Insite — providing a safe 'fix'

Vancouver’s legal supervised injection site for drug addicts

BY INGRID BROWN Associate Editor special assignments

Sunday, December 02, 2012

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IT'S just after 7:00 am but already a group of men and women stand shivering in the chilly Vancouver air, but it's not only the frigid Canadian weather and spending the night outdoors that has caused the shakes. These are drug addicts anxiously waiting for the doors of Insite — a safe and legal drug injecting facility — to open.

This facility, operated by the Portland Hotel Society with partial government funding, provides drug addicts with all the sterile paraphernalia needed to inject illegal substances — such as heroin — in a safe environment where they are monitored by the staff to prevent them overdosing.

Here at the centre the 1,000 drug addicts who utilise its services daily, are never short of what the staff refers to as harm-reduction supplies as they are issued a steady diet of condoms, lubricants, alcohol swabs, sterilised water, tourniquets, syringes, matches, candles and a spoon-like contraption used 'cook' the drugs.

Insite operates on a harm-reduction model, which focuses on decreasing the adverse health, social and economic consequences of drug use without requiring abstinence from drug use.

Explaining how the centre operates, Russell Maynard, programme director, said new participants undergo a brief registration process and thereafter they are just asked to log in when they arrive, and to indicate what drugs they will be using for that day. They are then assigned a booth and allowed to fill their tray with the harm-reduction supplies that they need. The addicts usually spend 15 minutes on average before they must make the booth available to someone else.

Maynard said the staff constantly monitors their 'clients' through a mirror for signs that they have overdosed. If they do, there are medical personnel on hand to ensure that if the person stops breathing CPR is administered while the in-house nurse renders medical attention.

There is also a mobile needle distribution unit which goes out combing the streets for those who won't come to the centre.

In justifying the centre's existence Maynard said several countries have tried the big stick approach to curb drug addiction among its population, but to no avail.

"The US has more people in prison for drugs, and yet there is more drugs on the streets in that country. Therefore, if we can't keep drugs out, how can we manage it?" he asked. He noted that drugs have been coming through the Vancouver port for years mainly from South East Asia, resulting in a long history of deaths from drug overdose.

Ten years ago, before the centre opened its doors in downtown Vancouver, it is said that at least one addict would overdose in a back alley almost every day.

According to Maynard, deaths from overdose are down 37 per cent in the downtown Vancouver area where the facility operates, while it's only down nine per cent outside of this circle.

In addition to its safe injection facility, Insite also operates a detox and treatment centre which sees some 450 persons a year.

"There is no other project in North America sending 450 people a year into treatment," he said.

Maynard explained that the province is broken into five regions and a centre like his is only allowed to operate in the Vancouver Coastal Health Authority.

"So this is how it is in downtown Vancouver, but 15 minutes east of here is the next authority, and there it would be quite different," he explained.

The centre is the only one of its kind throughout Canada and one of two safe drug-injecting sites in Vancouver. The other one operates on a much smaller scale out of the Dr Peter AIDS Foundation facility which provides residential and day programmes for HIV-infected persons.

Maynard said a safe drug-injecting set up like Insite can reduce the spread of HIV and Hepatitis C among the drug-injecting population, which is one of the groups most prone to getting infected through shared needles.

"This is one of the few jurisdictions on the planet where the rate of HIV and HPC is going down, especially among injecting drug users," Maynard said.

Although drug use is illegal, the centre was first allowed to operate as a research centre, out of which some 30 peer reviews have since been done.

"The only place you can have drugs where the police won't arrest you is Insite, so it had to be a research project," Maynard said.

Although the research aspect ended more than a year ago, the centre was allowed to remain open, despite resistance from the Federal Government, because of a recent Canadian Supreme Court ruling.

Meanwhile, at the Dr Peter AIDS Foundation, executive director Maxine Davis said an element of the residential and day programme for HIV-infected persons offers a supervised drug injecting services. Having such a site operating in a larger clinic, she said, has generated a lot of interest as other persons contemplate a similar approach.

She noted further that despite the push by the federal government to close down such sites, the decision by the Supreme Court to keep them open has been a major victory.

The chief justice, Davis explained, ruled that the federal government was not only interfering but infringing on the charter of rights. The ruling also noted that when other jurisdictions come forward for similar exemptions, the minister needed to use the guidelines governing these facilities, in order not to contravene the charter of rights and freedoms.

Additionally, she argued in defense of the controversial programme, the College of Registered Nurses of British Colombia has said it is within the scope of nursing practice to supervise injections for the purposes of preventing illness and promoting health. The code further requires that employers are required to have an environment which support nurses in their practice.

"So we could be sued if someone went and overdosed because we did not allow the nurses to practice according to their code," Davis said.





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