INSIDE INSITE: A FIRSTHAND LOOK AT ADDICTION

Federal Government In Court Monday To Fight Judge's Ruling

It's the confines of Insite's drug injection room that puts Derek
James at ease as he prepares to stick a syringe laced with heroin
into his forearm.

No one is trying to beat him for his dope. Nor is there any of the
drug-fuelled mayhem present that thrives outside the facility's doors
on East Hastings, near Main Street.

"It's dangerous out there," says the 53-year-old, one of the first
visitors to Insite Monday morning. "Without this place, a lot of
people would be dead--me included."

James overdosed here a few months ago. He survived because of medical
intervention from staff and paramedics. Another time, he wanted a
break from the drugs and spent nine days upstairs at Insite's detox
centre. The staff, he says, has been good to him.

He's a thin man, with a few days stubble and a nest of dark hair that
covers part of his face. He seems overdressed for the warm weather in
his cargo pants, sweater, scarf and thick brown winter jacket.

He's new to intravenous drug use, but not to heroin. Three years ago,
his wife died in a car accident in Taiwan. At the time, he owned a
drainage company and two houses near 29th and Main.

A friend turned him on to heroin to mask the pain of his loss. He now
lives in a suite on the edge of the Downtown Eastside. He receives
income assistance and sells small amounts of marijuana.

That's how he afforded the sprinkling of brown powder before him this
morning. He empties it onto a spoon, heats it with a match and draws
the liquid through a filter into a syringe. He wraps a tourniquet
around his atrophied bicep and sticks the syringe in his arm. He
pulls it out, puts it back in--and continues to do this a few times
until he places the blood-filled syringe on the booth's table.

"This never happens to me, but I can't find a vein," he says, before
attempting the whole exercise again on his right arm.

Eventually, a nurse helps James find a vein. He's relieved. He cleans
up his paraphernalia and heads to the facility's "chill-out room" for a coffee.

More users trickle in to greet nurses and other staff working the
floor. Pop music from a sound system fills the dimly lit room in what
is a relaxed, friendly atmosphere.

The setting, which has the feel of an art gallery, seems incongruous
to the facility's purpose--providing a haven for ill people to
legally inject themselves with untested, illegal drugs that can
ultimately kill them.

Since it opened in September 2003, Insite has been criticized and
celebrated for the service it provides to drug users, many of whom
are homeless, mentally ill and suffering from infectious diseases.

Several peer-reviewed studies published in international medical
journals say the facility is reducing the spread of disease, needle
sharing, preventing overdose deaths and linking people with
counselling, treatment and housing.

Critics such as former federal health minister Tony Clement suggest
the research is mixed, that Insite is a failure of public policy and
offers no hope.

Next Monday, the federal government will appear in the B.C. Court of
Appeal in an attempt to overturn a May 2008 B.C. Supreme Court
decision that allows Insite to operate indefinitely.

It's a case James wishes was unnecessary. But he understands how
people are quick to judge drug users.

"I was one of those guys who had no sympathy or compassion [for drug
users]. My thought was, 'You made your bed, you've got to sleep in it.'"

Now in the grips of addiction, and a frequent visitor to Insite,
James is convinced the facility provides a unique contact point for
people otherwise considered write-offs.

"Where else are people going to go?"

Richard Chenery is in the fog of his heroin high as he sits in an
office next to the chill-out room.

He will inject himself at least three more times with heroin or
morphine before the day is over. It's an addiction that costs him
$150 or more a day, and it has almost killed him.

"Three years ago, November 16 at 9:27," he blurts out.

It's the day he overdosed--or dropped, in the vernacular of the user.

Like James, staff at Insite kept him alive. He claims to be Insite's
"number one client," having come here since it opened. Not all his
visits were to inject drugs.

There was a time when his right leg from his ankle to his knee was
"mush," the result of being whacked with a baseball bat. Nurses
regularly dressed his wounds and arranged for a ride to St. Paul's
Hospital when he needed further treatment.

"Straight up--without the nurses in this place, I probably would have
lost my leg," he says, pulling up his pant leg to reveal the scars of
his injury. "The general public has to realize this just isn't a
shooting gallery. There's a lot more going on here."

He pays for his drugs with money he receives from government
assistance and any cash he can scrounge from collecting and selling
bottles, scrap metal and copper.

Chenery, a slight aboriginal man with tattoos and a partially shaved
head, lives on the street by choice. His leg can't take the
blood-sucking bedbugs in the single-room occupancy hotels. He's on a
waiting list for a B.C. Housing building.

He credits Darwin Fisher, the site's intake manager, for getting him
on the list. Fisher is sitting across from Chenery.

"This guy is like Obi Wan Kenobi around here," he says of the affable
Fisher, who easily interacts with visitors to the site.

It will likely be Fisher that Chenery consults if he wants to get
into the detox centre upstairs. That time hasn't come yet.

"I don't do anything halfway."

He turned to drugs at 14. He doesn't cite a specific reason but says
most drug addicts are victims of repressed emotional events in their lives.

Chenery, a trained pipefitter, enjoyed periods in his life when he
was clean. But like James, his wife died a few years ago. Her body
was discovered in the Astoria Hotel, a few blocks east of Insite.
"The paper said it was double pneumonia," says Chenery, who believes
drugs were involved. "After that, I just jammed a needle in my arm again."

Fisher listens intently to Chenery, who is considered one of the most
street-entrenched users at the injection site. Building relationships
with people such as Chenery is Fisher's primary role.

"The whole philosophy of this place is not to try and make the user
fit us, it's to try and fit us around the users--to reach out to them
as much as possible."

Once a trust is built, Fisher's goal is to get that person into the
facility's detox. On the day of the Courier's visit, two women agreed
to take that step.

It's difficult to get more than two people per day into the detox
because it only has 12 beds; Insite gets an average of 700 visits
over an 18-hour opening. Fisher will check with Harbour Light's detox
and Vancouver Detox but is not always successful in finding a bed.

"It's terrible when you have somebody who really needs to get off the
street and you can't find a bed for them," he says, adding that the
best staff can do some days is to tell the user to return the next
day. "But when you're on the street, that can take you to all kinds
of places in those hours that you're waiting for a bed."

Back in the injection room, a woman climbs on the stainless steel
table of a booth to get a closer look in the mirror for a vein in her neck.

She jams in a syringe.

A woman in the neighbouring booth chooses a vein in her forehead.
Across the room, an older man in a motorized wheelchair rolls up to a
booth and prepares his injection tools.

They've entered the injection room from a waiting area at the front
of the building. Those with shopping carts have parked them near the
facility's front doors.

A staff member notifies users when one of the 12 injection booths is
vacant. Some take no more than two minutes to get high, others can be
in the booth for an hour. Two nurses overlook the booths from a large
counter equipped with sterile injection equipment, including
syringes, filters, tourniquets, spoons and water.

Oxygen tanks and "crash kits" that contain a drug capable of
reversing the effect of a drug overdose are stored under the counter.

So far, no one has died here.

That fact is on Russ Maynard's mind as he considers the cost of
paramedics rushing to pick up an overdose victim in an alley and
going to hospital.

Maynard, a supervisor at the site, is monitoring the activity in the
room. He's witnessed users of the site overdose, only to have staff
intervene and prevent a death.

The stress on the body from an overdose is evident. Intervention has
proven to prevent death and it can also reduce serious harm to
organs, Maynard says.

Statistics from the PHS Community Services Society, which operates
Insite under a contractual agreement with Vancouver Coastal Health,
show staff performed more than 2,300 "overdose interventions" since
the site opened in 2003.

An intervention ranges from administering oxygen to calling for
paramedics, which staff did 470 times; 144 of those calls required
the person be transported to hospital.

"This is the most entrenched demographic of people in the country, if
not North America," Maynard explains. "And if we can save them from
going to hospital, think of the cost savings."

He notes Insite is also affiliated with the Community Transitional
Care Team at the nearby Pennsylvania Hotel, which offers intravenous
antibiotic therapy and treats infections.

This way, users of Insite who need such care from nurses and a doctor
don't have to remain in a hospital. He describes the nine-bed
facility as a small ward, which is open around the clock.

Staff at Insite have provided treatments such as wound care and safe
injection training close to 16,000 times, according to the PHS's stats.

Since its inception, more than 1.2 million injections have occurred
at the facility, which is the only legal injection site in North America.

The average age of the user is 40, with 74 per cent male. Almost 20
per cent of users are aboriginal.

On the day of the Courier's visit five days ago, Insite recorded 766
visits over an 18-hour period. The drug of choice was heroin,
followed by cocaine and morphine.

It's early afternoon and Liane Gladue has injected her first dose of heroin.

Like Chenery, the 44-year-old requires multiple doses to get her
through the day. Her high is in full swing when she takes a seat in
Fisher's office.

Gladue is a mother to five kids in their 20s who live in Ontario,
Edmonton and the Sunshine Coast. She comes from a good home in
Sechelt, where she married her "high school sweetheart."

He isn't with her today; he's in prison.

Gladue claims to have a master's degree in cultural anthropology and
worked for four years in "the education system." She doesn't want to
reveal more.

Why is she a drug addict?

She first tried cocaine when she was 13. Her cousin offered it to
her. There wasn't an immediate addiction, she says, noting she got
through Simon Fraser University and University of Victoria.

Then at 31, she was diagnosed with intestinal cancer. She pats a
small paunch on her stomach, where she says a tumour continues to grow.

Treated for years with morphine, the doctors eventually cut her off
the drug. She became addicted to it. She needed a substitute and
turned to heroin.

"They literally wired me to the tits with morphine and then sent me
on my way," she says in between bites of a donut.

Now she sells crack cocaine to pay for her heroin, which can cost
upwards of $250 a day. She's homeless and sleeps in back alleys and in alcoves.

She credits the nurses and staff at Insite for keeping her and her
husband alive; he's overdosed four times at Insite.

Last May, Gladue spent eight weeks in St. Paul's Hospital after
nurses at Insite noticed a red dot on her arm. It turned out to be
osteo militis, a life-threatening staph infection in her bones.

Her last attempt at getting sober was at Insite's detox centre,
commonly referred to as Onsite. She relapsed on her fifth week.

"I'm getting out of here anyway. My husband's getting out of jail
soon and we're leaving. Maybe we'll go to Burnaby, get on the
methadone program and sit on the couch and get fat."

But today, it's back to the heroin.

Less than an hour after leaving Fisher's office, the Courier
photographer captures Gladue in a photograph making her second
injection of the day.

While Gladue is getting her fix, a group of six former users of
Insite gathers on a sundeck on the top floor of the facility's detox centre.

Terry, Johnny, Tim, Dave, Guy and his girlfriend Tansia have a pretty
good idea of Gladue's state of mind.

They've all hit rock bottom at least once.

Today, they're clean and credit staff at Insite and Onsite, including
managers Liz Moss and Eva Breternitz, who are seated on the deck, for
getting them on the road to recovery.

The group, which declined to reveal their surnames, either live in
recovery houses, found their own place or, in Johnny's case, is about
to leave for a six-week residential treatment program in Armstrong, B.C.

"I was tired of doing heroin and getting sick and I wanted to get
better for me and my kids," says the 46-year-old, who can't read or
write and slept under the Georgia viaduct for four years. "This is my
third time through here and I am going to make it this time."

Onsite opened four years after Insite. It has two floors--the first
with 12 beds for detox, the second with 18 beds for people focused on
preparing for a life of sobriety.

There, they receive visits from a doctor and have access to drug
counselling and mental health workers. Acupuncture, yoga and
meditation, along with three meals per day, are included.

Almost 600 people have stayed at the detox since September 2007. More
than 100 were successful in entering long-term treatment programs and housing.

Dave and Tim, both in their early 40s, left Onsite for a recovery
house near 13th and Cambie. Dressed in jeans and T-shirts, they could
easily pass for suburban dads watching their kids on a soccer pitch.
Both have battled longtime alcohol and drug addictions.

"I was an alcoholic-drug addict of the most hopeless kind," says Tim,
who estimates he visited Insite 6,000 times and racked up more than
40 convictions in eight years for fraud. "So the last time I got out
of jail, I hit a low bottom and I knew what I had to do--I came here,
because this is where the support was."

Guy's story is one of armed robberies, long prison sentences and an
addiction to heroin that began at 16. He's now 39. He saw no hope and
was on a mission to kill himself when he reached out for help.

"If it wasn't for Insite or Onsite, I guarantee I'd be dead for sure.
There's no question about that. I didn't see any future in my life.
Now things are working out for me."

Over the weekend, Guy got a call from a man staying at Onsite. He was
ready to move to a recovery house. Could you help me, is what he asked Guy.

"It makes me feel really good," he says, noting he wants to set up
his own recovery house for youth. "We're all human beings just trying
to find our little spot in the world. And some people have got dealt
cards that aren't the greatest. Today I've got a choice, and before I
didn't see the choice. For me, the choice is never to use again, no
matter what."

And with that, he got up, walked down the hall and found the man who
called him over the weekend. They said their good-byes to staff and
pushed open a door into the sunshine.