Though she said SWAP doesn’t see as many medium or high-income drug users since, with money and without the stigma attached to people living in poverty, they have easier access to supplies.

“Naturally we would see people who have a whole lot of other barriers in their life, a lot of vulnerabilities and stuff because they have less access to other things in the community,” Keough explained. “People that are in higher tax brackets, or pooling in more money, or going about their day-to-day (lives), tending to their jobs and stuff – they don’t get questioned if they go to the pharmacy because they don’t look the part. So they can easily buy the supplies they need and get the resources they need without being questioned and without the stigma and discrimination being attached to it.”

Hoffe said getting to know the harm reduction workers and those who suffered from addiction helped him empathize with the cause, but “there was one statistic that nailed it for me,” he added. “When they said [the ACNL’s] operating budget for a year was $300,000, but then the health costs to treat somebody with HIV or hepatitis C over their lifetime is (also) $300,000…if you can prevent someone from getting HIV or hep C with a 45 cent needle, your yearly budget is paid for.”

The Needle and The Damage Undone aired on CBC Television last summer, but will make its theatrical debut tonight as the Nickel Independent Film Festival gets underway at the LSPU Hall in St. John’s. Showtime is 8 p.m. For more information, visit The Nickel’s website or call the LSPU Hall box office at (709) 753-4531, ext. 200.


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