drug injection sites

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Supervised injection sites (SIS) (also known as supervised injection facilitiessafe injection site safer injection facility (SIF), drug consumption facility (DCF) or medically supervised injection center (MSIC)) are legally sanctioned and medically supervised facilities designed to reduce nuisance from public drug use and provide a hygienic and stress-free environment for illicit drug users when consuming drugs, mostly injecting drug use.

2013 documentary film Making a Place Called Safe: A Public Health Case for a Safer Injection Facility in San Francisco interviews people on the need for a safer drug injection facility in San Francisco.

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intro’d while reading Johann Hari‘s chasing the scream.

using figures from the British Columbia coroners’ office, that drug -related fatalities were down by 80 percent in this period. To find a rise in life expectancy this drastic, you’d have to look to the end of wars— which is what this is.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 3944-3945). Bloomsbury Publishing. Kindle Edition.

with drug injection centers

.. they’ve got on to [the government] saying, ‘What’s this about somebody in Liverpool giving out crack cocaine? Close it down immediately!’

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4189-4190). Bloomsbury Publishing. Kindle Edition.

In all the time Dr. Marks had been prescribing, from 1982 to 1995 , he never had a drug-related death among his patients . Now Sydney, the Liverpool docker, went back to buying adulterated crap on the streets and died.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4194-4196). Bloomsbury Publishing. Kindle Edition.

Of the 450 patients Marks prescribed to , 20 were dead within six months, and were dead within two years. More lost limbs and caught potentially lethal diseases. They returned to the death rate for addicts under prohibition: 10 to 20 percent, similar to smallpox.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4197-4200). Bloomsbury Publishing. Kindle Edition.

(John Marks after his exile): “Whatever gave [you] the idea folk in authority operate according to reason? Your trouble is you’re being rational.”

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4210-4211). Bloomsbury Publishing. Kindle Edition.

Ruth Dreifuss – first female president of Switzerland and the first Jewish president of Switzerland. Even more significant , she would become the first president in the world since the 1930s who decided to run not away from drug reform, but toward it. She dedicated her presidency to sitting with addicts, listening to addicts, defending addicts— and getting them a legal supply of their drugs. (influenced by John Marks)

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4234-4237). Bloomsbury Publishing. Kindle Edition.

She found that sex workers, if you arm them with condoms and information, are actually “very good public health agents. But you have to trust them. You have to accept their job. So prevention begins with respect.”

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4254-4256). Bloomsbury Publishing. Kindle Edition.

would they choose sex as work if they didn’t have to work? if money weren’t an issue? – deeper still – no?

It had been discovered a few years before in Switzerland that there was a clause in Swiss law that allowed heroin to be given to citizens, provided it was part of a scientific experiment….   So Ruth said— Okay, we are going to have a really large experiment.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4262-4264). Bloomsbury Publishing. Kindle Edition.

a people experiment. 

rat park for 7 billion people.

let’s.

This is an emergency, she explained , and in emergencies, you take dramatic steps.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Location 4268). Bloomsbury Publishing. Kindle Edition.

Suddenly, his constant scrambling for his drugs was taken away, and he had a day ahead of him he had to fill. He tells me patients here “have to reinvent our lives. We have to reinvent the imagination.”

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4291-4293). Bloomsbury Publishing. Kindle Edition.

or just be quiet enough to find/listen to it again. no?

everyday. groundhog day. new day. ness. equity. the revolution: instigating utopia (rat park) everyday.

okay, what am I going to do now?” It’s hard to do this , after being addicted for so long, but Jean says “the pain I have now isn’t the pain of a sickness . It’s the pain of being reborn.”

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4295-4297). Bloomsbury Publishing. Kindle Edition.

detox

But within a few months, most addicts stop asking for more and choose , of their own free will, to stabilize their doses. 64 After that, “most of them want to go always down,” explains the psychiatrist here, Dr. Rita Manghi.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4308-4310). Bloomsbury Publishing. Kindle Edition.

trust people. spaces of permission. time and space. lag time.

Suddenly, the slightly depressing debate at the start of the drug war between Harry Anslinger and Henry Smith Williams— prohibition forever versus prescription forever— seems bogus.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4313-4314). Bloomsbury Publishing. Kindle Edition.

“This program,” Jean says, “gives you the chance to recover the control you have lost,” step by step, day by day.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4317-4318). Bloomsbury Publishing. Kindle Edition.

what we all need. no?

Over time, as your life has more in it, the glass will contain more and more, so it will take less and less heroin to fill it up. And in the end, there may be enough within you that you feel full without any heroin at all. Users can stay on this program for as long as they want, but the average patient will come here for three years, and at the end of that time, only 15 percent are still using every day.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4323-4326). Bloomsbury Publishing. Kindle Edition.

Ruth and the many people who agreed with her introduced something to the drug debate that nobody had ever tried anywhere else in the world. Ever since Anslinger , the drug warriors had presented themselves as the forces of order ranged against the chaos that would inevitably be brought by any relaxation in the drug laws. But, in a political jujitsu move , Ruth reversed that argument. Swiss citizens could see now that U.S.-style drug crackdowns had brought chaos to their streets —and after the government provided a legal route to heroin, the chaos vanished. So they argued that the drug war means disorder, while ending the drug war means slowly restoring order. This argument won. In 1997, some 70 percent of Swiss electors voted to keep the reforms. In 2008, the conservative forces regrouped and called another referendum. The campaign supported by Ruth ran posters of a young mother with her baby, saying: “I want to keep our public parks free of syringes.” Another poster showed a couple in their fifties saying: “Thanks to treatment, our son could quit drugs.” This time, 68 percent 78 backed the policy.

These campaigns showed, in embryo, the case that, I believe, could end prohibition around the world. 

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4353-4363). Bloomsbury Publishing. Kindle Edition.

there is no group that you can abandon.” – Ruth

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Location 4380). Bloomsbury Publishing. Kindle Edition.

How could it be, I asked myself, that opiate prescription worked so well in Switzerland but was proving to be a disaster in the United States? Is this just a deep cultural difference? Or is there a flaw in the Swiss model that I’m not seeing?

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4408-4410). Bloomsbury Publishing. Kindle Edition.

1\ us drug prescription isn’t like the swiss one – ie: once dr finds out a person is addicted.. he/she has to stop prescribing.. 24 yr prison sentence

2\ not a lack of access but an excess of agony/isolation – economic crisis

3\ prohibition always narrows the market to the most potent possible substance. – ie: Oxy is three times more expensive than heroin—

The war on drugs makes it almost impossible for drug users to get milder forms of their drug— and it pushes them inexorably toward harder drugs.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4530-4538). Bloomsbury Publishing. Kindle Edition.

the old drug war story— the chemical is to blame, and if only we could eradicate the chemical, we could eradicate the problem. It is a tempting story, because it is so simple— and allows us to avert our eyes from how much of this problem was created not by pills, but by people.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4539-4541). Bloomsbury Publishing. Kindle Edition.

the Swiss heroin experiment, combined with Rat Park, offers us the best answer not only to heroin, but to the prescription drug crisis, too.

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Location 4542). Bloomsbury Publishing. Kindle Edition.

throw in people experiment – for 7 billion issues.. crises..  no?

One afternoon, in the heroin clinic in Geneva, I told one of the psychiatrists there, Dr. Manghi , about how this story had all happened before, long ago, in Los Angeles. Heroin was prescribed; people got better; then it was shut down. Then again, much later, in Liverpool: heroin was prescribed; people got better; then it was shut down. She stroked her wooden necklace, thinking. “It’s like relapse in addiction,” she said. “It might look discouraging. But at every relapse, you learn something new.”

Hari, Johann (2015-01-20). Chasing the Scream: The First and Last Days of the War on Drugs (Kindle Locations 4544-4547). Bloomsbury Publishing. Kindle Edition.

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so… first in vancouver..

Insite is the only legal supervised drug injection site in North America, located at 139 East Hastings Street, in theDowntown Eastside (DTES) neighbourhood of Vancouver, British Columbia. http://en.wikipedia.org/wiki/Insite 

via John Marks – (currently exiled to n zealand) – influencing Ruth Dreifuss (was president of switzerland)  http://en.wikipedia.org/wiki/Ruth_Dreifuss

then in switzerland…

Heroin assisted treatment is fully a part of the national health system in Switzerland, Germany, the Netherlands, Denmarkand the United Kingdom. Additional trials are being carried out in Canada and Belgium.

1994-2014 summary (swiss heroin assisted treatment):

http://www.citizensopposingprohibition.org/resources/swiss-heroin-assisted-treatment-1994-2009-summary/

  • Crime Issues: 60% drop in felony crimes by patients (80% drop after one year in the program). 82% drop in patients selling heroin.
  • Death Rates: No one has died from a heroin overdose since the inception of the program. The heroin used is inspected for purity and strength by technicians.
  • Cost Issues: 48 dollars/day: Patient costs are covered by national health insurance agency. Patients pay 700 dollars/year  for the compulsory insurance. Note: The Swiss save about 38 dollars per day per patient mostly in lowered costs for court and police time, due to less crime committed by the patients.

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Looks like Seattle, Washington will be the 1st US city to start a legal safe injection site. Others soon to follow.
https://t.co/EJqzuudw6A

Original Tweet: https://twitter.com/ethannadelmann/status/826110360021237760

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addiction

Gabor Maté