InSite [11], the safe injection site for drug users in Vancouver's Downtown Eastside, has been shown to reduce public drug use, overdose deaths, and the spread of blood-borne diseases, but the Conservative government of Prime Minister Steven Harper is ideologically hostile. Now, with INSITE threatened with a September shutdown if Health Canada fails to approve a request for an extension of its exemption from Canadian drug laws, Vancouver is mobilizing to save it.
If Harper and Health Canada actually let the research results so far guide their decision, continuing InSite would be a shoe-in. According to published, peer-reviewed research and evaluation by the BC Center for Excellence in HIV/AIDS [13], a highly respected research organization monitoring the study, the safe-injection site:
- has led to increased uptake into detoxification programs and addiction treatment;
- has not led to an increase in drug-related crime;
- has reduced the number of people injecting in public and the amount of injection-related litter in the Downtown Eastside;
- is attracting the highest-risk users -- those more likely to be vulnerable to HIV infection and overdose, and who were contributing to problems of public drug use and unsafe syringe disposal;
- has reduced overall rates of needle sharing in the community, and among those who used the supervised injection site for some, most or all of their injections, 70% were less likely to report syringe sharing;
- is not increasing rates of relapse among former drug users, nor is it a negative influence on those seeking to stop drug use.
InSite also made more than 2,000 referrals in one year, with almost 40% of them to addiction counseling. It has also cut the number of drug overdose deaths. More than 500 overdoses occurred at the site over a two-year period, but because of the medical staff on hand, not one resulted in a fatality. As InSite notes, "If these overdoses happened on the street, many of these people may have died."
But Vancouver and its residents are not at all certain Harper will actually be guided by the science instead of his ideological predispositions, and they are mobilizing to ensure he understands that the city wants InSite to continue. "The community itself decided we need to tell the new prime minister and federal government how important InSite is for our community, so we started a campaign of concerned citizens called InSite For a Safer Community [14], said Gillian Maxwell, a spokesperson for the coalition. "We will be making the point that InSite makes the community safer, saves lives, and helps get people access to health services. Taking it away would be a very detrimental thing," she told DRCNet. "InSite is, of course, good for the people who use it, but it is good for the community as well, it improves our quality of life."
The coalition is playing softball right now, said Maxwell, but that could change. "We don't want the government to feel like it is being cornered or pressured. Instead, we are asking it to pay attention to the level of support in the community." To that end, the coalition has organized a letter-writing campaign on its web site where Vancouverites can write directly to the prime minister. It is also collecting letters of support from prominent members of the community.
The group also held a visual display and press conference on a Vancouver hillside Thursday, with the number of overdose deaths prevented by InSite represented by rows of crosses. Organizers made the point to the press that "this many people are alive today because of InSite, and if you close the site, hundreds could die."
Meanwhile, the Vancouver Area Network of Drug Users [15] (VANDU) is calling not only for the continuation of InSite, but its expansion. "Stopping Insite now is like having your body covered with running sores, and we give you some cream on one part of one arm, and it's completely healed, but we won't let you put it on the rest of your body," said VANDU spokesperson Anne Livingstone. "The idea of not extending the exemption is pure bullshit; the studies show it is working. But this is a study, not a program. If we had a program, there would be four or five or six of these sites. There are 15,000 drug injections in the Downtown Eastside each day, and Insite can handle only 600 of them."
The city of Vancouver very much wants to see the study continued, said Drug Policy Coordinator Donald McPherson. "The mayor has been very clear about this," he told DRCNet. "He has written to the prime minister pointing out that the evidence so far is that this is a very successful intervention and that we need further research to look at the long-term impacts it is having on things like HIV/AIDS and Hepatitis C rates."
In that letter, Mayor Sam Sullivan wrote: "To date, the impressive research findings that have been published demonstrate that this project not only provides a significant opportunity to generate knowledge, it also appears to be an important protective factor in the lives of those individuals that use the facility."
The city is actively involved in seeing that the exemption is continued, said McPherson. "We're part of the coalition that is trying to see that it stays. This is not really a contentious issue in Vancouver. The business community is behind it, the neighboring Chinese community supports it, we have a level of support for this in the community like never before," he said. "It would be very sad and harmful if Insite were discontinued at this point after the results it has achieved and all the work people put into it."
New Democratic Party Member of Parliament Libby Davies [16], who represents the Downtown Eastside, is also on board. Last week, she joined the letter-writing campaign with a widely circulated e-mail message. "I have a lot of contacts across the country," she told DRCNet. "People who are very supportive of InSite. I'm working with my contacts and with people in the community to encourage people to signify their support. There are a lot of emails going to the Health Minister right now."
InSite is also getting support from Australia, where a safe injection site in Sydney has produced similar positive results. On Monday, the 110-member Australian Parliamentary Group for Drug Law Reform sent a letter to Harper asking him not to close down the site.
"InSite has saved lives and transformed the response to drug users from health and social services," said the letter. "Our research has also shown the benefits of the injecting centre, not only in saving lives but also providing a pathway to recovery."
Davies said she hoped the campaign could convince the federal government it would run up against a united community if it stopped the safe injection site. "I'm hoping they won't want to make a big issue of this. I'm hoping Harper and Health Minister Clement will be pragmatic despite their ideological opposition to it, but if they try to turn it down, there will be a very strong reaction. They haven't seen anything yet," she warned.
Gillian Maxwell doesn't trust the Harper government to do the right thing. "We're a little nervous," she said. "The fact that we're even doing this campaign shows that. Vancouver Coastal Health asked for the extension in the spring, and now it's July. We can't say what the chances are, but we're not completely convinced it will happen because it hasn't happened yet."
VANDU's Livingstone wondered if the Harper government would simply delay. "I'm afraid they won't say yes or no, but just renew it month by month and leave it hanging in limbo," she said. "If they say no, there will be a strong campaign mounted."
That campaign could include guerrilla injection sites like the one VANDU set up earlier this decade to spur the officially sanctioned site to actually open. "I've been chomping at the bit to find another storefront or maybe a Winnebago. If we do another guerrilla operation, that keeps it on the public agenda. I think if you want an injection site wherever you are, just open one. I wish the churches would get involved, like they did in Europe and Australia, because this is not really a political movement, it's about people dying."