Loss of Fixed-Site Needle Exchange & Implementation of 'No-Service Area'

Victoria’s only fixed-site needle exchange was forced to close on May 31, 2008. Since this time, the Vancouver Island Health Authority (VIHA) has sanctioned mobile exchange services within a limited area. Below is a brief summary of how these service failures in the Victoria area came to be.

Fixed-site needle exchange services began to be offered through AVI in Victoria in 1987. Long recognized by municipal and provincial studies as a key component of community health provision, AVI’s needle exchange had come to serve upwards of 2,000 clients, preventing transmission of Hep C and HIV, acting as a contact-point between clients and other health services, and keeping used needles off the street.

By the Fall of 2007, the Cormorant street needle exchange faced increasing pressure from neighbours to relocate its services. Facing a steep rise in users unaccompanied by funding increases, and due to its presence as the only service open in the evenings, the needle exchange was over-burdened and unable to coordinate the needs of its many clients.

With the needle exchange facing a May 31, 2008 eviction, VIHA was in the advanced stages of a planned relocation of the needle exchange. In accordance with Mayor’s Task Force recommendations, the plan was to bring the needle exchange under one roof with the support services of doctors, nurses, social workers and community police.

In early March 2008, VIHA’s purchase of a central location next to Our Place on Pandora Avenue was announced. Members of the Victoria Conservatory of Music and St. Andrew’s elementary school confronted VIHA and city council, and by mid-March VIHA had back-tracked, placing an indefinite moratorium on plans for the new needle exchange site. Notably, VIHA-funded mobile needle-exchange services were also restricted from distributing clean needles and syringes in this area, as a result of a verbal commitment from VIHA executive director Howard Waldner to St. Andrew's Elementary School.

The boundaries of this informal 'no service area' restricts mobile needle-exchange workers from distributing safer drug use supplies in the blocks between Blanshard, Chambers, Balmoral and Yates streets. This informal restriction significantly extends the already existing service restrictions outlined in AVI's Mobile Needle Exchange Code of Conduct. This code of conduct restricts the distribution of clean needles and syringes in “no service zones” such as “residences, open businesses, schools and day-care centers” (AVI, 2008). The informal 'no service area' has been effective in reducing already inadequate access to harm reduction and support services for the health authority’s primary target groups, in an area heavily populated by people who use illicit drugs.

VIHA has offered only mobile exchange services since this time. All available evidence points to the lower levels of service provided by sole reliance on mobile exchanges, which lack the resources to offer health referrals, counseling and associated services, and have led to a dramatic reduction in distribution and recovery of syringes. VIHA’s needle distribution and recovery statistics show an average drop of 40% in needles being distributed, and of 18% in needle recovery rates, since the closure of the Cormorant needle exchange (VIHA, 2009). Pauly and MacNeil point out that “the decrease in numbers of clients and in needles distributed and collected directly relates to the closure of the fixed site” (McNeil & Pauly, 2008: 24). They also point to the critical role a fixed-site plays in the delivery of a range of essential health services. Because fixed sites offer the confidential spaces necessary for counseling and referral services, the loss of the fixed-site exchange has reduced the capacity of nurses to provide these services (2008: 24).

While VIHA’s service plan attests to the need for “comprehensive needle exchange” services, which would include testing, counseling, health referral and contact tracing among other services offered together at accessible locations (VIHA, 2006: 2), VIHA has yet to open a single needle exchange location. This failure occurs despite over a year of consultation with the Advisory Committee, and review of approximately 40 potential site locations.

Significantly, basic needle exchange services have been scaled back in the face of multiple recommendations to enhance existing harm reduction services, including the provision of supervised consumption services. The Health Officers Council of BC has called on health authorities to develop supervised consumption services, suggesting that “supervised injection services have been studied enough as research projects, and that it is time to move them into the mainstream of health service provision” (Health Officers Council of BC, 2008). This request follows nearing a decade of recommendations in reports commissioned by both VIHA and the City of Victoria (Fischer, 2007: 8; VIHA, 2006: 42; City of Victoria, 2005: 46; Stajduhar et al, 2002: 69). The recommendations of Victoria’s Mayor’s Task Force on Breaking the Cycle of Mental Illness, Addictions and Homelessness (2007) are indicative of this collective knowledge, pointing to the need for “small, properly staffed, supervised consumption sites to reduce the spread of disease, provide a stable point of contact for referrals and reduce the public disorder associated with public injection of drugs on our sidewalks” (City of Victoria, 2007:10).