NPR & Insite

Thanks to fellow nurse, Matt for this NPR link to radio commentary on Insite from a couple of years ago.

NPR InSite

Canadian University Press Link

Here's an excellent article hosted at University of Alberta's Gatway newspaper:

The forsight of Insite, Eric Szeto, Oct 25, 2006

VANCOUVER (CUP)—On any given morning on the corner of East Hastings and Columbia in front of the Radio Station Café in Vancouver, a drug dealer can make up to $35 000. Their customers approach them in a nonchalant fashion, do their business and quickly scuttle off in various directions.

Some may venture back to their hotel rooms, rented out at cheap monthly rates. Many will drift into the nearest alley and quickly dose. But these days, most will probably walk into Insite, the city’s highly publicized and contentious safe injection facility, open to all and just eight doors down.

Even on the slowest day, the Vancouver Area Network of Drug Users (VANDU), estimates that nearly 15 000 heroin injections take place in the Downtown Eastside, and Tyrone Caldwell, 39, used to take his fair share.

Caldwell spent the last 14 years of his life dabbling with different drugs, but it was during the last five years that things began to get really heavy. After nearly a decade of drug use, he lost control, and in order to support his $300-a-day cocaine habit, started dealing narcotics himself, including heroin.

It was in May that he went into the facility as he did on any normal day. He proceeded into the injection area to shoot up. The area is the width of a desk, with a mirror in front and two walls, giving an individual the suggestion of privacy. Immediately after dosing, Caldwell had an ominous feeling that something was not right.

“The minute the buzz or rush started coming on, I knew it wasn’t a cocaine rush,” he says. “I knew I was in trouble and that’s the last thing I remember.”

Caldwell was put into an ambulance after the paramedics gave him a shot of Narcan, a drug that reverses the effects of opiates, to revive him. Caldwell later discovered that what he had injected into himself wasn’t just cocaine—it was a nasty trail mix of heroin and cocaine, which led to his overdose. And it was because of the staff at Insite that Caldwell didn’t die that day.

“If Insite wasn’t there and I was in the alley, I’d be dead,” he says.

Caldwell isn’t the only one. Since its inception in 2003, Insite has grown in popularity among drug users in the Downtown Eastside, averaging around 700 visits per day. Section 56 of the Controlled Drugs and Substances Act allows Insite—in addition to doctors prescribing methadone for those in rehab—to have legal possession of controlled substances. Because of this exemption, Insite is currently the only place in Canada where a person can legally carry narcotics.

Before Insite, the number of overdoses and rates of infection for HIV and Hepatitis A, B, and C were soaring in the Downtown Eastside community. According to Anne Livingston, a project coordinator for VANDU, deaths by overdose climbed from 35 in 1989 to 350 in 1994. The 1995 Vancouver Injection Drug User sampled 5000 users in the Downtown Eastside and estimated that the prevalence of HIV/AIDS in the area was around 40 per cent while Hepatitis C hovered around 90 per cent.

The community was dying.

With the alarming rates of infection and death escalating rapidly, the city soon realized traditional drug enforcement and treatment strategies were failing. The city subsequently adopted its “Four Pillars Drug Strategy,” which consists of harm reduction, prevention, treatment and enforcement. Insite was implemented as a progressive step towards increasing harm reduction, though some argue it promotes all four pillars.

Open 18 hours a day, Insite has become one of the busiest safe-injection facilities in the world. There’s no limit to how many times a day a person can use the site. Accounts of its successes have been documented. There are over 7000 registered members and though there have been 500 overdoses, none have resulted in death. Furthermore, Insite has found that users of the site are twice as likely to get into detox.

While there’s no evidence yet to suggest that the rates of HIV/AIDS have gone down since Insite opened, neither have there been any studies investigating this issue. It would be counter-intuitive to think that the facility has been anything less than a bastion of prevention.

In spite of this, at the end of August, the future of the facility was in limbo. The federal exemption that allowed Insite to operate was due to expire on 12 September and Canadian Health Minister Tony Clement, rather than extending it another three years, reluctantly bowed to public pressure and renewed the exemption until December 2007. The scientific evidence, according to Clement, was inconclusive.

“Do safe injection sites contribute to lowering drug use and fighting addiction? Right now the only thing research has proven conclusively is that drug addicts need more help to get off drugs,” says Clement in a media release. “Given the need for more facts, I am unable to approve the current request to extend the Vancouver site for another three-and-a-half years.”

Despite scientific evidence and public support of the facility from all levels of government, the Ministry of Health opted to shy away from granting proponents of the site its full demands—the disconnection between those in Ottawa and the people at the frontlines is unsettling.

Jeff West, a coordinator at Insite, has witnessed first-hand the changes the facility has brought to the Downtown Eastside. He’s seen its successes and its failures. His modus operandi is to dispel the myths circulating in Ottawa and educate people about the many other services that Insite provides.

“We teach people. We never hold or touch the needle—that’s the bottom line,” West says. “[The staff] can tie people off, help them find a vein, [pick] what kind of angle to insert the needle. We also have a prosthetic arm that has veins and use that as a teaching tool.”

West stresses the strictness of these guidelines: if someone dies and they have gone beyond their immediate duties, it’s an automatic charge of manslaughter.

But the big appeal for Insite, West says, is giving a shelter to the people living in squalor. It provides the lost and hopeless a place to go.

“People are complex souls. Addictions are a result of other stuff going on. Ultimately you could really just focus on the addiction and they can go to detox,” West says.

Caldwell and many others attest to the success to this program.

“If Insite wasn’t there ... I really wouldn’t be here,” says Caldwell, who now volunteers at Insite. “I’m living on borrowed time and I’m here to help them. No questions.”

When her sister became a crystal methamphetamine addict, Darcy (who is using only her first name to protect her identity) took custody of her sister’s children. She was only 22. For the next 25 years, she was an operating engineer in northern BC, making an almost six-figure income for many years.

But after injuring her back and losing the pension she spent her entire life working for, everything came crashing down. She eventually moved to the Balmoral Hotel in Vancouver’s Downtown Eastside. She had nowhere else to go.

On welfare for the first time of her life, she started using drugs. From A to Z, she did it all, everything except crystal meth—something she promised herself she would never do after seeing it kill her sister.

“It was from 25 years of being straight, I wanted to experience it all. You name it, I did it. My sister was a junkie; it was like I wanted to experience what she experienced.”

At the height of her drug addiction she was visiting Insite nearly four times a day.

“What I went for was the congeniality and I’d go there because it’s a nice, clean place. I don’t actually inject anymore.”

She can barely describe some of the atrocities she’s seen because they are so egregious. Before Insite, she says, women were contracting HIV at enormous rates, which she attributes to the fact that women are most vulnerable in the Downtown Eastside.

Often times, she says, prostitutes, too messed up to do their own drugs, ask their pimps to shoot them up. But instead of using a clean needle, her pimp uses a “rake,” a needle that has already made the rounds, which is almost inevitably tainted and ridden with disease.

Insite, she says, offers these women an alternative.

“This is a place where women go to control disease,” she says.

Darcy admits there are many misconceptions about Insite, and says given the lack of understanding about addiction in general, it’s not surprising.

This lack of understanding was clearly shown in an online Globe and Mail debate between former mayor of Vancouver and current Senator Larry Campbell and Randy White, the founder of the Drug Prevention Network of Canada held in August, before the extension to the exemption was granted.

During the debate, White, a former Reform-Alliance-Conservative MP and vice-chairman of the parliamentary committee studying the non-medical use of drugs, gave a list of reasons why Insite’s exemption under the Controlled Drugs and Substances Act should not have been renewed and why the site should have been shut down.

Among the reasons:

1) Injection sites do not prevent and treat drug use.

2) Since the opening of the site, Vancouver has become more problematic with crime and addiction, and the injection site has contributed to the problem.

3) Responsible government does not sanction a person walking through a door and getting assistance to shoot up crystal meth.

4) Injection sites are the exception, not the rule, in most countries worldwide.

Campbell retorted. “To be blunt, [White] is a dinosaur and refuses to even consider scientific, peer-reviewed evidence. I suspect that deep in his mind, he believes the earth is flat.”

The inability to get past archaic misconceptions about the realities of drug use is at the root of the problem, says Nathan Allen, an organizer for Insite for Community Safety, which is an advocate group for Insite.

“Federal government doesn’t fund any component. Insite doesn’t provide drugs. They aren’t asking for a single red cent, just for the blessing, just for the exemption to be renewed,” he says.

Libby Davies, a proponent of Insite and an NDP MP, echoed Allen’s concerns.

“The evidence [about] Insite is irrefutable, there’s no research that suggests it’s not working as it should be,” Davies says. “They’re dead wrong with the disputes. You can’t ignore the scientific evidence from incredibly reputable sources. It’s been under a microscope for three years. It’s not a panacea for the drug solution, its part of the solution.”

Echoing Davies’s concerns, Darcy adds a more extreme viewpoint. She believes that Ottawa has given the addiction situation and Insite a lack of attention, and the subsequent drug-related deaths in the Downtown Eastside area is a form of population control.

“[Drug addicts] are seen as a subhuman species here, but they aren’t. It’s tough to make it as a man down here but it’s even tougher to make it as a woman. They’ll stab you, knife you. That’s the element you have to be in,” Darcy says.

According to VANDU and Insite, every ambulance coming into the Downtown Eastside costs $1000. Each case of HIV/AIDS costs the health-care system $320 000. The financial burden the area once carried has decreased significantly.

Surprisingly, one of the strongest messages of support comes from the Chinatown Merchants Association. Before the site opened, the association was among the most vehemently opposed groups to the injection site. Now they are one of Insite’s biggest supporters.

“There aren’t any people shooting up in front of the businesses anymore and Insite has [shown] by example that it works,” Allen says.

Six to eight hours after the last dose of heroin, a person can begin to have withdrawal symptoms that include severe anxiety, depression, diarrhea, convulsions, vomiting and uncontrollable body movements.

Mary Miller used to dose at Insite frequently to avoid these symptoms. “You don’t want to go sleep because when you wake up you’ll be too sick to move,” she says. To alleviate these symptoms she now gets a portion of her welfare check deducted to pay for her methadone.

Months before the creation of Insite, VANDU, which started in 1998 by a group of intravenous drug users that advocated living healthy and productive lives, opened their own de facto safe injection site for people like Mary.

The rogue site could barely operate and their hours were limited (10 pm to 2 am), but according to Ann Livingston, it was what gave the city the gumption to eventually open a legally sanctioned facility in 2003.

Livingston, a project coordinator for VANDU who also ran unsuccessfully for city council in 1996 and 1999, says it was this critical pressure from VANDU that finally started to change minds. The municipal government, she says, had repeatedly dropped the idea for the site for a number of years before Insite came to be.

Even with the cynical outlook, Livingston is still lobbying to open four more government-sanctioned sites. One site, she says, isn’t enough.

“It’s the equivalent of your whole body covered in running sores and one patch is cleared up,” she says. “We know it works but we can’t put it on the rest of our bodies. I said, ‘Fuck you, we can’t.’”

Her plan is to put three more sites on the perimeter of the Downtown Eastside. By surrounding the area with sites it would, in theory, be easier for addicts to get to a nearby site.

But the likelihood of three more sites popping up once the exemption expires in December 2007 seems like a stretch. Livingston knows it, and that’s why VANDU is doing whatever it can to help.

The group has already taken the matter into its own hands. If you know what they look like, you can spot them a block away. A team of ten people in fluorescent vests patrol the streets educating and, in many cases, illegally assisting the injections of addicts in the area who are unable to perform them alone.

These rogue patrols complement the limited services Insite can legally provide. Often, people have to be rejected from Insite because they are not capable of injecting their own drugs—and Insite workers cannot do it for them.

The patrollers look out for these people in particular.

This squadron of injectors, all trained health-care workers certified in CPR, assist in any way they can. If you’re blind and have an amputated arm, for example, they will help you inject.

“It’s considered illegal,” Livingston admits. “But if I inject you with drugs the joke is that you won’t die. You’re much less likely to die with a trained expert who knows CPR and has gloves on.”

There’s no doubt in Livingston’s mind that if the government in Ottawa decides to pull the plug after December 2007, rogue sites will replace Insite. Before Ottawa announced the extension on 1 September, VANDU and other groups were already getting one ready.

The rumour is that the Portland Hotel Society, a Vancouver-based substance abuse advocacy group, has already built a site.

“The only way to find out is if you find one of their workers and literally follow them around until you see them all going to the same place,” Livingston says.

The future of Insite remains uncertain until December 2007, but there’s no doubt that whatever decision is made in Ottawa, it will not sway supporters of Insite from fighting on behalf of their growing and evolving community.

Livingston can attest to that. If Ottawa says no to an exemption beyond 2007, the gloves are going to come off.

“[Ottawa is] going to mud-wrestle with us,” she says. “I don’t think that they want that because we would win.”

Wanna respond? Send your feedback to gateway@gateway.ualberta.ca.

This just in:

Recieved in the mail Oct 13, 2006 in response to my (late) letter of Aug 28, 2006.
From the Hon. Tony Clement, Minister of Health.

Dear Ms. [my name here]

Thank-you for your correspondence concerning Vancouver's supervised injection site, also known as Insite.

The research that has been completed to date on this project is not conclusive. As a result, there are outstanding questions that must be answered before the Government of Canada can make an informed decision about the future of supervised injection sites in Canada. Insite will continue to operate until December 31, 2007, while additional research is conducted to determine how such sites affect crime, and drug prevention and treatment.

Thank you for taking the time to write on this important issue.

Yours sincerely,

[signature: Tony Clement]
Tony Clement

Salon article, Sept 22, 2006

Salon magazine has a good summary of Insite and the background. (You have to watch a bit of an ad to get to the article...)

http://www.salon.com/news/feature/2006/09/22/harm_reduction/index.html

From the Vancouver Sun, Oct 7, 2006

Injection site could save millions: report
A few small sites in Victoria could prevent seven overdose deaths a year, report says

Cindy E. Harnett and Rob Shaw, Times ColonistPublished: Saturday, October 07, 2006

A supervised drug injection site in Victoria would cost $1.2 million to operate, save up to $3 million in health-care costs, and prevent the need for 3,000 hospital visits each year, according to a document obtained by the Times Colonist, the first of two studies to be used to apply in the spring for a downtown pilot project.

Based on about 2,000 intravenous drug users, the creation of a few small safe injection sites could prevent seven overdose deaths annually, divert more than 1,110 emergency room visits for a savings of $444,000, and reduce hospital admissions by 2,000 for a savings of $2.4 million, according to the document obtained through a freedom of information request.

Vancouver Island Health Authority's chief medical health officer Richard Stanwick details the savings in what he calls a "very preliminary" business case to be bolstered by a comprehensive study underway at the Centre for Addictions Research B.C., led by illicit drug researcher Benedikt Fischer.

It is that study that will form the basis of an application to Health Canada in early spring for an exemption to Canada's drug laws to run a pilot research project here, said Victoria Mayor Alan Lowe.

Health Canada put off making a final decision on whether to extend for another 31/2 years Vancouver's supervised injection site called Insite, in early September. Health Minister Tony Clement said at the time additional studies must be conducted into the impact of supervised injection sites.

Victoria's mayor says that tells him the government needs to be convinced of the case for supervised injection sites but he is not overly discouraged by the government's unwillingness to embrace the concept.

"I'm hoping a research project of this kind would give the government more information, the kind of information it needs," Lowe said, in an interview.

If Victoria goes forward with the application, as is the plan, it will likely be for the establishment of more than one drug injection site in downtown Victoria, said Fischer.

Clement had only one big location -- Insite, located in Vancouver's Downtown East Side -- to consider, said Fischer. There have been problems with that site given the high concentration of drug users in the area.

Victoria would propose "something very very different" and therefore its operation could be "attractive to Ottawa" to provide valuable research information for other cities across Canada, Fischer said. Montreal and Toronto are also interested in supervised injection sites.

While the federal Conservative government has not embraced supervised injection sites, "I also know Clement is quite open to the principles of public health,"Fischer said.

The health-care case includes a reduction in overdose deaths, HIV/AIDs and hepatitis C infection and transmission, and the threat of dirty abandoned needles.

Supervised injection sites are part of a broad harm-reduction strategy including a range health, addiction, treatment and social services.

A supervised injection site "will protect our citizens as well as the addicts -- we have to realize these people are sick," Lowe said. "If someone has cancer we want to find treatment. We have to treat drug addiction in the same manner."

ceharnett@tc.canwest.com
© Times Colonist (Victoria) 2006

Retrieved from: http://www.canada.com/vancouversun/news/story.html?id=2616dc10-0f66-41a4-bf44-a076ac0bac84&k=31721 Oct. 14th, 2006

New Article on Insite and Harms Reduction

http://www.visionpositive.ca/e/V8I1/Harm_e.htm

From the Globe and Mail, Sept. 11th, 2006

Setback not stopping injection-site plans
Victoria, Prince George ready proposals despite limited extension in Vancouver
PETTI FONG

VANCOUVER -- Officials in Victoria and Prince George say they still hope to open supervised injection sites in their cities soon, despite the federal government's limited extension for the Vancouver facility.

Victoria Mayor Alan Lowe said it's regrettable that Health Canada will not consider any new applications for injection sites until Ottawa reviews the effectiveness of Vancouver's Insite clinic. But he said his city still intends to submit its proposal by early next year, adding that Victoria would learn from the Vancouver experience.

"The Insite project in Vancouver has proved to be successful, and a facility similar to that will be beneficial to Victoria, but I also agree with the Canadian Police Association that you cannot rely on the supervised injection site alone. In Vancouver, they only focused on the supervised injection site and I think there are fears that the other pillars aren't getting the same focus."

Last week, the Canadian Police Association said the federal government should close Insite and focus on education, enforcement and treatment. A few hours later, federal Health Minister Tony Clement announced he would keep the site open until December, 2007, but was unable to approve a request to keep it open another 3½ years.

More research needs to be done about whether the site is achieving results, he said.

The province provides most of the funds for the injection site but Ottawa must provide an exemption from federal drug laws so that addicts can take drugs inside without fear of being arrested.

Insite, the first such facility in North America, accommodates more than 600 drug users a day.

The main argument in favour of supervised injection sites is that they reduce the number of overdoses and curb the rate of HIV and hepatitis-C infections.

Victoria wants to set up a number of smaller injection sites in its downtown, which is more compact than Vancouver's, rather than a single facility like the one operating in Vancouver's Downtown Eastside.

Prince George would also like to set up a supervised injection site in its downtown core. The city has a big hepatitis-C problem and HIV rates have skyrocketed in recent years.

Lorna Medd, chief medical health officer for the Northern Health Authority, said the immediate concerns are increasing hours and staffing of a needle exchange and getting a mobile van on the road.

"We've been watching what the process has been with the long hard look at the safe injection site in Vancouver and we're feeling if there isn't a long-term solution in Vancouver it will be a difficult thing for Prince George," she said.

Dr. Medd said despite the setback in Vancouver, she and other members of the community in Prince George are still proceeding with developing a plan to open a supervised injection site.

From the Globe and Mail

Drugs and 'consequences'
GABOR MATÉ , MD

Vancouver -- In his column on Insite, Vancouver's safe-injection site, Gary Mason quotes approvingly a British psychiatrist who suggests that reducing the number of overdose deaths is "not our responsibility . . . it's the responsibility of the addicts themselves."

Would Mr. Mason extend the same principle to other groups, such as, say, smokers with lung cancer or emphysema, type-A business executives who work themselves into a heart attack, battered women or people injured in automobile accidents?

As a physician at a clinic that serves drug addicts in the vicinity of Insite, I know who these drug addicts are. Without exception, they are children who were severely abused physically, sexually and emotionally and who endured abandonment and neglect.

Such maltreatment has physiological effects on brain structures and brain functioning and creates an overwhelming craving for self-medication to soothe a suffering most people cannot even imagine. Most addicts began using in adolescence and have since become psychologically and physiologically dependent on their drugs.

To neglect, ostracize, and punish such people when they become adults is shortsighted and inhumane. Insite is a small but necessary step toward helping and, perhaps, rehabilitating drug users.

More updates

This one from the National Post:
http://www.canada.com/nationalpost/columnists/story.html?id=e11e31aa-1b6d-42f4-ab31-10f3135f87b1

Addicts are not criminals

Adam Radwanski, National PostPublished: Tuesday, September 05, 2006

Almost all of the arguments against Insite, Vancouver's groundbreaking "safe injection" facility for heroin addicts, crumble under the weight of modest scrutiny. It has not, as critics predicted it would, prompted a spike in the local crime rate. It does not discourage junkies from seeking rehabilitation; on the contrary, it has given thousands of referrals to help them try to kick the habit. And contrary to the claims of some of its more confused critics, it most certainly does not turn the government into a supplier of illegal narcotics.

But as the federal government continues to deliberate over its future, having granted it a temporary reprieve until the end of next year, there is one legitimate strike against Insite: the blatant hypocrisy of effectively legalizing possession of heroin at a single, government-sanctioned facility, while arresting addicts for exactly the same offence elsewhere.

"So long as the drug laws remain on the books, the government cannot simply do as it likes, selectively enforcing prohibitions here while openly ignoring them there," Marni Soupcoff wrote in these pages last year. "At least not without a price." That price, she argued, is the authorities encouraging a disrespect for all laws by itself flouting the ones that it finds inconvenient.

That is a valid argument - so valid, in fact, that it should probably rule out more ventures like Insite. It's probably also the reason that, even as Vancouver police's support for the program has pointed to its effectiveness, the Canadian Police Association has taken a strong stance against it. But the answer is not to slowly kill off the safe-injection site, as the current federal government would seemingly prefer, and go back to treating all junkies like criminals. The answer is to stop treating any of them like criminals.

Decriminalizing or legalizing possession of hard drugs is not a decision to be taken lightly. We're not talking about marijuana, a substance that should be legalized because it does little harm to anyone. But it's explicitly because of the harm it currently does users that we need to reform our approach to heroin.

Study after study tells us that we can't force junkies to clean up; they have to be willing and able to do so themselves. In those cases, the best we can do is harm reduction. And that means pulling them out from underground - from flophouses with dirty shared needles, and back alleys where there's no one to help them when they overdose -- and into places like Insite.

The numbers from that one facility alone suggest it has already saved its share of lives. While too early to know just how many AIDS/HIV infections it's prevented, an RCMP report found that it's helped addicts learn how to inject themselves more safely and to prevent overdoses. For those who have overdoses while at the facility -- 453 of them over a two-year period in which it averaged 607 visits daily -- Insite has had the wherewithal to ensure that not a single one of them died. And the New England Journal of Medicine has reported that users who go there are more likely to go into rehab -- analysis born out by the 4,083 referrals handed out by Insite over that same two-year period, 40% of which were for addiction counselling.

If every city had its own version of Insite -- or ideally, several versions of Insite -- fewer Canadians would be killing themselves with drugs. It's that simple. But those services shouldn't be provided by government in a vacuum, while anyone else who tries to help gets busted. If there's to be an expansion, the work should be done mostly by the independent not-for-profits that already provide other social services.

None of this need get in the way of fighting the drug trade -- going after dealers and the networks that supply them. If anything, it could free up resources to go after them more effectively. But it's time to start treating their customers more as victims than perpetrators.

Yes, addicts are more likely to commit crimes -- stealing to pay for their drugs, or behaving anti-socially once they've taken them -- than the rest of us. But that means cracking down on them once they've committed those offences, not because they might do so at some point. In the meanwhile, we should be helping them deal with their sickness rather than arresting them for it.

Temporary Reprieve--Watch this space!

YAY! Insite has been given a reprieve of 16 months (Curious mandate for research on crime prevention--more on this later...)


Anyways, this site is ready to go--I'll keep compiling interesting info about this issue and in 12- 15 months start the drive to lobby folks again.

Here's the news from CBC:

http://www.cbc.ca/story/canada/national/2006/09/01/injection-announcement.html

B.C. injection site to continue operating, for now
Last Updated Fri, 01 Sep 2006 21:31:48 EDT
CBC News
Federal Health Minister Tony Clement announced Friday his department wouldn't give another three-year exemption to Vancouver's safe-injection site for heroin addicts, adding that the site will remain open until a decision is made by the end of 2007.

Insite will stay open until at least the end of 2007. (CBC)

Clement said in a statement that before a decision is made, additional studies will be conducted into how supervised injection sites affect crime prevention and treatment .

"Do safe injection sites contribute to lowering drug use and fighting addiction? Right now the only thing the research to date has proven conclusively is drug addicts need more help to get off drugs," Clement said.

"Given the need for more facts, I am unable to approve the current request to extend the Vancouver site for another three and a half years."

Intensive campaign
North America's only safe-injection site opened its doors in the Downtown Eastside in September 2003. It was established in Vancouver following a intensive campaign for a safe, clean place for the estimated 5,000 injection drug users in the neighbourhood, an area with above average HIV and hepatitis C infection rates.

Health Canada gave the clinic a three-year operating exemption under Section 56 of the Controlled Drugs and Substances Act. The B.C. government provided $1.2 million to get started and provides operating funding through Vancouver Coastal Health.

The exemption was set to expire on Sept. 12.

The impending deadline has resulted in a number of declarations for and against the site in recent weeks.

Last week, former city mayors Mike Harcourt, Philip Owen and Senator Larry Campbell released a joint statement in support of keeping the Insite clinic, saying that it made sense both scientifically and financially.

Current Mayor Sam Sullivan and Premier Gordon Campbell, a former Vancouver mayor, have previously spoken out in support of the clinic.

Police have mixed reaction
The reaction from the law enforcement community has been mixed. In May, Vancouver Police Insp. Larry Thompson credited the clinic for its interventions and said the department was in favour of another exemption.

But on Friday, Tony Cannavino, the president of the Canadian Police Association, said the group, which represents 54,000 members, voted unanimously on a motion to press Ottawa to stop financing Vancouver's safe-injection site and invest in a national drug strategy instead.

As well, the province's RCMP spokesman this week said the site was problematic.

"We only support an injection site that would have as its approach the four pillars strategy, and that of course is harm reduction, education, prevention and enforcement. Does this particular program have those four pillars? It doesn't at this point," said Staff-Sgt. John Ward.
Report contradicts critics

That statement came despite a report from two criminologists commissioned by the RCMP, Ray Corrado of Simon Fraser University and Irwin Cohen of University College of the Fraser Valley.

"The main argument for those against supervised injection sites would be that it would bring crime to the area, that it would increase the use of drugs, that it would actually encourage people who don't use drugs to begin to use drugs," said Cohen. "And none of that has been borne out by the research anywhere." However, Cohen noted that the site is not yet attracting enough users, adding that the vast majority of addicts in the area are still injecting drugs somewhere else.

Statistics compiled by the clinic over a two-year period ending March 31 show there was an average of 607 visits a day to the clinic, and that 453 addicts overdosed at the clinic — but with no deaths because of the trained staff. There were also 4,083 counselling referrals during the two-year period, including about 1,600 referrals to addiction counselling.

Some city activists have vowed they would keep running a site even if the federal government withdraws its support.

Clement also said in his statement that Ottawa is planning to launch a new national drug strategy.

"We believe the best form of harm reduction is to help addicts to break the cycle of dependency," Clement said. "We also need better education and prevention to ensure Canadians don't get addicted to drugs in the first place."

Insite Fact Sheet

Insite is the only Safe Injection site in North America.

How a Safe Injection Site works (pers. comm. from my tour and the Insite webpage).

• -Clients in the waiting area sign in the first time and sign waiver
• -12-seat injection room where they can inject their own drugs under the supervision of trained medical staff.
• -Self report drugs and recieve equipment and instruction for proper use.
• -Have access to clean injection equipment including spoons, tourniquets and sterile water, aimed at reducing the spread of infectious diseases. All equipment must be left in the injection room.
• -Average time in injection room: 20 minutes.
• -After injecting, they move to a post-injection room where, if appropriate, staff can connect clients with other on-site services. These include primary care for the treatment of wounds, abscesses and other infections; addiction counseling and peer support; and referral to treatment services such as withdrawal management, opiate replacement therapy and other services.

Why this is important and necessary

• - Injection drug users have access to resources the rest of us take for granted: an interdisciplinary healthcare team, clean equipment, social services and outreach.
• - There is access to injection site assessment for abcesses, infection, safe injection technique.
• - All equipment is safely disposed of, not left in the streets, alleys, public trash.
• - Common practice prior to the site opening included using any available water source for injecting, for example puddle water.
• - Individuals are giving the dignity to shoot up in a private space and public order is improved as there is now less conflict between injection drug users and other members of the community (for example business owners, like the Chinatown Merchants Association, who, while initially sceptical or opposed to the site, are now overwhelmingly supportive)
• - There is a reduction in crime in the community
• - Individuals inject individually, and equipment can't leave Insite; so, there is no chance of shared needles

Staff

Along with the on-site coordinator, two registered nurses are present at all times with an addiction counsellor and physician support available on-call. Program assistants from our partner, the PHS Community Services Society, help greet and register people, as well as provide peer contact to encourage safe injection practices and orient drug users to use the site.

Facts and Figures (from Insite homepage and pers. comm from my tour)

• -People using Insite are more likely to enter a detox program, with one in five regular visitors beginning a detox program
• -Over a two year period 4,084 referrals were made with 40 per cent of them made to addiction counseling
• -To date there have been over 500 overdoses at Insite. Thanks to prompt medical attention there have been no deaths.
• -Daily average visits: 607
• -Number of nursing care interventions: 6,227
• -Number of nursing interventions for abscess care: 2,055
• -Busiest day: May 25, 2005 (933 visits in 18 hours). So, nearly 1000 needles kept off of the street, nearly 1000 instances where a needle was not shared.1000 instances where an individual had the opportunity to access the healthcare system, not only for drug-related treatment but also for mental health, HIV/AIDS care, pregnancy testing and maternity care, social work services, counseling and peer-support.

Key Research Findings (thanks to S. Evans, VCH)

• -Insite has attracted and retained a high risk population of injection drug users, including those at high risk for HIV, overdose, and involved in public disorder.
• -The opening of Insite has been associated with improved public order, including reductions in public injecting and discarded syringes
• -Insite is associated with reduced syringe sharing. Data obtained before Insite opened showed that the reduction in syringe sharing only emerged after the opening of Insite. These are the first ever published findings to demonstrate an impact of a Supervised Injecting Facility on syringe sharing among Intravenous Drug Users.
• -The opening of Insite did not lead to negative changes in community drug use patterns. Therefore, the recently reported benefits of Insite on HIV risk behaviour and on public order have not been offset by negative community impacts.
• -Use of Insite and any contact with the facility's addictions counselor were both independently associated with more rapid entry into a detoxification program.

Funding

Funding for Insite is from both the federal government (Health Canada) and from the BC Ministry of Health via Vancouver Coastal Health.

Ministers to write to

The Hon. Tony Clement, P.C., M.P.
Why him? Sounds like the decision is up to him now (see previous post).
Minister of Health (and Minister for the Federal Economic Development Initiative for Northern Ontario)

Parliament Hill:
House of Commons
Ottawa, Ontario
K1A 0A6
Telephone: (613) 944-7740
Fax: (613) 992-5092
E-Mail: Clement.T@parl.gc.ca

Constituency Offices
202 Main Street West (Main Office
Huntsville, Ontario
P1H 1X9
Telephone: (705) 789-4640
Fax: (705) 789-8857

Department:
Health Canada
0916A Brooke Claxton Building, 16th Floor Tunney's Pasture
Ottawa, Ontario
K1A 0K9
Telephone: (613) 957-0200
Fax: (613) 952-1154
E-Mail: minister_ministre@hc-sc.gc.ca

The Right Hon. Stephen Joseph Harper, P.C., M.P.
Prime Minister
Why him? He's the one in charge.
Parliament Hill:
House of Commons
Ottawa, Ontario
K1A 0A6
Telephone: (613) 992-4211
Fax: (613) 941-6900
E-Mail: Harper.S@parl.gc.ca

Constituency Offices:
1600 - 90th Avenue SW, Suite A-203
Calgary, Alberta
T2V 5A8
Telephone: (403) 253-7990
Fax: (403) 253-8203

Department:
Prime Minister of Canada
Langevin Building
80 Wellington Street
Ottawa, Ontario
K1A 0A2
Telephone: (613) 992-4211
Fax: (613) 941-6900
E-Mail: pm@pm.gc.ca

The Hon. Jim Prentice, P.C., M.P.
Minister of Indian Affairs and Northern Development and Federal Interlocutor for Metis and Non-Status Indians
Why him? 18% of InSite users are Native Canadian

Parliament Hill:
House of Commons
Ottawa, Ontario
K1A 0A6
Telephone: (613) 992-4275
Fax: (613) 947-9475
E-Mail: Prentice.J@parl.gc.ca

Constituency Offices
105-1318 Centre St NE
Calgary, Alberta
T2E 2R7

Telephone: (403) 216-7777
Fax: (403) 230-4368

Department:
Indian Affairs and Northern Development
Terrasses de la Chaudière,
North Tower, Suite 2100
10 Wellington Street
Gatineau, Quebec
K1A 0H4
Telephone: (819) 997-0002
Fax: (819) 953-4941
E-Mail:

The Hon. Beverley J. (Bev) Oda, P.C., M.P.
Minister of Canadian Heritage and Status of Women
Why her? 29% of Insite users are women.

Parliament Hill:
House of Commons
Ottawa, Ontario
K1A 0A6
Telephone: (613) 992-2792
Fax: (613) 992-2794
E-Mail: Oda.B@parl.gc.ca

Constituency Offices
68 King Street East
Bowmanville, Ontario
L1C 3X2
Telephone: (905) 697-1699
Fax: (905) 697-1678

Department:
Canadian Heritage
Les Terrasses de la Chaudière, 12th Floor
15 Eddy Street
Gatineau, Quebec
K1A 0M5
Telephone: (819) 997-7788
Fax: (819) 994-1267
E-Mail:

The Hon. David Emerson, P.C., M.P.
Minister for International Trade and Minister for the Pacific Gateway and the Vancouver-Whistler Olympics
Why him? Insite is located just blocks from the proposed location of the Athletes" Village for the Vancouver 2010 Olympics. The entire area around False Creek, Main Street Station and Gastown are undergoing major gentrification. There is concern that a "clean-up" effort of the Downtown East side will push injection drug users and other marginalized members of the community on to other jurisdiction s like New Westminster and away from established resources like Insite, funded housing, food banks and detox programs.

Parliament Hill:
House of Commons
Ottawa, Ontario
K1A 0A6
Telephone: (613) 943-0267
Fax: (613) 943-0219
E-Mail: Emerson.D@parl.gc.ca

Constituency Offices
2148 Kingsway
Vancouver, British Columbia
V5N 2T5
Telephone: (604) 775-6263
Fax: (604) 775-6284

Department:
International Trade
Lester B. Pearson Building, Tower B, 5th Floor
125 Sussex Drive
Ottawa, Ontario
K1A 0G2
Telephone: (613) 992-7332
Fax: (613) 996-8924
E-Mail:

The Hon. Diane Finley, P.C., M.P.
Minister of Human Resources and Social Development
Why her? InSite is the enrty point for many injection drug users not only to health care, but also to other social services.
Parliament Hill:
House of Commons
Ottawa, Ontario
K1A 0A6
Telephone: (613) 996-4974
Fax: (613) 996-9749
E-Mail: Finley.D@parl.gc.ca

Constituency Offices
70 Queensway West
Simcoe, Ontario
Telephone: (519) 426-3400
Fax: (519) 426-0003

Department:
Human Resources and Social Development
Place du Portage, Phase IV,
14th Floor 140 Promenade du Portage
Gatineau, Quebec
K1A 0J9
Telephone: (819) 994-2482
Fax: (819) 994-0448
E-Mail:


The Hon. Lawrence Cannon, P.C., M.P.
Minister of Transport, Infrastructure and Communities
Why him? See below for the role of this office in the minister's own words. Remind him we're not only interested in public transportation. Make him aware that addiction is one of the "realities around us". 7278 members of the downtown Eastside community are registered at Insite.

Parliament Hill:
House of Commons
Ottawa, Ontario
K1A 0A6
Telephone: (613) 992-5516
Fax: (613) 992-6802
E-Mail: Cannon.L@parl.gc.ca

Constituency Offices
127 Joseph Street (Main Office)
Gatineau, Québec
J8L 1G1
Telephone: (819) 281-2626
Fax: (819) 281-2755


143-B Principale Street South
Maniwaki, Québec
J9E 1Z8
Telephone: (819) 441-2510
Fax: (819) 441-2680


Department:
Transport, Infrastructure and Communities
Place de Ville, Tower C, 29th Floor
330 Sparks StreetOttawa, Ontario
K1A 0N5
Telephone: (613) 991-0700
Fax: (613) 995-0327
E-Mail: mintc@tc.gc.ca

Notes for an address by the Honourable Lawrence Cannon Minister of Transport, Infrastructure and Communitesto the Federation of Canadian MunicipalitiesMontréal, Quebec June 4, 2006
(from: http://www.infrastructure.gc.ca/speeches-discours/20060604_e.shtml --accessed Aug 30, 2006)

[On the role of his office]: …Our goal is to build on the vitality of our cities and communities, and use our transportation system to make Canada more competitive in the global economy.

To do this, we need to be clear about how the pieces fit together. My approach has three main elements: understanding the world we live in, developing strategies to deal with this, and turning this into action.

First, we need to recognize that our challenges are rooted in the realities of the world around us. Consider dynamics like globalization, the rise of China and India, and the importance of our partnership with the United States.
Second, how do we respond to these challenges? We have to choose the strategic priorities on which action is required, a federal role is justified, and for which my portfolio is entrusted with practical tools.
There are four:
Economic competitiveness;
Quality of life;
The environment; and
Accountability to Canadians.

These four strategic priorities represent challenges of national scope, and important federal responsibilities. Those responsibilities include legislation, policies and investments that underpin the national transportation system, particularly its efficiency, safety, security and sustainability; the management of our borders; and investments in strategic and community infrastructure.

While each of these are legitimate areas for concrete federal actions, they will also demand strong partnerships with provincial and territorial governments, and our partners in Canada’s municipalities.
They will also require transparency and accountability on the part of all governments, and a renewed emphasis on results.

And finally, the third and most important of three main elements of this portfolio strategy – action. Over the coming months, I will be advancing practical, specific measures in four inter-related areas:
Sustainable infrastructure, which I will expand on shortly;
Transportation Gateways and Trade Corridors, starting with the Asia-Pacific Gateway Initiative to prepare for expanding trade with Asia;
Transportation security, including public transit; and
Building strong communities that offer a healthy environment and a good quality of life. (emphasis added)
…
Conclusion
Canada has been one of the great political and economic success stories of the 20th century. Together, we can ensure that Canada remains a model for the world, admired and even envied for its respect for diversity, the rule of law, and for the quality of life it offers its citizens. By building stronger communities, safer and more prosperous cities, by modernizing and developing our infrastructure and by cleaning up the environment, we are building a better Canada for future generations.

Recent update

From the Globe and Mail, Aug. 31, 2006
Safe-injection-site supporters demand answers from Ottawa
With deadline looming, Ottawa says fate of Insite facility to be announced 'shortly'
SHANNON KARI

VANCOUVER -- The federal government was urged yesterday to stop delaying its decision about whether to permit a safe-injection facility in Vancouver to continue operating after Sept. 12.

"It is getting kind of late in the game," said Thomas Kerr, a scientist at the B.C. Centre of Excellence in HIV/AIDS, who has conducted a number of scientific studies about the impact and effectiveness of the Insite facility.

"We have a community that is waiting to find out what is going to happen. We have a large research staff that is wondering whether they are going to continue gathering data in two weeks," Dr. Kerr said. "What we need is an answer."

Prime Minister Stephen Harper was a few blocks from the news conference held by supporters of Insite and declined to provide that answer, even though the facility's exemption from the country's drug laws expires in less than two weeks.

"The safe-injection site decision is the Health Minister's decision," Mr. Harper said after announcing a federal funding commitment for the 2010 Winter Olympics.

"I won't be announcing anything myself on that, on this trip. I anticipate he [Health Minister Tony Clement] will be making an announcement on that very shortly."

The Health Minister travelled to Sweden last week and is believed to have spoken to drug policy officials in that country about the merits of safe-injection sites.

"It is kind of a curious choice because Sweden has no experience with these facilities," Dr. Kerr said. "We don't need to go to Sweden to look for these answers. We have the Vancouver Police Department, Vancouver Coastal Health and many community organizations doing some of the most innovative work in the world."

The pilot project, which has operated for the past three years, permits addicts to inject their drugs in clean surroundings, supervised by trained staff.

The continued operation of the Insite facility has been endorsed by the chief of police in Vancouver, Mayor Sam Sullivan, community leaders and four former mayors.

With the deadline looming for the federal government to make a decision about the site, the RCMP issued a news release this week that said it had concerns and called for more scientific research.

Dr. Kerr explained that there have been 15 scientific studies about the impact of the site and many have been published in prestigious journals such as The Lancet and the New England Journal of Medicine.

"My great disappointment is that the RCMP has failed to acknowledge scientific evidence that the international scientific community has endorsed and accepted," he said.

He noted that the RCMP commissioned two reports from criminologists about the community impact of the safe-injection facility, which were favourable. "Yet we are not hearing about those reports," Dr. Kerr said. "I think it's time to acknowledge that this is a simple medical intervention. A sterile injection is better than an unsterile injection."

Susie Ruttan, a teacher whose son is recovering from drug addiction, also praised the Insite facility. "It just comes down to saving lives. What can possibly be argued against that?"