INSITE'S FIRST PRIORITY IS TO SAVE ADDICTS' LIVES

About a month ago, InSite staff came to work in the morning and found
a woman lying, in tears, in crisis, in the street outside the facility
in the Downtown Eastside.

Trauma Mama (I-Site users check-in at the reception desk using
pseudonyms) had been visiting the facility for four years to inject
cocaine, so they knew her well and approached, hoping to help.

At 39, but looking more like she was in her late 40s, Trauma had been
using heavily, she hadn't slept in days and had just been robbed.
Staff took her to the lounge and gave her a blanket and fluids. Two
weeks later she came in, used the injection room, then asked InSite's
counsellor for admittance to the OnSite detox and recovery facility
upstairs.

We have repeatedly invited Prime Minister Stephen Harper to visit to
meet some of those helped by the lifesaving service it provides. Susan
Martinuk deserves credit for doing what he has failed to do. And one
of the people she met was Trauma Mama. Transformed, Trauma had just
finished breakfast, and was clean for the first time in years.
Martinuk's recent column in the Calgary Herald doesn't mention the
encounter; instead, she argues that engaging with drug users just
encourages them to feel better about their choices. But InSite staff
engage with drug users out of compassion, but more importantly,
because engagement works.

After her crisis Trauma told InSite staff she had nowhere else to go.
Whether to use drugs or to recover after the traumas from which she
derives her name, her alternative is the street. Engagement is a
prerequisite for treating addiction in Vancouver's Downtown Eastside
because alienating drug users means banishing them to the places where
they are most at risk.

Like many with strong opinions I assumed I had the solutions before I
fully understood the problems. When I came to the Downtown Eastside 19
years ago after training as a nurse, I was out of touch, but I didn't
realize that I was.

Unfortunately, the price we pay for this lack of understanding is
perpetuating pain, suffering, death and disease in our cities.

I no longer think treating addiction is simple. I've learned drug use
is a lot more complicated than the "lifestyle choice" paradigm often
touted by drug war advocates. This ideology leaves little room for
Trauma.

The vast majority of drug addicts have experienced abuse -- emotional,
physical, sexual or some other variant. The correlation between trauma
and addiction is borne out by scholarly consensus, the observations of
InSite's counsellors, and my own experience listening to their
heart-wrenching stories.

The supervised injection site never promises to hold any magic
solution. Rather, its existence acknowledges that there are realities
for which simplistic paradigms have failed. There are people for whom
we have failed. As an effort to engage with those we fail, InSite's
approach has led to proven success in promoting detox and recovery.

A 2006 New England Journal of Medicine study found addicts who use the
facility have been 18 per cent more likely to use addiction treatment
and counselling services, including detox.

These data confirm that meeting people where they are and listening to
what they need is an effective way to facilitate treatment and
recovery. Canada desperately needs a comprehensive national
four-pillar approach to drug policy like Vancouver's; the safe
injection site is only one part of the addiction solution, but it's a
necessary part. We don't work to reduce the spread of disease and the
risk of overdose associated with using drugs because we think recovery
is impossible, we do it because dead drug addicts can't recover.

The safe injection site is an effective gateway to counselling and
health services, but its primary function is saving lives. InSite
staff have intervened in more than 1,500 overdoses since 2003, without
a single death. In the same period, the spread of HIV-AIDS in the
Downtown Eastside, the only area in the developed world where
infection rates once rivalled those of sub-Saharan Africa's
worst-affected countries, has declined significantly. Research
published in the International Journal of Drug Policy last year found
the site prevents enough new cases of HIV to save the public
health-care system $6 million each year.

The reasons people choose to pursue treatment are as complex as the
reasons they choose to use drugs. So we listen to what they need and
we try to make it less likely that they'll die before they ask to be
admitted to a facility like OnSite. When Trauma Mama came to InSite it
wasn't, as Martinuk suggests, to "feel better about (her) behaviour,"
it was just to feel better. Then she came back two weeks later for the
same reason and she did, eventually, feel better.