Drug epidemic has root cause
If policy-makers want to prevent a drug epidemic in Saint John, they must figure out why users are attracted to drugs in the first place, says a Vancouver-based HIV expert.
"The big thing is, what's the root cause of why people are abusing the drugs, and attack those issues. That's not a police issue, that's a societal issue," Michael O'Shaughnessy said in an interview after making a presentation for AIDS Saint John Wednesday night.
"Find out why they're doing it and provide a remedy," he said. "So if they're using crack, why are they using crack? Figure it out. And I can guarantee a lot are street youth, unemployed, homeless and you need to get them housing and if you can't engage individuals, you've lost them."
O'Shaughnessy, who made the keynote address at AIDS Saint John's annual general meeting Wednesday, initiated a pivotal study on Vancouver injection drug users that provided insight into what drove the HIV epidemic on Vancouver's downtown east side. He also helped set up Insite, a supervised injection site in Vancouver.
O'Shaughnessy highlighted a number of factors that led to Vancouver's HIV epidemic and overdose fatalities in the 1990s. Since Insite opened in 2003, there have been no overdose deaths at the facility, which acts as a bridge to detox and treatment.
Mental health is a key factor, he said. In the 1990s, 40 per cent of injection drug users had mental illness and "no one was looking after them," he said.
There were no detox units. For women, the closest detox beds were much farther north in Prince George, and there were six.
"This is how you generate an epidemic," he said.
Then, cheap cocaine entered the community, and users mixed cocaine and heroin to inject "speedball" up to 20 times a day. "It made the community crazy," he said, adding the users were extremely strung-out and damaged their bodies by injecting so often.
Aboriginal health issues were, and continue to be, another problem, he said. It's difficult to convince aboriginal people to stay on treatment because they frequently moved between the city and the reserves, where confidentiality is another concern.
In prison, drug users learned how to be high-risk individuals, often sharing dull needles because there is no needle exchange program. Unions continue to be against the idea because of the possibility of the needles being used as weapons.
"In the mid-90s, prison was a breeding ground for drug use," he said.
A lack of buy-in from some members of the police was another problem, with some officers seizing needles from users on the street, O'Shaughnessy said.
Things in Vancouver have changed, thanks to better needle exchange programs, better mental health and established methadone programs in prisons and jails. The drug of choice has also changed to crystal meth, which is not injected.
In Saint John, police have said the drug of choice is crack cocaine.
In an interview, O'Shaughnessy said if he could have done anything differently in his research and community work, he would have found a way to reduce child abuse. The vast majority of drug users have troubled childhoods, he said.
Julie Dingwell, executive director of AIDS Saint John, said it's important for communities to learn what fuelled Vancouver's epidemic.
"That's our omen that we need to really be paying attention to what's (happening) on the street and our public policy needs to really be reflective of what's going on," she said.