Members of the Vancouver, British Columbia, political elite mingled with hard core drug users Monday to mark the opening of the first officially-sanctioned safe injection site (SIS) for injection drug users in the Western Hemisphere. Similar sites, based on the tenets of the harm reduction approach to drug use, were pioneered in Germany in the early 1990s and have since begun to be accepted across Europe as an effective means for reducing drug overdoses and HIV/AIDS and Hepatitis C infection rates among drug users.
The Four Pillars plan -- prevention, treatment, enforcement, and harm reduction -- foresaw the need for an SIS, but unlike the other pillars, law enforcement in particular, the harm reduction component, or at least the SIS, was slow in coming. Cobbled together by city, provincial, and federal officials with considerable input from the citizenry, including the Downtown Eastside's remarkably well-organized drug users, the plan aims at reducing drug overdose deaths and the spread of infectious disease, as well as the criminality and quality of life problems generated by drug use under prohibition. But funding questions and bureaucratic requirements stalled the promised SIS.
The logjam began breaking apart this summer, not long after Downtown Eastside drug users spearheaded by the Vancouver Area Network of Drug Users (http://www.vandu.org), infuriated by a sudden, massive police crackdown on the area beginning in April (and still underway), opened their own, non-sanctioned SIS at 327 Carrall Street. By Monday, it was time for the grand opening of the official SIS.
Mayor Larry Campbell, the former city coroner who was elected on a pledge to actually implement the Four Pillars plan, was there in front of the gleaming, freshly-renovated SIS to be known as InSite at 139 East Hastings Street, the neighborhood's main drag. So was his predecessor, former Mayor Philip Owen, whose leadership helped bring the plan into existence, as well as assorted other political luminaries.
"The first thing that went through my head is the huge number of people that have died and the number that I saw and had to deal with their families," said Campbell in remarks marking the occasion. The SIS will not end drug addiction, he added, but it will quickly make a difference. "Most importantly, we won't have to take people out of these hotels time and time again."
At least 37 people have died from overdoses in Vancouver so far this year, and the number of overdose deaths in the last decade is estimated at somewhere around 800 by the health authority. And Vancouverites continue to die of AIDS at rate of about 60 per year (from all causes), while, according to the Vancouver Injection Drug User Study, 95% of its subjects are Hep C positive.
The Hastings Street SIS, which just completed a $900,000 renovation, is a clean, brightly lit facility lined on one side by mirrored booths where users can inject drugs under medical supervision. As Vancouver Coastal Health puts it: "Clients will be assessed and led to a 12-seat injection room where they can inject their own drugs under the supervision of trained health care staff. They will have access to clean injection equipment such as spoons, tourniquets and water, aimed at reducing the spread of infectious diseases. After injecting, they will move to a post-injection room where, if appropriate, staff can connect clients with other on-site services such as primary care for the treatment of wound and other infections; addiction counseling and peer support; and referral to treatment services."
The SIS, which will be open from 10:00am to 4:00am seven days a week, will be staffed by 16 registered nurses, four alcohol and drug counselors, and peer staff from the needle user community. Addiction counselors and physicians will be available on an on-call basis. Health Canada and the government of British Columbia have kicked in nearly $3 million to cover costs this year. The health authority estimates the SIS will soon be handling 800 injections per day.
"We are quite hopeful that this type of intervention will have quite a positive impact in reducing HIV infection rates in the injection drug user community," said Steven Smith of AIDS Vancouver, an agency that works to reduce the disease's spread and impact. "Vancouver is notorious for having the highest rate of infection for any city in the developed world," he told DRCNet. "We know we have a problem, and harm reduction strategies like this are a tangible way of reducing the harm associated with injection drug use. We hope lots of people will use the site as a way to connect with treatment and other services."
"This is a huge political victory," said Anne Livingston, VANDU's executive director and a constant thorn in the side of slow-moving officialdom. "A lot of credit goes to VANDU members and drug users on the street who kept the pressure up when others were not so passionate," she told DRCNet.
So far, so good, but tensions remain between the hard drug community and the police, and the Downtown Eastsiders are cautious about Vancouver Costal Health as well, according to Livingston. "The police have done nothing to let us trust them, especially since they dropped 55 officers on our heads in April. We have always been completely transparent with them, but they seem to operate in complete isolation," she said. "We intend to watch them closely."
And the police will be looking right back. According to Vancouver Police Department media relations specialist Constable Anne Drennan, eight officers have been assigned to work nearby to deal with issues related to the site. The department is behind the SIS, she told DRCNet. "Our intention is to facilitate the use of the supervised injection site as much as possible," Drennan said. "We want this to succeed, contrary to what some people might say. Vancouver adopted the Four Pillars approach, and we agreed some time ago that this was the best approach to take."
Vancouver police will not arrest people for possession of heroin or cocaine within a four-block radius of the site, Drennan said, "but we will not tolerate drug trafficking outside the site. If we come across people near the site who we become aware are carrying heroin or cocaine and intend to inject, we will direct them to the site. We will only arrest for simple possession if there is some other crime being committed," she said.
Livingston was skeptical. "So now people can have their drugs, but they just can't buy them? You're safe within the four blocks, but now you have to go six blocks to score?" she asked. "The police haven't thought this through. Arresting dealers isn't going to help; they are like the pharmacy for addicted people. In Europe they simply leave certain dealers alone to avoid these problems. The police say they want this to work, but they have a huge conflict of interest."
VANDU is also concerned about the quintessentially Canadian impulse to codify and regulate all endeavors, as manifested in the guidelines for the site. "The Health Canada guidelines have created a sort of over-the-top, hyper-medicalized site with over 40 employees," said Livingston. "They ignored us through the AIDS epidemic, the Hep C epidemic, the crack epidemic, the overdose epidemic. We fought like hell to finally get this, and they create guidelines so restrictive they could cause this place to fail. What we need is a site that works, not one that necessarily fits the guidelines. The site is meant to stop the spread of disease and prevent overdoses, not meet police goals or bureaucratic guidelines."
The guidelines aren't so onerous, responded Vancouver Coastal Health spokeswoman Vivian Zanocco. "The guidelines require that people register and provide an address, that people not share drugs, that they cannot inject someone else, things like that," she told DRCNet. "The point is to make the site a safe experience for everyone."
Livingston and VANDU and the users they represent, while skeptical, are determined to make it work. "While this is a victory, it could well prompt a backlash," she said. "Some people think it should be shut down right now. Your drug czar has already been up criticizing it. The drug warriors badly want to see this thing fail, so they can document the failure and say 'this doesn't work.'"
MP Davies agreed with VANDU's Livingston on both counts. "One thing we have to watch out for is that there will be a real media spotlight on this," she said. "If anything goes wrong, they'll get nailed. Likewise, I am also concerned that Health Canada not impose guidelines that drive people away."
But with the hemisphere's first safe injection site now open for business, the weight of the city, provincial, and national governments behind it, and ever vigilant activists like the VANDU people keeping a jaundiced eye on officialdom, it won't fail for lack of trying.