The Martlet

Two years after Victoria’s Cormorant Street needle exchange closed, there is still no primary location for people who inject drugs to replace used needles.

In 2008, the closure left a big void in the region’s harm-reduction strategy, forcing groups like AIDS Vancouver Island (AVI) to diversify their outreach strategy.

“We’re trying to increase the access, knowing that different people access needles in different ways and have different needs,” said AVI Communication Manager Andrea Langlois.

The Vancouver Island Health Authority (VIHA) is looking at different programs to help achieve this, drawing on experiences from Vancouver to Australia. One consideration is using public health clinics and pharmacies as exchange sites. And while over three-quarters of returned needles will go to a region’s fixed site, like the one closed on Cormorant, these decentralized, secondary sites will appeal to a certain demographic.

“It’s a diverse variety of people that use needle exchange. It’s not just the people you see on the street,” Langlois said, adding that this includes people who hold down jobs and don’t self-identify as drug addicts. “Some people who would go into the pharmacy to get needles or buy needles, wouldn’t come by [the fixed exchange site].”

Still, Langlois says no primary site leaves a big gap in the regional harm reduction plan. Not only does a site provide a stable, consistent location for exchanging used needles, it also brings users in contact with addiction professionals. The rapport built up at these sites becomes invaluable when an individual looks to get clean, she explained.

“We really know that if people are going to take the path to healing and recovering from their addiction, the start of the path is going to be someone that can provide services that they need nonjudgementally,” Langlois said.

She cited empirical evidence, which overwhelmingly states that needle exchanges provide both social and economical benefits. One report out of the University of South Wales found that $1 spent on needle exchange returned $4 by reducing infections and transmission of diseases like HIV and Hepatitis C. Still, it’s difficult to get a community to embrace primary exchange sites in their neighbourhood.

“Unfortunately, stigma is at the root of a lot of the challenges we’re having,” said Langlois, adding that still, everyone from outreach worker, to injection drug user, to business owner to resident wants safer, healthier communities. “One of our challenges in the community is that needles make people uncomfortable. That’s understandable, so let’s make sure they are used and disposed of properly.”

To help ensure safe disposal, the City of Victoria has placed drop boxes throughout communities. Individuals can also bring used needles to the mobile exchange vans run by AVI, or through secondary groups like Cool Aid. At times, peers are used to provide clean needles (meaning a harm reduction worker will provide one individual with extra needles to dispense within his or her group), and also help by collecting needles for disposal from their community. AVI also does active needle recovery, or “rig digging,” in parks and alleys that are frequented by injection drug users.

“Despite that effort, the amount of needles that is projected and that we actually get back has dropped dramatically,” said Langlois.

This raises concerns that needles are being shared — and concerns over where they end up.

“A fixed site is actually really important in making sure that needles are disposed of correctly and that we get them back,” she said.

But economic and social costs are keeping that site from happening in the immediate future. And that keeps people from having access to the full spectrum of health care they have a right to, resulting in an unhealthier society. As Langlois says, whether a specific person is addicted or not, we’re all touched by it in some way in our lives. But incremental changes can help minimize the harm of that touch.

“We’ve kind of created this myth about needle exchange that it’s this intense big thing,” she said. “But it can be as simple as handing someone a paper bag that is discreet and has the supplies they need.”

However, she doesn’t want to understate the importance of having a primary facility.

“In terms of harm reduction services, it’s really important to continue to work on this model where services are available in many different ways to people but, at the moment, there is a big hole in the middle of the doughnut,” said Langlois. “What’s missing is really a comprehensive, specialized needle exchange.”