Heroin and Creating Safe Injection Sites

DATE March 1, 2004 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Stephen Quinn discusses Vancouver, Canada's, safe
injection site
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

In dealing with heroin addicts, the Canadian city of Vancouver is trying an
experimental program that would be unthinkable in most American cities and
would be political suicide for any American politician who supported it. But
it's a program that Vancouver's mayor, Larry Campbell, campaigned on. Last
September he opened the city's safe injection site. It's a storefront where
heroin addicts can inject their drugs with clean needles in the presence of
nurses without risking arrest. The goal is to limit the spread of HIV and
other infections, prevent overdoses, counsel addicts and refer them to drug
treatment centers. The site is party of the city's policy to treat addiction
as a health problem.

Vancouver is the first city in North America to open a legal safe injection
site, but similar sites are operating in approximately 50 cities in Germany,
Switzerland, the Netherlands, Spain and Australia. Later we'll hear from
Mayor Larry Campbell and from a nurse who treats addicts on the streets of
Vancouver and supervises their injections.

First, we're going to hear from journalist Stephen Quinn, who covers city hall
in Vancouver for the Canadian Broadcasting Corporation and has been reporting
on the safe injection site. I asked him to describe the site.

Mr. STEPHEN QUINN (Canadian Broadcasting Corporation): From the street it's
fairly anonymous. When you walk up to it, you may not know what it is. It's
a street-level storefront in a renovated heritage building. It's probably the
nicest-looking thing on the block. When you walk in there's a counter, a sort
of reception area. And the back room of the site itself is 12 stainless-steel
carrels, sort of like library carrels you might see in a university library.
That's where the injections take place. It's clean. It is functional.
There's a room where people can sit for a while after they've injected.
They'll get some medical attention there if they need it. There are a number
of staff and nurses. It looks like a medical facility. It looks like a
clinic of some kind.

GROSS: What is the block like?

Mr. QUINN: The block is notorious in the city of Vancouver. Some
people--police, for instance--refer to it simply as `the 100'. It's the 100
block of East Hastings Street. And the center of the drug trade in the city
has been the corner of Main and Hastings, which is at the heart of a
neighborhood called the Downtown East Side. The downtown East Side is--well,
it has the distinction of being Canada's poorest postal code or ZIP code. A
lot of people down there, a majority of people, are infected with HIV, with
hepatitis C. A majority of the population lives in the small, little
residential hotel rooms that welfare pays for.

The block itself has a lot of vacant storefronts in it and a lot of bars that
are underneath the hotels and some pawn shops and some little grocery stores
that don't really have much on the shelves. But the block has been in the
past the center of all drug activity in the city. Now police have made a very
concerted effort to try to crack down on that over the last year. They've had
a special project going down there where they doubled or tripled the number of
officers who walk that beat. They park a police cruiser up at the top of the
block near a place called the Carnegie Center. The Carnegie Center is a sort
of library and community center that used to be just crowded with drug
dealers. In the middle of the day you could stand on the stairs there and
watching 20 crack cocaine deals go down a minute in front of you, and police
really didn't do much to stop it.

The belief was always that police were happy as long as the drug trade was
contained to that one block. But since the crackdown a lot of the dealers
have moved elsewhere, and the block has actually been cleaned up a lot.
Residents down there will sure tell you that they're happy with it.

GROSS: It sounds like no one is objecting to the safe injection site because
it's attracting drug users or because it's, you know, a bad thing for the
neighborhood. It sounds like the neighborhood is already in really bad shape
and that the drug users already live there.

Mr. QUINN: Yeah, that's right. And the police crackdown sort of coincided
with the opening of the safe injection site. In fact, it happened just a few
months before but in preparation for the opening of the supervised injection
site. There's kind of a zero tolerance policy on drug dealing around the safe
injection site. Police just don't want people standing outside the door
selling heroin there for people to take inside and shoot up. So police are
quite proud of the fact that they've cleaned the block up. In truth, you
don't have to walk very far around the corner to find out where all of the
drug dealers have gone; they're just hanging around in the adjacent alleys and
the streets around the neighborhood. Some have moved to other parts of the
downtown.

But the neighborhood--if you just talk to people on the street down there,
there's more legitimate activity returning to that block and returning to the
neighborhood. There are a couple of cafes now where people are actually
sitting on the sidewalk having coffee. And if you talk to those people, most
people are happy with the extra police attention that the safe injection site
has brought.

GROSS: How is the identity of the drug users protected when they go to the
supervised injection site, protected so that they're not arrested in a
crackdown in six weeks?

Mr. QUINN: There was a lot of concern about that from the beginning. There's
a surveillance camera, for instance, on the way into the injection site, and a
lot of people didn't like the idea of being photographed. They register when
they go in. A lot of these people can't provide any identification, so
sometimes registration is simply a first name. And then they probably rely on
staff recognition to a great deal after that. There are--2,000 people are
registered users of the site now, and the staff is a fairly regular staff. So
they have a pretty good idea of who is coming and going.

But that was what made a lot of drug users apprehensive about using this site
in the first place--was that it was government and government operated through
the provincial government and the Health Board. And they didn't like the idea
of losing their anonymity or certainly the anonymity they had when they were
injecting in the back lanes. They didn't like the idea that this was
something official and something that was government sanctioned. It seems
most people have got over that now. The site itself has done a great job of
recruiting people from the neighborhood, people who are former drug users,
people who have worked with drug advocacy groups. So you can walk in there
and recognize a lot of the faces that you would see on the street in the
Downtown East Side as people who are now employees of the site.

GROSS: Is the medical staff comprised of nurses? Are there doctors on the
staff, too?

Mr. QUINN: Nurses. There are a total of 16 nurses on staff, and they're all
trained in dealing with injection drug users. They're trained to deal with
people with problems like HIV and hepatitis C. They spend a lot of time
looking after wounds. A lot of people walk into the site, and they have open
sores or untreated wounds. And if someone is sitting in the chill out room
after injecting, a nurse may try to help them dress their wound or talk to
them about taking care of it or that sort of thing. And there are still
street nurses working down there as well, who are walking up and down the back
lanes and trying to get people into the supervised injection site or even in
the back alleys helping people inject safely in the back alleys. Again, it
sounds a little unusual to have a nurse walking around the back alleys of the
city doing that, but that's exactly what they do.

GROSS: You know, the kind of program we're talking about, a supervised
injection site with nurses making sure that addicts don't kill themselves, you
know, by overdosing and making sure that they have, like, clean needles so
that they don't get HIV--this kind of thing is so unlikely to happen anytime
in the near future in the United States. And it would probably be considered
political suicide for any politician who tried to introduce such a program.
What was the public reaction when the mayor of Vancouver introduced the
program, and do you think he did an effective job in explaining his reasons
for introducing it?

Mr. QUINN: Well, what was interesting was that this wasn't a sitting mayor
who introduced the supervised injection site. This was a mayor who actually
campaigned on it and got an unprecedented number of votes and who--the voter
turnout for the last civic election was bigger than it's been in 80 years in
this city. It was an issue that he campaigned on vigorously. And it was all
to do with changing the mind set of people, telling people that, `Injection
drug users aren't criminals; that they're people who have an illness, they're
people who have an addiction and that this is something that should be treated
as a medical problem and not as a criminal problem. The symptoms of the drug
trade end up being criminal in that people are breaking into cars to get the
$10 they need to get their next hit. But the addicts themselves are people
with a medical problem.' And he hammered away at that for a long time and
spent a lot of time selling it, and it seems to have been successful. You
don't hear a lot of people now saying that this was a bad decision, that this
was a bad idea.

GROSS: Was there an organized opposition when the idea was first proposed?

Mr. QUINN: There was. There was a lot of fear from the Chinatown community,
which is nearby, which is just a couple of blocks away. And Chinatown has
always had a very dodgy relationship with the Downtown East Side. They've
hired their own private security force to sort of patrol the storefronts to,
more or less, push drug users out of neighborhood. There was a really
concerted effort by a merchants association there to fight the supervised
injection site. There were a number of Downtown East Side business
owners--there's a part of the neighborhood that's being gentrified, so you get
a lot of, you know, architects' offices and designers, and that sort of thing
has moved into the neighborhood. They were opposed to the safe injection site
to begin with. If they are still opposed, they are no longer vocal about it.
We don't hear any opposition about it. But those people, the Chinatown
merchants association--there was a lot of opposition to begin with, yeah.

GROSS: Is there anything that has been particularly controversial about the
supervised injection site since it's opened?

Mr. QUINN: Not a whole lot. If there's one thing I can point out, it's that
the number of overdoses that they've recorded at the site has become a little
bit of a political football. People use the number of overdoses as evidence
that lives have been saved in there. I think the number we had for the first
two months the site was open was about 25 overdoses. That doesn't mean that
every one of those people would have died had they not had immediate medical
attention. Sometimes an overdose intervention is nothing more than nudging
somebody on a shoulder and saying, `Hey, are you OK there, Dave? Are you with
me?' They count that as an injection intervention, but it doesn't mean that
someone would died as a result of an overdose. The mayor's office likes to
say, `Well, about a quarter of those 25 people, you know, may have succumbed.'
The Health Authority says it's closer to two or three people; it really isn't
that many per month that actually require medical attention or they get moved
out by ambulance. It's very rare that an ambulance gets called to the site
because the nurses there know what they're doing. And it's very rare that
police get called to the site. So the number of lives saved potentially has
become a bit of a political football.

GROSS: Are there numbers that have been published yet about how many people
use the supervised injection site each day or any projections of how many
people have been saved from contracting HIV because of the clean needles
available at the site?

Mr. QUINN: Well, none of those numbers have been released yet. They're
waiting--after six months of the site operating, they'll release some of the
preliminary figures. But, again, those probably won't be very telling.
Remember, we've had clean needles available in the Downtown East Side since
1988. Right now they distribute about three million needles a year to
addicts, and that's either through the storefront offices--there's actually a
table set up on the sidewalk where addicts can walk up and get clean needles.
There's a van that drives around the back lanes handing clean needles out to
people. The street nurses distribute clean needles. So whether those rates
of infection will actually drop and whether any of that is attributable to the
supervised injection site, I think they're going to have a hard time figuring
out those numbers.

The number of overdose deaths hasn't actually dropped. In, I believe,
2000--the last three months of 2002 we had about 18 people die of overdoses.
In 2003, when the site was open for three months, we had about 16 or
18--again, just about the same number of people die in the neighborhood of
overdose deaths. So there hasn't been any tremendous drop in that either.
Again, all of the figures are really preliminary, and this is a three-year
trial project. Health Canada, which is one of the partners in this, has
funded the clinical study for three years. So they'll probably make some
determination at the end of three years.

GROSS: Is there any breakdown that you've seen so far in terms of gender or
ethnicity, race, you know, in terms of who's showing up at the safe injection
site?

Mr. QUINN: Well, the one thing the Health Authority says that it's surprised
to see is the number of women who have registered as users of the site. Of
the 2,000 people who have registered as users, 40 percent of them are women,
and proportionately that's way more women than live in the Downtown East Side.
And they say this is good for a couple of reasons, the first being that
they're, you know, putting more women in contact with health services, which
is great, but, secondly, because when two people are in a back alley
injecting, inevitably it's the woman who ends up getting the needle second.
And they're much more likely to contract whatever the disease is of the first
person on the needle. The health people say they call it `second on a
needle.' So they're really happy to see the number of women registered in the
site be so high, be as high as 40 percent. And, you know, they're saying that
that by itself is a success, even before any actual figures come out.

GROSS: My guest is journalist Stephen Quinn of the CBC. We'll talk more
about Vancouver's safe injection site after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Stephen Quinn of the Canadian Broadcasting Corporation.
He's been covering Vancouver's new safe injection site.

Is there any way of measuring if the supervised injection site has had any
impact on crime? Even if you argue that addicts aren't criminals, they're
just sick, they need medical help, they're addicted, many addicts steal in
order to get money for the drugs that they need to buy. And a supervised
injection site doesn't eliminate the need to get money to buy the drugs.

Mr. QUINN: No, it doesn't, and that's the one part of this that police don't
like. Virtually all petty crime in the--and when I say petty crime, I mean
most of it is people breaking into automobiles and stealing CDs and whatever
happens to be visible in the car. Most petty crime is driven by the drug
trade. Break-and-enters to houses are driven by the drug trade; certainly,
you know, most shoplifting. If you walk into any of those bars in the
Downtown East Side, you can buy virtually anything you want from somebody
sitting at one of the tables. That's definitely been a downside. And it's
identified a problem, which is now we've got harm reduction, but there still
isn't adequate drug treatment.

And so while the supervised injection site may be referring two or three
people a day to drug treatment, a place where they can go get clean, those
facilities just aren't there. The number of people who want treatment far
exceeds the number of treatment spaces available. And, ultimately, the goal
is to get people off the drugs, to cure people's addictions or to at least put
them into a remission. And that hasn't happened. And a lot of people who are
the victims of break-and-enters, while they may be sympathetic with what the
mayor's been trying to do, there's still a lot of frustration that these
crimes are happening because people need money for drugs. And everybody in
the city feels that. The crime rate has, by no means, dropped when it comes
to petty crime. If anything, it's got worse.

GROSS: Do you think this program is likely to continue after Mayor Campbell
leaves office?

Mr. QUINN: That's a good question. You know, it was Mayor Campbell's
predecessor, a person by the name of Philip Owen, who actually got the ball
rolling on this. And I don't know how this can go backwards now. It seems to
be so widely accepted by the public, only because it's not that big an issue
for the other people who live in this city, people who have no contact with
that neighborhood at all. I don't know how you can go back. And I'd be very
interested to see the results that come out of this because I don't know how
those results are going to be interpreted. What's probably even more
controversial than this is there's a free heroin trial that's scheduled to
begin in a little while giving addicts, actually providing them, with free
heroin. So this is going to pale in comparison to that study when all they're
doing here is providing people a place to shoot up safely.

GROSS: Where will that study be conducted, and what is the rationale behind
it?

Mr. QUINN: The Kaiser Foundation, in fact, is funding it, and it's being done
through Health Canada in three cities in the country: Toronto, Montreal and
Vancouver. They haven't found a location for the heroin trial yet, but it's
going to include about 300 people; 150 of them will be given
pharmaceutical-grade heroin to inject, along with Methadone. And I think
there's a control group that will receive just Methadone. And this is a study
that's supposed to take place--I think it's over two years. And there's,
again, been a lot of opposition about that: `It's bad enough that you're
giving people someplace to shoot their drugs. My God, do you now have to give
them the drugs to shoot?' But the idea is that for people for whom Methadone
may not be an appropriate treatment, maybe putting them on heroin maintenance
is a better treatment. If you can supervise the dosage, if you can supervise
the injection and if you can--the idea is to see if it leads to any better
health outcome--I guess that's the phrase they would use--two years down the
road.

GROSS: Are other Canadian cities keeping their eyes on the supervised
injection site program in Vancouver and considering trying a program like
that?

Mr. QUINN: I would imagine they are, and I know that other cities here in
Canada have needle exchanges, but nobody has gone as far as Vancouver has. I
think people are waiting to see some of their results. Again, this is the
city going out on a limb here. I mean, this has not been tried in North
America before. And people have all of the fears that you asked about
earlier: `Is it going to attract drug dealers? Are you enabling people
rather than helping them? Are you, you know, creating a drug market? Is
crime going to increase?' I think people are waiting for all of those answers
to come out of Vancouver. I think the mayor, because of who he is--you know,
he's a former RCMP officer, he's walked that beat as a drug cop, he's become a
coroner--he's a little bit of a folk hero. I don't know if you're aware that
there's a TV series here modeled on his life. There's a television series
about a chief coroner who investigates the deaths of people who have died in
strange circumstances. He's a little bit of a folk hero that way, and I think
a lot of--I don't know that other cities have a leader who is willing to take
those sorts of risks.

GROSS: Well, Stephen Quinn, thank you very much for talking with us.

Mr. QUINN: You're very welcome.

GROSS: Stephen Quinn covers City Hall for the CBC. We'll meet the mayor of
Vancouver and talk more about the safe injection site in the second half of
the show. I'm Terry Gross, and this is FRESH AIR.

(Soundbite of music)

(Announcements)

GROSS: Coming up, Larry Campbell, the mayor of Vancouver, who campaigned in
support of the safe injection site. He opened the site last September. He's
a former narcotics officer. And we talk with Nurse Fiona Gold, who treats
addicts on the streets of Vancouver.

(Soundbite of music)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Larry Campbell discusses the safe injection site in
Vancouver, Canada
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Today we're talking about an experimental program in the Canadian city of
Vancouver, which is treating heroin addiction as a health problem, not a
criminal problem. In September the city opened a safe injection site, a
storefront location, where addicts can get clean needles and inject in the
presence of a nurse. The goal is to prevent overdoses as well as the spread
of HIV and other infections and to counsel addicts and refer them for
treatment. Vancouver's mayor, Larry Campbell, who opened the site, is a
former narcotics officer. He also served as British Columbia's chief coroner.
I asked Mayor Campbell to explain the legal parameters of the program.
Although the drugs remain illegal in the city, users do not risk arrest at the
safe injection site.

Mayor LARRY CAMPBELL (Vancouver, Canada): Basically, this is set up under a
medical supervision. This is a scientific study that is allowed under all of
the agreements the country signed with regards to drugs. So that's the first
thing. The second thing is that we believe in what's called the Four Pillars,
which is Harm Reduction, prevention, treatment and enforcement. And the
police have worked very well with us. We have a very progressive police
force, a progressive police chief. And so, in fact, in many cases they're
directing addicts who are shooting up in alleys to go to the supervised
injection site. You do not want to be dealing in the immediate vicinity,
however, or you will suffer the consequences of the law.

GROSS: Can you explain a little more the understanding that your office, the
mayor's office, has with the police about how to enforce drug laws now that
you have this program in effect?

Mayor CAMPBELL: Well, I'm also the chair of the Police Board.

GROSS: Uh-huh.

Mayor CAMPBELL: So it's an understanding that we're going to be pragmatic
about what is going on here. We don't ignore enforcement. But, quite
frankly, prior to this coming into place, we did not arrest people for simple
possession of heroin or cocaine or crack unless there was some other reason
for doing it--for instance, you may have a warrant outstanding, or you may be
committing another offense--because there were just too many people. You
couldn't do it. We'd have no police left on the street. We're carrying
forward with that. We're seeing certainly the people where we've, you know,
set up the injection site--the police have put in a program to deal with drug
dealing. And it's a much quieter, probably much safer and certainly more
sightly place that it was four months ago.

GROSS: Do you and the police make a big distinction between drug users and
drug dealers and how you enforce the law?

Mayor CAMPBELL: Yes. A drug user is somebody who's suffering from a disease.
A drug dealer is somebody who's peddling death and will be arrested and will
be charged.

GROSS: So the police are much more likely to go after the dealers than the
users.

Mayor CAMPBELL: Oh, there's no question.

GROSS: And while we're on the subject of the police, what kind of protection
do the police officer in the area of the supervised injection site? I mean,
are there--do the police have protection for the health workers who are there
and for the other addicts?

Mayor CAMPBELL: Well, there is no need for protection. We haven't had one
incident of either violence or anything like that. I mean, there's a
misguided thinking that addicts are violent. They're not violent at all. So
it hasn't been an issue. It's not an issue at any of the other injection
sites around the world. So it's not that the health--in fact, there are no
police inside the health care facility.

GROSS: Before you became the mayor of Vancouver, you worked as a narcotics
officer, and then you served as British Columbia's chief coroner.

Mayor CAMPBELL: That's right.

GROSS: How did your experiences in those areas affect your point of view now
about safe injection sites, supervised injection sites?

Mayor CAMPBELL: Well, I was a narcotics officer in the Royal Canadian Mounted
Police first, so I viewed drugs from a criminal point of view. When I became
coroner and chief coroner, I had to take a different view that my job then was
not to enforce the law but was, rather, to keep people alive. And so I was
able to take a look at this and come to the conclusion that this is a medical
problem and has to be treated as such. And so I suppose I had a significant
change in thinking.

GROSS: When you were a narcotics agent, did you believe at that time that a
low-enforcement approach to drugs was effective?

Mayor CAMPBELL: Yes. Yes, I did.

GROSS: What made you think that then?

Mayor CAMPBELL: I think because it was a different time and a different
place. If we could get back to, for instance, the early '70s, if we could go
back to the level that we had at that time, we'd probably as a society be
feeling very good. But the disease and the problems associated with drug
addiction have just ballooned, have mushroomed. I mean, we've gone from
heroin to cocaine, crystal meth, cocaine and heroin as speedballs. It's an
entirely different world now, and enforcement simply cannot deal with it.
I'll give you an example. In the early '70s we seized a kilogram of heroin at
the airport. There'd be panic on the streets of Vancouver; it would affect
the distribution so much. Recently we took a hundred kilos off, and we didn't
miss a beat. In fact, more people died after that.

The heroin on the street, at one points was close to 100 percent pure, which
says to me there's a huge amount of drugs out there. They're not even
stepping on it. So the type of drugs, the type of people, the number of
people have changed dramatically. And, in many cases, we've allowed that to
happen. We've given up on parts of our cities; just said, `Well, that's the
way it always is,' and given up on them. I'm not prepared to give up on any
part of my city.

GROSS: Do you think that Vancouver has had a proportionately large drug
problem, larger than other cities of a comparable size?

Mayor CAMPBELL: At one time we had probably the highest death rate in North
America...

GROSS: Well, why do you think that is?

Mayor CAMPBELL: ...from overdoses. Well, we're on the Pacific. We have easy
access to Asian heroin. We are also a port city where you can get--you know,
cocaine comes up from the south. Methamphetamine is readily available. It's
because we're--I mean, we've always had drugs in this city. It's a port city;
it's always had it. Why did we get to that point? I think because of the
large number of addicts, the purity of the drug and just, I think, a general
disregard for the area where the majority of these deaths took place.

GROSS: Are you worried that now that you have this supervised injection site,
in which you can legally get medical supervision while you shoot up, that
other addicts will be attracted to Vancouver and, in the long run, you'll have
a bigger problem on your hands?

Mayor CAMPBELL: No, there's no evidence--the scientific evidence actually is
the opposite. There is no honey-pot effect to the supervised injection site.
We aren't giving out drugs. So if you have a five-block radius, that's about
it. And so we know that people won't move to--they don't come just for a safe
injection site. They'll use it if it's there and within their geography, but
they will not move to it.

GROSS: What about tourism? Afraid it's going to hurt tourism?

Mayor CAMPBELL: No. Why would it hurt tourism? In fact, we're seeing a
tremendous change in this neighborhood. It is the most historical part of
Vancouver. I mean, it's where Vancouver started. It's the heart of
Vancouver.

GROSS: My guest is the mayor of Vancouver, Larry Campbell. We'll talk more
about the city's new safe injection site after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is the mayor of Vancouver, Larry Campbell. Last September he
opened the city's safe injection site. It's part of the city's policy of
treating addiction as a health problem.

From your vantage point in Vancouver, how does the US approach to dealing with
drug addiction look to you?

Mayor CAMPBELL: It's a failure. It's not that there--I mean, there's no
other way to describe it. You have a prison system which is a growth
industry. You have a very disproportionate number of people in prison for
drug offenses. And enforcement doesn't work. We know that. By itself, it
simply does not work. Just look at the facts. I mean, it doesn't work.

GROSS: I think one of the theories here behind the criminal penalties for
drug possession--it's partly this--the fear that drug addicts may not be
violent people, but they may resort to violence to get the money to score the
drugs. What are your perceptions, as a former narcotics officer, about the
connection between drug use and crime and about the connection between drug
users and needing to get the money to purchase the drugs? And drugs are not
cheap usually, not heroin anyway.

Mayor CAMPBELL: Well, there's no question...

GROSS: Yeah.

Mayor CAMPBELL: ...I mean, we have a tremendous property crime in Vancouver
that is driven by drug addicts. And there's a direct correlation between drug
addiction and crime, and that's why, at the end of the day, you want to be
getting people into treatment, you want to be getting them off of the drugs in
whatever manner that may be. `Just say no' works for about 10 percent. I
know that 10 percent will respond to opiate treatment, heroin maintenance.
And in the middle is 80 percent who are responding to Methadone, to
counseling, any number of different methods. But to just throw them in jail
does nothing. What do you do? You have an addict that goes to jail. Then
they come out of jail, and they start all over again. So unless you want an
industry of jails, then you need to do something different. And, you know, to
be pragmatic, jails are tremendously expensive compared to treatment. Jails
are tremendously expensive compared to prevention. This whole thing is about,
you know, not only helping the addicts from a medical point of view but also
helping society. I mean, what's an addict cost us in stolen property? And we
can deal with that.

GROSS: Part of your Four Pillars is treatment for drug addiction...

Mayor CAMPBELL: Yes.

GROSS: ...helping people to get off of drugs. What are you doing in that
area now?

Mayor CAMPBELL: We don't have near enough treatment that is recognizable.
The one area that I'm doing is trying to get a catalog of all the treatment
within the province. But there is a recognition that we don't have enough;
that it has to be on demand. When an addict's ready to go into treatment, we
have to be able to have that treatment there because it's a fleeting thing for
them. It's a part of the disease. And so we need to get treatment on demand.
I mean, that's one of the things that we're pushing, of course, with the
federal and provincial governments.

GROSS: I don't know if you plan on having a political career when your term
as mayor is up, but do you think that the work you're doing with drugs now,
particularly the supervised injection site--do you think that that will prove
to be good or bad for your political career?

Mayor CAMPBELL: I don't plan on having a political career because I don't
consider myself a politician. If I never ran again, I've succeeded. There
are people alive because of the work of Philip Owen before me and myself and
my council and the cities of Vancouver. This is just one thing that's the
right thing to do, and so I don't plan on--I don't have any huge political
ambitions.

GROSS: Are you confident that this program will continue when you leave
office?

Mayor CAMPBELL: Yes.

GROSS: Why are you so confident about it?

Mayor CAMPBELL: Because it works, and any politician loves to have something
that works.

GROSS: And how important is this program in your larger plan as mayor? Is
this, like, just another thing, or is this toward the top of your priorities?

Mayor CAMPBELL: Well, I think probably the two things that were the largest
issues during the election was the drug use and transit. It's critical to my
trying to help the Downtown East Side become a healthy and prosperous place
for all the citizens who live there now, not necessarily those who move in.
And so, certainly, helping with the drug addiction, the issues of poverty,
which are also associated with drug addiction, are critical to the vitality of
this neighborhood. So it would be a linchpin.

GROSS: How, finally, will you judge the success of this program? How will
you finally evaluate it?

Mayor CAMPBELL: It's actually being evaluated as we go along. It's a
three-year project. It's being independently evaluated on many number of
criteria. I suppose the ones that I would be interested in is the drop in
disease, drop in deaths, a drop in crime and a rise in the livability of the
area. And I think that those are all measurable and will all be looked at
during this period. But there's many other criteria that's been studied
scientifically.

GROSS: Have you spoken to any of the addicts who use the supervised injection
site?

Mayor CAMPBELL: I've spoken to a couple of them, not very many of them. I've
spoken to thousands of addicts before that. I've sort of stayed out of the
way of it because I don't want it to become a political--I mean, for the first
couple of days we had camera crews camped outside it and that, and now they've
gone away. And, I mean, it's a quiet success, and that's really how it should
be. I see it the same as a cancer clinic, for instance. It's simply a
medical facility to help people with an illness.

GROSS: I'll tell you, if I was an addict, I'm not sure I'd want to be
introduced to the mayor.

Mayor CAMPBELL: Oh, they love meeting me. I'm a great guy.

GROSS: Oh, yeah? No, I won't...

Mayor CAMPBELL: Sure.

GROSS: But, no, you don't necessarily welcome being introduced as an addict
to somebody who represents the law.

Mayor CAMPBELL: I don't judge them, and I don't represent the law. They
don't mind meeting me because I recognize that they have a disease, they have
an illness. And they're not stigmatized to me. I have no idea how they
became there, but I do know this: They didn't wake up--they weren't born with
the idea that someday they'd be a junkie. So, you know, for whatever reason,
they became addicted. And sometimes it's because they made a bad decision to
try drugs, but, you know, thousands of people try drugs and don't get
addicted. I mean, it's a--you know, an addiction is an illness, and it can
take many forms.

GROSS: If you could go back again to your years working as a narcotics
officer, if you could go back knowing then what you know now, would you have
changed your approach to dealing with drugs, drug users?

Mayor CAMPBELL: I wouldn't have been a narcotics officer.

GROSS: Go on. Yeah?

Mayor CAMPBELL: I mean, it would be--I think that there still is a role for a
narcotics officer. I don't know that I would have been there in that
position. I didn't want you to think that I didn't enjoy being a narcotics
officer because I very much enjoyed all of my time in the Mounted Police. I
think that probably now, when I look back--if it was now, if I was a narcotics
officer, I'd be going out and getting a degree in accounting, so I can chase
the money. I think that that's where we should be going. I would be going
out and finding out, you know, how all of these major crime rings are
interconnected and not worrying so much about what's going on on the street
but taking it off at the top. That's always the aim of every narcotics
officer, but now I think it's very much more complicated.

GROSS: Well, Mayor Campbell, thank you very much for talking with us.

Mayor CAMPBELL: OK. Thank you.

GROSS: Mayor Larry Campbell is the mayor of Vancouver.

Coming up, we hear from a nurse who works with addicts on the streets of
Vancouver. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Fiona Gold discusses working as a street nurse to help
drug addicts
TERRY GROSS, host:

The nurses who work with Vancouver's safe injection site are not giving
interviews now, but we talked with a nurse who does similar work. Fiona Gold
is a street nurse with the AIDS and sexually transmitted diseases prevention
program run by the Center for Disease Control of British Columbia, the
Canadian province that Vancouver is located in. She's been with the program
for eight years: four as a street nurse, four as a team leader. She still
works with addicts on the streets of Vancouver two nights a week. I asked her
to describe a typical night.

Ms. FIONA GOLD (Nurse, AIDS and sexually transmitted diseases prevention
program, Center for Disease Control of British Columbia): Wednesday nights I
usually buddy up with drug users in a certain part of Vancouver. It's the
east part of Vancouver. And we head out. They have a needle exchange route
that they do, and I go along as the nurse. And it's very interesting. I
mean, we just run into users in back alleys, you know, hanging around the bus
stations, that kind of thing. And very often--I think what's really important
in working as a street nurse is that there's a lot of consistency; that you're
just out there the same night, you're there again and again. And any outreach
worker knows this but that you're there again and again because very often I
think working with people who are struggling with addiction, you have to gain
a certain amount of trust. And that trust comes from just being really
straightforward, really honest with people. I mean, in our program we work
very much with a client-centered approach, so we really allow clients to
determine what they want to do with respect to their health care.

GROSS: Now do you do the kind of work that the nurses do in the safe
injection site, where you will help an addict find a vein or...

Ms. GOLD: Yeah.

GROSS: ...safely shoot up?

Ms. GOLD: Absolutely. I mean, that's part of building a rapport. And our
primary concern here is health, and I think that's where--you know, that was
the big shift that happened in Vancouver. People had to stop viewing this as
a criminal issue but really start viewing it as a health issue. And we will
sit down and we will say, `Look, you know, you're missing all over the place.
You've got abscesses through the ying-yang.' And, I mean, some people's arms
were just unbelievable in the late 1990s. I mean, as a nurse coming from the
hospital, I was horrified at what I was seeing on the street. I was seeing
people with enormous holes in their arm, so you could see the bone, you know?
And I just really felt, you know, we have to help people do this as safely as
possible. And in that, you build a relationship with that person, and that
relationship does lead into a day where that person says, `You know, I've got
to get off this stuff. Can you help me? Can you help me find a detox bed?
Can you help me find a treatment facility?'

GROSS: What can you do that will help prevent an addict's arm turning into,
you know, lots of abscesses...

Ms. GOLD: A bigger hole.

GROSS: Yeah, right...

Ms. GOLD: Yeah.

GROSS: ...to prevent that big hole with the bone sticking out?

Ms. GOLD: Yeah. What we usually do is we just encourage people, really, to
cook their drugs; that's number one. So to take a spoon, put their drug in a
spoon, add water and to cook it with a lighter. And what that does is it just
kills the bacteria. Then we also hand out filters, and we--when they draw
this solution up into the needle, we say, `Use the filter because it will
filter out any of the cut the dealers might have used.' I mean, sometimes
dealers use talcum powder or gypsum or--there's all kinds of things that
people use to make the drugs go further.

GROSS: What are some of the other addiction-related wounds or health problems
that you can treat meeting somebody on the street?

Ms. GOLD: Well, you know, when you think of addiction-related, you think
right away the real basics: `Are they eating enough? Do they have a place to
sleep?' Those are big, huge ones. Then in terms of, you know, actual sharing
needles or, you know, drawing water out of puddles--I mean, as soon as you
have needle-sharing going on, you have risks for HIV, for hepatitis C and
other blood-borne pathogens. And this is quite common. You know, people will
inject a little bit, and then they'll give it to their girlfriends, you know,
or the other way around. And you get the transmission of blood-borne
pathogens that way. You also end up in situations where if people have not
cooked it, they're also injecting a kind of bacteria. And this can be--I
mean, we just had this situation where people were drawing water out of
puddles in alleys, and this water--I mean, there's garbage containers there,
so on, so forth, and they're injecting this into their body. And so the
concern there is, of course, that the person will go into a state of sepsis.

GROSS: Is it ever hard to continue standing by a person when you've seen them
blow their chances to get off of the drug and when you've seen them, you know,
get deeper and deeper into addiction or crime?

Ms. GOLD: No. For me, that's not really an issue because I think, you know,
that very much, you know, getting more street-involved, getting more into
crime, that kind of thing, it is all fueled by the addiction, and that's a
part of it. I mean, a part of it is, you know, you--and this is very much the
philosophy of the safe injection site. You know, I might not be able to get
you, as a drug user, from the street today into a detox bed because it's way
too freaky for you to go directly from a street into a detox or a treatment
program. And so maybe we need to come up with some middle steps, and some of
those middle steps do involve falling off the wagon and involve maybe
accessing a safe injection site. And, really, through accessing a safe
injection site or something like that, you can develop a rapport with the
people, the nurses, the other workers that are working in the injection site
and through that rapport really begin to develop a relationship back to the
health care system.

GROSS: Do you ever feel at risk working on the streets?

Ms. GOLD: You know, we always try and buddy up, so we're either with another
member of the community--we do a lot of collaborative work with different
community organizations. So usually we have somebody with us. You know,
sometimes the nurses go out in twos or the nurses go out with a health care
worker, or we're buddied up with somebody from the community. And the only
situations where I've really felt uncomfortable is when there's a mental
health component and a lot of drugs on top of that. I've been in a couple of
situations where I thought, `Yeah, I have to get out of here.'

GROSS: And have any of the nursing organizations taken a stand on the Street
Nursing Program?

Ms. GOLD: Yeah, they have. The Registered Nurses Association here of
British Columbia--they basically said that supervising injections for the
purposes of education and health promotion was completely within the scope of
nursing practice. And that was actually a very strong statement that came out
from the Nursing Association and I think a statement that really pushed Health
Canada forward.

GROSS: The Street Nurse Program that you work with started about 16 years
ago, and the safe injection site in the city of Vancouver just started a few
months ago. How has the initiation of the safe injection site affected your
work on the street?

Ms. GOLD: You know, it's really quite amazing. We really see a huge decrease
in people injecting in the lanes, and I can't tell you how happy that makes
me, you know, just not to see people, like, cowering behind garbage
containers, you know, putting needles in their arms. And so that's been a
really positive step. And we're also hearing from users on the street that
they do like accessing the injection site.

GROSS: Fiona Gold, thank you very much for talking with us.

Ms. GOLD: Oh, you're more than welcome.

GROSS: Fiona Gold is a team leader with the AIDS and sexually transmitted
diseases prevention Street Nurse Program, which is run by the Center for
Disease Control of British Columbia.

Last week NPR ran a series about heroin use in the US. You can hear those
stories and get information about drug-treatment resources on NPR's Web site,
npr.org.

(Soundbite of music)

(Credits)

GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.