THE INSIDE STORY OF VANCOUVER'S SAFE INJECTION SITE

Supporters Work to Convince Opponents That Insite Saves Lives, Still
Fearing for the Facility's Long-Term Future

VANCOUVER -- Using heroin and cocaine can be a dirty business. That
means Bethany Jeal sometimes has a lot to do as a nurse helping
addicts at North America's first safe injection site.

The 28-year-old says she isn't shy about strolling off the nursing
platform in the injection room of the Insite operation in the city's
Downtown Eastside and going up to clients in one of Insite's 12 booths.

Each booth is brightly lit so addicts can find good veins into which
to plunge a syringe's needle. But there are also mirrors, which allow
nurses from across the room to get an idea of what addicts are doing
- - whether, for example, they are using alcohol swabs.

"We can see everything that's going on," said Ms. Jeal, who added
"there's a lot of unclean practices with regard to drugs."

She explained that users do not always wash their hands. The drugs
themselves, bought on the street are not sterile. (Insite allows the
use of drugs, but does not provide them.) And people do not always
use alcohol swabs before plunging needles into their flesh.

"I will definitely walk over to them, and if I don't know them,
introduce myself and say, 'Hey. There's a great way to do this. Why
don't you use an alcohol swab first?' " Ms. Jeal said in an interview.

Ms. Jeal, who has been a nurse for three years, once worked full time
at Insite.

Now she pulls the occasional shift in the operation, which opened in
2003 with support from the province, city and Vancouver Police
Department, among others, as a means of dealing with disease,
overdoses and other problems related to injection drug use, largely
in the poverty-stricken Downtown Eastside.

However, many Insite supporters now fear for its future because
federal Health Minister Tony Clement this week agreed to only a six-
month extension in the Controlled Drugs and Substances Act exemption
that allows illegal drugs in the facility without legal sanctions.
Insite opened with a three-year exemption granted by the then-Liberal
government.

Some say the federal Tories want the issue of Insite's future off the
table with the possibility of a fall election, especially since the
operation is popular in B.C. - with Premier Gordon Campbell and,
according to polls, with the public as well.

B.C. Health Minister George Abbott says Insite represents a practical
approach to issues of injection drug use.

"The challenge we have is that for drug-addicted individuals, at
least until they resolve to try to move beyond their addictions, they
are going to be using. When they use, we want to minimize the public
health hazards that are associated with intravenous drug use," he said.

"No one is saying drug addiction is a good thing. It is clearly a
very bad thing. It's how we manage those addictions in a thoughtful
and humanitarian way that is the key to understanding Insite."

Inside the Site

Insite is open 18 hours a day and, in a rare look at its inner
workings, The Globe and Mail had a recent opportunity to visit during
working hours.

Despite its unusual business, the injection room was subdued and
quiet. The exception was one client, who came in on his bicycle and
rode it back and forth, within a range of about a metre. (The man
likely kept his bike with him, one observer noted, because it would
be stolen if he left it on the street.) There were seven men and one
woman, largely focused on taking out their drugs, preparing them and
using them under nursing supervision.

A poster on the wall warns: "Take care Of your veins. Avoid abscess,
dirty hits, embolism and edema. Avoid injecting particles."

With its track lighting, black tile and white walls, the injection
room has the disconcertingly elegant feel of a furniture showroom in
a slick Vancouver shopping district. But as they arrive, clients can
pick up clean syringes, little aluminum plates for cooking their
drugs, a match or lighter and tourniquet.

"We wanted it to be as calm as it could be, and simple," said Mark
Townsend, manager with the Portland Hotel Society that runs the
facility with the Vancouver Coastal Health Authority, explaining the design.

Ms. Jeal was not on duty this day. She spoke about Insite during an
interview at a cafe up the street from the injection site, which is
laid out on one floor behind a storefront-style facade on East
Hastings, the main street in the Downtown Eastside neighbourhood that
is home to about 4,000 injection drug users.

During her shifts, she said, she tries to constantly walk around the
injection room, interacting with clients. "That's how we get to know
people, get a rapport with people, find out what their thoughts are.
Maybe they have an infection going. Or maybe they really want to get
into detox."

The point is to head off unsafe practices that can lead to HIV or
hepatitis C, or to direct addicts to detox programs. Sanctioning
injection-drug use within Insite also allows for a quick response to
overdoses that occur on site as nurses look on, sending them into a
scramble of sudden treatment and calls to ambulances. There were no
fatalities among 453 overdoses reported between April, 2004, and
March, 2006, the last period for which statistics are available.

"You can read through the protocol and study what to expect, but you
never really know until you experience it," Ms. Jeal said on the
overdose issue, recalling she was "scared shitless" six weeks into
her work at Insite when a man fell off his chair after shooting up.
With treatment, he recovered.

The Burnaby-raised nurse, who never came to the Downtown Eastside in
her youth, said Insite is no doubt necessary.

"It's not so much sanctioning drug use. The whole basis of harm
reduction is accepting that people use [drugs]," she said. "It's not
saying it's a good thing. It's not saying it's a bad thing, or
marginalizing people who use drugs. It's saying they do use drugs and
taking means to prevent harm that might come from using. It's a moral
obligation to do that."

But the federal government has its doubts. Prime Minister Stephen
Harper, announcing a $63.8-million national drug strategy in Winnipeg
this week that balances prevention and treatment, said he remains a
skeptic about Insite, calling it a "second-best strategy at best."

The Prime Minister stated, "If you remain a drug addict, I don't care
how much harm you reduce, you're going to have a short and miserable
life." He said his government will continue studies on Insite, en
route to a conclusion about its value.

The B.C. government provided an initial $1.2-million in capital
funding for Insite, plus $2-million for first-year operating costs.
Since then, the Vancouver Coastal Health Authority has covered the
$2- million annual cost, drawing on its funding from the province.
Health Canada provided $1.5-million over Insite's first three years
to cover the research aspect. And Ottawa has a key power over its
fate because of the controlled-substances exemption.

"I would have preferred a longer extension but I will tell you this.
It certainly is better than not having any extension," Mr. Campbell said.

"I think it's important that the extension has been made and what we
will do now is continue to work with, not just the city, but with the
federal government to ensure an even further extension."

Mr. Campbell, a former Vancouver mayor, acknowledged that people will
have questions about whether Insite is working. "We believe it is
making a difference. We think it is effective. So our job is to
continue to work on behalf of the province, the health-care system
and patients in this regard."

The current mayor, Sam Sullivan, said that city council would like
the exemption extended for at least 31/2 years, and that he plans to
continue to make the case for Insite with federal officials. "It's a
great achievement to have an exemption," he said. "I look forward to
getting a further exemption."

Political Battle

Insite has its critics. The Canadian Police Association and the RCMP
have criticized the operation for, among other things, creating an
enabling environment.

Although there have been a number of studies endorsing Insite for
steering addicts into detox and addiction programs and encouraging
safe injection practices, other studies have not been so
enthusiastic. One, by the Drug Prevention Network of Canada that was
released in the Journal of Global Drug Policy last May, said positive
findings about Insite had been overstated while negative findings
were not given prominence.

In an interview, Mr. Clement said he is awaiting more research on how
supervised injection sites affect prevention, treatment and crime
before a decision would be made on Insite's fate. Six contracts have
been put to tender. Successful bids have been accepted for three.

Mr. Clement, who opposed safe injection sites when he was an Ontario
health minister years ago, insisted that his government has yet to
make a final decision on Insite's fate, and dismissed the allegations
of critics that the six-month extension was intended to put Insite
beyond debate in an election.

"When we have decided something, we will certainly let everybody
know, but we have not made that decision," he said when asked about
the required federal exemption.

Mr. Clement, who toured Insite last year, said it isn't yet clear how
the facility fits into the tough drug strategy announced in Winnipeg.
The government's posture this week is all about research, he said.

"The researchers said, 'We need more time in order to do proper
research for you and for Canadians,' and we gave them more time.
There's nothing more sinister than that," Mr. Clement said.

Mr. Abbott, B.C.'s Health Minister, said Ottawa deserves some credit
for continuing with exemptions for Insite that were launched by a
previous Liberal government. But he said Insite is a key to B.C.'s
goals on injection drug use.

"I have always made it clear to Tony that I am supportive of this
facility, that we believe it is a valuable part of the continuum of
care for the drug addicted, and have always made clear to him we're
prepared to assist in providing whatever information they believe
they need to support the extension of their support for this facility."

Mr. Abbott would not speculate on what Victoria will do if Mr.
Clement eventually rules out an extended exemption for Insite, saying
he was reluctant to consider hypothetical questions.

"We'll cross that bridge if and when we get to it. I would like to
think that over the next six months, we will be able to provide them
with the evidence that would support what they need to get their
support for this," he said.

But Insite's operators are thinking about a Tory-engineered demise
for Insite, and Mr. Townsend of the Portland Hotel Society says the
situation looks bleak. "I believe if the PM does the wrong thing, we
will have no choice but to keep the site open," he said. "We would
try our best to carry on as we could."

But, he said, it wouldn't be easy. "It's hard to run a medical
facility, a hospital or a supervised injection site with volunteers.
You can't run these things with bake sales."

Letters have been written to the Prime Minister's Office, and there
is a talk of a protest visit to Parliament Hill. Mr. Townsend's
society and a pair of drug addicts even filed a statement of claim in
B.C. Supreme Court arguing the closing of Insite would violate their
Charter rights to "security of the person."

A Personal Story

One of those addicts, Shelly Tomic, warmly recalls the support she
has received from Insite since its first day as she grappled with a
hunger for heroin, cocaine, speed and meth. She is now in recovery,
but visits Insite when she feels the need to inject heroin.

Ms. Tomic, who has tested positive for hepatitis C and is disabled
and unemployed, said she once had a heart attack at Insite - nurses
called 911 when they noticed she was in distress. She said the site
is better than the alleys and bar bathrooms she once used to shoot up.

"In Insite, you've always got clean rigs every single time, and even
if you could get clean needles before Insite, you didn't necessarily
have a sterile place to do it," said Ms. Tomic, 39.

"You have got clean rigs. You don't have to rush to get it into you
for fear of being arrested, or somebody taking [your drugs] from you
or [being] mugged for it. And if you overdose at Insite, you have got
medical staff right there to help you."

She added: "[Insite] is sort of like the show Cheers, for Norm," she
says. "That's how I feel about Insite. I go in. Everybody knows me."

[sidebars]

MILESTONES IN INSITE'S HISTORY

November, 2002

Larry Campbell, Vancouver's newly elected mayor, promises to move
quickly on the creation of a safe injection site, acting on debate
over the issue that has been under way for years.

September, 2003

Insite opens as North America's first safe injection site, bolstered
by $1.2-million in capital funding from the B.C. government, plus $2-
million for first-year operating costs. (Since then, the Vancouver
Coastal Health Authority has covered the $2-million annual cost of
the operation, drawing on its funding from the province.) Health
Canada allots $1.5-million over three years to cover research costs.

September, 2006

Federal Health Minister Tony Clement approves a 16-month extension in
an exemption to Section 56 of the Controlled Drugs and Substances Act
that allows Insite to operate. He rules out considering applications
from other municipalities for such sites until the review is
completed. Vancouver police salutes the minister's decision, noting
the department "congratulates the federal government for making a
very difficult decision on a complex issue."

Oct. 2, 2007

Mr. Clement announces a six-month extension of the exemption to June
30, 2008, to allow for more research on issues around supervised
injection sites.

Insite client data collected from April, 2004, to March, 2006 (the
most recent statistics available):

Client Gender

Female: 30%

Male: 70%

Client Injections, by Drug

Other: 20%

Morphine: 12%

Cocaine: 27%

Heroin: 41%

Client Numbers

There were 453 overdoses and no fatalities.

4,084 referrals were made with 40% to addictions counselling.

The busiest day was May 25, 2005, with 933 visits in 18 hours.

There were 6,227 nursing care interventions with 2,055 for abscess care.

Source: Vancouver Coastal Health Authority, Insite, B.C. Centre for
Excellence in HIV/AIDS