Tag Archives: heroin

Vancouver’s supervised injection site providing a safe place for changing lives

By Amanda Waldroupe, Staff Writer

Vancouver, B.C., knows how to deal with heroin addicts.

Vancouver is the home to North America’s only supervised injection site, and the world’s largest. Called Insite, it allows addicts to bring in their own drugs — more often than not, heroin and cocaine — and inject them in a booth supervised by nurses. Addicts can stay at Insite after injecting as long as they like afterwards; nurses are constantly available to provide immediate medical care if someone overdoses or experiences related medical issues. Clean needles and condoms are made available to users.

Insite is in a three-story building. The first floor is the supervised injection site. The second floor is a detox program serving 12 people, and the third floor houses an 18-bed drug recovery program called Onsite. Insite was intentionally designed that way to encourage people using Insite to enter recovery programs, and it also makes it as easy as going up a flight of stairs.

Insite opened in 2003 and is a partnership between the Portland Hotel Society, an affordable housing provider, and the city’s public health agency, Vancouver Coastal Health Authority.

Insite’s founding was a direct response to an escalating public health crisis in Vancouver. During the 1990s, there was a rampant and increased use of injection drugs, fatal overdoses, and transmission of HIV and Hepatitis C. Ground zero is an area in downtown Vancouver known as the “Downtown Eastside.” The area is five blocks by about 15 blocks wide, and it is home to Vancouver’s poorest and most vulnerable residents, including an estimated 4,000 to 7,000 injection-drug users.

There were 201 overdose deaths in Vancouver in 1993. That number had hovered between 30 and 50 in the prior decade. HIV infection increased along with the overdose deaths — in 1996, there were 2,100 cases of HIV transmission, and a United Nations report found that the Downtown Eastside area had an HIV rate of 30 percent, compared to Canada’s rate of 0.2 percent.

“These two things literally created a recognized health crises,” says Russ Maynard, Insite’s program coordinator.

Maynard says there was a recognition that increasing the number of needle exchange clinics would not help to solve the overdose and health crisis. The Vancouver Area Network of Drug Users (VANDU), a grassroots organization, formed and began pressuring Vancouver’s local government to open a supervised injection site modeled after sites already in operation in Europe and Australia.

“The luck is having a health authority and a city hall that, at that particular time in history, seemed to be open to new ideas,” Maynard says.

Since opening, Insite has had more than 1.5 million visits. There are 12,000 people registered with Insite (though not all of them may be using Insite at once). In 2009, Insite had 276,178 visits by 5,447 individuals. There were 484 overdoses, but no deaths. Insite made 6,242 referrals to social-service agencies, including housing placement and drug treatment programs.

Maynard says Insite’s biggest asset is not that it prevents overdose deaths or is an integral piece to Vancouver’s public health system. But rather that it allows people to change their lives. He frequently gives tours of Insite to the public, and he remembers one tour that he gave when a woman using Insite’s services began answering questions from the group and speaking with them.

“You don’t know what this place means to me,” Maynard remembers her saying. “They treat us as if we’re normal.”

Amanda Waldroupe: In what way was harm reduction available to the community before Insite opened?

Russ Maynard: There would have been street nurses walking around with a shoulder bag. There would have been needle exchanges. VANDU (the Vancouver Area Network of Drug Users) and other organizations would have had harm reduction classes to some degree. The problem is that it was piecemeal.

A.W.: How does Insite work?

R.M.: The first time you come in you have to register. The registration process is very unencumbersome. You’ll be handed a clipboard and directed to fill out 20, 30 questions. Obviously, if you have literacy issues, you’re dope sick, or have mental health issues, that can be a Herculean, if not impossible, task. (It’s) designed around the population. It asks for your birth date, which isn’t giving a lot of information. It asks your gender. It asks your ethnicity. Then you will make up a handle or a pseudonym. We don’t need your real name. We just want to get you in. That is very reflective of the bottom up design (of) Insite.

Hopefully your wait is very minimal. One minute, two minutes. They’re called into the injection room. The door is locked. They walk in. Right away, there’s a computer on their left. They self report to the nurse what they’re using. There are 12 booths. Staff are walking the floor back and forth about two feet from the booths. They are sitting in a cubicle with a large mirror in front of them, a stainless steel tabletop and two walls. That mirror does a few things. If they are stimulated, it allows them to have a sense of what’s going on behind them. It (also) allows them to look at themselves. If you’re homeless, you don’t have a mirror. You can see the sores on your face, your gaunt look. Staff are right there (if they overdose) and are intervening within minutes. They are trained to recognize the signs.

A woman demonstrates the injection process. The booths have mirrors to encourage another level of awareness toward recovery

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Harm reduction, anyone?

For the past two years Street Roots has covered what some are calling an opiate/heroin epidemic in the region. SR is in no place to determine if the region is dealing with what we can call an epidemic — but it’s not pretty.

Last week, as reported by SR, the State of Oregon Alcohol and Drug Policy Commission gave an overview of Oregon’s drug treatment system. The report calls for a complete overhaul of the system, which is “fragmented” with “significant gaps in coverage.”

Dr. Dennis McCarty, a member of the commission, told SR that Oregon’s treatment system continues to reflect what the need was 20 or 30 years ago, when treatment programs were developed to serve a population of “public inebriates.” Now, he says, there is growing demand to provide treatment for women, youth, and other groups who are addicted to drugs other than alcohol, such as heroin. “This is about catching up to the year 2010,” he says.
Yes, finally someone who is thinking in the 21st century. Wait, maybe not. Continue reading

Return of the dragon – heroin takes over Portland’s streets


From the Sept. 18 edition of Street Roots.

On a sunny Monday during the early afternoon, a 27-year old homeless man only wanting to be identified as “Joe” for this story walks down a hill overlooking I-405 and sits on a piece of cardboard laid out among, bushes, empty bottles and litter. The sounds of cars and buses are all around. Joe takes out a blue bag, unzips it, and takes out a twisted-up piece of white wax paper. Inside the paper is an almost imperceptible amount of a gooey, dark brown substance. Joe says it’s a couple dollars worth of black tar heroin.

“I treat this like a medicine,” Joe says. “Oh shit, a cop just went down the street.” He quickly gets up to move.

“You’re focusing on doing something pretty intricate and you have one eye scanning so you don’t get caught and hemmed up,” he says as he walks down the street.

Stopping at an intersection, Joe looks around. “I think we’re good,” he says. He walks down along a hill overlooking another part of I-405. Tucking himself in between two bushes and setting his backpack next to him, he takes out a needle from a Ziploc bag of 10 he recieved at Outside In’s Syringe Exchange Clinic. Holding it in one hand, he takes the tin cup out of his backpack and puts the heroin in it. He also takes out a small water bottle, puts it on the ground, and puts a red lighter on his leg.

Pulling the syringe with his mouth, he pulls water out of the bottle and shoots it into the tin cup. Holding the cup with a twisted bread tie, he heats it for about 20 seconds with the lighter.

With the syringe’s plunger, Joe mixes the liquid. Licking the end of the plunger, he sucks the heroin into the syringe.

“She didn’t give me a tourniquet,” he says, looking through the Ziploc bag.

He takes off his belt and wraps it tightly around his bicep. His veins begin to pop out, and faintly lining his arm are the scabs and scars from previous injections.

Slowly, he inserts the needle, his fist clenched. But he doesn’t inject. Instead, he moves the needle left to right inside his arm, looking for and missing the much-sought-after vein. Murmuring to himself in pain, he pulls the needle out. A small bead of dark blood follows.

“Maybe there’s something wrong with this needle,” Joe says. “I’m just used to having the tourniquet.”

Swiping the blood onto his fingertip, he licked it off. Every time Joe saw a drop of blood as he poked his arm three more times, he’d lick—not to miss a single grain of heroin.

On the fourth injection, Joe stopped moving the needle. Holding it still for a moment, he slowly pushed the plunger with one finger, staring at the point of entry the entire time, watching until every drop of light amber fluid disappeared into his arm.

He loosens the belt before he lets the needle out. Blood trails down his arm. Wiping his arms with his hands, he licks his fingers.

“Sometimes it turns into a bloody mess and you’re just trying to get your fix,” he says as he uses an alcoholic wipe given to him at the needle exchange clinic operated by Outside In.

Joe says he does not feel that much different after taking the heroin. “This is even for me,” he says, not describing the high any further.

On his way up the embankment, Joe stops to talk to a panhandler sitting at the corner. Crossing the I-5 bridge back to downtown, he quickly walks in the direction of a surplus store, his gait almost gliding.

Joe says he will probably shoot up in another four to six hours.

A growing trend

Dennis Lundberg and Mike Reese rarely see eye to eye. But recently, the outreach worker for the homeless youths organization Janus Youth and the commander of the Portland Police Bureau’s central precinct have found common ground on a unlikely topic: the rise of heroin use in Portland.


Heroin use, Lundberg and Reese say, ebbs and flows in Portland with the seasons. Summertime is when the presence of the drug reaches it peak, coinciding with the presence of a seasonal homeless population frequenting downtown. As the weather cools and dampens, the amount of heroin declines as some youths leave town. Continue reading

Street Roots wins honors from Society of Professional Journalists

Street Roots writers Mara Grunbaum, Tye Doudy and Joanne Zuhl  took home honors from the Oregon and Southwest Washington Society of Professional Journalists May 30. The event honors journalistic achievements of 2008.

Mara Grunbaum received the second place award in the News Feature category for “Rest in peace, and dignity,” a report on work to preserve the memory of Hawthorne Asylum patients buried in unmarked graves in Lone Fir Cemetery. The package of stories not only looked at the memory of the Hawthorne Asylum, but also society’s changing view of mental illness.

Tye Doudy was awarded second place for general columns for his highly personal series of columns called “Addicts Almanac.” The seven-part series gave Portlanders an eye-opening tour of their city through the life of a heroin addict.

Joanne Zuhl received third place honors for social issues reporting for her piece “In need of a New Deal,” a report on the obstacles facing affordable housing developers following the economic collapse. The report was part of a Special Edition of Street Roots that navigated the maze of affordable housing.

Congratulations to all the winners!

Street Roots, a nonprofit newspaper, competed in the non-daily category for papers with 8,000 circulation or less.

Addict’s Almanac, Part IV

Sept. 18, 2008

Tye Doudy is 33 years old and lives in Portland. His stories chronicle his experiences and are told in the hopes that others may learn from his mistakes. This is the latest in a series of articles about his life. He can be reached at wurmstar@gmail.com.

By Tye Doudy
Contributing Columnist

Waking up under the Jackson Street Bridge is never a good way to start the day. Looking out from under the meager warmth of the mildew-smelling blankets, I can’t see the sky, only the mud, the beer cans and discarded piles of wet clothing revealed in the sodden half light of early dawn. It is a typical Portland morning in late spring. Cold, slate-grey sheets of rain pound the overpass and the cars rushing overhead. The rhythmic sounds of their passing greet my ears like the waves of a great industrial ocean crashing on blacktop shores.

Addict’s Almanac, Parts I-III
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Addict’s Almanac, Part III

Tye Doudy is 33 years old and lives in Portland. His stories chronicle his experiences and are told in the hopes that others may learn from his mistakes. This is the latest in a series of articles about his life. He can be reached at wurmstar@gmail.com

By Tye Doudy
Contributing Columnist

There is mariachi music playing quietly when I enter the car. Julio smiling with bulging cheeks, reaches over and turns off the stereo. “Hola, mi amigo,” he greets me as we pull away from the curb. “Hay mang, what chew need?”

“First, I need two white” I hand him the $30 for the two bags of coke and Julio holds his hand up to his mouth and spits out two small yellow balloons from the right side of his mouth. He dries them off on his leg and hands them to me. I wipe the balloons again on my own leg and place them in my mouth. I can immediately taste the harsh, almost diesel flavor of the cocaine in the balloons and I gag a little.

“Ees that eet?” Julio asks, sounding a little disappointed.

“No, I need some black too” With my own money and the money from the Scarecrow I have $100 to spend on heroin. I ask Julio what kind of deal he will give me if I spend a hundred bucks. He says, “Four for feefty, so eight for uno hundred.”

“Come on man, you can give me 10 for a hundred.”

Julio grins sheepishly. “Hokay, nine,” he says, looking at me to see if I will take the deal. I know nine is all I’m going to get so I count out the money fold it in half and hand it to him below the dash. He unfolds the bills and recounts them. Satisfied that all the money is there, he spits out nine blue balloons from the left side of his mouth. He repeats the ritual of drying them on his leg before handing them to me, and I do the same before placing the balloons in my own mouth. I put two balloons of the heroin in the left side of my cheeks with the two bags of coke and place the remaining balloons in the other side. That way I can hand the Scarecrow guy his shit without having to count it out on the sidewalk and also avoid letting him see how much I am holding.

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