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Pacific Summit on Drug User Health 2009. HEALTH STATUS OF PEOPLE WHO USE ILLICIT DRUGS IN BRITISH COLUMBIA. Overview: Prevalence of Drug Use in British Columbia. Number of Persons Using Injected Drugs by Geographic Area Number of Crack Smokers in British Columbia.

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Pacific Summit on Drug User Health 2009

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Pacific summit on drug user health 2009

Pacific Summit on Drug User Health 2009

HEALTH STATUSOF PEOPLE WHO USE ILLICIT DRUGS INBRITISH COLUMBIA


Overview prevalence of drug use in british columbia

Overview: Prevalence of Drug Use in British Columbia

  • Number of Persons Using Injected Drugs by Geographic Area

  • Number of Crack Smokers in British Columbia

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Number of persons using injected drugs

Number of Persons Using Injected Drugs

Canada :

British Columbia :

Vancouver :

Downtown Eastside :

125,000

40,000

10,000-12,000

5,000

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Number of crack smokers in british columbia

Number of Crack Smokers in British Columbia

British Columbia:

Downtown Eastside:

55,000 (Approx.)

7,000 (Approx.)

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Overview prevalence of drug use in british columbia1

Overview: Prevalence of Drug Use in British Columbia

  • Number of Persons Using Injected Drugs by Geographic Area

  • Number of Crack Smokers in British Columbia

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Pacific summit on drug user health 2009

CCENDU Report, 2005

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Pacific summit on drug user health 2009

Illicit Drug Deaths

In 2005, 146 illicit drug deaths in BC (down from 417 deaths in 1998). In 2005, deaths in the DTES were 7 times the provincial rate.

Highest rate of overdose deaths for people between the ages of 31-40

Overdoses for men was more than double the rate for women. Individuals of First Nations ethnicity accounted for 9.6% of illicit drug deaths although only 4.4% of the BC population.

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Death rates attributable to illegal drugs

Death rates attributable to illegal drugs

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Illicit drug deaths

Illicit Drug Deaths

By Local Health Area of death 2006 (n= 223)

Source: http://www.harmreductionjournal.com/content/6/1/9

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Pacific summit on drug user health 2009

Illicit Drug Deaths

By Gender

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Pacific summit on drug user health 2009

Illicit Drug Deaths

In B.C. by Ethnicity

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Overview: Non-Fatal Drug Overdose

1) Ambulance calls for the 2 stations that serve the majority of DTES calls

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Overview: Blood-Borne Pathogens

1) HIV Prevalence and Newly Positive HIV Tests Vancouver and B.C.

2) Newly Positive HIV Tests with Identifiable Risk Factor

3) Reported Hep C Rates in Vancouver, B.C. and Canada

4) Rate of Newly Identified Hep C by Health Service Delivery Area

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Hiv rates

HIV Rates

The prevalence of HIV among IDUs is reported to be somewhere between 17% to 31%.

In Vancouver, HIV prevalence among Aboriginal IDUs has increased from less than 5% in the early 1990s to approximately 40% in 2004. (CCENDU)

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Pacific summit on drug user health 2009

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Pacific summit on drug user health 2009

Hepatitis C Rates - Vancouver, BC and Canada

* DTES core HCV rate 2007= 788/100,000

Source BCCDC iPHIS

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Overview hospitalization rates

Overview: Hospitalization Rates

1) Hospitalization Rates Attributable to

Illegal Drugs by Region

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Hospitalization Rates Attributable

To Illegal Drugs

37% increase 2002 to 2007

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Overview methadone and opiate treatments

Overview: Methadone and Opiate Treatments

  • B.C. Methadone Stats

  • B.C. Methadone Program Clients by Age and Gender

  • B.C. Methadone Program Clients Receiving Methadone Maintenance

  • Info on First Nations Access To Methadone

  • Info on Buprenorphine

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B c methadone statistics

B.C. Methadone Statistics

A small number of physicians are licensed to prescribe methadone

The CPSBC no longer reports on the geographic distribution of methadone prescribing physicians, but in 2001, 44% of methadone prescribing physicians were located in the Lower Mainland, 22% on Vancouver Island or the Gulf Islands, 8% in the Okanagan, 7% in Fraser Valley, and 4% in Northern BC.

Doses are dispensed on a daily basis, so it is difficult to maintain a regular job for many people

The BC government pays pharmacists $16.30 for every daily dose of methadone they dispense. If a pharmacy can get a user to fill all of their prescriptions at its outlet, it receives approximately $6,000 a year in dispensing fees, just for that customer (CBC News, Sept. 2008)

In spite of the College of Pharmacists ‘no inducement’ policy, many methadone-distributing pharmacies in the DTES provide coffee and cookies and offer cash kickbacks.

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Pacific summit on drug user health 2009

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Pacific summit on drug user health 2009

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First nations access to methadone

First Nations Access to Methadone

The First Nations population has a higher illicit drug use mortality rate than the BC population as a whole.

Despite this fact, methadone is not available on reserve

Those seeking services may be forced to travel long distances to larger urban areas to obtain methadone.

Although First Nations may have access to methadone while living in other jurisdictions there is a lack of comprehensive harm reduction services available to those living in rural and reserve communities.

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Buprenorphine

Buprenorphine

Buprenorphine has been available as SUBOXONE in the United States since 2003. In Europe, buprenorphine was introduced during the mid-90s. It is available in 17 countries in Europe alone. Today, more than 400,000 opioid-dependent patients worldwide have been treated with buprenorphine.

SUBOXONE was approved by Health Canada in May of 2007

Buprenorphine may increase safety and treatment access for opioid-dependent patients. Taken on its own, SUBOXONE has lower potential for fatal overdose than a full opioid agonist because it has a limited effect on reducing breathing.

The effect of buprenorphine peaks at 1–4 hours after the initial dose.

Although buprenorphine has not yet been priced in Canada, in the United States the cost of a month’s supply of the drug may be as much as 10 times that of the cost of a standard month’s supply of methadone. (as of 2006)

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Overview needle exchange harm reduction supplies

Overview: Needle Exchange & Harm Reduction Supplies

  • Info on Needle Distribution in B.C. and Needles Distributed by Region

  • B.C. Needle Distribution Map

  • B.C. Needle Exchange Map

  • Harm Reduction Supplies Distributed by the Vancouver Health Service Distribution Area

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Provincial needle distribution

Provincial Needle Distribution

Needles Per Population

The Harm Reduction Supply Service (HRSS) Program, previously known as the Needle Exchange Program was transferred to Provincial Health Services Authority on April 1st 2003

From April 1st 2006, to February 15th 2007, (10.5 months) 5,023,600 sterile needles and syringes were ordered from the BC Center for Disease Control for the entire province.

The greatest proportion (52%) was ordered by Vancouver Coastal, followed by the Vancouver Island (24%), Interior (9%), Northern (8%) and Fraser (7%) Health Authorities.

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Pacific summit on drug user health 2009

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Harm reduction supplies vancouver

Harm Reduction Supplies - Vancouver

In BC, 5 million syringes; 2.4 million water vials distributed/yr

2008/09 -- 218 x 100 ft plastic tubing – cut into 4 inch mouth pieces; 37,200 wooden push sticks

Source: BC Centre for Disease Control pharmacy database

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Overview enforcement court police and prison

Overview: Enforcement, Court, Police and Prison

  • Vancouver and B.C. Enforcement Stats

  • B.C. Drug Offences by Crime Type

  • B.C. Drug Offences by Drug Type

  • Breakdown of Federal Offences

  • Info on Legal Aid Cuts for Procedural Offences

  • Canadian Drug Charge Conviction Stats

  • Stats on Drug Use In Canadian Prisons

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Enforcement

Enforcement

In Canada, 70% of federal funding to address the drug problem goes to enforcement-based initiatives.

Locally, VPD’s budget for District 2 has nearly doubled ($6.7 million in 1995 ---- $11.2 million in 2001)

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Drug offences in bc 1998 2007

Drug Offences in BC, 1998-2007

Source: Police Services Division,

Ministry of Public Safety and Solicitor General, BC

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Drug offences in bc 1998 20071

Drug Offences in BC, 1998-2007

Source: Police Services Division,

Ministry of Public Safety and Solicitor General, BC

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Breakdown of federal offences 2006 2007

Breakdown of Federal Offences (2006-2007)

Statistics Courtesy of Corrections and Conditional Release Statistical Overview 2008, available online at: http://www.publicsafety.gc.ca/res/cor/rep/2008-04-ccrso-eng.aspx#a3

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Legal aid cuts for procedural offences

Legal Aid Cuts for Procedural Offences

Legal Aid cuts which came into force on April 1, 2009 have withdrawn access to legal aid lawyers to those charged with procedural offences, including breach of probation, breach of bail conditions or failure to appear. These persons may face sentences of up to six months in jail.

The only access to help navigating the justice system will be brief meetings with duty counsel, who can discuss the charges but will not represent these individuals in court.

Information courtesy of the CBC News, available online at: http://www.cbc.ca/canada/british-columbia/story/2009/04/01/bc-legal-aid-cuts-could-jam-courts.html

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Drug charge convictions

Drug Charge Convictions

Drug-related cases are less likely to result in conviction than cases in general. In 2006/2007, 55% of adult cases and 48% of youth cases involving drug-related charges resulted in a finding of guilt. This compares with 65% and 60% for cases in general.

A higher proportion of drug-related cases were stayed, withdrawn, dismissed or discharged compared with cases in general.

In 2006/2007, half of all adults convicted of drug trafficking were sentenced to custody, compared with 16% of adults convicted of drug possession. For youth, probation was the most common sentence for both possession and trafficking convictions.

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Drug use in canadian prisons

Drug Use in Canadian Prisons

  • 12% of inmates reported using IV drugs only while in prison

  • 68% admitted to having used them both on the street and in prison

  • 23% reported sharing a needle only in prison

  • 47% admitted to sharing needles both in and out of prison

A study of self-reported drug users in Canadian penitentiaries

found that:

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Overview women and drug use

Overview: Women and Drug Use

  • Stats on Women’s Health from “Me I’m Living With It, VANDU Women’s Report”

  • Women’s Health Stats Continued

  • Child Apprehension and Harm Reduction Stats from the SHEWAY Pregnancy Outreach Program

  • Stats on the Over Representation of Aboriginal Children

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Women s health

Women’s Health

Health Issues

43.2% had 3 or more chronic health problems

23.6% had 4 or more chronic health problems

56% had Hepatitis C

40% had dental problems

32.7% reported mental health problems

30% had lung problems

16% were HIV positive

14% were diabetic

From “Me I’m Living It VANDU Women’s Report”:

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Pacific summit on drug user health 2009

( Women’s Health Continued )

Drug Use

83.7% of the women we spoke to smoked crack

85% of women who reported that they inject drugs also reported smoking crack

95% of women interviewed were on some form of income assistance. Among those women, many identified welfare cheque issue day (or week) as the time they use drugs the most

17% of women reporting an overdose in the past year.

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Pacific summit on drug user health 2009

( Women’s Health Continued )

Other Impacts on Health:

61.2% of women reported having health problems related to their housing situation

79.2% of women reported experiencing violence that currently impacts their physical health and mental health

90% of women talked about problems with access to prescription medications

32% of women interviewed identified mental health concerns as one of their chronic health issues

70% of women interviewed described stigma as a regular aspect of their primary health care experience

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Child apprehension harm reduction

Child Apprehension & Harm Reduction

The SHEWAY P.O.P (Pregnancy Outreach Program)

Prenatal/delivery care: 30% of women had no medical/prenatal care at intake and at the time of the birth of their children 91% of women were connected to a physician or midwife

Improvement in nutritional status: 79% had nutritional concerns at intake and this was reduced to 4% at six months postnatal.

Decrease in substance misuse: (estimated) 24% of women accessing services in the 1998 year met one of the three indicators of a positive outcome in relation to their substance use: had accessed alcohol and drug treatment services while also accessing services at Sheway; were not using substances at discharge; and/or were stabilized on methadone at discharge

Improvement in housing: 27% had no fixed address and 65% had housing concerns at intake, and by six months after the birth of their child, this was reduced to 6%

Parenting and custody: For 22% of mothers, the Ministry did not become involved at all, and for an additional 36% the Ministry was involved for the provision of support only. Thus for over half the mothers (58%) child custody did not become an issue.

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Over representation of aboriginal children

Over Representation of Aboriginal Children

In 2006, the number of Aboriginal children in care surpassed the number of non-Aboriginal children for the first time.

Less than 16 percent of these children are placed with an Aboriginal caregiver

Less than five percent of MCFD staff are Aboriginal (Pivot, Broken Promises Report)

“Aboriginal Family” by Don Baker

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Overview harm reduction

Overview: Harm Reduction

  • Harm Reduction Overview

  • Safer Crack Smoking Info and Reported Drug Use Stats by VIDUS Cohort

  • Safe Crack Kit Information

  • Reach of Traditional Helping Systems

  • Reach of Comprehensive Four-Pillar System

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Harm reduction

Harm Reduction

Humanistic Approach to substance use which aims at keeping people safe, minimizing death, disease, and injury associated with higher risk behaviour

Examples in British Columbia include:

Needle Exchange Programs

Safe Injection Facilities

Crack Kit Distribution

NAOMI Project – Prescription Heroin Trials

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Safer crack smoking

Safer Crack Smoking

The CCENDU Report highlights a downward trend in injecting cocaine, speedballs, and heroin. Crack and crystal meth use seem to be on the rise.

Studies suggest crack users may seroconvert HIV at a significant rate1, and suggests crack users are less likely to be reached by current harm reduction initiatives2

1. Montaner 2. SCORE Report

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Safe crack kits

Safe Crack Kits

A year after 10,000 safe crack kits were distributed in Vancouver, 100% of the survey participants reported smoking crack, only 39% reported injection drug use, suggesting that over 60% of these individuals may not be reached by other harm reduction initiatives such as needle exchange.

SCORE Report

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Reach of traditional helping systems

Reach of Traditional Helping Systems

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Reach of comprehensive four pillar system

Reach of Comprehensive Four-Pillar System

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Overview drug user activism

Overview: Drug User Activism

  • Civil Disobedience and Harm Reduction in Vancouver - 356 Powell Street

  • VANDU Needle Table Main & Hastings

  • 213 Dunlevy

  • 327 Carrall

  • Insite

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Civil disobedience and harm reduction in vancouver

Civil Disobedience and Harm Reduction in Vancouver

Before Vancouver’s legal injection site Insite opened, delays in decision making necessitated the opening and maintenance of several “unofficial” safe injection sites.

356 Powell Street

Operated :

9 months in 1996

Run by :

Drug user volunteers

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Needle exchange facilities

Needle Exchange Facilities

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213 dunlevy

213 Dunlevy

Operated from :

Winter of 2000 for about

5 months

Run by :

User volunteers

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327 carrall

327 Carrall

Operated from :

May to October 2003

Run by :

User volunteers

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Insite

Insite

September 12 2003

While Insite is a huge political victory, inhalation rooms must be introduced, and more sites need to be opened to deal with the demand

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Pacific summit on drug user health 2009

CANADA’S DRUG LAWS


Drug prohibition

Drug Prohibition

Controlled Drugs and Substances Act

  • Federal law

  • Bans over 100 “controlled substances”

  • It is a criminal offence to possess, traffic, produce, import/export


Section 56 of the cdsa

Section 56 of the CDSA

  • A person or group can apply to be exempt from the application of the drug laws.

  • An exemption will be granted if it is seen as necessary for a

    • MEDICAL PURPOSE

    • SCIENTIFIC PURPOSE

    • OTHERWISE IN THE PUBLIC INTEREST


Fighting for insite

Fighting for Insite

  • Vancouver’s Supervised Injecting Facility was given permission to open its doors in September 2003. (ie an exemption 56)

  • This permission was extended twice, for two six-month periods.

  • It was unlikely that the Federal Government was going to allow Insite to operate past the June 30, 2008 deadline.

  • Despite all of the very strong evidence in support of the SIS, the Federal Government waged a war against Insite and harm reduction in general.


Phs and vandu v canada

PHS and VANDU v Canada

  • PHS and VANDU took the matter to court and argued that drug users have a constitutional right to the health and harm reduction services of the SIS

  • The Court found that the laws prohibiting possession and trafficking of drugs are unconstitutional because they:

    • prohibit the management of addiction

    • treat all drugs and all drug users the same

    • contribute to harm

    • do not contribute to individual and community health and disease prevention.


Pacific summit on drug user health 2009

"Denial of access to Insite and safe injection for the reason by Canada, amounts to a condemnation of the consumption that lead to addiction in the first place, while ignoring the resulting illness….there is much to be said against denying addicts healthcare services that will ameliorate the effects of their condition. While those are not prohibited substances, society neither condemns the individual who chose to drink or smoke to excess, nor deprives that individual of a range of healthcare services. Management of the harm in those cases is accepted as a community responsibility. I cannot see any rational or logical reason why the approach should be different when dealing with narcotics… I cannot agree with Canada's [argument] that an addict must feed his addiction in an unsafe environment when a safe environment that may lead to rehabilitation is the alternative.“ Justice Pitfield


What does this decision mean

What does this decision mean?

  • The possession and trafficking laws are not officially struck down until June 30, 2009

  • The Federal Government has appealed the decision

  • We are very optimistic!

  • Opens the door for a range of harm reduction initiatives


But the government is still waging a war on drugs

… but the government is still waging a “War on Drugs”

  • Law enforcement continues to receive most of Canada’s Drug Strategy resources

  • Bill C-15 creates mandatory minimum sentences for certain trafficking, importing/exporting and production offences

  • The federal government is fighting hard stop the move towards harm reduction.


Drug users have rights

Drug users have rights!

Everyone has the right to life, liberty and security of the person...

Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law…

Canadian Charter of Rights and Freedoms

Everyone has the right to the enjoyment of the highest attainable standard of physical and mental health.

International Covenant on Economic, Social and Cultural Rights - Article 12


Continue the fight

Continue the fight

We can use the law to defend drug users right and fight for access to:

  • Inhalation rooms and crack kits

  • Treatment or detox

  • Prescription heroin, methadone and buprenorphine

  • Human rights protection in jail


Pacific summit on drug user health 2009

Working together we can treat Canada’s 50 million dollar a year addiction to the War on Drugs.

- Original quote from American Polly Wilmoth… adapted to the Canadian context


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