Outside Insite, one of two safe injection sites in Vancouver.
VANCOUVER – In the notoriously needle-ridden Downtown Eastside, drug users cluster at all hours inside Insite.
Since 2003, Canada’s first safe injection site has helped cut overdose deaths in the area by a third and stopped an HIV epidemic in its tracks. It’s one of two supervised injection sites in Vancouver – clean, low-stigma facilities where users can inject with sterile equipment under the watchful eye of trained staff.
In the face of an overdose crisis, Toronto city council voted enthusiastically last summer to open injection sites in three pre-existing public health locations. They’ll operate on a much smaller scale than Insite, however, and may only accept clients during regular business hours. Users here say that’s a terrible idea. Given the amplified risk of death by fentanyl-laced drugs, they warn, -Toronto can aspire to more.
Laura Shaver is familiar with the need for a clean place to use drugs.
“I’d been in Vancouver three days when I witnessed a woman – her name is Brenda, she’s blind – asking somebody to help her inject,” she says. “They pulled the water out of a filthy puddle beside them, took Brenda’s dope, injected themselves and then injected her with that.”
For harm reduction workers like Shaver, president of the Vancouver Area Network of Drug Users (VANDU), Canada’s current harm reduction policies just aren’t enough. Shaver finds safe injection services inadequate, pointing to design flaws such as limited hours, overly clinical environments and a lack of prescription drugs.
“There needs to be more,” she says. Assisted injection, rooms for smoking drugs, and accessible prescription heroin are some of VANDU’s more challenging proposals. Even Insite doesn’t offer these services.
In Toronto, three existing needle exchange hot spots, including The Works at Yonge and Dundas, have applied for federal approval to install three to five injection booths at each facility and a “chill-out” room staffed by at least one peer.
Ward 20 Councillor Joe Cressy, who chairs Toronto’s drug strategy panel, defends the site design, pointing to a study that concluded smaller, integrated sites were the city’s best option. Cressy blames federal red tape for any complaints about slow progress and pared-down services.
“We are in the middle of a rapidly escalating overdose crisis, and the research is that [safe injection sites] will save lives,” he says in a phone interview. But “we currently have an overly subjective and onerous federal process that needs to be abolished.”
He’s referring to the Respect For Communities Act, which imposes 26 conditions an injection site must meet before it’s federally sanctioned. The Harper government passed the act in 2015 as a means of ensuring community-wide involvement, but critics wince at the lengthy approval process. Cressy notes the two years of years of planning and consultation that went into the Toronto sites.
Health Minister Jane Philpott announced in September that she would act to remove unnecessary barriers to injection site approval. At least nine communities across the country have faced similar roadblocks in bringing these sites to fruition. Toronto city council itself first discussed injection sites 11 years ago.
A safe injection facility is simple, says Jordan Westfall, president of the Canadian Association of People who Use Drugs. “It’s a room where people inject drugs under supervision. But when it comes to community concerns, getting people on board, all the consultations and research that the Respect For Community Act -dictates, it becomes a massive undertaking.”
Conservative MPs have defended the legislation in the name of public health and safety, arguing for more focus on treatment and law enforcement rather than services that they say make it easier to consume illegal drugs.
Addiction specialists are quick to point out the flaws in that reasoning. Supporting only one kind of treatment, abstinence, ignores the overwhelming evidence for alternatives. Dr. Jürgen Rehm, director of mental health policy at CAMH and chair of addiction policy at University of -Toronto’s school of public health, considers abstinence only one aspect of a more “comprehensive” health plan for drug users.
Offering prescription heroin, for instance, “is not simply providing drugs to users,” Rehm writes in an email response to questions from NOW. “It... enables users to start thinking about other aspects of their lives” rather than spending all day worrying about tracking down their next dose. It’s been shown to be “beneficial when other treatments fail,” he adds.
But accessing prescription heroin – which was legalized in Canada this fall after a trial found it more effective than methadone – is exceedingly difficult, according to Westfall, who cites further legislative barriers.
Harm reduction is slowly working its way into political consciousness, but Shaver thinks policy-makers still need to recognize the differences between users. Not all respond to abstinence alone, and for the benefit of those who continue to use, she warns that injection sites shouldn’t be overly medicalized. A sterile environment might scare people away – or worse, cause psychological harm to vulnerable clients.
Natalie Catherine, a former intravenous drug user from Toronto, says the shame and guilt of using publicly might alienate high-functioning addicts, preventing them from frequenting the sites.
She points out that for a whole subset of drug users who don’t fit the stereotype, the ritual of getting high is part of the addiction. “You want to make it comfortable and attractive. You don’t want to be worried about who’s watching you.”