Hamsterdam in Vancouver

Matthew Power writes in Slate about how legalizing drug use in a building in Vancouver has worked towards addressing their drug problem. Within a government-sanctioned supervised injection site called Insite, users can do their drugs 18 hours a day, 365 days a year.

A counter was laden with clean needles, sterile water, cookers, filters, tourniquets, alcohol swabs, condoms. The database includes more than 2,000 users, identified only by code names, and an average day will see 645 injections. There are always two staffers and two nurses on duty, standing by with oxygen masks and syringes of the overdose drug naloxone. To date they have intervened in more than a thousand overdoses without a single death.

The idea of supervised injection sites is not original to Vancouver. There are approximately 90 worldwide, in eight countries: The first was opened in Bern, Switzerland, in 1986, and when Zurich closed "Needle Park," the Swiss launched supervised injection sites nationwide. The Netherlands, Spain, Germany, and several other European countries followed suit, and a site in Sydney, Australia, opened its doors in 2001. The operating principle is simple: If injection drug use is going to occur regardless, why not create a space that mitigates its dangers? That way, say its proponents, lives will be saved and the spread of disease will be checked. The risks of unsupervised injection are manifold; public drug users are often rushed and are less likely to have sterile equipment and practices. In Vancouver, researchers described addicts drawing up puddle water to mix their drugs, or doing "shake and bake," mixing the drugs in the syringe without first cooking out their impurities. Such techniques can cause gangrenous abscesses and endocarditis, a bacterial infection of the heart valves. Public users are also less apt to test their drugs for potency. "What's really difficult on this job is finding out that people use elsewhere, because the site's not open 24 hours a day, and they die of an overdose," says Fisher. "If people aren't using here, they're using behind a dumpster."