The Expanding Role of Safe Injection Sites in Metro Vancouver

For years Insite operated under heavy political opposition. Now the safe injection site approach is being adopted elsewhere.
Joseph Keller, Web Editor

It’s been 14 years since Insite, the first supervised safe injection location in Vancouver’s Downtown Eastside, opened its doors as an experiment in a radical new approach to harm reduction.

The concept of a safe injection site—where drug users are provided with a clean place, sterile needles, and medical supervision while they use opiates—has obvious humanitarian benefit as it helps to keep addicts alive, but the approach has been seen as a form of enablement by critics. Throughout its early years, Insite faced intense political opposition and scrutiny, which continues to this day.

But mental and physical health experts, along with advocates for those using the facilities, say that now is a better time than ever to expand the harm reduction service.

Today, in the midst of the most serious public health crisis in the history of the community, the safe injection site method looks poised to grow into the Lower Mainland and beyond.

The Harm Reduction Method

Over the past few years, fentanyl has taken a serious toll on the Metro Vancouver community. Throughout British Columbia there were 922 overdose deaths connected to the potent and deadly opiate in 2017, according to an April report by The Vancouver Sun. The substance was found in four out of every five drug samples collected by Vancouver Coastal Health.

Insite, currently the province’s only sanctioned safe injection site, has been overwhelmed by the influx of addicts who would otherwise be left to try their luck with no medical supervision. Advocates say that the harm reduction method of having supervised safe injection sites staffed by medical attendants and equipped with the means to respond to overdoses is among the most effective tools at a municipal government’s disposal to prevent loss of life.

Among Insite’s advocates is the Vancouver Area Network of Drug Users (VANDU), which aims to be a voice for the marginalized community of addicts in Metro Vancouver. The organization has been a vocal supporter of safe injection sites since before Insite first opened its doors.

Karen Ward, a board member for VANDU, says that the one government sanctioned site is not enough to serve the entire Lower Mainland and that it’s time for expansion of these services.

“The [Downtown Eastside] community is incredibly strong and resilient but we’re suffering right now because the burden of constant death is overwhelming,” says Ward.

Ward says that the battle being fought by safe injection site advocates is one for public understanding of harm reduction as a technique for keeping addicts alive so that they might have a hope of recovery. This approach stands in direct opposition to the zero tolerance stance that has traditionally been characteristic of mainstream drug enforcement.

“What we’re up against is the entire history of the war on drugs, which has been proven again and again to be an abject failure. The war on drugs is actually a war on the poor and a war on other marginalized communities.”

Now, 14 years after Insite broke new ground with the safe injection site harm reduction model, neighbouring communities are looking to what has been done with the goal of saving lives in the Downtown Eastside and applying those lessons in their own troubled areas. Still, the move towards implementation is slow and political reluctance and even outright opposition continues to exist.

Safe Injection Sites Coming to Surrey

The situation unfolding in the Downtown Eastside is by no means unique. Troubled areas across the Lower Mainland are struggling to keep people alive through the fentanyl crisis. Following the lead of Insite, plans are well underway for two supervised safe injection sites in Surrey.

Two locations have been selected for the sites by Fraser Health, and Surrey’s first safe injection site is set to open in June. The process of gaining local government support and approval from Health Canada was not an quick one. The final steps in the approval process were submitted to Health Canada by Fraser Health in mid-February. Throughout the establishment process, Fraser Health has been careful to maintain support for the sites from the surrounding community and local government.

‘’We’ve been very encouraged by the response that we’ve received, and generally speaking people are very supportive of supervised consumption services, especially when they understand the big picture and how that can support the neighborhood,” says Jacqueline Blackwell, senior consultant for Fraser Health.

“At Fraser Health, we look at supervised consumption services as being an evidence-based solution. Everything that we’ve pursued on that front as far as supervised consumption services has been based on evidence and based on research, and that’s how we’re going to continue moving forward.”

Throughout the process of establishing the Surrey sites, Fraser Health has not had to face the same political opposition faced by Insite in its early years, but the initiative was still met with some skepticism by the municipal government. Surrey Mayor Linda Hepner told reporters late last year that the city could not support the supervised injection sites unless they were offered alongside a clinical treatment plan for addicts.

“When we initially started out it was about a safe injection site or a consumption site and we were very adamant that as mayor and council we wanted to see a fully integrated response plan for the entire continuum of care relative to that,” said Hepner.

Throughout January, Fraser Health has been busy consulting with the City of Surrey and other stakeholders, outlining their plans for not only the safe consumption services but also a treatment-based approach, including opioid agonist treatment and recovery services that will be available at the sites. Hepner says that city officials have a defined set of expectations that include data at the end of a two-year period of operation showing that Fraser Health’s services have resulted in more addicts moving into treatment and recovery. The mayor is optimistic that Fraser Health will be able to present such data.

“Frankly, my early concerns with the consumption site have now been addressed with the plans and policies that they have now put in place,” says Hepner.

While Ward recognizes the necessity of offering users a chance at treatment, she says that the city’s insistence that a clinical treatment program be fully integrated before it can give its support puts priorities in the wrong order. She believes the government’s main concern should be getting the sites operational as soon as possible in order to save lives now, so that drug users can have a chance of recovery in the future.

“The point of these sites in this kind of emergency is to keep people alive to the point where they can have options,” says Ward. “We believe that everyone, including every drug user, is a competent human being who’s able to make their own choices.”

According to Blackwell, the key to maintaining support for the facilities in the community and from government officials has been the consultation process. In addition to the City of Surrey, Fraser Health has identified the Downtown Surrey Business Improvement Association, the Whalley Community Association, and the Surrey School District as stakeholders, and has been collaborating and consulting with all of these groups about their public health approach. Additionally, Fraser Health has held two public information sessions to address the concerns of residents in the surrounding neighbourhoods.

“It’s really all about having those conversations and hearing from people who are in the neighborhood, hearing what their concerns are and how we can address them better,” says Blackwell.

Ward says that her hope for Fraser Health, as they go through this consultation process, is that drug users will be included in the conversation, as research shows that users need to be sure they can trust the people running the site or they will not use them. Ward argues that users should be considered the primary stakeholders.

“It’s very important to put the users first and to include the users in the development of these places. Ask, ‘What would work for you? Would you come here? If you come here you’ll be safer, so would you come here?’ Lets ask them,” says Ward. “Let’s take the voices of the people who are at risk here most seriously.”

Walking The Road Paved by Insite

When Insite opened in 2003 it was able to receive an exemption from the government under the Controlled Drugs and Substances Act.

But in 2006 the Conservatives came to power, bringing with them a strong ideological opposition to safe injection sites and the very philosophy of harm reduction.

Under Prime Minister Harper, the federal government took a hard-line stance against drug use and attempted to legislate against the safe injection site, arguing that such a facility was dangerous to the community. The Tories attempted to withdraw the exemption that allows Insite to operate, but the move was struck down by the Supreme Court of Canada. The court argued that since the data is on the side of of the harm reduction method—according to research done by sources like the Canadian Medical Association—the federal government’s decision to withdraw the exemption and close the sites was counter to public health and safety.

Today, with a federal Liberal government more friendly to the supervised injection site approach to combating opioid related deaths, Fraser Health’s political task becomes maintaining support for its services on a local level.

The Last Gasps of Opposition

While the results shown by Insite have been enough to quell much of the criticism of the harm reduction approach, political opposition is still very much alive.

As the Conservative Party decides its path forward, there is debate among leadership hopefuls as to whether the it should continue the opposition to safe injection sites and the concept of harm reduction that was maintained under the leadership of Stephen Harper.

At the February leadership debate in Vancouver, several Conservative candidates expressed the opinion that safe injection sites are the wrong approach to dealing with the crisis.

“We need to invest in addiction and health recovery programs, not safe injection sites,” said candidate Andrew Scheer at the forum. “Not making it easier to get to the drugs, but a program that actually shows compassion to the people that are trapped in a cycle of addiction.”

This opinion was mirrored by other candidates such as Steven Blaney and Erin O’Toole.

“The fentanyl crisis is a national healthcare emergency and British Columbia is on the front lines of that emergency,” said O’Toole. “There needs to be acute healthcare funding dollars for frontline work, not just with harm reduction, but for mental health.”

Opinions like these from prospective national leaders are unacceptable to harm reduction advocates like Ward, who feel that keeping addicts safe should be the government’s immediate concern.

“We need people to be alive so they can get the treatment when they choose to. They need to be alive first,” says Ward. “Opposing basic harm reduction is killing people.”

Opposition to safe injection sites is far from unanimous in the Conservative Party. At the Vancouver forum, candidate Rick Peterson expressed open support for Insite to the applause of the largely conservative audience. Peterson is joined by other top Conservative candidates such as Michael Chong. It seems that even in right-leaning circles, Canadian opposition to the once highly controversial harm reduction approach is waning.