Summer House

Times Union — Tatum O’Neal, the Oscar-winning actress, took a plea deal last week stemming from her June 1 arrest while supposedly trying to score some crack cocaine on the Lower East Side of Manhattan. She was initially charged with possession of a controlled substance and faced a year in prison if convicted. The court allowed her to plead out to a disorderly conduct charge and ordered her to attend two half-day drug treatment sessions. If she follows the court’s orders, the cocaine possession charges will be dismissed.

O’Neal has been open about her history of heroin addiction as outlined in her memoir, "A Paper Life." When she was arrested by undercover officers, they searched her and found two bags of cocaine along with an unused crack pipe. She had initially told police she was doing research for an acting role. Then she changed her story and told them that the death of her 16-year-old dog nearly triggered her into relapse.

Some say O’Neal was treated with a slap on the wrist. Others say she did not deserve to do any jail time because of her addiction. This raises a critical question that we as a society need to address. Should we treat drug addiction as a criminal matter, or as a medical problem?

For most people, treatment is a much more effective approach than imprisonment for successfully breaking their addictions, yet our prisons are full of individuals whose only crime is their drug addiction.

According to Justice Department statistics, the United States has more prisoners than any country in the world, 2.5 million and rising. In 2006, the Justice Department recorded the largest increase since 2000 in the number of people in prisons and jails. Criminal justice experts attribute the exploding prison population to harsh sentencing laws and record numbers of drug law violators entering the system, many of whom have substance abuse problems.

Nonviolent drug offenders like Tatum O’Neal should be given an opportunity to receive treatment, not jail time, for their drug use. This would be a more effective (not to mention much more affordable) solution for both the individual and the community. Prosecutors in many states, most notably New York, have leeway to recommend a defendant to treatment instead of incarceration. More than likely, however, they will not do it. This is because it would not be considered a victory for them. The system does not reward prosecutors for doing the compassionate thing.

O’Neal can be an example for millions of young people. One can only hope that her experiences with addiction and the realities of the drug war will encourage her to join the movement to reform U.S. drug policy. If she decides to take up the cause of treatment, she could help change laws across the country. After all, if treatment instead of jail is good enough for her as she struggles with her addiction, surely it is good enough for the thousands of others just like her who struggle with their own substance abuse problems.

Like depression, addiction affects tens of millions of Americans. How best to treat it is a serious a question we need to explore. Rich or poor, young or old, addiction has no boundaries. But the drug war does. Our long war on drugs has stifled the open debate society should be having about the nature of addiction and how best to deal with it. It is time to treat addiction for what it is — a medical problem, not a criminal one.

Fox News — The U.S. leads the world in marijuana and cocaine experimentation, as well as in lifetime tobacco use, according to a survey released this week by the World Health Organization.

For the survey, which was partially funded by a division of the U.S. National Institutes of Health, researchers at the University of New South Wales in Sydney, Australia looked at drug, alcohol and tobacco use in 17 countries throughout North and South America, Europe, Asia, the Middle East, Africa and Oceania. More than 54,000 people participated in the survey.

"The United States, which has been driving much of the world’s drug research and drug policy agenda, stands out with higher levels of use of alcohol, cocaine, and cannabis, despite punitive illegal drug policies, as well as (in many U.S. states), a higher minimum legal alcohol drinking age than many comparable developed countries," the authors wrote in the study, which was published in the July 1 issue of the journal PLoS Medicine.

"The Netherlands, with a less criminally punitive approach to cannabis use than the U.S., has experienced lower levels of use, particularly among younger adults," they added.

The U.S. had the highest percentage of respondents admitting to lifetime tobacco use at 74 percent, followed by Lebanon at 67 percent, and Mexico and the Ukraine at 60 percent, according to the study.

The lowest percentages of lifetime tobacco use were found in the African countries of South Africa with 32 percent and Nigeria with 17 percent.

More U.S. respondents said they used marijuana at 42.4 percent, followed by New Zealand at 41.9 percent. Lifetime marijuana use was virtually non-existent in Asian countries, however.

Sixteen percent of U.S. survey participants said they used cocaine at least once, followed by Colombia, Mexico, Spain and New Zealand where between 4 and 4.3 percent of respondents admitted to use.

The only area where U.S. respondents trailed was in alcohol use. Almost 92 percent of U.S. respondents said they used alcohol, compared to 97 percent of Ukrainians and 95.3 percent of Germans. Just 40 percent of South African respondents used alcohol.

The skyrocketing use and abuse of prescription narcotics in Las Vegas is accompanied by a similarly startling increase in the number of fatal overdoses, a Sun analysis has found.

Fatal overdoses involving prescription painkillers more than quadrupled in a decade and now exceed those involving illicit drugs, according to data compiled by the Clark County coroner’s office.

The trend reflects the extraordinarily high use of narcotic painkillers by Nevadans. The Sun reported Sunday that its analysis of Drug Enforcement Administration data shows that Nevadans per person use more hydrocodone — the potent ingredient in the drugs Vicodin, Lortab and Norco — than residents of any other state. Nevadans rank fourth nationally in per person consumption of methadone, morphine and oxycodone, the main ingredient in OxyContin.

The increased use and availability of the drugs are primary factors in the rise of addiction, illegal distribution and fatal overdoses, experts say.

In 1997, there were 57 fatal overdoses in Clark County in which prescription narcotics were a contributing factor, a rate of about five per 100,000 people. In 2007, 258 people died in Clark County from overdoses of prescription narcotics, a rate of 13 per 100,000 people.

In contrast, the number of deaths caused by illicit drugs has plateaued. Street drugs such as cocaine, methamphetamine and heroin were involved in a combined 197 fatal overdoses in 2007.

Deaths involving prescription narcotics exceeded or rivaled those caused by firearms (321) and motor vehicle accidents (234) in Clark County in 2007.

Clark County Coroner Mike Murphy called the prescription drug deaths a “dire situation.”

Doctors who specialize in pain management, and pharmaceutical companies that make the drugs, emphasize that many people are helped by prescription narcotics while acknowledging that a small percentage may become addicted.

Prescription drug overdoses draw national attention when the victims include such celebrities as Heath Ledger and Anna Nicole Smith, but aside from the sensational anecdotes, little is reported about the overall toll of overdoses.

Poisoning, usually caused by unintentional drug overdose, is the second leading cause of injury death in the United States, surpassing firearms in 2004, according to the National Center for Health Statistics.

Prescription narcotics deaths accounted for 56 percent of poisoning deaths nationally in 2005, according to the Centers for Disease Control and Prevention, and their absolute number increased by 84 percent from 1999 to 2005.

Some regional data compiled by medical examiners further illustrate the problem:

• In King County, Washington (Seattle), prescription opiates killed 148 people in 2006, a 572 percent increase since 1997.

• In Virginia, prescription narcotics took 399 lives in 2006, compared with 146 deaths from cocaine and amphetamines.

• In Oklahoma, of 603 drug-related deaths in 2006, more than half, 327, were attributed to hydrocodone, methadone or oxycodone.

• In Florida, people who died of drug overdoses in 2007 had prescription drugs in their systems more often than illicit drugs.

No prescribed narcotic is involved in more deaths among Nevadans than methadone. The long-acting painkiller was named in a third of the 1,771 prescription drug overdoses in Clark County from 1991 to 2007, according to the Clark County coroner’s office. The number of deaths involving methadone climbed from three in 1993 to 20 in 1998 and 105 in 2007. (Cocaine was a factor in 116 Clark County deaths in 2007.)

Methadone, widely used to wean addicts off other drugs, has grown in popularity as a painkiller in recent years. Several doctors said it’s preferred by insurance companies because it’s inexpensive — though insurers dispute this, saying there are many low-cost generic narcotics so there would be no reason to favor methadone.

But methadone is a challenging drug to prescribe because it stays in a person’s system for five to 11 days, even after its effects have worn off, said Las Vegas pain specialist Dr. Jim Marx. That means a patient could take multiple doses of methadone over time to keep pain in check, allowing potentially lethal amounts of the drug to build up in the body. In comparison, hydrocodone leaves the body within hours.

“It’s trickier to prescribe because of its persistence,” Marx said.

Methadone deaths have increased more than those involving any other narcotic, the Centers for Disease Control and Prevention reports.

Its data show Nevada had almost four methadone deaths per 100,000 people from 1999 to 2005, the fourth-highest rate in the United States, behind Maine, Utah and Washington.

The CDC said it’s hard to determine whether the increase in opioid-related deaths is due to prescribing practices, a failure by patients to take drugs properly, or illegal abuse.

CDC medical epidemiologist Leonard Paulozzi told Congress in March the drug overdose deaths correspond to the rapidly rising rates of prescription narcotic use reported by the Drug Enforcement Administration, and the overdose deaths are expected to continue.

Statistics through 2005 “probably underestimate the present magnitude of the problem,” Paulozzi said.

•••

There are many ways to get prescription narcotics illegally, said Matt Alberto, deputy chief of investigations for the Nevada Public Safety Department, the state’s lead prescription drug policing agency.

Unscrupulous doctors sell prescriptions for cash. Abusers shop for doctors who prescribe narcotic painkillers without asking many questions. Children fish around in their parents’ medicine cabinets. Patients forge prescriptions. Pharmacy workers, clinic workers and hospital employees steal the drugs.

The most notorious criminal case of a doctor in Las Vegas illegally providing narcotic drugs involves Dr. Harriston Bass Jr., who, according to evidence at his trial, made house calls to prescribe and distribute prescription narcotics.

Bass drove to patients’ homes, conducted 10-minute exams and then sold the patients two or three bottles of 100 pills each — even though he had no license to distribute controlled substances, according to testimony at his trial. He also wrote prescriptions for patients to fill at pharmacies.

Among his patients was Gina Micali, who received about 300 hydrocodone tablets from Bass every other month, plus a prescription for another 180 and one refill. On each visit she also received the muscle relaxant Soma and the anxiety medication Xanax, plus prescriptions for each. In pills and prescriptions, Bass sold Micali a total of about 1,400 pills per visit, said Conrad Hafen, the chief deputy attorney general, who prosecuted the case.

On Oct. 5, 2005, Micali, 38, died after ingesting too many painkillers she got from Bass.

Hafen told the jury that when police searched Bass’ home, they found $150,000 in cash and large quantities of hydrocodone in bottles labeled with the name of his company — DOCS-24-7 — and a wholesale prescription drug company in Illinois.

Alberto said the Illinois company offered no good explanation for why it was selling drugs to a doctor who didn’t have clearance from the Drug Enforcement Administration.

In March, Bass was convicted of second-degree murder in Micali’s death and was found guilty on more than 50 drug-related charges. He was sentenced to 25 years to life in prison.

A more typical case of illegally diverting prescription painkillers involves Stephanie Ortiz, a former pharmacy technician at four Smith’s grocery stores in Las Vegas. She admitted to the pharmacy board that she gave unauthorized refills of Lortab — a painkiller made with hydrocodone — and free drugs to friends posing as patients. Ortiz filled out refill requests but never faxed or phoned them to physicians for approval, the complaint against her says. She admitted illegally diverting 10,680 doses of the painkiller.

In a letter she wrote admitting her guilt, Ortiz says she started giving the purloined drugs to people she knew, and then got text messages and phone calls saying a random person would come by for another pickup. In exchange for the drugs, Ortiz said, she received VIP tables at nightclubs and access to hotel rooms on busy weekends.

Authorities say young people are cavalier with prescription drugs, sharing them among themselves or sneaking them from their parents and passing them around to their friends. Such a transaction ended in death two years ago this week in Mesquite.

According to an affidavit filed by the Nevada Public Safety Department, Brett Sawyer, 19, was found dead in his bedroom on July 8, 2006. Hidden in a gym bag by his bed was an empty bottle of hydrocodone pills prescribed by a dentist in St. George, Utah, to one of his friends.

Sawyer’s family told investigators he was a drug user. “Brett was the type — if one aspirin worked, three would work better,” his mother said.

Police learned that Sawyer was addicted to OxyContin and often obtained drugs from Cody Morris, who was also an addict and dealt the drugs to his friends.

On July 7, 2006, Morris sold Sawyer three 80 mg OxyContin pills — what some call the Cadillac of prescription narcotics — for $45 each. Morris said he warned Sawyer not to take more than one at a time and to avoid mixing them with alcohol.

Sawyer was dead the next day.

Morris pleaded guilty to manslaughter and was sentenced to three years’ probation.

Alberto, the investigator, said it’s as common for drug dealers to sell prescription narcotics as it is methamphetamine or cocaine — and more profitable. An ounce of methamphetamine might sell wholesale in Las Vegas for $700, he said, but the same weight in OxyContin pills would be $3,000. He guessed the illegal abuse of prescription painkillers could account for 10 percent of the state’s total use.

Alberto laments that policymakers and the public are focused on street drugs, and virtually ignore the dangers in people’s medicine cabinets. Narcotics investigators for Metro Police do not investigate prescription drug dealing and deal with the drugs only on a reactive basis, a spokesman said.

Yet prescription narcotics are becoming more popular than marijuana for new abusers. The 2006 National Survey on Drug Use and Health found that among new drug abusers, 2.2 million people chose prescription painkillers and 2.1 million preferred marijuana.

Nothing stimulates the brain with pleasure more than drugs. But doctors disagree about the threat of drug addiction. People at risk of becoming addicted to them range from 3 percent to 18 percent of the population, depending on the study or the expert.

Prescription narcotics can change the brain’s chemistry, creating a physical and psychological dependence that compels addicts to forgo career, children, money, sleep, sex and all-around well-being in pursuit of the drug of choice.

Officials with the Nevada Substance Abuse Prevention and Treatment Agency say the rise in prescription narcotic addiction in the state cannot be quantified because of the way records are kept. Nationally, a 2006 Substance Abuse and Mental Health Services Administration survey showed that an estimated 5.2 million people 12 and older took narcotic painkillers for nonmedical purposes 30 days before the survey, up from about 4.4 million in 2002.

People seem to think that because the drugs are commercially manufactured and approved by the Food and Drug Administration, their abuse is less risky than that of illicit drugs, said Steve Pasierb, president of the Partnership for a Drug-Free America.

“This is a deadly behavior,” Pasierb said of the drug abuse. “When prescription drugs are abused in the same way as illegal street drugs, they’re every bit as addictive and they’re every bit as deadly.”

WASHINGTON (AP) — They were indelible images of the cocaine world of the 1970s and ’80s: Rich yuppies and white suburbanites partying down with a couple of lines of "blow." Stockbroker Charlie Sheen snorting up in the limo in "Wall Street." Woody Allen’s sneeze in "Annie Hall."

More than 30 years later, the image remains but the reality of coke in the United States has shifted significantly. Long portrayed as a white crime, Hispanics now make up the overwhelming majority — 60 percent — of federal offenders facing powder cocaine charges.

In fact, data show, more Hispanics than whites or blacks have been sentenced on federal powder charges as far back as 1992. Law enforcement officials say that’s because federal agents almost exclusively pursue cocaine traffickers from South America and Mexico instead of end-of-the-line U.S. consumers.

Until the last decade, when the price of cocaine dropped sharply, consumers were largely affluent and educated. That fed into the misperception — often reported by The Associated Press and other news organizations — that most powder cocaine offenders were white, experts say.

"There was a lot of publicity about the white population using it; it was more of a higher economic status thing," said Dorothy K. Hatsukami, a behavioral scientist at the University of Minnesota’s Masonic Cancer Center. She co-authored a 1996 study medically challenging federal sentencing guidelines that penalized black cocaine offenders more harshly than white ones.

The study cited 1993 data indicating that 69 percent of powder and crack cocaine users were white, compared with 15 percent black and 13 percent Hispanic. However, it suggested that far more blacks and Hispanics used the cheaper crack cocaine than whites.

"Articles in the papers were all related to the jet-setters into powder cocaine, so that’s probably why we were focusing on the white population," Hatsukami said in an interview this week. "There was a lot of media focus on whites and powder in the 1980s — then, it was almost legitimate to be using powder.

"That’s what people did at parties, and people didn’t think it was all that harmful."

The issue of race in cocaine use surfaced again recently with last winter’s U.S. Sentencing Commission vote to ease penalties for crack cocaine offenders — more than 80 percent of whom have been black, according to data between 1992 and 2006. Fewer than 10 percent of crack offenders are white or Hispanic, the Sentencing Commission data show.

By contrast, the number of Hispanic offenders has risen steadily over the years, from 40 percent in 1992 to 58 percent in 2006, the data show. At the same time, the number of white offenders has steadily dropped: from 32 percent in 1992 to 14 percent two years ago.

Federal drug agents and prosecutors are quick to defend their focus on leaders of major drug rings and international traffickers — mostly blacks and Hispanics — instead of small-time or individual cocaine users who are generally charged with state and local crimes.

Last year, for example, federal prosecutors won convictions against 445 people suspected of simply possessing drugs, according to Justice Department data provided in a study by the Transactional Records Access Clearinghouse at Syracuse University. The federal government convicted more than 12,209 — nearly 30 times as many — drug traffickers, manufacturers and distributors during that time, the TRAC study shows.

In the late 1970s and early-to-mid 1980s, cocaine traffic mostly moved up the Interstate 95 corridor. Colombian traffickers airlifted or shipped bricks of the drug to Miami, then moved it up the East Coast to New York, where it was distributed. A kilogram (about 2.2 pounds) then was usually worth at least $50,000, Drug Enforcement Administration agent Michael Sanders said.

"That’s a chunk of money — it was a big affluency thing," Sanders said. "It was pretty much white Americans — that was the market that was purchasing it."

Once the feds started cracking down on Miami, much of the traffic moved to Southwestern states, where Colombians paid Mexicans to smuggle the cocaine across the border, Sanders said. The price of a kilogram has since dropped substantially — to as little as $15,000 in Houston and New Orleans recently, he said.

By 2000, half of all cocaine traffickers facing federal charges were Hispanic, U.S. Sentencing Commission data show. Additionally, Hispanics made up 61 percent of traffickers smuggling in more than 5 kilograms (about 11 pounds).

"I’m not going to tell you it’s not worthwhile to put the user in jail," Sanders said. "But we are mandated to dismantle and disrupt major cartels. That’s our ultimate goal."

For the most part, Sanders said, state and local police and prosecutors are responsible for cracking down on cocaine consumers.

The FBI reports that more than 875,000 whites and Hispanics were charged with local and state drug abuse crimes in 2006. By comparison, 483,800 blacks were similarly charged.

The data do not detail how many Hispanics alone were charged because the statistics only look at differences in race, not by ethnicity, said FBI researcher Nancy Carnes.

In recent years, the big-time distributors have started sending cocaine traffic to Europe.

"It’s a market that’s been largely untapped — up until now," Sanders said.

WASHINGTON (CNN) — The U.S. Supreme Court ruled Monday that federal judges have the discretion to give "reasonably" shorter prison terms for crack cocaine crimes to reduce the disparity with crimes involving cocaine powder.

The 7-2 ruling represents a victory for lawyers who argued that crack cocaine offenders were unfairly targeted under U.S. sentencing guidelines.Current federal penalties for selling 5 grams of crack cocaine can warrant the same prison sentence as dealing 500 grams of the powdered variety.

The Supreme Court case centered around Derrick Kimbrough of Norfolk, Virginia, who according to court records, pleaded guilty to distributing more than 50 grams of crack cocaine. Federal sentencing guidelines called for 19 to 22.5 years behind bars. But Judge Raymond Jackson instead gave the defendant a 15-year sentence, calling the case "another example of how crack-cocaine guidelines are driving the offense level to a point higher than is necessary to do justice."

A federal appeals court overturned the case and sent it to a higher court, saying Jackson’s discretion was "unreasonable when it is based on a disagreement with the sentencing disparity for crack and powder cocaine offenses."

Said Kimbrough’s attorney, Michael Nachmanoff in October, "A sentence of 19 years for a man with no felony convictions who served his country honorably, who had never spent a night in jail … that was ridiculous."  Kimbrough is a veteran of the 1991 Persian Gulf War and is African-American.

African-Americans were nearly 82 percent of defendants sentenced in federal court for dealing crack, but only 27 percent of those sentenced for dealing powder cocaine, according to 2006 federal statistics. Each year, federal courts handle about 11,000 cocaine sentences, which are roughly evenly divided between crack and cocaine cases.

The issue long has been a source of contention between government prosecutors and civil rights advocates, who argue crack dealers are often targeted for longer prison terms because that drug is prevalent in urban and minority communities, while the powdered version is more commonly associated with higher-income users.

Writing for the majority, Justice Ruth Bader Ginsburg took a practical approach, saying it is important to preserve judicial discretion, while ensuring most sentences remain within federal guidelines established two decades ago to ensure a measure of uniformity.

Ginsburg said a federal judge was right to give a crack offender a lesser prison term than the guidelines called for, since federal law "mandates only maximum and minimum sentences," she wrote. "It says nothing about appropriate sentences within those statutory guidelines."

Ginsburg noted the trial judge "honed in on the particular circumstances of Kimbrough’s case and accorded weight to" reports by the U.S. Sentencing Commission that show "the crack/powder disparity yields unjustifiably harsh sentences for crack offenders."

Justices Clarence Thomas and Samuel Alito dissented in the Kimbrough case. Thomas said it will now be up to courts "to assume the legislative role of devising a new sentencing scheme," something Congress never intended.

The government had no immediate reaction to the high court’s ruling.

The U.S. Sentencing Commission — an independent federal agency that advises all three branches of government on sentences — recently cut the gap in recommended prison time for crack cocaine offenses. The guidelines took effect November 1 after Congress decided not to overturn the changes.

The commission is scheduled to vote Tuesday on whether to make those guidelines retroactive for prisoners convicted in the past of crack dealing.

Almost 20,000 inmates could be eligible for shorter sentences under the proposed changes.

Congress recently has introduced at least four bills that would reduce the current disparity in cocaine sentences. One widely circulated proposal led by Sens. Orrin Hatch, R-Utah, and Edward Kennedy, D-Massachusetts, would revise the cocaine ratio downward to 20-to-1. That ratio is also supported by the Sentencing Commission.

Harsher sentences for crack offenses came after a social epidemic of crack cocaine began destroying many urban areas in the 1980s.

"The crack-cocaine guidelines were put in place because crack was fueling crime waves across the country, in particular with respect to street violence," said Kendall Coffey, a former U.S. attorney in Miami who comments on legal matters for CNN. "And it is clear that crack cocaine and white powder cocaine had a very different impact in terms of not only the lives of the users but the impact on the community."
 

The case is Kimbrough v. U.S. (06-6330).

VANCOUVER, British Columbia (CNN) — I didn’t know quite what to expect when I entered the injection room at Insite, the world’s busiest supervised drug clinic.

Inside the Vancouver facility, I found more than a dozen people taking illegal drugs, such as heroin and cocaine, under the watchful eye of trained nurses. These drug users were among the more than 700 people who visit the facility every day, bringing their drugs with them. Insite’s goal is to reduce the risk of overdose and limit the spread of diseases like HIV by giving addicts clean needles and a safe place to use them.

"People need to be kept alive long enough in order to get treatment," said Liz Evans, a nurse and founder of Insite.

The clinic, which is sanctioned by Vancouver’s health department, opens each day at 10 a.m. and stays open until 4 a.m. the following day. Many of the people in the clinic on the day we visited had tattered clothes, missing teeth and glassy eyes. They swayed as they struggled to keep their balance. Video Watch people shoot up in the Vancouver clinic »

Outside of the clinic, police patrolled the streets to keep people from buying and selling illegal drugs. Inside, patrons were given access to Insite’s clean needles, injection booths and nurses. Similar facilities can be found at 65 locations in eight different countries. San Francisco health officials recently held a day-long conference on the Vancouver drug clinic, with an eye toward possibly opening a similar one. But San Francisco Mayor Gavin Newsom said the city is unlikely to do so.

"You had a lot of health officials there that did participate in the pros and cons. But my director of the department of public health doesn’t feel the city should move forward," Newsom said.

Defenders of the Vancouver clinic say more than two dozen peer-reviewed studies have shown its benefits. One study found a 45 percent reduction in public drug use as a result of the clinic; another showed 33 percent of addicts are more likely to go to drug detox after using Insite. Dr. Thomas Kerr, a University of British Columbia research scientist who has studied the program, believes Insite benefits the wider community.

"In the absence of such a facility, not only would [drug users] be high out on the street, but they would be leaving their syringes in school yards, in parks and on city streets," Kerr said.

Dr. David Murray, chief scientist for the White House Office of National Drug Control Policy, opposes opening drug injection clinics in the United States. He believes they do little to help addicts overcome their additions.
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"It is a cruel illusion because they are still addicted, trapped, trying to get out and dying by the virtue of the drug itself," he said.

Nurses at the Vancouver clinic say they get all kinds of people using their facility, from an old grandma who comes to inject her pain medication to men in business suits hiding their addictions from their families.

At the clinic, we met Lorraine Trepanier, 50, a longtime drug user. Trepanier said she used to sell her body for drugs, but now relies on a friend to give her the $20 she uses every day to buy cocaine and heroin.

"I get up in the morning and I make sure I have one down or half a down," she said, referring to her heroin fix. Trepanier believes Insite has helped keep her alive by giving her a supervised setting in which she can take drugs.

Evans and other operators of Insite say that rather than chase addicts from corner to corner and alley to alley, it is more effective to encourage them to use their drugs in a supervised setting.  In the more than four years Insite has been open, there have been roughly 800 overdoses at the facility, but there have not been any deaths. When someone does overdose, nurses try to revive them. If the drug user is in critical condition, they are sent to a hospital.
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Trepanier doesn’t care what critics have to say about Insite. All she wants is a chance to get her next fix in a clean facility, until the day she finally works up the willpower to kick her drug addiction.

"I don’t want to be down here all my life," she said. "I don’t want to be chasing this all my life."