INTO INSITE

Dispelling The Myths Of Drug Addiction In 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 in a
nonchalant fashion, do their business and quickly scuttle off in
various directions.

Some may venture back to hotel rooms, rented out at cheap monthly
rates. Others 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, just eight doors away.

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. Tyrone Caldwell used to take his fair share.

Caldwell, 39, spent the last 14 years dabbling with different
substances, and after nearly a decade of drug use, he started dealing
drugs (including heroin) to support his $300-a-day cocaine habit.

Last May, he entered the facility as he did on any normal day. He
proceeded into the injection area, a booth the width of a desk with a
mirror in front and two walls, to shoot up.

"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 revived him
with a shot of Narcan, a drug that reverses the effects of opiates.
Caldwell later discovered he hadn't injected pure cocaine, but a
nasty mix of cocaine and heroin that led to his overdose. The staff
at Insite are the reason Caldwell didn't die that day, and he knows it.

"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 on the Downtown Eastside--averaging around 700
visits per day--and of the 500 overdoses, none have resulted in
death. Section 56 of the Controlled Drugs and Substances Act allows
Insite 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.

Before Insite, the number of overdoses and rates of infection for HIV
and hepatitis A, B and C were soaring in 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 area
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 the 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 created as a progressive step
toward harm reduction.

Open 18 hours a day, it has become one of the busiest safe injection
facilities in the world, with 7,000 registered members. (Other sites
exist in Portugal, Australia, Germany and Switzerland.) Though how
the facility has had an impact on the rate of HIV/AIDS is not known,
Insite has found that its users are twice as likely to get into
detox. In spite of this, the future of the facility was in limbo at
the end of August, with the federal exemption that allowed Insite to
operate due to expire on Sept. 12. When Health Minister Tony Clement
announced the government's decision to extend the exemption, he
shortened the time span from three years to a deadline of December
2007. "Do safe injection sites contribute to lowering drug use and
fighting addiction?" Clement said 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."

Jeff West, a co-ordinator at Insite, has witnessed firsthand the
changes the facility has brought to the Downtown Eastside. He's
working to dispel the myths he says are circulating in Ottawa and
educate people about the many other services they provide.

"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
Insite workers have gone beyond their immediate duties, it's an
automatic charge of manslaughter.

But the big appeal, West says, is giving a shelter to the people
living in squalor. Insite gives the lost and hopeless a place to go.

When Darcy (who is using only her first name to protect her identity)
was 22, her sister became a crystal methamphetamine addict and Darcy
took custody of her sister's children. Twenty-five years later, she
found herself living in the Balmoral Hotel in Vancouver's Downtown
Eastside after a back injury forced her onto welfare. Darcy started
using drugs--everything except crystal meth.

"I wanted to experience it all. 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."

Before Insite, she says, women were contracting HIV at enormous
rates, and adds that women are the most vulnerable on the Downtown
Eastside. Darcy says that prostitutes are often too messed up to do
their own drugs. They receive help from their pimps, who inject the
women with used needles, increasing the risk for HIV and other diseases.

"Closing the site would force many women back into the alleys," she
says. She admits there are many misconceptions about Insite and says
that, given the lack of understanding about addiction in general,
that's not surprising.

"[Drug addicts] are seen as a subhuman species here," she says, "but
they aren't."

Case in point: The Globe and Mail held an online debate before the
extension to the exemption was granted. Randy White, founder of the
Drug Prevention Network of Canada, 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 should not be renewed.

Among The Reasons:

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

2) Since its opening, crime and addiction have increased in Vancouver
and the injection site has contributed to the problem.

3) Responsible governments do 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.

Former mayor of Vancouver and current senator Larry 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 the advocate group Insite for Community Safety.

Libby Davies, a proponent of Insite and an NDP MP, echoed Allen's
concerns. "The evidence [about] Insite is irrefutable; there's no
research that suggests it's not working as it should be.... 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; its part of the solution."

The "federal government doesn't fund any component," adds Allen.
"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."

Though perceptions of addiction range from a crime to an illness, in
almost all drug addiction cases, there's a story behind it being overlooked.

"People have experienced trauma, and some of these injection drug
users are basically self-medicating, and they basically become
criminals because of what they start using. It's a downward spiral
from there," says Davies. "It's an insane situation."

Darcy agrees. "[Drug addicts have] lost their self-esteem," she says.
"A lot of people are forced here. A lot of people are unable to take
care of themselves and they get into drugs."

Even for those opposed to the work of Insite, 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.

One of the strongest messages of support comes from the Chinatown
Merchants Association. Before the site opened, the association was
among those most vehemently opposed to the injection site. Now they
are one of its 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.

Six to eight hours after their last dose of heroin, a person can
begin to experience 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.

Months before the creation of Insite, VANDU--which was created 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 Miller.

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

The municipal government, she says, had repeatedly dropped the idea
for the site in previous years.

When the Sept. 12 shutdown seemed imminent, VANDU sought an
injunction to the BC Supreme Court stating that it was
unconstitutional for the site to be closed. The following day, Tony
Clement announced the government would extend the exemption.

The news was less than encouraging to Livingston, who feels that the
federal government is stalling in making a real decision. She sees
Ottawa's non-committal attitude as an indication that a shutdown,
regardless of the extension, is looming. "It's unprecedented to have
a minister of health ignoring info that's published in the [New
England Medical Journal]," Livingston says, referring to studies
published about the impact of Insite. She is lobbying to open four
more government-sanctioned sites.

"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.'"

But the likelihood of more sites popping up once the exemption
expires in December seems small. Livingston knows it, and that's why
VANDU is doing whatever it can to help. Spotted easily from a block
away, VANDU's team of 10 people in fluorescent vests patrol the
streets, educating and, in many cases, illegally assisting with the
injections of addicts who are unable to inject alone. These rogue
patrols complement the limited services Insite can legally provide.
Often, people have to be rejected from the facility because they are
not capable of injecting their own drugs.

This squadron of injectors, all trained health-care workers certified
in CPR, will do what Insite workers can't.

"It's considered illegal," Livingston says. "But if I inject you with
drugs [you're] much less likely to die with a trained expert who
knows CPR and has gloves on." Livingston expects illegal sites will
replace Insite if it's closed. Before the extension was announced,
VANDU and other groups were getting one ready. There are also rumours
of a site built by the Portland Hotel Society, a Vancouver-based
substance abuse advocacy group.

The future of Insite after December remains uncertain, but regardless
of what the government decides, support for Insite remains strong.

Livingston can attest to that.

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