I was offered drugs three times during my first walk down Hastings. Homeless men with unkempt beards would ask me for cigarettes and then rescue used butts from the sidewalk, hoping that they might have some tobacco left in them. People openly injected and smoked drugs in public–it reached a point where I was beginning to forget that heroin and cocaine are illegal substances. As I tripped over the used syringes that decorated the sidewalks and alleys, I was beginning to witness the reality of “Canada’s poorest postal code.” This was Vancouver’s Downtown Eastside, today was May 10, and this was my first day volunteering at Insite.
Insite is North America’s only medically supervised injection facility, located on 139 East Hastings Street in Vancouver, British Columbia. As the name implies, supervised injection facilities (SIFs) are locations where drug users can inject drugs under the direct supervision of nurses with sterile needles and other equipment provided by the facility. Albeit a very controversial method of remedying the impoverished state of the Downtown Eastside, Insite has been paramount in regard to preventing overdose deaths, improving the health of Downtown Eastside residents, and lowering the costs–health, social, and legal–associated with injection drug use.
Supervised injection is working better than any other available healthcare method to help the residents of the Downtown Eastside, but it has been receiving outrageous political criticisms threating to shut it down. Since Stephen Harper and the Conservative Party of Canada took power in 2006, the federal government has been incessantly challenging the site. Prime Minister Stephen Harper has directly voiced his aversion towards the SIF, saying in February of this year, “We, as a government, will not use taxpayers' money to fund drug use.” This is a particularly absurd statement considering the cost benefits that Insite provides. Pressure from the United States, which represents a vehement ‘War on Drugs’ perspective, has also not helped the situation. Upon the facility’s opening in 2003, the director of the White House Office of National Drug Control Policy called Insite "state-sponsored suicide,” an equally irrational statement if one simply looks at the number of overdose deaths prevented per year because of Insite. Pressure to shut down the facility has never been stronger and more loosely based on anything factual, which brings me to my intentions for this three-part article.
Canadian SIF conflict reached a culmination on May 12, the date of a Supreme Court case held to determine whether Insite will continue to operate legally. The results of this case will not be released until 2012, February at the latest, as inferred by Insite lawyer Monique Pongracic-Speier. While I’ve found that attitudes regarding the future of Insite vary greatly among the Canadians with whom I have spoken, the fact is that many people–especially those living in the U.S.–have never heard of Insite, let alone the idea of supervised injection. Insite represents one of the most important healthcare issues of our generation and is a potential archetype for other cities plagued by similar drug-abuse problems. In fact, overdose has overtaken homicide as the leading cause of premature death in many North American cities, making it likely that supervised injection will be incorporated into the United States healthcare system. Additionally, political pressure from the U.S. has a significant influence on Canadian debates about Insite, especially with respect to the recent Supreme Court case. This only further highlights the contemporary necessity of increased education about supervised injection. Phrases like “state-sponsored suicide” can no longer be used to describe a healthcare method that saves hundreds of lives each year.
A New Third World Country: Vancouver’s Downtown Eastside
An extensive study of the Downtown Eastside commissioned by the city found that 77% of the residents in this community make less than $15,000 a year, with more than half of that coming from government transfer payments. The study also concluded that 79% have health problems and 52% use drugs. Downtown Eastside had 4,700 chronic drug users in 2000, only further contributing to its status as the center of an “injection drug epidemic.” The United Nations conducted a survey that uncovered even more shocking data: 70% of residents are reported to have Hepatitis C, and 30% are reported to have HIV. To emphatically reiterate, 30% of Downtown Eastside residents – that’s almost one in every three people – have HIV. This is absolutely unacceptable. In Botswana, 24.8% of the population has HIV; in Lesotho and Swaziland, two other deeply impoverished African countries, 23.6% and 25.9% are reported to have HIV, respectively. If this didn’t sound bad enough, the release of this survey was delayed due to arguments presented by Downtown Eastside advocates, proclaiming that the government was massaging the data, trying to conceal the true disparity of the situation. Nevertheless, the reality is that these statistics rival those of the Third World, and they’re representing one of the oldest districts of one of the richest countries on the planet.
Even more outstanding, however, are the numbers behind overdose deaths in the Downtown Eastside. In the late 1990s, the yearly overdose death toll in this small ten-block-by-five-block area of Vancouver represented almost half of the total number of overdose deaths in the province of British Columbia. There are sources that document overdoses deaths occurring at rates of almost once a day in the Downtown Eastside in the early 2000s. Something had to be done.
And thus came Insite. In 2003, the regional health authority in Vancouver requested an operational exemption of Section 56 of the Controlled Drugs and Substances Act so that they could pilot North America’s first medically supervised injection facility. The request was granted, and Insite was founded. The idea of supervised injection may appear novel, but there have been clinics of this type in other countries for quite some time. In 2009, there were 92 facilities operating in 61 cities around the world, most of which are in Germany, the Netherlands, and Switzerland. The success of these sites was an important factor in the regional health authority’s allowing the legal operation Vancouver’s SIF in 2003. Several years later, Insite has developed into the busiest SIF in the world and is now serving as a template of improvement for the sites that originally helped open it.
This is the first part of a three-part series about supervised injection and Trevor Thomas' experience at Insite. Part 2 of the series, Supervised Injection: injecting the facts, will discuss the evidence that supports supervised injection and part 3, Supervised Injection: Insite and the Supreme Court, will discuss Insite's success in the Canadian Supreme Court.
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