INSITE SAVES ADDICTS' LIVES

About a month ago, In-Site staff came to work in the morning and
found a woman lying, in tears, in crisis, in the street outside the
facility in Vancouver's downtown eastside.

Trauma Mama (In-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.

Thirty-nine years old, but looking more like she was in her late 40s,
Trauma had been using heavily, she hadn't slept in days and she had
just been robbed. Staff took her to the site's lounge and gave her a
blanket and fluids. Two weeks later she came in, used the injection
room, then approached In-Site's counsellor and asked to be admitted
to the OnSite detox and recovery facility upstairs.

We have repeatedly invited Stephen Harper to visit the safe injection
site personally and take the time to meet some of the people helped
by the lifesaving service it provides.

Herald columnist 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 doesn't mention the
encounter; instead, she argues that engaging with drug users just
encourages them to feel better about their choices. InSite staff
engage with drug users out of compassion, but more importantly,
because engagement works.

After her crisis on Hastings Street that late January morning, Trauma
told InSite staff she didn't have anywhere 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 people with strong opinions on this issue, including Prime
Minister Harper and Martinuk, I assumed I had the solutions before I
fully understood the problems. When I first 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
collectively pay for this lack of understanding is perpetuating pain,
suffering, death and disease in our cities.

Now, after having met hundreds of people who have taught me
otherwise, I no longer think treating addiction is simple. As the
executive director of the non-profit organization that runs InSite,
I've learned that drug use is a lot more complicated than the
"lifestyle choice" paradigm frequently 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 -- in their lives.
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 too often heart-wrenching stories.
Many InSite users are people for whom trust and understanding are
among a phalanx of social and institutional barriers making treatment
often feel impossible.

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 study in the New England Journal of Medicine found that
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. In-Site
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
that 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
in January, 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.

Liz Evans is executive director of the PHS Community Services
Society, the not-for-profit organization that runs InSite, a
safe-injection site in Vancouver's downtown eastside