At the Vancouver Insite injection centre in Canada, clean needles and condoms are available to users who bring their own drugs to inject in a supervised room. They can relax afterwards in the lounge as needed, and staff are available to help them with other needs, like housing applications.
Modelled on similar clinics that first opened in Switzerland in the 1980s and then spread to other European countries and Australia, Insite remains North America’s only safe-injection site. Like its counterparts, this brand of harm reduction has proven to be a tremendous success here in Vancouver.
“For us it’s a very basic thing: Insite saves lives,” says Mark Townsend, executive director of the PHS Community Services Society, which operates the safe-injection site in partnership with the provincial government’s Vancouver Coastal Health (VCH). “We’re able to reach the people that would have been dying in their hotel rooms if Insite wasn’t here. Now we can get them the necessary help and get them into detox and treatment.”
Before Insite, the Downtown Eastside saw overdose deaths and infectious diseases reach calamitous heights. Overdose deaths in Vancouver spiked to a high of 201 in 1993 and, according to a United Nations report, the Downtown Eastside has an HIV rate of 30 per cent, while Canada as a whole has a rate of only 0.2 per cent.
A mass mobilization led by drug users and the creation of illegal injection sites in the neighbourhood finally helped secure the political will needed to create Insite, which has witnessed hundreds of overdoses, but as yet no deaths. And since it opened, overdose deaths across the city have declined—reaching a low of 34 in 2008.
The health crisis has also subsided. There were just 30 new HIV cases in the Downtown Eastside in 2006, compared to 2,100 a decade before. According to a 2008 Canadian Medical Association Journal study, Insite could prevent 1,517 HIV infections in 10 years, saving the Canadian health system $14 million in costly treatments.
The road to recovery
As Insite helps keep addicts alive, just a few steps upstairs are the 12 detox and 18 transition beds at Onsite. Also run by PHS and VCH, Onsite is a drug recovery facility working at getting users sober.
As Insite helps keep addicts alive, just a few steps upstairs are the 12 detox and 18 transition beds at Onsite. Also run by PHS and VCH, Onsite is a drug recovery facility working at getting users sober.
Together, the facilities have led to a 30 per cent increase in enrollment in detox programs, according to a 2007 study published in the Society for the Study of Addiction.
Onsite and Insite are the first steps to engaging the Downtown Eastside’s 5,000 homeless and impoverished addicts—people who generally feel isolated from the rest of society.
Addicted to heroin for more than 30 years, 49-year-old Brad Taylor began using Insite in 2003 while homeless. He wanted to be safe, and the site’s clean needles and nurses kept him so. Six months ago he moved up to Onsite to try and overcome his addiction.
Since beginning the program, Taylor has relapsed three times, the last occurrence on Christmas Eve when he was alone in his house. But he said the clean spells between relapses have increased the longer he stays in the program.
“Being around people who are actively trying to get clean motivates me,” he says, as does the “honest compassion of the staff.”
What is most important for Taylor is the chance to come back. It is a rarity among recovery and rehab facilities to allow a relapsed patient back into treatment. For Onsite, the hope for a second chance is essential.
Fighting for survival
Despite its accomplishments, Insite has found itself fighting for its survival. Originally approved by a federal Liberal government, Canada’s Conservative government is opposed to the site and has attempted to shut it down.
Despite its accomplishments, Insite has found itself fighting for its survival. Originally approved by a federal Liberal government, Canada’s Conservative government is opposed to the site and has attempted to shut it down.
“We think [safe-injection facilities] are inherently harmful to health,” said Pamela Stephens, press secretary for the Minister of Justice. “They deepen and prolong addictions.”
Prime Minister Stephen Harper initially planned to shut down Insite after its Criminal Code exemption ran out in June 2008.
“It would be catastrophic,” says Townsend of a Vancouver without Insite. “People will die because of it and there will be more HIV and Hepatitis- C. It would be a step backwards and a much more oppressive way to treat those that are suffering from addiction.”
However, on January 15, the B.C. Court of Appeal upheld a successful court challenge by PHS and the Vancouver Area Network of Drug Users (VANDU), which allowed Insite to remain open and operating with provincial funding. Nearly 50 supporters of the clinic who filled the room and waited outside applauded after Chief Justice John Finch read the court’s ruling. Advocates insisted that if Insite had been forced to close, hundreds would die as a result.
The ruling also raises proponents' hopes that similar facilities will now open in other cities, and aid more addicts across the country. Addicts like ‘Razor’, who was homeless and sold drugs at the corner of Main and Hastings for seven years, but has been clean for the past 16 months and lives in social housing in East Vancouver. A user of both Insite and Onsite, he says the facilities helped him realize that he never wants to be addicted again.
“I don’t want to be homeless,” he says. “I don’t want to puke and shit myself, I don’t want to be dope sick, I don’t want to rob people, I don’t want to go to jail.”
Friday, September 30, 2011, the Supreme Court of Canada made a historic decision to keep Insite—Canada’s only safe injection site—open. This isn’t simply about a building or initiative; this is about a systematic and national change to our approach and attitude towards people who suffer from addiction.
Until today, our country didn’t officially tolerate those living with addiction.
Addicts have long been labeled as worthless criminals and helpless individuals. And even now, many still think they are. But they’re not just the crack addicts in the bad part of town. These people—who we are all affected by—are our family members, our friends, and our neighbours. They are real people.
A small victory, but an important victory, the decision is symbolic of the direction our country is choosing to take in recognizing people who are suffering immense pain.
How addiction is perceived in our society
For a long time, our society has been convinced that unless you are clean and sober, you don’t matter. You can stay homeless, die of disease or overdose, and go to jail. Keeping Insite open delivers a strong message that these people do matter. People’s lives matter. They matter despite the fact that they are injecting drugs into their body. People’s lives are worth saving.
This may provide a glimmer of hope to thousands of people by telling them we care. We want to offer them access to safer interventions, we want to get them off the street, and we want to connect them to support systems.
In the years leading up to this decision, the four pillars strategy seemed to take a backseat and the idea of prevention and harm reduction slowly disappeared from the public sphere alongside Gordon Campbell’s popularity. Keeping Insite open adds one piece to this complex puzzle of public health and safety.
And as Health Minister Mike de Jong said, “This decision by the Supreme Court of Canada represents a wise and humane ruling…”
Credit: - bcliving
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