The needle and the damage undone

Vancouver has halted a drug epidemic by helping street addicts shoot up in safety. Will U.S. cities -- and Bush's drug czar -- learn from the Canadians' success?

By Mark Follman

Read more: Drugs, AIDS, War on Drugs, Politics, HIV, Public Health, Cocaine, Addiction, News, Heroin, Vancouver, Mark Follman

Sept. 22, 2006 | VANCOUVER, British Columbia -- Three years ago, Vancouver opened a bold new front in the eternal war on drugs. In a downtown neighborhood notorious for street addicts, healthcare workers began welcoming clients into a new "safe injection site," a legal facility for users of illegal narcotics such as heroin and cocaine.

Since then, 18 hours a day, seven days a week, users have been free to enter Insite, located in a renovated storefront at 135 East Hastings Street, and inject their own drugs under the supervision of healthcare professionals. Inside, there are 12 individual booths where users shoot up. They are given clean gear, including needles, spoons and tourniquets. Afterward, they are free to relax in an adjacent "chill-out" room, where they can drink coffee and watch TV. They can also get medical advice and information about rehabilitation programs.

The operation, which today remains the only one of its kind in North America, is funded and run by the provincial Canadian government. This month, the federal government was set to rule on whether to extend Insite's legal status, but has decided to delay the decision. In the meantime, Insite will be allowed to continue operating while additional studies are conducted into how the program affects treatment, prevention and crime.

For drug experts across North America, it will continue to be a closely watched experiment in curtailing drug use, and related crime and urban blight. They know that eradicating the world's supply of illicit narcotics is a statistical impossibility. According to the United Nations' 2006 World Drug Report, despite a record seizure of massive quantities of opiates -- 120 metric tons worldwide -- law enforcement managed to intercept less than one-quarter of the total produced.

But while the war can never be won, Vancouver is winning a key battle. The Insite program has saved hundreds of lives. It has wiped away much of the drug use in the surrounding streets, while increasing the number of addicts seeking treatment and rehabilitation. Some local conservatives, once fierce opponents of the injection site, are now backing it. And supporters believe the site's success will prove a beachhead for a less punitive and more humane war on drugs extending across Canada -- and even to drug-troubled cities south of the Canadian border.

By the time Insite opened in September 2003, Vancouver was reeling from a decade-long drug crisis, with an estimated 12,000 addicts in the city. That August, I spent some time in the bleak environs of the Downtown Eastside, home to one of the most desperate populations of junkies anywhere. The streets were littered with discarded needles and trash. They were also littered with bodies -- nearly three per week on average, the victims of overdoses. Infectious disease ravaged the thousands of addicts in the neighborhood, some of whom dissolved their stashes using puddle water, or even their own blood, before fixing with shared needles in the back alleys. A third had contracted HIV, and no less than nine out of 10 were infected with hepatitis C. The situation had become so grim that authorities had tacitly allowed the operation of an illegal safe injection site run by neighborhood activists, while plans for the government's own, first set in motion in 1997, crawled forward.

On a warm day in late August this year, the same neighborhood felt strikingly different. While there were still plenty of indigent people around, the streets were cleaner, and the visceral sense of foreboding and despair was gone. On the sidewalk in front of Insite, flanked by a pornography store and a Chinese barber shop with bars on the windows, I met Nathan Allen, a bespectacled 29-year-old resident of the neighborhood. A banker by trade, Allen was helping run a community campaign to secure Insite's future. "Just seeing the renewed optimism of the neighborhood has been amazing," he told me. "It's been a dramatic change over the last three years. I remember a person dying almost every day out here. One of your neighbors was always in mourning."

Those victims and neighbors were a range of people, many of whom fit the image of a typical street junkie -- homeless, broke and frail -- and others who did not. Dean Wilson, a wiry middle-aged addict and neighborhood activist I met then, expressed the outrage many felt at the time about the glacial pace of the government's response to the crisis. "Our friends are out on the streets dying," he'd told me. "We'll do what we have to do, with or without the authorities." Wilson and the activist group Vancouver Area Network of Drug Users patrolled the back alleys for medical emergencies, handing out clean needles and guiding junkies to the illegal safe injection site, which was located in a decrepit storefront just a couple blocks from where Insite now operates.

The population they were urgently trying to save included hundreds of impoverished Canadian Aboriginals, and thousands of women, many of them sex workers. But there were also young professionals and college kids buying and using. One of them, a student named Aaron, wearing a hooded sweatshirt and a backpack, had sat down next to me on a park bench at 1 a.m. He was soft-spoken, intelligent and articulate. He talked candidly of his failure to stay sober, and told of the city's then more aggressive law-enforcement approach to addicts. During a crackdown that April, "tons of cops were just jacking anybody on the street and throwing them into paddy wagons," he said. "It was like a war zone down here."

Nevertheless, disease kept spreading, and street junkies kept dropping.

By June 2003, facing down the hostility of Canadian conservatives and Bush officials in Washington, the provincial Vancouver Coastal Health authority received an exemption under Canada's Controlled Drugs and Substances Act to establish and operate Insite for three years. It was approved as a pilot project to halt the devastation, with the additional goal of gleaning data useful to public policymakers. The British Columbia Ministry of Health put up $1.2 million (Canadian) to renovate the former retail space, and has supplied approximately $2 million annually for operating costs. Modeled after successful "harm-reduction" programs in Europe begun in the 1980s, the plan to open Insite had wide political support in a city socially progressive by most measures. It was part of then Mayor Larry Campbell's "four-pillars" strategy that also emphasized prevention, treatment and law enforcement -- the latter targeting drug dealers, but not users, who were viewed as sick people in need of help rather than handcuffs.

Rising support for the policy north of the border agitated Washington. Shortly after Insite gained Canadian federal approval, President Bush's drug czar, John P. Walters, slammed the program as immoral. "There are no safe injection sites," he declared, calling Vancouver's policy "a lie" and "state-sponsored personal suicide."

Since Insite opened, there has not been a single death inside or connected to the facility among the more than 7,200 individuals who have used it -- including at least 453 people who have overdosed. Preventing overdoses from ending in fatalities is a primary objective of the program. "Those were all overdose events that could have been life-threatening without immediate medical intervention," said Jeff West, a coordinator for Vancouver Coastal Health who has been on staff at Insite since its launch. "These are people who stop breathing, or who suffer seizures or aneurisms. If they pass out in an alley and nobody sees them, they are at risk of death."

Next page: Would the site have a "honeypot effect" -- attracting a swarm of drug users from beyond the city?