New beginnings: A city park reopens and help comes to Bergen’s heroin addicts
By Lori Ann Reinhall, president, Seattle-Bergen Sister City Association
It was a rainy Saturday afternoon in September, but rain never keeps the citizens of Bergen away from a celebration, especially not when one of the most beautiful parks in the city was being dedicated. There were free coffee and traditional Bergen “skillingsboller” cinnamon buns, a drum brigade set the mood, and lively musical performances to added to the festive atmosphere. Hundreds were on hand, old and young alike, to watch Mayor Marte Mjøs-Persen cut the red-white-and-blue ribbon. After three years of refurbishment at the cost of 25 million Norwegian crowns, Nygårdsparken (Nygård’s Park) was officially re-opened.
Going back in time five decades, things looked much different in Nygårdsparken. Already in the late sixties, the residents of Bergen could see drugs being bought and sold in the city’s largest urban green-space, located in an older, well-established residential neighborhood. Ten years later, it was common to see hash traded openly, and the park was becoming a regular hangout for users. An attempt was made to shut down the drug scene there in 1989, but as users made their way to the city center, there were concerns about the negative impact on tourism and the overall safety of Bergen’s citizens.
With time, police surveillance of the park eased up. The situation degenerated, and within ten years, Nygårdsparken had achieved a position of notoriety as the largest open drug scene in all of Europe. By the mid-nineties, heroin had found its way to Norway, and the park lawns were filled with needles and syringes. But while addicts were dying of overdoses, law enforcement turned its focus away from them and directed its attention towards drug cartels, dealers and smugglers. Public health and safety concerns mounted, and eventually the drug scene in the park became intolerable for the surrounding neighborhood. Finally, in August of 2014, Norway and Europe’s oldest open narcotic scene was shut down once and for all. Bergen’s heroin addicts suddenly had nowhere to go.
But Bergen is a city that does not leave its citizens in the lurch. A comprehensive program was put in place to build out an infrastructure of drug treatment facilities as well as housing for those being displaced from the scene at Nygårdsparken. Special residences for heroin addicts are now subsidized by the municipality, with 24-hour onsite supervision by qualified social workers to ensure the success of the program. Furthermore, two new rehabilitation sites were opened with plans for a third in the making, and a safe injection site was added to the municipality’s existing heroin treatment facility. All this was done as part of an effort to reduce the plight of Bergen’s addicts, reducing their health risks and offering settings where they could be encouraged to receive further enhanced treatment.
Coming from Seattle, a city with its own heroin crisis, I wanted to learn more about the drug treatment initiatives in our sister city. I reached out to officials at Bergen City Hall and was put in contact with Marit Sagen Grung from the Department of Social Services, a healthcare professional and social worker with eighteen years of experience working with drug abuse. A few days later, Marit and I set off together to visit two of three Bergen facilities specialized in the care of heroin addicts.
Our first stop was Nesttun, a half-hour trip on the tramway from the city center, the home of a day rehab center. The facility is strategically situated close to the main shopping area, easy to access from public transportation, yet quietly tucked away in a cul-de-sac, offering privacy and repose.
When you enter the house, you are struck by its cleanliness and lightness. Colorful artwork decorates the walls to welcome you, along with the smell of fresh coffee. We were welcomed by Rasmus Litland, the center’s director, who is assisted by a staff of committed professionals: nurses, social workers, and a cook. Their goal is to provide a safe, friendly and encouraging environment for those in need, a place away from the streets, the crime and threats that loom over the life of an addict.
The staff wears ordinary street clothes in order to mix in with the clients, yet one can immediately recognize who is who. The faces of the addicts show the wear-and-tear of years of drug abuse and personal neglect; even a smile cannot hide it. Some look tired from a night on the streets, others are ready for a shower or a hot meal. All of this is available to them at the center. They can also lie down on a comfortable sofa for a rest. While all clients have subsidized apartments in buildings that are supervised by certified social workers, they may not always find their way home, depending how their night has gone.
Hygiene and nutrition are major concerns at the center, as heroin addicts have their own special needs. Injection by needle carries the risk of infection and wounds, and the proper equipment and a sterile environment provide some protection. Clients may consult with the nurse on duty for advice and assistance with any wounds, and they receive instruction on how to safely inject and avoid overdosing. While medications are not distributed, natural remedies may be administered to relieve discomfort from the ailments that accompany drug abuse. The Nalokson nasal spray program to reduce the effects of overdose is also a key part of the services offered. Finally, three solid meals a day with healthy snacks are available from a well-equipped kitchen, to provide needed sustenance to bodies that have been worn down from drug abuse and a hard life on the streets. Clients can also wash their clothes, or even get new clothes donated by volunteers.
The staff at Nesttun believes that maintaining a sense of dignity is key on the road to recovery. While most addicts never find their way, there are some success stories. The next step is treatment at a methadone clinic. Some may never return to productive working life, but there may be hope for the next generation. Rasmus tells of a female client who still struggles with addiction but can be proud that both her daughters are studying at the university with bright futures ahead.
As I talked with the staff at Nesttun, I asked them if they have a vision for the future. Their answer was without hesitation and unanimous: to see heroin use decriminalized in Norway. Beyond that, it is their dream that even more centers will be built to reach out to more of those in need, and that they will want to come to get help. They understand that their clients are “social cases,” victims of broken homes, violence and child abuse, many in a third generation of drug abuse, and their goal is to break this cycle. The staff sees itself as part of a humanitarian effort to help those who have fallen victim to unfortunate circumstances in life, including criminal drug cartels. They view their work as vitally important and they like their jobs: for them the rewards outweigh all challenges.
Much closer to the city center is Strax-huset, the largest center for heroin addicts in Bergen. The facility opened already in 1995, dating back to the earlier days of the HIV epidemic. Here the atmosphere is considerably more institutional, due to its size and sheer volume of visits. Located next to a bridge with a tunnel where addicts displaced from Nygårdsparken now congregate, it has a reputation as a rough and tough environment among the local Bergen population. But I learn from the facility’s director, Hugo Torjussen, that the approach at the treatment center is much the same as at Nesttun, one of humanitarian assistance.
“Strax-huset” roughly means “the straightaway house” in the sense of immediacy or urgency. It is a place where heroin addicts can drop in and get help on an “on demand” basis, providing they meet certain criteria. When the center opened two decades ago, clean needles were distributed to curb the rising HIV epidemic and lower overall health risks. In December 2016 a safe injection room was added, the second of its kind in Norway, following the first in Oslo already in 2005.
This year alone the staff of 100 has already seen 5,000 visits, servicing approximately 1,500 unique users. To receive treatment, you must be addicted to heroin; other addicts are turned away and sent to facilities with programs designed to meet their needs. Torjussen explains that different addictions require different routines and protocols, while the staff at Strax-huset is highly skilled in trained in dealing with the heroin addict specifically.
Incoming clients are carefully vetted before the staff oversees their safe injections. Many of them overdose in the immediate surroundings by the bridge, and there is an urgent need to teach them how to correctly use heroin. Torjussen underlines that this by no means constitutes an effort to encourage drug abuse, rather it is an attempt to save lives. Last year over 5,000 nasal spray antidotes were administered to prevent death by overdose.
At both Strax-huset and the Nesttun facility, approximately 75% of the clients are men. More than women, they suffer from loneliness and alienation, which may predispose them to drug abuse. Approximately 50% of all those vetted suffer serious mental health issues, and the staff is careful to screen for psychotic behavior that may put others at risk. Psychiatric treatment or psychological counseling is not provided at the center, but those identified at risk may be referred to other programs.
Like at Nesttun, once admitted, the clients can shower and wash their clothes, and they can also get a room where they can crash. Strax-huset also functions as an overnight facility for those who don’t have a residence or who are unable to stay at their homes for any given reason. The rooms are simple, clean and quiet. Meals are also available. The clients may consult with medical assistants in the health room, get a flu shot, or receive instruction on how to safely inject or what to do in the case of overdose. They may learn about the benefits of smoking heroin as opposed to injecting it, although paradoxically, smoking must take place outside the premises, which by law are operated only for safe injections.
Currently, the facility is engaged in a research project on hepatitis C, a major cause of death among heroin addicts. New drugs have been developed to treat the disease more effectively, and the goal of the three-year study is to find a way to eradicate it within the next ten years. The drugs are expensive and normally a stable condition is required for full efficacy, but all addicts will nonetheless receive treatment.
Another innovative program at Strax-huset is an effort to clean up the facility’s immediate environment. Upon arrival, a group of clients was busy cleaning up the debris left there the night before, and some painted over the graffiti on the surrounding concrete walls under the nearby bridge. They are allowed to work four hours a day and receive 50 Norwegian crowns an hour in tax-free money, which provides them with some pocket money and some sense of positive contribution. In the life of an addict, it is a very small amount of money, with habits costing up to 3,000 crowns a day. This is a life that leads to prostitution for women and criminal activity for men, and many addicts steal from each other to survive.
Over the years, the program at Strax-huset has not been without critics. There are “moral” arguments against drugs, with the reasoning that the Norwegian state should not embrace drug addicts. The media have also put a negative spin on safe injection sites in Bergen, reporting of the dangers of working there, while no cases of serious violence against employees have ever been reported. Nonetheless, all seem to agree that the war on drugs did not work. When one network is broken apart, new ones form, the cycle continues and more lives are put at risk.
At the end of the day, short of any hard data or statistics, my visits to the heroin treatment sites at Nesttun and Strax-huset left me with the impression that something positive was happening in Bergen. Grappling with heroin addiction is a difficult, perhaps unsolvable challenge, but it was encouraging to meet highly trained, committed professionals dedicated to helping their fellow citizens. Nygårdsparken is now a place for families to gather, the streets of Bergen are safer, and help is coming to those in dire need. There is a general consensus about the necessity to decriminalize heroin and to focus on saving lives — and they feel certain that the work they are doing is making a difference.
Ultimately, the decision to open safe injection sites and eventually decriminalize heroin possession and use may boil down to a philosophical question, but the choice to help our fellow human beings must always remain a central guiding principle in our society. I, for one, in the spirit of Bergen, opt for new beginnings, for humanity, for life.