Who's saved by safe shooting?

Posted: Aug 11, 2003 12:00 AM

Even in a culture as (how to put it?) comfortable with its own relativism as ours is, it's unlikely that a recent Washington Post front-page article about Canada's "safe injection sites" for intravenous drug users went down quite as smoothly as the morning coffee. It wasn't the pathetic degradation of the addicts that was tough to swallow, but rather the extremely creepy revelation that the gentle art of healing now includes such, well, harmful practices as "vein maintenance" and "injection techniques" as part of a Canadian government-approved effort to ensure that junkies inject themselves with their poison of choice according to the highest medical standards.

First, consider the Canadian drug lexicon. What are "safe injection sites"? The euphemistically named product of Canada's euphemistically named "harm reduction" drug policy, "safe injection sites" are where Canadians may shoot heroin, crystal methamphetamine, Drano or whatever, directly into their bloodstreams under the expert supervision of registered nurses.

"Go flush with the skin," Patti Zettel, a nurse, instructs an addict -- sorry, "client" -- preparing a fix (dose?) of crystal methamphetamine at the Dr. Peter Centre, a "safe" site in Vancouver, British Columbia. "Then up. Once in the vein, release the tourniquet. Look," the nurse says, apparently to the Post reporter on hand. "She has good blood flow."

Frankly, a pitiable addict's "good blood flow" is less than likely to elicit celebratory whoops in the casual reader -- unless, of course, the casual reader happens to be a "harm reducer" like Nurse Zettel. She, along with two nursing colleagues, articulated the definition of "harm reduction nursing" in a recent issue of Canadian Nurse magazine as a practice aimed at "reducing the consequences of drug use without necessarily requiring a reduction in the drug use itself."

In other words, if a "client" is killing himself with drugs; destroying his loved ones with drugs; reducing his community to a crime-ridden slum with drugs; and keeping money flowing to narco-terrorists the world over with drugs, by all means encourage the "client" to do so -- as long as he is harm-reducingly equipped with a sterile syringe, a proper tourniquet and some decent gauze. "The approach," the nurses explained in their article, "is to educate participants and to support them in making their own informed choices."

Considering the "informed choices" a "participant" awaiting a "safe" injection of heroin is likely to make, such jargon is not only peculiar, it is sanitized to the point of fantasy. Indeed, it is disconcerting to realize that the only educating "safe injection sites" set out to do concerns the unhealthiness of unsanitary drug use, which often leads to HIV infection, and not the unhealthiness of drug use in the first place.

Lori-Kim Veenstra, the addict with "good blood flow," says nobody in the center "pushes" treatment information on her; indeed, the only signs on the clinic walls mentioned in the Post article read: "No nurse, no fix." And: "If you are not injecting or using the bathroom, stay out." Zettel, who says she wants to come across as being "nonjudgmental," explains the "safe" site philosophy this way: "I can't push my agenda. If Lori is interested in detox treatment, it is about what Veenstra wants when she wants it." The article ends with Veenstra wanting another fix.

While a few pesky kinks in Canada's new policy remain -- addicts, for example, continue to risk arrest by buying the illegal drugs they bring to "safe" sites, which operate as drug-arrest-free zones -- harm reduction proponents would likely see in Veenstra's case evidence of "safe injection site" success. John Walters, White House drug policy director, would disagree. "The very name is a lie," he told the Post. "It can't be made safe. We believe the only moral responsibility is to treat drug users. It is reprehensible to allow people and encourage people to continue suffering."

I must say it seems doubly reprehensible for medical professionals to allow and encourage people to continue suffering. "It's the most ethical work I've ever done as a nurse and a human being," says Ms. Zettel. "We as a society have reinforced their (addicts') marginalization. They have a poor sense of self-esteem and value. We have reinforced that. That to me is criminal."

So much for being nonjudgmental. Meanwhile, how it is that injection sites, which would seem to promise only to keep addicts addicted, can possibly undo anyone's "marginalization" is a mystery.

As for "self-esteem" -- "self-respect" would be a healthier aim -- it's hard to see how shooting up, however safely, can ever help.