With files from Claire Allen and Tim Dickert
As part of the CKNW Leadership Series, Claire Allen and Tim Dickert examine Vancouver’s Insite, North America’s first legal supervised injection site which opened in 2003.
The idea of Insite was a reaction to the “injection drug epidemic” that was occurring on the downtown east side at that time. To learn more, they spoke to Dr. Patricia Daly, Chief Medical Health Officer for Vancouver Coastal Health – the health authority that oversees Insite.
The early days of Insite
“At that time, among drug using populations, Vancouver was reporting the highest incidence rate of HIV among any injection drug using population anywhere in the world. And this is despite the fact that we had a very large needle exchange program operating out of the DTES. So we realized that this wasn’t enough.”
Daly says those in the DTES looked to Europe for inspiration and involved local government, the mayor, and the police department in the process of proposing, and eventually opening, a similar model.
But it wasn’t that simple. Between 2003 and 2008, the site operated under a special exemption of Section 56 of the Controlled Drugs and Substances Act, granted by the Liberal government via Health Canada. However, the real challenges started when the Conservative government was elected to power in 2006.
“After Insite was up and running we did have a change in the federal government and the previous Conservative government was not supportive of harm reduction, or the Insite model. They stopped the funding for the research, so Vancouver Coastal Health picked up the ongoing funding to support the continuation of the research project until the results were published. And they made it very, very challenging to keep a legal exemption for Insite.”
In 2008 a constitutional challenge was heard by the Supreme Court of British Columbia to keep Insite open after then Federal Health Minister Tony Clement refused to renew the exemption beyond July 2008.
The court ruled that laws prohibiting possession and trafficking of drugs were unconstitutional because they denied drug users access to Insite’s health services. Justice Ian Pitfield gave Ottawa until 30 June 2009 to amend the Controlled Drugs and Substances Act and bring it in line with the constitutional principle of fundamental justice.
But that never happened, which means Insite currently operates under a constitutional exception to the Controlled Drugs and Substances Act.
Despite the victory, Insite still had a heavy weight to carry. It had to prove to Canada and the rest of North America that supervised injection sites were an appropriate and safe form of harm reduction.
Negative views, misunderstanding of Insite’s mission
Insite also had to deal with a certain amount of misunderstanding from people outside of Vancouver. Licia Corbella is a columnist with the Calgary Herald, and in 2013 she wrote a column that made a direct link between the death of actor Corey Monteith and Insite. She spoke with CKNW’s Simi Sara about her column.
“I’m not saying that Calgary doesn’t have a drug problem. It’s just that most people don’t know where to get drugs if you were interested in doing drugs. And as I said in my column, I once overheard these three young people in a Japanese restaurant talking about their upcoming Vancouver vacation. They were planning on going to the DTES to get some heroin and try it in the safe injection site. So it’s a gateway for people to try hard drugs.”
That attitude has shifted in recent years, Dr. Daly notes that it’s interesting how saying ‘harm reduction’ no longer warrants an attack from the public.
“Everyone has accepted that these services are necessary to keep people alive, we’re not offering them instead of treatment or instead of prevention. People now recognize that addition is a chronically relapsing condition. Harm reduction just keeps them alive until we can provide better treatment”
Not only that, but it’s opened the door for other cities to consider the same approach.
Leading through example
Earlier this year, Simi Sara spoke with Svante Myrick, the mayor of Ithaca, about how Vancouver’s Insite inspired him to submit a proposal for a safe injection site in his city.
“We were not getting the results from our war on drugs that we wanted. We’ve been locking people up, arresting them, and demonizing them for years and still we had an opioid problem that was, that is, killing one person a month… and causing street crime, causing high rates of infectious diseases, causing poverty and suffering. So we took a look around the world at some of the best approaches… and the one thing that’s got a lot of attention is something that we learned from Vancouver which was how a safe injection facility, even though it’s counter-intuitive works to save lives, lower healthcare costs, lower transmission rates, and, interestingly enough, to move more people into treatment and into active drug use.”
Here in B.C., Insite’s leadership has prompted Victoria, Kelowna, Kamloops and Surrey to pursue similar facilities, and Vancouver announced it had applied to Health Canada to open two more injection sites in existing health centres in the Downtown Eastside.
To date, there have been 2.6 million injections at Insite and zero fatalities. With stats like those, cities from around the world continue to visit the facility to check out how Vancouver is leading the way in harm reduction.