How a substance abuse clinic gets people clean by helping them take drugs
By Andrea Bichan
In Vancouver, British Columbia, one substance abuse clinic stands out above the rest as a voice for change in drug policy.
Insite, based in Vancouver’s downtown East Side, is North America’s only “safe injection” facility. What this means is that people who have purchased illegal intravenous drugs, such as heroin, cocaine or methamphetamines outside the clinic can bring them inside and inject them using clean equipment, under the supervision of medical professionals. These professionals are able to distribute needles, see that the drugs are being used in a safe manner and will intervene in the event of an overdose by a patient. The center is also the home of Onsite, a drug rehabilitation facility.
The mission of Insite is to be a harm-reduction facility for the citizens of Vancouver. The idea of “harm-reduction” drug policies as a more practical way to deal with drug abuse has been gaining momentum in recent years. Harm-reduction centers on the idea of accepting drug use as an unavoidable reality, not a possibility that can be avoided through strict laws.
“Use isn’t affected by legality or how easy it is to get,” said Evan Nison, vice president of Ithaca College’s Students for a Sensible Drug Policy. All year, the campus organization has been working to introduce harm-reduction policies at Ithaca College, including implementing a medical amnesty policy so inebriated students can seek treatment without fear of punishment. The policy is up for a vote by the end of the year.
Other harm-reduction policies include needle exchanges to limit disease transmission and the decriminalization of marijuana to reduce the amount of drug-related offenders using tax dollars by being incarcerated in prisons. In short, they offer new solutions to existing problems by addressing them head on.
“It’s such a great way to look at use. Right now we’re trying to eradicate the drugs instead of reducing the number of people using drugs,” said Celeste Brooks, IC sophomore and SSDP member.
Currently, there is clearly a lot of harm caused by drug use under current policies. About 25 percent of all prisoners in the United States are incarcerated for drug-related crimes. Lack of access to clean and safe hypodermic needles can certainly cause the spread of diseases like HIV. Vancouver itself experienced an outbreak of HIV related to needle sharing in the 1990s, which some say led to Insite’s creation.
“In 1996, there was a dramatic spread of HIV amongst injection uses in the downtown East Side. And over the following two years, overdoses significantly increased,” said Dr. David Marsh, medical director of addictions, HIV/AIDS and aboriginal health at Vancouver Coastal Health, in a recorded interview on Insite’s website. “People looked around to see what could be done.”
And thus, in 2003, Insite opened its doors to drug users.
Insite brands itself as a harm-reduction facility. But is this local institution really reducing the harm that intravenous drugs inflict on downtown Vancouver? Some say that by giving addicts a safe haven to pursue their addiction safely, they are condoning, if not encouraging drug use. Additionally, as addicts flock to Insite, some fear that the facility will make the surrounding area less safe.
The Royal Canadian Mounted Police, for instance, has voiced its opposition not only to Insite, but also to all harm-reduction policies. “The RCMP has concerns regarding any initiative that lowers the perceived risks associated with drug use,” said Staff-Sgt. C.D. Doucette in a 2006 statement released on behalf of the police service. Canadian Prime Minister Stephen Harper has also been quoted saying, “We as a government will not use taxpayers’ money to fund drug use.”
Gretchen Duerr, IC senior and president of SSDP disagrees. “They believe that junkies will all come to the city,” Duerr said. “Junkies don’t really travel that far.”
Marsh views the issue similarly. “The safe injection facility has been very positive for the downtown East Side.” The facts agree. Numerous studies have been published regarding Insite, and they have almost entirely come out in the instutition’s favor.
Public drug use in the area has decreased dramatically, as has needle sharing, a serious concern even fourteen hears after a HIV outbreak. More studies have claimed that Insite patients are more likely to seek and use drug addiction treatment programs than other drug addicts. “They estimate eight to 15 lives per year that are saved because of the site,” said Mash.
A large part of the Vancouver community has also voiced their approval of the facility, including Mayor Gregor Robinson and British Columbia Premier Gordon Campbell.
“The least that I, or anyone there can do, is to listen,” said Insite Clinical Coordinator Bethany Jeal in another interview from Insite’s website. “To say that…you do matter. And you have needs, just like I have needs.”
The clear success of this harm-reduction facility shows several possibilities in Canada and the United States’ future. As of right now, there are no other safe injection sites in either country. But could there be in the future?
“We are involved in San Francisco, New York City, and elsewhere for the implementation of safe injection sites,” said Ethan Nadelmann, founder and executive director of the Drug Policy Alliance. He claimed that places like Insite could be seen in America within the next few decades.
“The resistance in the United States is very much like that to needle exchange programs, where there were needle exchanges in cities in Europe in the late 80s and 90s but there was a lot of resistance in America. So what we have here are safe injection facilities being opened up all over the world, and the United States is showing the same resistance.” As of 2007, there were 185 needle exchange facilities operating in the U.S. Ithaca currently has its own exchange, the Tompkins Country Prevention Point.
The students of SSDP agree.
“I think pockets of these are going to pop up in the U.S. in like, the next 20 years,” Duerr said. “I could see one in Ithaca.”
“I think it’s pretty likely,” Nison concurred.
However, the future of Insite is hanging in the balance.
When Insite began in 2003, it was given a legal exemption from the Canadian government in order for studies to be conducted and its impact on the city to be analyzed. Seven years and dozens of published studies later, Insite is still only legally operating through its exemption. The current Canadian administration, one far removed from the administration that allowed the facility’s creation, has been actively working to close Insite’s doors for good since the Conservative Party took office in 2006.
They’ve taken the issue to several federal courts, all of which upheld Insite’s legality to operate. In retaliation, the Harper administration just announced in January that they are attempting to get the issue heard by the Supreme Court of Canada.
If Insite closes, the Vancouver’s downtown East Side stands to lose a vital institution and harm-reduction advocates will lose a major battle in the fight for drug policy reform. Right now, Insite’s proven success and massive local support are a beacon of hope for reform advocates.
“The scientific evidence has shown that safe injection facilities have helped overdose resistance, and has been associated to reducing transmitted diseases among illegal drug users and to improving lives immediately,” Nadelmann said.
If Insite stays open and Nadelmann proves to be right, safe injection facilities could be seen across the United States relatively soon. If their results are as positive as the findings being published about Insite, the United States as well could see a reduced number of overdoses, public drug use and transmitted diseases. More addicts would enroll in treatment programs and get rehabilitated freely. It would be a new age for drug policy, and a giant step in addressing drug use and reducing the negative effects.
But if Insite closes, that will probably never happen.
Since 2003, the Insite safe injection facility has not only worked to protect its citizens from public drug use, but has also protected drug users from themselves. It has treated the downtrodden and drug addicted with respect, and in many cases, helped them on the path to a drug-free life. It fulfills its mission and more. It is a voice for change and an alternative to advocate for, perhaps eventually, within our own borders.
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Andrea Bichan is a junior journalism major who thinks Insite is out-of-sight. E-mail her at [email protected]