By Amanda Waldroupe, Staff Writer
Vancouver, B.C., knows how to deal with heroin addicts.
Vancouver is the home to North America’s only supervised injection site, and the world’s largest. Called Insite, it allows addicts to bring in their own drugs — more often than not, heroin and cocaine — and inject them in a booth supervised by nurses. Addicts can stay at Insite after injecting as long as they like afterwards; nurses are constantly available to provide immediate medical care if someone overdoses or experiences related medical issues. Clean needles and condoms are made available to users.
Insite is in a three-story building. The first floor is the supervised injection site. The second floor is a detox program serving 12 people, and the third floor houses an 18-bed drug recovery program called Onsite. Insite was intentionally designed that way to encourage people using Insite to enter recovery programs, and it also makes it as easy as going up a flight of stairs.
Insite opened in 2003 and is a partnership between the Portland Hotel Society, an affordable housing provider, and the city’s public health agency, Vancouver Coastal Health Authority.
Insite’s founding was a direct response to an escalating public health crisis in Vancouver. During the 1990s, there was a rampant and increased use of injection drugs, fatal overdoses, and transmission of HIV and Hepatitis C. Ground zero is an area in downtown Vancouver known as the “Downtown Eastside.” The area is five blocks by about 15 blocks wide, and it is home to Vancouver’s poorest and most vulnerable residents, including an estimated 4,000 to 7,000 injection-drug users.
There were 201 overdose deaths in Vancouver in 1993. That number had hovered between 30 and 50 in the prior decade. HIV infection increased along with the overdose deaths — in 1996, there were 2,100 cases of HIV transmission, and a United Nations report found that the Downtown Eastside area had an HIV rate of 30 percent, compared to Canada’s rate of 0.2 percent.
“These two things literally created a recognized health crises,” says Russ Maynard, Insite’s program coordinator.
Maynard says there was a recognition that increasing the number of needle exchange clinics would not help to solve the overdose and health crisis. The Vancouver Area Network of Drug Users (VANDU), a grassroots organization, formed and began pressuring Vancouver’s local government to open a supervised injection site modeled after sites already in operation in Europe and Australia.
“The luck is having a health authority and a city hall that, at that particular time in history, seemed to be open to new ideas,” Maynard says.
Since opening, Insite has had more than 1.5 million visits. There are 12,000 people registered with Insite (though not all of them may be using Insite at once). In 2009, Insite had 276,178 visits by 5,447 individuals. There were 484 overdoses, but no deaths. Insite made 6,242 referrals to social-service agencies, including housing placement and drug treatment programs.
Maynard says Insite’s biggest asset is not that it prevents overdose deaths or is an integral piece to Vancouver’s public health system. But rather that it allows people to change their lives. He frequently gives tours of Insite to the public, and he remembers one tour that he gave when a woman using Insite’s services began answering questions from the group and speaking with them.
“You don’t know what this place means to me,” Maynard remembers her saying. “They treat us as if we’re normal.”
Amanda Waldroupe: In what way was harm reduction available to the community before Insite opened?
Russ Maynard: There would have been street nurses walking around with a shoulder bag. There would have been needle exchanges. VANDU (the Vancouver Area Network of Drug Users) and other organizations would have had harm reduction classes to some degree. The problem is that it was piecemeal.
A.W.: How does Insite work?
R.M.: The first time you come in you have to register. The registration process is very unencumbersome. You’ll be handed a clipboard and directed to fill out 20, 30 questions. Obviously, if you have literacy issues, you’re dope sick, or have mental health issues, that can be a Herculean, if not impossible, task. (It’s) designed around the population. It asks for your birth date, which isn’t giving a lot of information. It asks your gender. It asks your ethnicity. Then you will make up a handle or a pseudonym. We don’t need your real name. We just want to get you in. That is very reflective of the bottom up design (of) Insite.
Hopefully your wait is very minimal. One minute, two minutes. They’re called into the injection room. The door is locked. They walk in. Right away, there’s a computer on their left. They self report to the nurse what they’re using. There are 12 booths. Staff are walking the floor back and forth about two feet from the booths. They are sitting in a cubicle with a large mirror in front of them, a stainless steel tabletop and two walls. That mirror does a few things. If they are stimulated, it allows them to have a sense of what’s going on behind them. It (also) allows them to look at themselves. If you’re homeless, you don’t have a mirror. You can see the sores on your face, your gaunt look. Staff are right there (if they overdose) and are intervening within minutes. They are trained to recognize the signs.