Vancouver’s safe injection site

I was glad to read today that the safe injection site for heroin in Vancouver has received approval from the federal minister of health, Tony Clement, to remain open until December 2007. Safe injection sites represent what I see as the most intelligent approach to dealing with addictive drugs, namely that of harm reduction. Given the enormous amount of harm that arises from activities peripheral to drug use, this is an approach with real promise.

By providing clean facilities and sterile needles, such sites reduce the probabilities of the transmission of infectious disease through intravenous drug use. Given the ever-rising numbers of people with AIDS and Hepatitis C, this is an incontrovertible benefit. Dr. Julio Montaner, director of the B.C. Centre for Excellence in HIV/AIDS has said, of this facility:

The supervised injection site has saved lives, has optimized the use of medical services by entrenched addicts who are sick because of their addiction, has decreased risky behaviors that promote HIV spread, hepatitis C and others, has diminished the inappropriate use of medical resources, has not had a negative impact attracting news users, promoting drug use.

More generally, safe injection sites provide a window for public health authorities into lives that would generally be concealed from them: a glimpse that can only be afforded on the basis that those being helped can be sure they will not be turned over to the police.

Those sites that actually provide addicts with heroin generate additional benefits. Firstly, doing so eliminates the need on the part of addicts to generate funds to sustain a drug habit. Since those funds are likely to be generated in illegal ways, this reduces the amount of crime associated with drug use. Secondly, since distributional channels are often controlled by organized crime, giving addicts means of circumventing them reduces the income and influence of these groups. Given the enormous corrupting power organized crime groups have on governments and police forces, this is most welcome. Such groups are also notoriously violent, and prone to engaging in bloody competition with one another, as well as perpetuating other criminal activities related to the practice or profits of the distribution of illegal drugs. The fact that the Vancouver Police Department has repeatedly expressed support for the safe injection site demonstrates that the arguments about crime reduction have merit. On Clement’s politically risky decision, they supported him “for making a very difficult decision on a complex issue, and for the care with which it has approached it.”

In the end, criminalizing drug use is a strategy where the intuitive appeal falters on the shoals of practical considerations. Countries that have vigorously pursued the enforcement of drug laws – especially the United States – have increased their prison populations while doing little to deal with the underlying issues. Given the reduced life prospects for anyone who has been convicted, as well as the toxic and criminally encouraging environment inside many prisons, such policies generate further harmful knock-on effects.

I am glad that drug policy is an area where Canada has generally been able to steer its own course, subject to the occasional frantic denouncement from across the border. It shows that Canadian values like compassion and pragmatism can be applied successfully even in policy areas that are frequently the source of vitriol and extreme polarization.

Author: Milan

In the spring of 2005, I graduated from the University of British Columbia with a degree in International Relations and a general focus in the area of environmental politics. In the fall of 2005, I began reading for an M.Phil in IR at Wadham College, Oxford. Outside school, I am very interested in photography, writing, and the outdoors. I am writing this blog to keep in touch with friends and family around the world, provide a more personal view of graduate student life in Oxford, and pass on some lessons I've learned here.

21 thoughts on “Vancouver’s safe injection site”

  1. I wasn’t so glad to hear that their application for another *three year* permit was turned down on the grounds that there was no evidence that the facility reduced crime. They are being given a year to show that they have reduced drug crime, and you can probably guess what the chances of that are.

    You see, Harper added a review by the Ministry of Justice to the normal review by Health Canada, and it seems law & order (read: moral) concerns completely trumped the saving of human lives. You’d better send an e-mail to Minister Clement if you want the facility to stay open. I doubt it’ll do much good though. “Tackling crime” is Harper’s big thing now (to take attention of Afganistan, I suppose). I got a thing in the mail just yesterday (paid for by taxpayers) saying how great a job the conservatives are doing at fighting crime. I don’t see how a drug injection site can survive under such a government. They probably would have canned it immediately if it weren’t for the strong community support.

  2. E-mailing Minister Clement is pretty unlikely to accomplish anything. I have written about a dozen letters to ministers. Here is the standard response:

    Two weeks later: “Dear Mr. Ilnyckyj. Thank you for your letter. I have forwarded it to [next most related minister on the matter]. Here is a copy of the original.”

    Two weeks after that: “Dear Mr. Ilnyckyj. Thank you for your letter. I have forwarded it to [the minister to whom you originally sent it]. Here is a copy of the original.”

    It is the world’s slowest document duplication service.

  3. I think it is interesting that “rank-and-file members of the force voted unanimously yesterday to call on the government to shut it down …[as they’re] seeing unprecedented levels of crimes.” It comes as no surprise that individual police officers see the safe injection sites negatively. Police culture is highly conservative and focused almost exclusively on a retributive approach; they’re rarely interested in ameliorating problems through pragmatic solutions. Instead, the vast majority of cops I’ve spoken to are in favour of a “lock ’em up and throw away the key” -carceral approach. Their focus is on crime rates and not on HIV infection rates in the downtown eastside (a place which has one of the highest instances of HIV infection in North America).

  4. How does all of this fit in with questions about the Downtown Eastside and the 2010 Olympics?

  5. Canada gives more time to drug injection site

    VANCOUVER, British Columbia (Reuters) – The government granted another reprieve on Tuesday to North America’s only sanctioned injection site for drug addicts, saying it wants more research before deciding its fate.
    Vancouver’s Insite facility had faced closure at the end of the year, but Health Minister Tony Clement notified the local health authority that the injection site can stay open until June 30, 2008.

  6. Court rules against Ottawa in injection site case

    Updated Tue. May. 27 2008 11:07 PM ET News

    A B.C. judge has ruled that the federal government cannot constitutionally shut down Vancouver’s safe-injection site.

    Justice Ian Pitfield wrote in a 60-page ruling that “Society cannot condone addiction, but in the face of its presence it cannot fail to manage it, hopefully with ultimate success reflected in the cure of the addicted individual and abstinence.”

  7. OPIUM production increased to nearly 9,000 tonnes in 2007, the highest level for years, according to a United Nations annual “World Drug Report” published on Thursday June 26th. Opiates remain the main problem drug in terms of treatment. But while there is cause for concern, comfort may be had in knowing things are not nearly as bad as they used to be. In 1909, international concern over the ravages of the then legal and freely traded drug culminated in a meeting of the International Opium Commission in Shanghai. And from UN estimates using Commission documents, it is plain to see why. Some 16.4% of the population were puffing on opium in Singapore, and over 8% in Hong Kong and Macau. The only country to use more than it did a century ago is America.

  8. Conservatives get tough on drug offences
    Feb 27, 2009 06:29 PM


    VANCOUVER – The Conservative government continued its law-and-order blitz Friday by reintroducing tougher penalties for drug offences.

    The changes came a day after Ottawa announced Criminal Code amendments aimed at gang violence.

    But a veteran defence lawyer gave the government’s lock ’em up strategy a failing grade, saying it doesn’t get at the roots of gangsterism – alienated young people and widespread demand for illegal drugs.

  9. Heroin supply clinic ‘cuts crime’
    By Danny Shaw
    BBC home affairs correspondent

    A scheme in which heroin is given to addicts in supervised clinics has led to big reductions in the use of street drugs and crime, the BBC has learned.

    More than 100 users took part in the pilot – part funded by the government – in London, Brighton and Darlington.

    They either injected heroin or received the drug’s substitute methadone.

    Those given heroin responded best and an independent panel which monitored the scheme over six months are advising ministers to set up further trials.

    About three-quarters of those given heroin were said to have “substantially” reduced their use of street drugs.

    Research suggests that between half and two-thirds of all crime in the UK is drug-related.

    The Home Office says on its website that about three-quarters of crack and heroin users claim they commit crime to feed their habits.

  10. Welcome to Insite
    By Matthew Power
    Posted Monday, Feb. 1, 2010, at 9:35 AM ET

    At the corner of East Hastings and Carrall Streets in Vancouver, Canada, a raucous crowd milled around the sidewalk. Goods were on offer from a dozen sellers: hand tools, electronics, clothing, toiletries, all of uncertain provenance. There was a frenzy to make deals. A man opened a backpack filled with new tubes of toothpaste, smiling with stumps of teeth. Another sold cartons of orange juice out of a baby carriage. A shiny new mountain bike was on sale for $20. Below it all, a hushed chorus: “Powder. Powder.” “Rock. Got rock.” “Down. Need down?” This last is the local term for heroin, and there were capped syringes, tourniquets, and empty ampoules of sterile water scattered on the ground. In a shuttered doorway, a pale blonde girl in a dirty pink miniskirt, her thumb bruised black from constantly flicking her lighter, drew sunken-cheeked at a crack stem and looked up for a moment to ask, “You hooking?” A police car rolled slowly by but didn’t stop.

    The Downtown Eastside of Vancouver is a short walk and a world away from the glittering skyline of its business district, where a new billion-dollar convention center will soon welcome 400,000 visitors to the winter Olympics. Last year, the Economist magazine ranked Vancouver as the “world’s most livable city.” With a temperate climate and progressive mores, it has long been a destination for Canada’s lost and dislocated. The Downtown Eastside, a dozen square blocks of dilapidated tenements and boarded storefronts, is home to one of the highest concentrations of drug addicts in the world. Scenes of open drug use recall the depths of the crack epidemic in New York City or the failed drug zone of Zurich’s “Needle Park” in the early 1990’s. An estimated 5,000 injection heroin and cocaine users live in the neighborhood, and the addict population suffers from HIV rates that are 30 times higher than the national average. Seventy percent have hepatitis C. Much of Vancouver’s homelessness is concentrated in the neighborhood, as is 40 percent of the city’s violent crime. The HIV incidence rate—the increase in new cases—hit 19 percent in 1996, the highest ever observed in the developed world. That’s comparable to the situation in Botswana.

  11. “Addicts arrive with drugs scored on the streets and inject them in a supervised environment, 18 hours a day, 365 days a year. A counter was laden with clean needles, sterile water, cookers, filters, tourniquets, alcohol swabs, condoms. The database includes more than 2,000 users, identified only by code names, and an average day will see 645 injections. There are always two staffers and two nurses on duty, standing by with oxygen masks and syringes of the overdose drug naloxone. To date they have intervened in more than a thousand overdoses without a single death.

    The operating principle is simple: If injection drug use is going to occur regardless, why not create a space that mitigates its dangers? That way, say its proponents, lives will be saved and the spread of disease will be checked. The risks of unsupervised injection are manifold; public drug users are often rushed and are less likely to have sterile equipment and practices. In Vancouver, researchers described addicts drawing up puddle water to mix their drugs, or doing “shake and bake,” mixing the drugs in the syringe without first cooking out their impurities. Such techniques can cause gangrenous abscesses and endocarditis, a bacterial infection of the heart valves. Public users are also less apt to test their drugs for potency. “What’s really difficult on this job is finding out that people use elsewhere, because the site’s not open 24 hours a day, and they die of an overdose,” says Fisher. “If people aren’t using here, they’re using behind a dumpster.””

  12. Upstairs, Downstairs
    By Matthew Power
    Posted Tuesday, Feb. 2, 2010, at 10:04 AM ET

    By 11 a.m. on the day I visited, there had been 54 users in the injection room. Some were in and out in moments, while others took hours. When they finished in their booths, most retired for free coffee in the “chill-out room” which had an exit back onto the street. Cocaine injectors might return many times a day, while some users merely stopped in to pick up handfuls of free “rigs,” or syringes. (Three million syringes are distributed in the neighborhood annually.) In between users, each booth was swept out and sterilized by the staff. Darwin Fisher, the program’s intake manager, checked in arrivals and the drugs they were using on a drop-down chart that listed among its options heroin, speedball, morphine, cocaine, crack, dilaudid, oxycontin, and methamphetamine. The user’s choice of drug and the outcome of each visit was stored in a database for researchers. In keeping with the nonjudgmental ethos, there are two key rules at Insite: no sharing or selling drugs and no violence. Indeed, once they were settled in their cubicles, most of the users were as still and focused as students in library carrels.

  13. Does It Work?
    By Matthew Power
    Posted Thursday, Feb. 4, 2010, at 10:05 AM ET

    One study of Vancouver’s injection-drug users has taken harm reduction to a level even beyond Insite. In 2003, the same year that the supervised-injection site opened its doors, an epidemiologist named Martin Schecter began planning a trial that had never been conducted in North America: heroin maintenance. Would a daily course of heroin, administered in a clinical setting, release users from the destructive aspects of maintaining their addiction? Would it benefit society and allow users to stabilize their lives? Similar studies had been conducted in Europe with positive results. Switzerland alone has 38 heroin maintenance centers, and they are a fully integrated part of its national health system; Germany followed suit last year. Schecter, who has worked in Vancouver since the first signs of the AIDS epidemic in 1983, wanted to see whether such a program would make a difference in Canada.

    For the neighborhood’s recovering addicts, the ability to escape the daily demands of supporting an addiction is often achieved with a dose of methadone. Methadone’s relative benefits are well established: It is slow-acting. It greatly reduces cravings for heroin and blocks heroin’s euphoric effects. When successful, methadone maintenance can give addicts their lives back. But there are high rates of relapse among long-term addicts.

    Drawing from a population of addicts in Vancouver and Montreal who had repeatedly failed methadone therapy, Schecter began the North American Opiate Medication Initiative in 2005. The Vancouver trials were set up in an abandoned bank a few blocks from Insite; the Swiss pharmaceutical-grade heroin was delivered by armored car and stored in the empty vault. Addicts were given heroin three times a day and monitored over a three-year period. A parallel group was given an ordinary course of methadone, and the results were compared.

  14. B.C. HIV transmission decline unique in Canada, expert says
    Richard Watts, Times Colonist

    British Columbia is the only part of Canada where transmission of HIV is declining, a medical expert told a Victoria audience Wednesday.

    Dr. Julio Montaner, director for the B.C. Centre for Excellence, past-president of the International AIDS Society and professor of AIDS medicine at the University of B.C., noted that every other part of Canada is showing an increase.

    Montaner credited the province’s widespread commitment to early treatment with anti-AIDS drugs for the decline.

    Montaner pointed to the federal government’s court challenge, now before the Supreme Court of Canada, to the operation of INSITE, the safe injection site in for illegal drugs in Vancouver.

    It is a move that flies in the face of provincial court rulings, provincial government support, local police approval and demonstrable improvements in public health, such as a 35 per cent reduction in fatal overdoses, he said.

    “Why is the federal government trying to sabotage my work?” Montaner asked.

    “They have a moralistic attitude and they are ignoring the science. They [the federal Conservatives] have a fundamental problem with the groups who are at high risk of acquiring HIV -gays and drug addicts.”

    Montaner said in 2009, while he was still president of the International AIDS Society, he was invited to the White House three times. Not once was he invited to Ottawa.

  15. Health officials to pitch proposal for safe drug injection facilities in Toronto

    Toronto health officials are expected to make a pitch for supervised safe injection facilities in Toronto.

    The new proposal aims to take illegal drug use off the streets, and prevent overdoses and the spread of disease by giving users a safe and supervised place to inject drugs.

    In a statement released Saturday, Toronto Public Health said that Dr. David McKeown, Toronto’s chief medical officer of health, will discuss “expanding harm-reduction services” in Toronto at a news conference on Monday.

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