‘IT WOULD BE EVEN WORSE’ WITHOUT US

On a recent afternoon, a woman sat on the sidewalk, steps from this city’s supervised drug-injection facility, Insite, pant leg rolled up, needle in hand. A young man walked by and casually offered a reporter a ball of speed. A short time later, three police cars swooped in to arrest a man in a hoody for allegedly wielding a hammer in a nearby alley during a suspected drug-induced frenzy.

Thirteen years after this facility, North America’s first, opened in the Downtown Eastside with an emphasis on harm reduction over treatment — a model now being contemplated in several Canadian cities — one might be tempted to wonder: what’s changed?

A lot, insist Insite staff, academics, and area residents, who point to a reduction in overdose deaths and the spread of disease in the neighbourhood.

“Go back to the 30-plus peer-reviewed journals and look at what the evidence seems to be suggesting,” said Andrew Day, operations director at Vancouver Coastal Health, which runs the facility. “If we weren’t here, it would be even worse.” Still, skepticism persists. Toronto’s medical officer of health, Dr. David McKeown, recently called for three supervised-injection sites

B.C. INJECTION SITE INSISTS IT IS MAKING A DIFFERENCE

in the city amid growing overdose rates.

In response, federal Conservative health critic Dr. Kellie Leitch warned that “drugs like heroin are dangerous and addictive which is why we believe that every effort should be made to help people get off drugs.”

The Toronto Police Association’s president is worried such facilities will attract crime and loitering and swallow up police resources. The city would be better off directing money at treatment, Mike McCormack said. “Insite is not a model we want to see replicated.” Nestled in the shadow of the dilapidated Balmoral Hotel, Insite sees 600 to 900 visitors daily. Clients register using whatever name they want and tell staff what drug they’ve brought with them — typically heroin, cocaine or meth.

They pick up whatever supplies they need from a counter — syringe, cooker, alcoholic swab, tourniquet — and are assigned to one of 13 mirrored, and constantly disinfected, booths in plain view of nurses and support staff.

Nurses won’t perform injections for clients but may offer guidance on certain techniques to reduce risks, Day said.

Afterwards, clients can grab a coffee or juice in the “chill lounge” before leaving.

Clients are never pressured to use the detox facility upstairs or enrol in addiction treatment. Most of them are entrenched in their drug use and have extensive histories of trauma and abuse, Day said. It takes time to build relationships with them.

“Some people are really marginalized and they’re not going to go to a walk-in clinic … (or) a regular family physician. For some people, this is that starting point.”

The Liberal government has clearly been won over. Health Canada last week granted Insite a four-year exemption from federal drug laws. (Under the Conservatives, it had to apply annually for the exemption).

Talk to frontline staff and they’ll tell you the harmreduction model is making a difference, said Jennifer Vishloff, a registered clinical counsellor. She was given unprecedented access to Insite nurses for her Simon Fraser University master’s thesis, which was published last year.

Vishloff said she was struck by their compassion, resilience and ability to win the trust of clients.

“They were working hard to show there are no disposable people,” she said. “That’s what motivates them day to day.”

Further, nurses recognize the need to give clients freedom to make their own choices, she said.

“Allowing people to be independent … and make their own decisions about their health, goes a long way in people actually wanting to seek out help.”

Nurses shared with Vishloff how rewarding it was to teach clients even small things, like how to inject properly and independently.

But they were also candid about the challenges, including the unpredictable behaviour of some clients.

One time, a client was face down and had a bent needle in his mouth, Vishloff was told. His arm was still tied with a tourniquet.

A nurse grabbed his shoulder and called for help. But another nurse yelled, “Don’t touch him!” Apparently this was normal behaviour for the client and touching him could make him violent.

Nurses also shared the ethical dilemmas they face, like whether to turn away someone who is a recreational user. One time, a drunk party reveller who had never injected before walked in.

“I didn’t feel comfortable signing them up because they definitely weren’t entrenched,” a nurse told Vishloff. “Yet at the same time they were intoxicated which increases their overdose risk. … I made the call to let them use the site, and there wasn’t a consensus on the team.”

One nurse described to Vishloff how she had to suppress the urge to tell young women to “run out of there!”

“It’s just hard to reserve judgment because having worked for many years and knowing what I know, you’re just like … Ooh, don’t do it! Like, ahhhh! But in reality what I have to kind of remember is that it’s safer for the girls to know how to inject themselves than it is for them to be injected by their boyfriends or pimps.”

Nurses also spoke of the helplessness they felt when clients came in looking worse than their last visit. “You just see people waste away sometimes,” one nurse said.

The work of Insite staff has, without question, paid off, said Thomas Kerr, director of the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/ AIDS.

“The evidence is pretty clear. There’s no real serious academic debate.”

Kerr co-authored a 2011 study that showed overdose deaths in the immediate area fell 35 per cent during the first two years of operation.

In a 2007 study, Kerr and his colleagues surveyed more than 1,000 Insite clients. A majority reported being less rushed when injecting, were injecting less frequently outdoors, and were more careful about syringe disposal.

Criminologists at SFU estimated in a 2010 study that Insite, on average, prevented 35 new cases of HIV and almost three deaths per year, saving more than $6 million annually.

“You’re not risking dying; it’s a lot safer,” said Cody Zutz, 32, a drug user who has lived in the neighbourhood for 15 years. “In the back of your mind, you know if (you’re) going to overdose, those people are there to save your life.”

So why do people still shoot up in the alleys? Usually because they don’t want to line up to get in, he said, admitting moments later: “If you’d been here 20 minutes ago, I shot up (crystal meth) outside because I didn’t have the patience.”

However, if he was going to inject heroin that he was “unsure” about, he’d go in “just to be safe.”

Street-level drug use in the neighbourhood is less visible and there have been fewer overdose deaths and medical calls since Insite was introduced, said a Vancouver police spokesman.

“It has taken people out of alcoves, alleys, stairwells,” Sgt. Randy Fincham said. The facility can also alert drug users to new dangers, such as the recent spike in fentanyl-related deaths.

Fincham added that the disproportionately large number of officers in the Downtown Eastside is not because of Insite.

“These officers were there before Insite. We have not had an increase in officers as a result of its introduction.”

Buy-in from officers does not appear to be universal, however.

One officer responding to the man wielding the hammer just let out a chuckle when asked for his views on Insite.

“You don’t want to know our opinion.”

IF (YOU’RE) GOING TO OVERDOSE, THOSE PEOPLE ARE THERE TO SAVE YOUR LIFE.