A registered nurse holds a tray of supplies to be used by a drug addict at the Insite safe injection clinic in Vancouver on May 11, 2011.JOHN LEHMANN/The Globe and Mail
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On Sept. 21, 2003, Insite, Canada's only supervised injection site, opened its doors – and what a decade it's been.
Insite began as a three-year research project to determine if providing a safe place for intravenous drug users to shoot up would help reduce the carnage on the streets of Vancouver's Downtown Eastside.
The idea was a controversial then, and it's a controversial now.
In fact, if you look back at the clippings from 2003, you quickly realize that the debate has not changed one iota, at least on the emotional and political level.
Opponents say that Insite condones illicit drug use, encourages the congregation of unsavoury characters and mollycoddles junkies instead of putting them in jail where they belong.
Proponents say that providing a place for addicts to inject street drugs (heroin, cocaine, meth) with clean needles is better than the alternative, having them share needles in back alleys, that it actually reduces criminal activity, and that mitigating the self-harm of drug user is a better use of tax dollars than jailing them.
What has changed is the evidence, and the evidence shows that Insite works.
Overdose deaths are down, transmission of diseases like HIV-AIDS and hepatitis C among is down, drug-related crime in the area is down and use of addiction treatment services is up.
Insite is not solely responsible for all these changes, but it has played a role, particularly in the vulnerable population of IV drug users.
Insite was never meant to be a panacea, a magic wand ending the scourge of drug addiction.
A supervised injection facility is a harm reduction measure and, bottom line, harm has been reduced.
It is for that reason and that reason alone that public health officials support supervised injection.
Drug addicts are now shooting up in a facility dedicated to that purpose instead of doing so in back alleys, at the public library, in parks and in the washrooms at McDonald's. They are uses clean needles instead of sharing. While getting their fix, addicts might get some wound care, reducing their need to go to the emergency room.
Overdoses are now occurring where nurses are nearby to revive people (there have been nearly 1,500 at Insite since it opened and not a single death) instead of those same ODs happening on the streets and ambulance technicians rushing users to ER, or the coroner have to come by and tag the body.
Should we be proud of the fact that there are thousands of addicts living on the streets of a wealthy Canadian city? Of course not.
But we need to take measures that make the daily horrors of that reality a little lesser.
Public health officials know that addiction is a sickness, not a crime. They are also a pragmatic lot; they take their victories, however small, wherever they can get them. Insite's ongoing existence is, for the pragmatists, a big victory.
A comprehensive drug strategy needs four pillars: prevention, treatment, harm reduction and enforcement.
The federal government, under Stephen Harper, has put most of its eggs in the enforcement basket and, in recent years, has taken more interest in treatment and prevention. But it is not enthusiastic about harm reduction, and of Insite in particular, which it continues to try to shut down.
Truth be told, we have paid far too much attention to Insite and too little on the larger concept of harm reduction. If harm reduction works – and it does – why don't we have supervised injection sites in Toronto and Montreal? And why don't we also invest in supervised inhalation sites, distribution of safe crack kits and wet shelters? Why not find innovative ways to counter the scourge of methamphetamine and opioids addiction?
What we have had instead, over the past decade, is a lot of moralistic lectures about the evils of addiction and the need to get "tough on crime."
The government has a right to use the law to restrict the use of drugs, to declare them illicit and impose sanctions on those who sell and use them. But government also has to recognize that you can't legislate away an illness like addiction, no matter how hard you try.
Prevention and treatment (areas that are woefully neglected in our health-care budgets) and, yes, even harm reduction, are all necessary components if we are going to have any hope of enforcement working.
The legal and political fights about Insite – and there have been many – should serve as a reminder that governments are supposed to be stewards, promoting the greater public good. They have a duty to act in ways that enhance the health of individuals and their communities, in a manner that is evidence-informed, even when doing so is politically unpalatable and does not fit one's world-view. The war-on-drugs mentality is not working.
Insite has now been around for a decade. Isn't it time we used the insight gleaned from their experience to create a smarter drug strategy?
André Picard