A Vending Machine for Crack Pipes? Now that Rocks!

Well, I’ll be damned, harm reduction is getting down with drug users -how  fabulous when we find a glowing example of a perfectly useful, innovative and user friendly invention that actually makes it out of its’ idea stage, only to leap frog over the community hysterics into production and onto our streets; the streets of Vancouver in this case. A vending machine for crack pipes -selling the pipes that one may be constantly in need of (if one has a constant preoccupation with the white rocks, that is…) for just 25c.

OK, so as the VICE news item below says, the over-arching idea behind this was to prevent HIV or Hepatitis C transmission that people COULD be exposed too, when finding themselves sharing pipes and some bodily fluids from the associated burnt or cut thumbs and lips that can occur from heavy sessions on the pipe. But I notice at least one of the vending machines is located in a popular drop in service, which on its own provides an important moment for a user to touch base, be seen by peers and health professionals, add to an important data pool on drug usage, – and all at the same time as making a personal positive health choice and a chance to reduce harm. Nice one!

But what is really cool is that this is an evolution of the work our rather clever peers are doing in Vancouver, work started in the area by VANDU (Vancouver Area Network of Drug Users),

Mariner James of the Portland Hotel Society with the machine.

Three Cheers for our Junkie Peers!

So three cheers to the continuation of user ingenuity and peer outreach in Vancouver, they have done us all proud. I should say however, that the sheer scale of what drug users are up against in Vancouver seems to ensure our colleagues are constantly fighting hard to maintain some semblance of humanity  for our community there.

The Downtown Eastside, centered on the intersection of Main and Hasting streets in Vancouver, has one of the highest concentrations of injection drug users in the world. An overgrown ‘Skid Row’ is flush with prostitution and destitution, most of its residents live in badly maintained hotels and hostels lining Main Street.

Out of 12,000 residents in the area, some 5,000 are estimated to be drug users and any chat with a peer from these streets or indeed a look at any of the  documentaries on You Tube about the area, shows our peers are struggling;  crack and methamphetamine use remains steady or is increasing and even injecting heroin use continues to rise as much of the scene is now buoyed by pharmaceutical opiates which appears to be collecting young, newer users whereas in other places, like the UK and Western Europe, we are seeing injecting heroin use dropping among the young and plateauing among older users..

Since 2008 it seems over half of Vancouver’s opiate users are on methadone or similar OST’s although the figures aren’t as encouraging for its aboriginal population. For up to date information on the drug situation in Vancouver, Click here.

With such numbers of heavy drug users living in such a deprived area, an outsider could believe any inroads made by progressive harm reduction policies and initiatives are slowly unpicked again by repeated incarceration, illness and infection, discrimination and homelessness. Yet this is the battle that harm reductionists and drug user activists are fighting; it is indeed one step forward and two steps back and lives are literally won and lost on the back of populist election promises, just like in so many parts of the world…

Humanity on Skid Row

Although the battle to save lives and promote humane drug policies in Vancouver however is ongoing, there are certainly signs that the current interventions are working. Yet the aim must be to examine the strategies that are showing results  Statistics show the number of new HIV infections (incidence) may be decreasing among people who inject drugs, females and Aboriginal people and where targeted, innovative health and harm reduction responses are delivered, results generally follow.

According to 2011 national HIV estimates, an estimated  14% of new infections were attributed to injection drug use compared to an estimated 17% of new infection in 2008.*

In Vancouver itself, initiatives across the board have given us all a welcome insight into just what targeted, user friendly and progressive health interventions can do. The project STOP (The Seek and Treat for Optimal Prevention of HIV/AIDS Project) was a three-year pilot funded by the Ministry of Health and ending in March 2013. This fascinating endeavour would  ultimately transform the HIV system of care in the city through a variety of initiatives and activities we now know as imperative for change, such as community engagement with people living with HIV, evidence review, consultations with both service and healthcare providers, the development of population-specific reports, constant assessment of the current state of the HIV system of care, policy change, and the funding, monitoring and evaluation of over 40 pilot activities. Phew! A terrific document was recently published which I urge anyone interested in progressive health interventions for this community, to read this (Click Here).

Toronto user activists, still innovating and agitating for their community.

Across the other side of Canada in Toronto, we have the same level of innovative peer initiatives and activism behind many of the most progressive  community approaches to the drug issue. Raffi Balian, a founder member of Toronto’s  exceptional harm reduction service CounterFIT,  told me “The best and most innovative harm reduction initiatives are taking place in cities where people who use drugs are represented by strong unions; such as VANDU in Vancouver, and Brugerforeningen in Copenhagen.  In Toronto” he continued “we have been blessed because we were the first city to distribute crack stems.  A lot of the push came through the work of the Illegal Drug Users Union of Toronto in 2000, followed by the Safer Crack Use Coalition of Toronto (SCUC, 2001-2011).  In Toronto, service users can get as many as 200-300 stems without questions asked.” Upon being asked about the popularity of Vancouver’s crack pipe vending machine, Raffi was quick to enthuse  that the distribution of crack stems through vending machines, “is a brilliant idea and something that we will surely import here [Toronto].  It will take some time and effort, but I’m sure we will learn from VANDU’s efforts and will make it a reality in Toronto – just as we are doing with supervised injection sites. ”

Recent moves to copy Vancouver’s famous safer drug consumption room INSITE – (sometimes known as a supervised injection centre or clinic) has been underway, and a feasibility study on injection rooms was actually requested by the City of Toronto in 2008 (and later expanded to include Ottawa). The study was then undertaken by researchers at the University of Toronto and staff at St. Michael’s Hospital,  after watching the developments at INSITE.

The results of the study were released in April 2012 and it advised Ottawa to introduce two “safe consumption” sites and Toronto to open three sites. While they didn’t recommend specific locations, they did suggest more than one centralized location, which is what Vancouver has with its Insite program. Around the same time a Public Health initiated study emerged recommending Montreal also open up to four safe drug consumption rooms, openly referring to the benefits such sites have repeatedly shown in reducing the number of overdose deaths, assisting people to make positive changes in their lives and reducing the drug paraphernalia found on the streets and in the parks.

INSITE – North America’s first drug consumption room in Vancouver

Although conservatives in Toronto raced to  dampen spirits with their usual confused concerns about the recommendations, the brilliant partnership working recently undertaken by drug user activists like those at VANDU, who worked long and hard with various  groups, advocates, researchers, health professionals, lawyers and others to fight for the special exemption to Canada’s Federal Drug Laws which enabled INSITE to remain open for good, (an exemption which now finally stands) today means that cities and provinces like Toronto, Ottawa and Montreal, can also fight for a similar exemption -and should.

Yet before we say goodnight to our peers in Vancouver (and across Canada) may we just wish our friends luck as they embark on their latest Crack Pipe Vending Machine initiative and hope that other countries may soon follow their courageous lead. Well done in using another tool in the fight to prevent HIV and Hep C, in fostering rights and responsibilities for people who use drugs, and forwarding the adage that judgements and moralising will never help the drugs debate, only humanity, intelligent policies and community partnerships involving the drug using community -will provide us all with the solutions we require now and for the future. G ‘Night friends.

Toronto Public Health

Pic: Another recent initiative that drug using peers have been trained up in, in Toronto -using the anti overdose drug Naloxone, to be administered to an opiate user at the time of an overdose to essentially restart breathing again.

*2011 Estimates of HIV prevalence and incidence in Canada, published by the Public Health Agency of Canada (PHAC)

The Crack Pipe Vending Machine -A Vice Article.

“Crack pipes: 25 Cents,” reads the sign on a shiny vending machine, painted in bright polka dots. Decades ago, this device sold sandwiches. Now, when you put in your quarter and punch in a number, there is a click, a pause, and a little whirr. Then the spiral rotates until a crack pipe—packaged in a cardboard tube to avoid shattering—drops into a tray. Then you reach through the flap and retrieve your new stem.

According to the BC Centre for Disease Control, Hepatitis C and HIV can be spread through sharing crack pipes. The intense heat and repeated usage that comes with crack addiction can quickly wear pipes down to jagged nubs. Users are always in need of fresh supplies. Like distributing clean needles, making crack pipes available is just good public health policy, as users don’t have to resort to risky activities to come up with the cash to buy one on the street.

The crack pipe vending machine was the dream of Mark Townsend and Mariner Janes, of the Portland Hotel Society (PHS), a non-profit that provides services to persons with mental health and addiction issues. There are currently two machines and they’ve been in place for six months.  Each holds 200 pipes and needs refilling a couple times each week.

One of the machines is located at PHS’s bustling Drug Users Resource Centre. As I arrive there with Mariner, people greet each other as a writing workshop wraps up, while others queue up for lunch. I ask if anyone wants to talk to me about the vending machine that stood in the corner.

Joe looks at me like I’m an idiot, then smiles, and adds: “It’s a vending machine, what else do you need to know?” He says he uses it all the time and that “a quarter is way better than what’d you have to pay on the street.” A bit of a debate kicks off about how to improve the machines e.g. including other crack related supplies: lighters, push sticks, etc.

A woman named DJ chimes in. She uses the machine and tells her friends about it. She says she’d like to see more pipe vending machines around the Downtown Eastside. “But bolt them down… People go: ‘Hey, pipes!’ And shake it to get them to drop out for free.” Mariner nods his head, all too aware of the shaken machine dilemma.

Mariner hopes that distributing pipes will one day be as accepted a practice as handing out needles to IV drug users has become. He says, “the stigma around crack use is much higher than, say, heroin or any other drug. There’s a particular quality of panic.” And he worries about the possible sensationalism that the vending machines might attract from more conservative commentators.

But community support for handing out safe crack smoking supplies is growing. Three years ago, the Vancouver Coastal Health Authority began a pipe distribution pilot program. The Vancouver Area Network of Drug Users started even before that. Vancouver Police have come round, giving the nod to some harm reduction initiatives, even directing users to the safe injection site and other programs.

“Aiyanas Ormond of the Vancouver Area Network of Drug Users told me the vending machines are “a good intervention. Access to a pipe can make the difference for people having a safe practice.” Citing research from the Safer Crack Use, Outreach, Research and Education (SCORE) project, he noted that significant harm reduction comes from distributing pipes to users in the sex trade. They won’t have to work potentially unsafe dates just to pay for the pipe itself.”

Mariner spends his days behind the wheel of PHS’s needle exchange van, doing outreach and distributing clean needles and pipes around Vancouver. There is a neighbourly, comradely feeling between him and the people who use the vending machines, or sidle up to the his van whose purpose is announced in giant letters on the side panel of the vehicle.

Sometimes, a client will ask for a more subtle approach, so as not to announce to the entire neighbourhood what’s going on. Mariner will pull into an alley, or even use a less obvious vehicle. And if a more anonymous interaction is what the user wants, all they need is a quarter. That’s his philosophy—meet people on their own terms, and provide services as a peer, not an authority.

It’s not by chance the vending machine has a happy—rather than official—design; as its meant to contrast the typically cold, heavily secured, and clinical facilities for addicts. The vending machine has an aesthetic that exudes care for the people who will use it. Mariner says “part of the design that we chose is to provide a sense of respect and dignity to the user, who is pretty much stigmatized and reviled everywhere else in the city.”

The look and feel says: I am a machine that dispenses a basic health care supply to the community, not a judgement or moral lecture.

This article was authored by: Garth Mullins ; for VICE and has been copied fully from the VICE.com website.

Feb 7 2014

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