The drugs and pipe, acquired elsewhere, are hers. But the shelter, the equipment she uses to prepare her fix and the volunteers standing by to respond if she overdoses are provided by a small nonprofit. Funding and supplies come from the city of Vancouver and the province of British Columbia.

“I was outside. It’s warmer in here,” says Coleman, 22, although the tent is open to the damp and chill of a western Canadian winter. “It’s just safer.”

In barely a year, five sites like this one have opened within a few blocks of one another to contend with a surge of fentanyl on Vancouver’s streets. In December, the organization that runs this location, the Overdose Prevention Society, took over a vacant building next door, giving users a clean indoor place to inject drugs. There are 29 similar sites in British Columbia, the epicenter of Canada’s drug crisis, and more across the country.

“To save lives, you need a table, chairs and some volunteers,” said Sarah Blyth, the manager here. “We literally popped it up in one day. And then you have people saving lives. Immediately.”

As fentanyl rampages across North America, several U.S. cities have announced that they will open the first supervised drug-consumption sites like those in Canada. Their plans illustrate the gulf between the two nations: While Justin Trudeau’s government is doubling down on its “harm reduction” approach, any U.S. organization that tries to follow suit would be violating federal law and risking a confrontation with the Justice Department.

U.S. researchers say that at least one underground site is operating on American soil, and they predict that a public operation will open despite the potential consequences.

“That’s the way that drug policy issues have moved forward in this country [over the] last 25 years,” said Alex Kral, an epidemiologist at the think tank RTI International who has studied supervised drug consumption. Cities enduring the deaths, disease, crime and cost of drug epidemics have taken the lead in handing out free needles and distributing the overdose antidote naloxone — sometimes after legal battles.

San Francisco plans to add supervised injection services to an existing community health facility. Those could start as soon as July 1.

“We just have to do what’s best for the client, and we hope the federal government will understand,” said Barbara Garcia, director of health for the city and county of San Francisco. “I’m not looking to change federal law. I’m looking to save lives.”

Canada’s plans do not stop at supervised injection. Some sites now test users’ drugs for fentanyl, and some are aiming to provide prescription opioids from vending machines.

The most far-reaching intervention is just two blocks from the pop-up site, where the Providence Crosstown Clinic provides 130 of the city’s hardest-core drug users with pharmaceutical-grade heroin and other narcotics. Users come to inject themselves as often as three times a day, and some also swallow a morphine tablet to carry them through the night.

Freed of the need to steal, beg and trade sex for drug money, some now have apartments and jobs. The clinic, run by a medical center, hopes to add 50 more clients soon.

“The ability to say, ‘I’m receiving treatment; I’m not a dirty user,’ does so much for their self-esteem,” said Jennifer Mackenzie, the clinical nurse leader. “It opens so many doors for them. They’re getting medical treatment, and they look at themselves differently.”

Research shows that the approach, like supervised drug consumption, saves lives, cuts criminal justice and health-care costs, limits the spread of diseases such as HIV and helps reduce used needles and other debris in the immediate neighborhood. A similar facility recently opened in Ottawa, and Canada has loosened requirements to encourage others.

But British Columbia’s programs have not blunted its opioid crisis. Overdose deaths have skyrocketed from fewer than 400 in 2014, when fentanyl became widely available on the street, to more than 1,400 in 2017. Eighty-one percent of last year’s deaths involved fentanyl.

Critics said that statistic speaks to the futility of harm reduction. “To say the best we can do is to revive people who are victims and are going to be victims again . . . is reprehensible,” said John P. Walters, drug czar under President George W. Bush and now chief operating officer of the Hudson Institute, a conservative think tank in Washington.

Walters favors a dramatic expansion of drug treatment in the United States, which recorded 42,000 opioid deaths in 2016, coupled with a much more concerted effort to keep drugs such as fentanyl out of the country. He questions the rigor of the academic studies that support harm reduction. And he believes that normalization and tolerance of drug use are reasons that addicts crowd the streets of this city’s small Downtown Eastside district.

“Look at Vancouver, it’s tried every bad policy you can try,” Walters said. “This is another step in that whole policy that has made Vancouver a nightmare.”

*****

“This is my flail,” Coleman said between hits on her pipe, scattering the contents of her backpack on a table. A coloring journal, cellphone, some clean socks. “It’s what I do when I’m high.”

She does not yet have the battered look of the legions of longtime drug users who are everywhere in this neighborhood. Yet her story is typical: She fled an abusive mother, got into hard drugs at 17 and soon was pimped out by her supplier. She has an 18-month-old son in foster care, lives with friends and is trying, again, to find her way out through treatment.

“It looks like I’m enjoying it because I’m high,” she said. “I don’t have anything in my life that really means anything. All the drugs that I have [are] not going to fill the emotional void that I have.”

The Overdose Prevention Society runs one of Vancouver’s safe-injection sites, an operation that started as a pop-up and now includes a permanent facility. Frederick Williams checks off users as they enter. (John Lehmann/For The Washington Post)

Drug smokers like Coleman are restricted to the Overdose Prevention Society’s outdoor tents because the new building, a former grocery, has no ventilation system. It is home mostly to injection drug users. A long, narrow main room is nearly bare except for 13 stainless-steel tables and some posters on the walls. Red partitions divide the rest of the floor, making space for a couple of desks, a cot where workers can calm down after resuscitating overdose victims, and supplies piled high in boxes.

The most critical are oxygen and naloxone, the antidote that has saved countless lives. In the 30 years that supervised sites have been open in Europe, and the 15 years that they have existed in Canada, no site has suffered an overdose death, Kral said.

Users enter here through a guarded door off a back alley that used to be the scene of widespread drug use, dealing and prostitution. A small street shrine to a dead woman sits just outside the entrance.

From a small table of supplies they pick up what they need: syringes, matches, elastic strips to tie off veins, water to dilute drugs, small squares of foil, tiny tins for cooking heroin. Also available are condoms and lube.

Some of the volunteers who greet them are current or former users themselves. They usher clients to the tables. On a clipboard, one staff member logs names (usually aliases), gender, the drugs being used and the time a person comes in. Between the indoor and outdoor sections, 300 to 700 people show up daily. The largest crowds are on days when welfare payments arrive.

More here

Canadian figure skater Eric Radford has become the first openly gay man to win a gold medal at the Winter Olympics.

Radford, 33, took gold at the Pyeongchang Games in the team figure skating event with his partner Meagan Duhamel, and said he “might explode with pride” after his routine set to Adele’s Hometown Glory finished first.

After his win, Radford wrote on Twitter: “This is amazing! I literally feel like I might explode with pride.”

Later, he shared a picture of himself with Rippon, along with the hashtag “#outandproud”.

Angela Ruggiero, the head of the International Olympics Committee's Athletes Commission, praised Radford’s “fantastic” achievement.

“[He's] paving the way to send a really positive message globally to say that everyone should be accepted and that everyone should be able to compete at the Olympic Games,” he said.

US skater Adam Rippon, who is the first openly gay athlete to be selected for the US Winter Olympics team, meanwhile won bronze in the same event at the Gangneung Ice Arena.

The pair join openly bisexual Dutch speed skater Ireen Wust, who has won 10 medals including golds from four consecutive Winter Olympics.

(independent.co.uk)

CARACAS, Venezuela — “Would you like to see the little ones?” asked Magdelis Salazar, a social worker, beckoning me toward a crowded playground.

We were at Venezuela’s largest orphanage, just after lunch. The yard was an obstacle course of abandoned children. A little chunk of a boy, on the cusp of 3, sat on a play scooter. He was called El Gordo — the fat one. But when he was left here a few months ago, he was skin and bones.

He zoomed past a 3-year-old in a pink shirt with tiny flowers. “She doesn’t talk much,” one of the attendants said, tousling the girl’s curly hair. At least, not anymore. In September, her mother left her at a subway station with a bag of clothes and a note begging someone to feed the child.

Poverty and hunger rates are soaring as Venezuela’s economic crisis leaves store shelves empty of food, medicine, diapers and baby formula. Some parents can no longer bear it. They are doing the unthinkable.

Giving up their children.

“People can’t find food,” Salazar told me. “They can’t feed their children. They are giving them up not because they don’t love them but because they do.”

Ahead of my recent reporting trip to Venezuela, I’d heard that families were abandoning or surrendering children. Yet it was a challenge to actually meet the tiniest victims of this broken nation. My requests to enter orphanages run by the socialist government had gone unanswered. One child-protection official — warning of devastating conditions, including a lack of diapers — confided that such a visit would be “impossible.” Some privately run child crisis centers worried that granting access to a journalist could damage their delicate relations with the government.

My Venezuelan colleague Rachelle Krygier introduced me to Fundana — an imposing cement complex perched high on a hill in southeastern Caracas. Her family had founded the nonprofit orphanage and child crisis center in 1991, and her mother remains the head of its board and her aunt its president. Rachelle remembered volunteering there a decade ago, when she was a student and the children were almost exclusively cases of abuse or neglect.

There are no official statistics on how many children are abandoned or sent to orphanages and care homes by their parents for economic reasons. But interviews with officials at Fundana and nine other private and public organizations that manage children in crisis suggest that the cases number in the hundreds — or more — nationwide.

A poster with the hands of children living at Fundana, a private institution that is part orphanage, part temporary care center for children. (Alejandro Cegarra for The Washington Post)

Fundana received about 144 requests to place children at its facility last year, up from about 24 in 2016, with the vast majority of the requests related to economic difficulties.

[Venezuela’s Maduro cements control as the opposition fractures]

“I didn’t know what else to do,” said Angélica Pérez, a 32-year-old mother of three, near tears.

On a recent afternoon, she showed up at Fundana with her 3-year-old son and her two daughters, ages 5 and 14. She lost her job as a seamstress a few months ago. When her youngest came down with a severe skin condition in December and the public hospital had no medicine, she spent the last of her savings buying ointment from a pharmacy.

Her plan: leave the children at the center, where she knew they would be fed, so she could travel to neighboring Colombia to find work. She hoped she would eventually be able to take them back. Typically, children are allowed to stay at Fundana for six months to a year before being placed in foster care or put up for adoption.

“You don’t know what it’s like to see your children go hungry,” Pérez told me. “You have no idea. I feel like I’m responsible, like I’ve failed them. But I’ve tried everything. There is no work, and they just keep getting thinner.

“Tell me! What am I supposed to do?”

Venezuela descended into a deep recession in 2014, battered by a drop in global oil prices and years of economic mismanagement. The crisis has worsened in the past year. A study by the Catholic charity Caritas in poorer areas of four states found the percentage of children under 5 lacking adequate nutrition had jumped to 71 percent in December from 54 percent seven months earlier.

Children nap at the Caracas orphanage. (Alejandro Cegarra for The Washington Post)

Venezuela’s child welfare ministry did not respond to requests for comment on the phenomenon of children being abandoned or put in orphanages because of the crisis. The socialist government provides free boxes of food to poor families once a month, although there have been delays as food costs have soared.

For years, Venezuela had a network of public institutions for vulnerable children — traditionally way stations for those needing temporary or long-term protection. But child-welfare workers say the institutions are collapsing, with some at risk of closing because of a shortage of funds and others critically lacking in resources.

So, increasingly, parents are leaving their children in the streets.

In the gritty Sucre district of Caracas, for instance, eight children were abandoned at hospitals and public spaces last year, up from four in 2016. In addition, officials there say they logged nine cases of voluntary abandonment for economic reasons at a child protective services center in the district in 2017, compared with none the previous year. A child-welfare official in El Libertador — one of the capital’s poorest areas — called the situation at public orphanages and temporary-care centers “catastrophic.”

“We have grave problems here,” said the official, who spoke on the condition of anonymity out of fear of reprisals from the authoritarian government. “There’s definitely more abandoned children. It’s not just that there are more, but also their health conditions and nutrition are much worse. We can’t take care of them.”

With the public system overwhelmed, the burden is increasingly falling on private facilities run by nonprofit organizations and charities.

Leonardo Rodríguez, who manages a network of 10 orphanages and care centers across the country, said that in the past, children placed with his centers were almost always from homes where they had suffered physical or mental abuse. But last year, the institutions fielded dozens of calls — as many as two per week — from desperate women seeking to give up their children so that they would be fed. Demand is so high that some of his facilities now have waiting lists.

[A Venezuelan woman had grown used to shortages. Then her HIV drugs ran out.]

To manage the surge in demand at Fundana, the organization opened a second facility in Caracas with the aid of private donors. But it still had to turn down dozens of requests to take in children. AtBambi House, Venezuela’s second-largest private orphanage, requests for placements surged about 30 percent last year, said Erika Pardo, its founder. Infants, once in high demand for adoption or foster placement, are also lingering longer in the organization’s care.

“Foster families are asking for older children because diapers and formula are either impossible to find or too expensive,” she said. The number of pregnant women seeking to put their children up for adoption is also jumping.

José Gregorio Hernández, owner of one of Venezuela’s main adoption agencies, Proadopcion, said that in 2017, his organization received 10 to 15 requests monthly from pregnant women seeking to give up their babies, compared with one or two requests per month in 2016. Overwhelmed, the organization had to turn down most of the women. It accepted 50 children in 2017 — up from 30 in 2016.

For many Venezuelan families, hunger presents an excruciating choice.

Dayana Silgado carries her daughter to the playground minutes before the end of a visit to Fundana. Silgado cannot provide enough food for her children, so she placed two of them at the center. (Alejandro Cegarra for The Washington Post)

I met Dayana Silgado, 28, as she entered Fundana’s new food center for parents in economic crisis. Silgado seemed drained. The shoulder blades on her thin frame protruded from her tank top.

In November, she surrendered her two youngest children to Fundana after losing her job as a cleaner for the city during a round of budget cuts. At the center, she knew, they would get three meals a day.

Fundana’s home for children did not accept older kids, so Silgado was still trying to feed her two eldest — ages 8 and 11 — at home.

The free milk, sardines and pasta offered by the center helped. It still was not enough, though.

After eating dinner, Silgado said, her children tell her, “Mom, I want more.”

“But I don’t have more to give,” she said.


(The Washington Post)