INSIGHT ON INSITE

Darlene Palmer started using drugs at age 11. The victim of abuse, she
would spend the next 26 years of her life sometimes homeless,
sometimes hungry and always hoping for a fix - wherever and whenever
she could get it.

"I couldn't deal with reality, so I used [drugs] to escape it," she
told the crowd.

An image flashes on-screen of a couple lying sprawled on a bare
mattress surrounded by garbage and discarded clothing, wearing next to
nothing, looking dazed and confused.

"These are heroin users," said Gillian Maxwell, introducing herself to
an audience of students, teachers and activists last Thursday evening.

This picture is only one of many common to Vancouver's downtown east
side, which in 1997 was declared an emergency zone, with the largest
outbreak of HIV ever witnessed within a developed country.

Originally from England, Maxwell's formal black suit and conservative
looks are almost clashing at first sight with Palmer's funky coloured
clothing, unruly blonde hair and more outgoing personality. Palmer has
learned about life the hard way, a heroin user on the streets of
Montreal; Maxwell's booksmart knowledge about addiction-related
illnesses reveals a more business-like approach.

But both women's faces light up as they see each other and warmly
embrace.

Despite their contrasting looks and history, these two women have a
strong common ground: both work hard at promoting harm reduction, to
ameliorate drug users' living conditions.

Maxwell is a trained mediator and negotiator and works as a
spokesperson for Vancouver's safe injection site, Insite, the first
health assistance facility of its kind in North America.

Palmer works as a street worker for Montreal's Cactus centre, where
she counsels and guides users addicted to hard substances such as
cocaine, meth and heroin - the same background she managed to escape a
few years earlier.

Both women promote harm reduction - a pragmatic response that focuses
on keeping people safe and minimizing death, disease and injury
associated with higher risk behaviour, while recognizing that it may
still continue despite the risks.

The harm reduction philosophy, which is supported by the UN drug
agency and the World Health organization, maintains a neutral value
and humanistic view of the drug user.

"Everybody is a drug user, even if it's not intravenous drugs.
Alcohol, cigarettes, coffee - most of us can barely spend a whole day
without consuming some sort of stimulant," said Maxwell. "I don't
think it's fair to ostracize intravenous drug users, labelling their
addiction a crime or a disease."

Many, on the other hand, see this view as far too sympathetic, and
fear that the harm reduction approach might just encourage people to
use intravenous drugs by making it seem socially acceptable. Insite
provides users with both a safe facility and sterilized material to
inject the drugs, with medical professionals on hand to assist
patients if an overdose should occur.

"It's not the typical shooting up joint," admitted Maxwell. "Rather it
looks a bit like a fancy hair salon."

Visitors are greeted in a brightly light, modern reception, and then
are shown to a room of minimal design with 12 cubicles neatly lined
against the right side of a wall.

After the drug has been injected using only sterilized syringes and
antiseptic cleansing, users may then proceed to the "chill out room,"
a comfortable area with seats and tables, while still under strict
supervision from the nearby health care professionals.

It's not difficult to see how some might find the Insite process more
of an endorsement of risky behaviour rather than a rehabilitation clinic.

Therein lays a major distinction. "The main goal of such a site is not
to get people off drugs, it's to reduce the number of people getting
infections," explained Pierre Cote, Centre Hospitalier de l'Universite
de Montreal director of the HIV/drug-addiction unit.

Rewind five years with the initial election of Larry Campbell as mayor
of Vancouver in 2002, and Insite begins to make more sense.

Campbell, a former RCMP officer, already knew the realities of working
with drug users on the streets of Hastings, after having served as a
member for Vancouver's Drug Squad several years prior to his being
elected.

Determined to undertake this major initiative in the face of public
scrutiny and criticism, Campbell allowed Insite, the first safe
injection site, to be opened in September of 2005.

"Mr. Campbell saw the difference between risky behaviour and body
bags," said Maxwell. "Our main priority is educating people that this
isn't just about help, but it's about health care."

Vancouver's Four Pillars Drug Strategy program, which got Campbell's
approval, seeks to reduce the likelihood of harm through safe
injection sites and needle exchange programs, as well as providing
prevention methods, treatment and enforcement.

Harm reduction accounts for only a part of the whole strategy, and it
aims primarily at limiting the spread of HIV, Hepatitis C and other
blood-transmitted diseases.

Out of the approximate 12,000 intravenous drug users in Montreal, 20
per cent have HIV and over 62 percent have Hepatitis B.

In Vancouver, the numbers are even more shocking: 40 per cent of drug
users are contaminated with HIV, and 95 per cent are infected with
Hepatitis C.

The site oversees some 600 injections every day, but workers at the
centre agree that while their efforts are making a difference, it
still isn't enough.

"Our site is only able to deal with five per cent of users. There is
still another 95 per cent who are not being reached," explained Maxwell.

Amanda Ayansen, a worker from Cactus' sister organization, Spectre de
Rue, agrees.

"For many, it is also the lifestyle that comes with drug addiction
that gets them sick: lack of sleep, bad nutrition, physical symptoms,
and isolation keeps them from seeking help. Hospitals won't admit them
only because of that, so specialized healthcare centres such as Insite
may be the only way to make contact with these people."

Indeed, the majority of site users tend to be the most marginalized
and socially disadvantaged in society, often living in unsanitary
conditions, from low-income households and having a history of
incarceration.

Add to that the numerous pressures Insite has faced since its
inception, both from the community and politicians, and it's no wonder
it's one of the most controversial debate topics within North America.

The Harper government, since its election in 2006, has repeatedly
tried to close down Insite and has made it clear that if elected with
a majority government, doors will be closing; and while Quebec's
former health minister, Phillipe Couillard, had supported the
establishment of a safe-investment site for Montreal, the new health
minister has backed away from the proposal in view of the
Conservatives' policies.

But whatever its critics may say, Insite can still boast that it has
not seen a single death since it opened its doors.

"This is about health care, not rehab," said Maxwell. "This is about
life being precious - nothing else."