THE FORESIGHT OF INSITE

Dispelling the Myths of Drug Addiction on Vancouver's Downtown Eastside

VANCOUVER (CUP) -- On any given morning on the corner of East Hastings
and Columbia in front of the Radio Station Cafe, a drug dealer can
make up to $35,000. Their customers approach them in a nonchalant
fashion, do their business and quickly scuttle off in various
directions. Some may venture back to their hotel rooms, rented out at
cheap monthly rates. Many will drift into the nearest alley and
quickly dose. But these days, most will probably walk into Insite,
Vancouver's highly publicized and contentious safe injection facility,
open to all and just eight doors down.

15,000 Needles on the Wall, You Take One Down, Pass It Around . . .

Even on the slowest day, the Vancouver Area Network of Drug Users
(VANDU) estimates that nearly 15,000 heroin injections take place in
the Downtown Eastside, and Tyrone Caldwell, 39, used to take his fair
share.

Caldwell spent the last 14 years of his life dabbling with different
drugs, but it was during the last five years things began to get
really heavy. After nearly a decade of drug use, he lost control, and
in order to support his $300-a-day cocaine habit started dealing
narcotics himself, including heroin.

It was in May that he went into the facility as he would on any normal
day. He proceeded into the injection area to shoot up. The area is the
width of a desk, with a mirror in front and two walls, giving an
individual the suggestion of privacy. Immediately after dosing,
Caldwell had an ominous feeling that something was not right.

"The minute the buzz or rush started coming on, I knew it wasn't a
cocaine rush," he says. "I knew I was in trouble and that's the last
thing I remember."

Caldwell was put into an ambulance after the paramedics gave him a
shot of Narcan, a drug that reverses the effects of opiates, to revive
him. Caldwell later discovered that what he had injected into himself
wasn't just cocaine, it was a nasty trail mix of heroin and cocaine,
which led to his overdose. And it was solely because of the staff at
Insite that Caldwell didn't die that day. Caldwell knows this full
well.

"If Insite wasn't there and I was in the alley, I'd be dead," he
says.

Caldwell isn't the only one. Since its inception in 2003, Insite has
grown in popularity among drug users on the Downtown Eastside,
averaging around 700 visits per day. Section 56 of the Controlled
Drugs and Substances Act allows Insite, in addition to housing doctors
prescribing methadone for those in rehab, to have legal possession of
controlled substances. Because of this exemption, Insite is currently
the only place in Canada where a person can legally carry narcotics on
them.

Before Insite, the number of overdoses and rates of infection for HIV
and hepatitis A, B, and C were soaring on the Downtown Eastside.
According to Anne Livingston, a project co-ordinator for VANDU, deaths
by overdose climbed from 35 in 1989 to 350 in 1994. The 1995 Vancouver
Injection Drug User study sampled 5,000 users in the Downtown Eastside
and estimated that the prevalence of HIV/AIDS in the area was around
40 per cent while hepatitis C hovered around 90 per cent.

The community was dying.

With already alarming rates of infection and death escalating rapidly,
the city soon realized traditional drug enforcement and treatment
strategies were failing. Vancouver subsequently adopted its "Four
Pillars Drug Strategy," which consists of harm reduction, prevention,
treatment, and enforcement. Insite was implemented as a progressive
step towards increasing harm reduction, though some might argue it
promotes all four pillars.

Open 18 hours a day, Insite has become one of the busiest safe
injection facilities in the world. There is no limit to how many times
a day a person can use the site. Accounts of its successes have been
exhaustively documented. There are over 7,000 registered members and
there have been 500 overdoses, none of which have resulted in death.
Furthermore, Insite has found that users of the site are twice as
likely to get into detox.

And while there is no evidence yet to suggest that the rates of HIV or
AIDS have gone down since Insite opened, neither have there been any
studies investigating this issue. It would be counterintuitive to
think that the facility has been anything less than a bastion of
prevention. The evidence of its success speaks for itself.

In spite of this, at the end of August the future of the facility was
in limbo. The federal exemption that allowed Insite to operate was due
to expire on Sept. 12 and Canadian Health Minister Tony Clement,
rather than extending it for another three years, has reluctantly
bowed to public pressure and renewed the exemption only until December
2007. The scientific evidence, according to Clement, was
inconclusive.

"Do safe injection sites contribute to lowering drug use and fighting
addiction? Right now the only thing research has proven conclusively
is that drug addicts need more help to get off drugs," said Clement in
a media release. "Given the need for more facts, I am unable to
approve the current request to extend the Vancouver site for another
three and a half years."

Despite scientific evidence and public support of the facility from
all levels of government, the Ministry of Health opted to shy away
from granting proponents of the site its full demands -- the
disconnection between those in Ottawa and the people at the frontlines
is unsettling. Jeff West, a co-ordinator at Insite, has witnessed
firsthand the changes the facility has brought to the Downtown
Eastside. He's seen its successes and its failures. His apparent modus
operandi is to dispel the myths circulating in Ottawa and educate
people about the many other services that Insite provides.

"We teach people, we never hold or touch the needle, that's the bottom
line," says West. "[The staff] can tie people off, help them find a
vein, [pick] what kind of angle to insert the needle. We also have a
prosthetic arm that has veins and use that as a teaching tool."

West stresses the strictness of these guidelines. If someone dies and
they have gone beyond their immediate duties, says West, it's an
automatic charge of manslaughter.

But the big appeal for Insite, West says, is giving a shelter to the
people living in squalor. It provides the lost and hopeless a place
where they can go. This is fundamental, he says.

"People are complex souls.Addictions are a result of other stuff going
on. Ultimately you could really just focus on the addiction, and they
can go to detox."

Caldwell and many others can attest to the success of this
program.

"If Insite wasn't there . . . I really wouldn't be here," says
Caldwell, who now volunteers at Insite. "I'm living on borrowed time
and I'm here to help them. No questions."

Meanderers, Misconceptions, and Misdemeanors

When her sister became a crystal methamphetamine addict, Darcy (who is
using only her first name to protect her identity) took custody of her
sister's children. She was only 22. For the next 25 years, she was an
operating engineer in northern B.C., making almost a six-figure income
for many years.

But after injuring her back and losing the pension she spent her
entire life working for, everything came crashing down. She eventually
moved to the Balmoral Hotel in Vancouver's Downtown Eastside. She had
nowhere else to go.

On welfare for the first time of her life, she started using drugs.
From A to Z, she did it all, everything except crystal meth --
something she promised herself she would never do after seeing it kill
her sister.

"It was from 25 years of being straight, I wanted to experience it
all. You name it, I did it. My sister was a junkie; it was like I
wanted to experience what she experienced."

At the height of her drug addiction she was visiting Insite nearly
four times a day.

"What I went for was the congeniality and I'd go there because it's a
nice, clean place. I don't actually inject anymore."

She can barely describe some of the atrocities she's seen because they
are so egregious. Before Insite, she says, women were contracting HIV
at enormous rates. She attributes this to the fact that women are most
vulnerable in the Downtown Eastside.

Often times, she says, prostitutes, too messed up to do their own
drugs, ask their pimps to shoot them up. But instead of using a clean
needle, her pimp uses a "rake," a needle that has already made the
rounds, which is almost inevitably tainted and ridden with disease. As
soon as that needle is used, the woman has contracted HIV.

Insite, she says, offers these women an alternative.

"This is a place where women go to control disease," she says. Closing
the site would force many women back into the alleys.

The misconceptions about Insite were clearly shown in an online Globe
and Mail debate between former mayor of Vancouver and current Senator
Larry Campbell and Randy White, the founder of the Drug Prevention
Network of Canada held in August, before the extension to the
exemption was granted.

During the debate, White, a former Reform-Alliance-Conservative MP and
vice-chairman of the parliamentary committee studying the non-medical
use of drugs, gave a list of reasons why Insite's exemption under the
Controlled Drugs and Substances Act should not have been renewed and
why the site should have been shut down.

Among the reasons:

1. Injection sites do not prevent and treat drug use.

2. Since the opening of the site, crime and addiction have become more
problematic in Vancouver, and the injection site has contributed to
the problem.

3. Responsible government does not sanction a person walking through a
door and getting assistance to shoot up crystal meth.

4. Injection sites are the exception, not the rule, in most countries
worldwide.

Campbell retorted: "To be blunt, [White] is a dinosaur and refuses to
even consider scientific, peer-reviewed evidence. I suspect that deep
in his mind, he believes the earth is flat."

The inability to get past archaic misconceptions about the realities
of drug use is at the root of the problem, says Nathan Allen, an
organizer for Insite for Community Safety, an advocate group for Insite.

"[The] federal government doesn't fund any component. Insite doesn't
provide drugs. They aren't asking for a single red cent, just for the
blessing, just for the exemption to be renewed," Allen said.

Libby Davies, a proponent of Insite and an NDP MP, echoed Allen's
concerns. She herself is baffled as to why the scientific evidence
that has accumulated over the past three years is being disputed.

"The evidence [about] Insite is irrefutable, there's no research that
suggests it's not working as it should be . . . They're dead wrong
with the disputes. You can't ignore the scientific evidence from
incredibly reputable sources. It's been under a microscope for three
years. It's not a panacea for the drug solution, it's part of the solution."

Echoing Davies' concerns, Darcy adds a more extreme viewpoint. She
believes that Ottawa has given the addiction situation and Insite a
lack of attention, and the subsequent drug-related deaths in the
Downtown Eastside area is a form of population control.

"[Drug addicts] are seen as a subhuman species here, but they aren't.
It's tough to make it as a man down here but it's even tougher to make
it as a woman. They'll stab you, knife you. That's the element you
have to be in."

Even if you don't believe in what Insite does, there are many
right-wing libertarian arguments that point to a decrease in tax
dollars being spent. According to VANDU and Insite, every ambulance
coming into the Downtown Eastside costs $1,000. Each case of HIV/AIDS
costs the health-care system $320,000. The financial burden the area
once carried has decreased significantly.

Surprisingly, one of the strongest messages of support comes from the
Chinatown Merchants Association. Before the site opened, the
association was among the groups most vehemently opposed to the
injection site. Now they are one of Insite's biggest supporters.

"There aren't any people shooting up in front of the businesses
anymore and Insite has [shown] by example that it works," says Allen.

Perceptions of addiction differ drastically between "experts." People
like White, hell-bent on sticking to anti-drug dogma, see addiction
anachronistically as a crime rather than an illness. But what people
like White fail to see in almost all drug addiction cases is that
there's often a story behind it that is overlooked. Traumatic events
- -- rape, abusive pasts, a string of bad luck -- all these things can
act as catalysts to addiction.

"[Drug addicts have] lost their self-esteem," Darcy says. "A lot of
people are forced here. Just like myself. You end up getting down here
because bad things happen to you. A lot of people are unable to take
care of themselves and they get into drugs."

Rogue Squadron: Disperse and Resist!

Six to eight hours after the last dose of heroin, a person can begin
to have withdrawal symptoms that include severe anxiety, depression,
diarrhea, convulsions, vomiting and uncontrollable body movements.
Mary Miller used to dose at Insite frequently to avoid these symptoms.

"You don't want to go sleep because when you wake up you'll be too
sick to move," she says. To alleviate these symptoms she now gets a
portion of her welfare check deducted to pay for her methadone.

Months before the creation of Insite, a group called the Vancouver
Area Network of Drug Users (VANDU), started in 1998 by a group of
intravenous drug users that advocated living healthy, productive
lives, opened their own de facto safe injection site for people like
Mary.

The rogue site could barely operate and their hours were limited (10
p.m. to 2 a.m.), but according to Ann Livingston, it was what gave the
city the gumption to eventually open a legally sanctioned facility in
2003.

Livingston, a project coordinator for VANDU who also ran
unsuccessfully for city council in 1996 and 1999, says it was this
critical pressure from VANDU that finally started to change minds. The
municipal government, she says, had repeatedly neglected the idea for
the site for a number of years.

When the Sept. 12 shutdown seemed imminent, VANDU sought an injunction
on Aug. 31 to the B.C. Supreme Court, stating it was unconstitutional
for the site to be closed. The following day Tony Clement made his
statement stating the government would extend the exemption for
another 17 months.

The news wasn't so encouraging to Livingston, who says that the
federal government is just stalling in making a "real" decision. The
noncommittal attitude Ottawa had taken during the whole ordeal seemed
to indicate to Livingston that a shutdown, regardless of the
extension, is imminent. The extension doesn't really mean anything,
she says.

"[Tony Clement] hasn't read the studies, he doesn't know what he's
talking about. Most of our struggles in the long-term [have been to]
provide public health facilities and it will save you money in the
long run," she says in response to the health minister's recent statements.

"It's unprecedented to have a minister of Health ignoring info that's
published in the [New England Medical Journal]," Livingston adds,
referring to studies published about the impact of Insite.

Even with the cynical outlook, she is still lobbying to open four more
government-sanctioned sites. One site, she says, isn't enough.

"It's the equivalent of your whole body covered in running sores and
one patch is cleared up," she says. "We know it works but we can't put
it on the rest of our bodies. I said 'Fuck you, we can't.'"

Her plan is to put three more sites on the perimeter of the Downtown
Eastside. By surrounding the area with sites it would, in theory, be
easier for addicts to get to a nearby site.

But the likelihood of three more sites popping up once the exemption
expires in December 2007 seems a stretch. Livingston knows it, and
that's why VANDU is doing whatever they can to help.

The group has already taken the matter into its own hands. If you know
what they look like, you can spot them a block away. A team of 10
people in fluorescent vests patrol the streets educating and, in many
cases, illegally assisting the injections of addicts in the area who
are unable to perform them alone.

These rogue patrols complement the limited services Insite can legally
provide. Often, people have to be rejected from Insite because they
are not capable of injecting their own drugs, and Insite workers
cannot do it for them. These people -- the most impaired, and the most
at risk of contracting disease -- are the ones the patrollers put
first when on the street.

This squadron of injectors, all trained health-care workers certified
in CPR, assist in any way they can. If you're blind and have an
amputated arm, for example, they will help you inject.

"It's considered illegal," Livingston admits. "But if I inject you
with drugs the joke is that you won't die. You're much less likely to
die with a trained expert who knows CPR and has gloves on."

Livingston is sure that if the government in Ottawa decides to pull
the plug after December 2007, rogue sites will replace Insite. Before
Ottawa announced the extension on Sept. 1, VANDU and other groups were
already getting one ready. They were just waiting for the signal.

The rumour is that the Portland Hotel Society, a Vancouver-based
substance abuse advocacy group, has already built a site.

"The only way to find out," says Livingston, "is if you find one of
their workers and literally follow them around until you see them all
going to the same place."

The future of Insite remains uncertain until December 2007, but there
is no doubt that whatever decision is made in Ottawa, it will not sway
supporters of Insite from fighting on behalf of their growing and
evolving community.

Livingston can attest to that. If Ottawa says no to an exemption
beyond 2007, the gloves are going to come off.

"[Ottawa is] going to mud-wrestle with us," she says. "I don't think
that they want that because we would win."