safe injection site

Underground Safe-Injection Site Forced to Close: Vancouver health authority shuts down unsanctioned drug user-run site in the Downtown Eastside
By William Damon and Scott Neufeld

On a rainy day last December, a delegation from Vancouver Coastal Health (VCH) delivered a letter to the Vancouver Area Network of Drug Users (VANDU) ordering the organization to “cease and desist” fromoperating an unsanctioned supervised-injection site in the Downtown Eastside, where members of the drug user group assisted other people to inject illicit drugs. It was a harm reduction service that was widely known and used by hundreds in the Downtown Eastside and had been operating for four years, but flew under the radar of many in the city, and did not have government approval.

VANDU started its unsanctioned, unfunded, peer-run supervised injection service out of a repurposed office room in their Hastings Street storefront “at least four years”, says its president Hugh Lampkin. Unlike the other safe injection sites in the city, Insite and the Dr. Peter Centre, no nurses were present.

VANDU—a grassroots organization of current and former injection drug users—began operating the site as a “humanitarian response to an unmet need,” according to Lampkin, specifically the needs of the approximately 40 per cent of IV drug users who sometimes require assistance injecting, a service that Insite and other supervised injection services cannot legally provide.

For four years VANDU quietly offered a safe space, clean supplies, and the watchful eye and occasional assistance of a trained peer support worker (current and former drug users) for an estimated 50 to 100 injections a day.

In an interview with Megaphone, VCH Chief Medical Health Officer Dr. Patricia Daly explained that, as VANDU’s funder, “VCH could not support an operation that was not run according to VCH best practices and that might put clients at some risk.” She did not expand on how long VCH had known about the peer-run injection service, or why the health authority ordered it to close when it did. “We found out about it—we were advised about it by City of Vancouver staff,” she says.

Daly added that VANDU’s supervised injection site could “jeopardize [VCH’s] application with Insite [Vancouver’s supervised injection facility in the Downtown Eastside] and the Dr. Peter Centre [a residential care and treatment facility for people with HIV/AIDS in the West End],” referring to ongoing efforts to obtain legal recognition from the federal government for existing supervised injection services.

VCH’s decision to close VANDU’s unsanctioned supervised injection site is the latest chapter in long-running tensions between controversial, but research-tested, peer-run models and more professionally driven approaches to harm reduction. A peer-run site improves outreach, but increases other risks. However, unlike past episodes of this ongoing debate, VCH is in uncertain and politically fraught negotiations with the federal government to protect the legal standing of existing harm reduction infrastructure in the city, which puts the future of any such a program in prolonged purgatory.


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Insite: Evidence, compassion and effectiveness overcome fear and reactiveness

The Supreme Court has ordered the federal government to allow Insite, Vancouver’s supervised injection site, to stay open. While on one level the case was about a battle of powers between the provincial and federal government - does health policy trump criminal law - at a deeper level it was a case about evidence based public policy. The question was, when lives are at stake and people will die as a result of a policy choice, can ideology trump evidence?

The answer, for now, is no.

Thank god.

It is great to know that data, analysis, evidence, along with compassion and effectiveness can overcome fear and closed mindedness.

For those unfamiliar with Insite, it is a needle injection site, where heroine users can use drugs under the supervision of a nurse. There has not been one death at the injection site since its opening in 2003 (unlike on the streets), and the facility reduces the spread of AIDS and other diseases, puts users in contact with the health system where they are more likely to ask for help and get into detox, as well as takes pressure off (and reduces costs) the regular medical system, in particular ambulatory services and the emergency room. In Vancouver, it is a measure that has support across the spectrum, from the left to the right.

To read more on the Supreme Court ruling it can be found here. My friend DR points out that paragraph 140 is particularly relevant. It is in this piece that the court discusses how the government may set policy, but it cannot do so in a way that violates Canadians “right to life.” Removing access to Insite diminishes greatly the prospect of an addict to not only live, but to find the help they need and so meets that test:

[139]                     Canada submits that exempting Insite from the prohibitions in the CDSA “would effectively turn the rule of law on its head by dictating that where a particular individual breaks the law with such frequency and persistence that he or she becomes unable to comply with it, it is unconstitutional to apply the law to that person” (A.F., at para. 101).  Canada raises the spectre of a host of exempt sites, where the country’s drug laws would be flouted with impunity.

[140]                     The conclusion that the Minister has not exercised his discretion in accordance with the Charter in this case, is not a licence for injection drug users to possess drugs wherever and whenever they wish.  Nor is it an invitation for anyone who so chooses to open a facility for drug use under the banner of a “safe injection facility”.  The result in this case rests on the trial judge’s conclusions that Insite is effective in reducing the risk of death and disease and has had no negative impact on the legitimate criminal law objectives of the federal government.  Neither s. 56 of the CDSA nor s. 7 of the Charter require condonation of crime.  They demand only that, in administering the criminal law, the state not deprive individuals of their s. 7 rights to life, liberty and security of the person in a manner that violates the principles of fundamental justice.

Via eaves.ca

Today I had a conversation with one of the staff at the Supervised Injection Site, as she was concerned about me taking Valium before I shoot my heroin.

As an example, she reminded me of a man who overdoses nearly every time he’s there because he drinks alcohol, takes benzodiazepines and uses heroin all together, and I assured her that I would be fine.

However, I have already taken 30mgs of valium, .18gs of heroin, 110mgs of morphine and I am really craving a glass of wine.

An Eye-Opener

I say it a lot, but I love my job. I love the work Reputations does, and I’m particularly proud of our work with organizations in the Downtown Eastside (DTES). For those of you not in-the-know, the DTES is one of the poorest neighborhoods in Canada. We have done work with Insite (Canada’s only supervised injection site), Lookout Society, First United Church, and others. (I joke that this is the work that’s going to get me into the universe’s good graces, but that remains to be seen.)

Because of the agency model, we don’t always get to know everything we’d like to about our clients—it’s the nature of the beast—and on occasion, one small thing can give you a whole new perspective. This is the story of one of those times.

I was a second year account coordinator and had been assigned to support the first press conference held inside InSite. The media had never been allowed inside the facility with cameras and reporters were very excited at the idea (note: media will not always be excited about your pressers).

We had arranged to hold the event before the facility opened, as to not interrupt their regular operations. Everything went off without a hitch—every major media outlet in the city was there, and the press conference garnered positive national media attention. Mission accomplished!

As the press conference wrapped, we noticed the long line-up which had formed outside InSite’s front doors. Apparently this wasn’t out of the ordinary.

The eye-opener came when I left the building. The first person in line looked like my dad. He was in ironed dress pants, a crisp button-up shirt, he was freshly showered, and didn’t look like he ‘belonged’ in the city’s roughest neighbourhood, let alone using a supervised injection site.

To this day, his image is so clear in my memory.

This gentleman gave me a whole new perspective on InSite, the work it does and who needs it to stay open.

Sometimes, no matter how much effort we put into getting to know and understand our clients’ businesses, it is the everyday details that can provide the most understanding of what they do. 

–Iris

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Insite - Not Just Injecting, But Connecting