Page 8
Street Roots • Aug. 28-Sept. 3, 2015
News
Page 9
News
Street Roots • Aug. 28-Sept. 3, 2015
How some U.S. cities are campaigning for a controversial solution to public intravenous drug use
It's really challenging to address safer
injection, education and overdose
effectively when it's happening ...
BEHIND
CLOSED
DOORS
BY EMILY GREEN
STAFF W R IT E R
n the concrete floor of a public
restroom, inside a parking garage in
Portland’s Old Town, a heroin addict
took his last breaths. He was overdosing while
his “street brother” pounded aggressively on
the locked door that stood between them.
“I don’t know if it was stronger or if he did
more than Usual,” says Raymond Thornton, as
he recounts his 40-year-old friend’s untimely
death. He had been a couple of blocks away
from the SmartPark garage on Northwest
Naito Parkway and Davis Street when he
heard news of the overdose. When he arrived,
he saw an ambulance, “but he was already
gone,” Thornton says.
This was one of 60 heroin-related deaths in
Multnomah County in 2010. There would be
284 more over the next four years. All deaths
where heroin is found present in the
bloodstream are categorized as heroin-related
deaths by the state medical examiner.
“There’s been a significant increase in
heroin use in the last few years in the
Portland area,” says Kim Toevs, Multnomah
County Health Department harm reduction
manager.
In 2014, there were 122 heroin-related
deaths in Oregon, 80 of which were in
Portland’s tri-county area — three fewer than
the year prior, although Multnomah County’s
heroin-related deaths were down
significantly, from 65 to 54,
according to Oregon State Police
medical examiner reports.
, ! This decrease is a sign ’'
Oregon lawmakers’ 2014
move to allow for wider
distribution of the
overdose-reducing drug
naloxone is helping
reduce deaths from
overdose in places where
it’s available to users,
Toevs says.
Naloxone is not
distributed in Washington
County, where heroin-related
death rates have increased, or
Clackamas County, where they have
stayed roughly the same.
Multnomah County’s homeless
popluation is hit disproportionately.
While homeless individuals make up
less than 1 percent of the county’s
total population, they accounted for
25 percent of heroin-related
deaths in 2014. A total of 57
homeless people died with
heroin listed as a contributing
or primary factor in their
death during the past four
years.
O
Death lurks in the
shadows
Injecting unregulated
drugs is risky for many
reasons. The potency of
the dose and nature of
contaminants put into
the drug by dealers and
suppliers is often
unknown to the user.
“Cut,” a study on
contaminants found in
illicit drugs by the Centre
for Public Health at
P H O T O C O U R T E S Y O F T A E K O FR O ST
D uring the film in g o f “Everywhere B u t Safe," Sarah, Rock and J eff talk on a stairway near the site where they reversed an overdose in Washington
Heights, N.Y. The film is aim s to spread awareness about the risks and problems associated with public injection.
Liverpool John Moores University, found many
adulterants manufacturers cut into heroin can
cause overdose and a host of other adverse
health reactions.
Lindsay Jenkins, Multnomah County" Health
Department research analyst, said taking a few
days off from heroin can lower tolerance
levels, increasing the chance of overdose.
Being sick or run down or mixing opiates with
other drugs also increases the risk of
overdose, she says.
Additionally, when intravenous drug users
inject in a place hidden from public view, such
as in an alley or behind a dumpster, an
overdose has the potential to kill them before
anyone sees they’re in trouble — or before
help can get to them, like Thornton’s friend.
Thornton, an ex-heroin user familiar with
life on Portland’s streets, says injecting drugs
with other users doesn’t necessarily make it
any safer.
“So many times, people shoot up in a group
and when someone can’t handle it, they just
leave them there,” Thornton says. “They don’t
want to get in trouble.”
The Good Samaritan Law that passed
during this year’s legislative session is aimed
at encouraging people to call 911 in these
cases; after Jan. 1, they will be immune from
prosecution when doing so.
Heroin users aren’t the only ones injecting
drugs.
“The number of visits to syringe exchange
sites by people who said meth was their
primary drug injected has increased steadily
over the last four years,” Jenkins says.
However, she says that doesn’t necessarily
mean more people are injecting meth. As of
2014, meth addicts accounted for 19 percent
of syringe exchange users in the county.
In 2014, meth-related deaths in Oregon
reached an all-time high of 166, exceeding
heroin-related deaths for the second year in a
I row- But in Multnomah County, heroin is still
■ a factor, in more drug-related deaths than :
•
(m etham phétam itte .1
■ <
A controversial solution
The visibility of Portland’s homeless crisis
and drug problem has become a point of
contention with business and citizens groups
pressuring City Hall to find solutions.
During a recent presentation to Mayor
Charlie Hales, the North Park Block
Neighbors shared photos of people injecting
drugs openly in the park blocks between
Northwest Eighth and Park avenues.
Public injection, whether hidden or in plain
view, has also contributed to the abundance of
dirty needles sprinkled around Portland,
reported on repeatedly by KGW earlier this
year — from failed cleanup efforts under the
Burnside Bridge to needles found near
playgrounds.
Many cities outside of the U.S. have
discovered an effective but controversial
solution that’s proved to significantly reduce
the occurrence of many problems associated
with injection drug use.
Now, harm-reduction advocates and drug
users in several major U.S. cities are
campaigning to bring this approach, known as
supervised injection, to the United States.
Supervised-injection sites, also known as
drug consumption rooms, have been operating
in many parts of Europe since the 1980s and
i in Australia and Canada since the early 2000s.
They offer a dedicated space for people to
i inject illicit drugs, which they have already
obtained, under the supervision of trained
medical staff who are there to intervene with
life-saving measures if anything goes awry.
Staff also teaches safer injection methods and
offers counseling and a connection to
resources when a user is ready to quit
There are close to 100 operating
supervised-injection facilities around the
world.
Numerous independent, peer-reviewed
studies have indicated supervised-injection
sites significantly reduce deaths from
overdose, increase drug-treatment enrollment
among intravenous drug users and decrease
rates of public drug use.
Within the first 12 weeks of opening,
Vancouver, B.C.’s supervised-injection site,
Insite, was independently responsible for near
50 percent reductions in public injections,
improper syringe disposal and other injection
related litter, according to a study by the
Canadian Medical Association.
In another study of Insite, conducted four
years later by the University of British
Columbia and the British Columbia Centre
for Excellence in HIV/AIDS, 23 percent
of respondents stopped injecting before
the study had ended and 57 percent
had entered addiction treatm ent
Seventy-one percent indicated Insite had
led to less public injecting.
According to a summary of 44 studies
on supervised-injection sites put together
by Ontario HIV Treatment Network, not only
do supervised-injection sites reduce overdose
incidence, fatality rates and injection-related
disease, they also “lead to reductions in
injecting behavior and an increase in the
number of clients accessing addiction
treatm ent services.”
It also found these sites “do not lead to any
significant disruptions in public order or safety
in the neighborhoods where they are located.”
The biggest victory among supervised-
injection advocates so far came in 2012 when
the New Mexico Legislature approved a
feasibility study on establishing a supervised-
injection facility, but that effort lost
momentum shortly thereafter.
Another campaign has been underway in
San Francisco since 2007, and social service
agencies and health departments in Boston,
Los Angeles, Washington D.C. and other U.S.
cities have started talking about the possibility
of introducing supervised-injection facilities,
as well, according to a representative for Drug
Policy Alliance, a national leader in promoting
drug policy reform.
“We’re sort of where syringe access was in
the early days of needle exchange,” says Laura
Thomas, who has been working on the
campaign in San Francisco in her role as the
deputy director of California’s branch of Drug
Policy Alliance.
She says some San Francisco-area
politicians, as well as the city attorney, have
become supportive of the idea; however, “it’s
continued to face the same kind of political
barriers and pushback that it’s faced in other
areas.”
One of the big issues driving political will to
find solutions to public drug use in San
Francisco is gentrification. It has brought
million-dollar condos to neighborhoods that
that
didn’t have real estate like
before, Thomas says.
“I know Portland
is going through
a lot of the
same thing in
different ways,”
she says. “Some
of these newer
residents have
expressed a lot of
concern about
people
who are homeless, homeless encampments in
the area, things like syringes being found on
sidewalks and street comers, and things like
that. Even though it’s not necessarily a new
issue, it’s new people seeing them and
complaining about them.”
She says this dynamic has pushed the
issues of syringe disposal and public drug use
higher on police and health departm ents’
agendas.
“In the next few years, we’re going to see
some real breakthroughs,” Thomas says. “I
think New York is taking the lead right now,
but it’s a really pragmatic solution, and it’s got
all the evidence behind it.”
A documentary that premiered in Harlem,
N.Y., on Aug. 25, “Everywhere But Safe,”
highlights the dangers of public injecting and
its effect on communities where it’s prevalent
The film’s co-directors, Taeko Frost and Matt
Curtis, both work for New York City social
service agencies, and they say the film is a
way of educating the public and policymakers
about the problems public injection poses.
It’s their hope that once people become
aware, they will be more likely to support the
establishment of a supervised-injection room.
The film’s premiere kicked off two months of
events aimed at spreading awareness and
lobbying elected officials.
Curtis, the policy director at VOCAL NY,
says there are no laws against supervised-
injection sites in the U.S., “but there are
some real questions about the gray areas of
this. At the end of the day, it needs to be a
place where it’s legal to possess and use
drugs.
“At minimum,” he says, “you’d want an
exemption of some variety from the drug laws
so that a cop couldn’t walk in there and bust
somebody.”
It’s important that local law enforcement is
supportive so “they’re not targeting people
outside and profiling people for going into the
location and harassing them later,” he says.
A previous effort to establish safe
rooms in New York in 2005 “trickled
out,” Curtis says.
Frost, director at Washington
Heights CORNER Project, which
offers a syringe exchange and
other harm-reduction services,
sees the renewed effort as a
reaction to having clients
“overdose left and right” at her
clinic.
“It’s really challenging to address
safer injection, education and overdose
effectively when it’s happening behind
closed doors — whether it’s here or
outside in the community,” she says. “We
know that people who are injecting in
See INJECTION, page 11
M ultnom ah County Health Department
employee Shelley Dunlop gives a tutorial
on how to adm inister a dose o f naloxone,
an overdose-reversing drug that county
officials say is helping reduce overdose
P H O T O BY
M A R IO T T A
G A R Y -S M IT H
Coming to the U.S. soon?
In August, advocates in New York
City are launching a campaign and
lobbying effort aimed at
establishing what would be the
first supervised-injection site in
the U.S.
■ i