David Lands enters an upscale office building, checks in with the receptionist and goes inside to shoot heroin and cocaine into his veins.
The frail, long-haired addict is one of the first to use North America's only government-sponsored safe injection site -- called Insite -- which opened last month as a trial project in a seamy downtown neighborhood known for junkies and prostitutes.
"They should have more places like this," Lands said afterward, holding two peanut butter and jelly sandwiches provided by Insite clinic staff as he recovered from his heroin and cocaine speedball. "You'd find less people that have overdosed in the alleys."
Critics disagree, saying that providing a legal place for addicts to shoot up only enables more drug use. US drug chief John P. Walters has called the Insite clinic "state-sponsored suicide," but those who use it believe the opposite.
Lands, 32 and a heroin addict since 1997, said junkies can end up injured or dead from robbers or overdosing when injecting in alleys of the Downtown Eastside, a 15-block area frequented by 5,000 drug addicts.
The Insite clinic means an addict can feed his habit without worrying about getting attacked while lying comatose after injecting.
"If you overdose, they help you here," he said. "Not in the alleys. There they don't care."
Lands and another longtime addict, who would give his name only as Joe, outlined the Insite procedures. Users bring their own drugs, and clinic staff provide a kidney-shaped bowl containing a needle, a "cooker" and matches to heat up the goods and an antiseptic swab.
Joe, a 39-year-old construction worker wearing a bandanna on his shaved head, agreed the clinic was safer than the streets.
"I was in an alley shooting up and two guys stuck a knife in my throat," he said, describing a robbery of his stash. "They would have killed me if I hadn't given it up."
At Insite, the junkies have their backs to nurses when shooting up, but are monitored by mirrors in the 12 injection booths, according to Joe and Lands. Nurses show those who ask how to inject safely, but otherwise have no direct role in the process.
Vivianna Zanocco of the Vancouver Coastal Health Authority, which runs the clinic with a local advocacy group, said 153 addicts came during the first two 18-hour days the site was open. Total pre-registration for the clinic was 600 people, she said.
After injecting, users are monitored in a "chill-out room" -- where Lands got his sandwiches -- before leaving. They also can get help if they want to kick their habits.
The WHO and the UN have singled out Vancouver for high HIV infection rates in a wealthy, western city. According to the British Colombia Center for Disease Control, more than 30 percent of addicts in the area have HIV or full-blown AIDS. The city already hands out needles to addicts under anti-infection programs. The Insite clinic is exempt from Canadian drug laws, allowing the addicts to posses heroin and cocaine inside. Such an exemption can be made for medical or scientific reasons, or if it is in the public interest.
Zanocco said smoking marijuana or crack cocaine is prohibited, and initial fears that drug dealers would congregate around the site have proven unfounded, so far.
Police officers maintain a low profile outside, permitting addicts to enter the clinic with their drugs.
"It is not the police intention to intervene or interfere with anyone entering the site, unless there is a lawful reason to do so," Police Chief Jamie Graham said. However, the police presence presumably scares off dealers
Mayor Larry Campbell, a former police officer and coroner, was elected last year after pledging to establish safe injection sites as part of a "four pillar" drug policy involving treatment, prevention, harm reduction and enforcement.
He called the Insite clinic a vital part of a plan to reduce overdose deaths and the spread of AIDS and hepatitis C, and to provide primary health care to drug users. So far this year, 37 people have died of drug overdoses in Vancouver.
Two blocks away, users inject at an illegal shooting gallery that opened in April due to impatience over waiting for the opening of the government-sponsored clinic. Police are letting it operate for now, but say they are keeping a close watch.
Joanne Csete, a spokesman for the international group Human Rights Watch, praised the opening of the Insite clinic as essential to helping users avoid overdose and infection while exposing them to help toward kicking the habit.
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