Harm Reduction Facility Faces Renewal Challenge

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From the outside, it appears to be a modest building in Vancouver’s Downtown Eastside. But in the last three years, the city has been completely transformed by Insite, the first North American government-sanctioned safe injection facility for people who use intravenous drugs. As a next step, supporters would have liked to see more resources funneled toward making Insite’s services more women-friendly. Now, however, the future of the entire project may be at risk – and with it, that of all the women who stand to benefit from supervised, safe injection support.

When Insite opened its doors on September 12, 2003, surrounding resident and business communities feared that the facility – which had been approved as a three-year scientific pilot project with an exemption from Federal drug enforcement laws – would bring more drug users and crime to the streets, and would condone and encourage drug use among non-users. However, Insite soon gained not only the support of these communities, but also that of members of Vancouver’s RCMP, Police Department, and politicians -- including BC’s Premier, Gordon Campbell. Though there is room for improvement – particularly in funding more women-friendly services – observers agree that over the last three years Insite has had nothing but a positive impact on local communities, on public health, and most importantly, on the lives of people who inject drugs.

However, to remain open after the expiry of its initial three-year term, Insite required a permit renewal from the new Federal government — some of whose members argued that it's morally wrong to aid illegal drug addiction. Following several months of speculation, in September of 2006, Canadian Health Minister Tony Clement postponed the critical final decision on whether or not Insite would receive another extended exemption from Canada’s Controlled Drug and Substances Act until December 31, 2007. During this time, Insite will remain open while the government conducts further studies into how supervised injection sites affect crime, prevention and treatment.[1]

This delay has met with mixed reactions from Insite supporters. On the one hand, it is a small victory that will allow Insite to continue saving lives for another 16 months. On the other hand, Clement cited the need for more evidence supporting this project as the reason for the delay. However, numerous studies have shown that rather than an increase, there has been a significant decrease in crime rates in the area surrounding Insite. There has also been a major reduction in public injections, and no one has started using drugs at Insite.

Since opening its doors, approximately 6500 individuals have used Insite’s facilities and there is an average of 600 injections on site per day. During this time there have been substantial reductions in syringe sharing among primarily high-risk populations, and there has been a notable increase in the number of people enrolling in detox services. The facility works to provide information and education to clients about safe injections and to offer them health care services. To date, Insite has managed approximately 500 accidental drug overdoses and has not seen a single death among them.

Speaking at the sixth World AIDS Conference in Toronto last summer Dr. Julio Montaner, Director of the BC Center of Excellence in HIV/AIDS – an organization that has been conducting an arms-length evaluation of Insite – declared, "In 35 years of research, this is the single most successful project I have ever been involved in." He added, "It’s unfathomable to me, owing to the body of evidence, why you would not let Insite continue."

Thomas Kerr, also from the BC Center of Excellence on HIV/AIDS, echoed Montaner’s concerns. He warned that if the government forced Insite to close, there would be significant deterioration of public order, a sharp elevation in HIV prevalence, and many lives would be lost.

Room for Improvement – Gender Sensitivity, Access, and Drug Policy Issues

Despite all of these groundbreaking results, observers note that Insite, as it exists now, is not nearly as effective as it could be. One major concern is the lack of women using the facility. Also speaking at the World AIDS Conference, Joanne Csete from the HIV/AIDS Legal Network expressed a pressing need for more woman-specific research and services. She noted that women are often "second on the needle"[2], meaning that they are more likely to share injection equipment, and to seek or require assistance when injecting drugs. This reality means that in many cases, women’s ability to negotiate for clean injection equipment is compromised. Access to clean equipment would not be an issue if women injected at Insite, but the current policy against assisted injections deters many women from visiting.

Csete argued that safe injection site facilities need to allow for assisted injections, and must do more to attract women who use drugs. Women require specialized support and treatment services at such facilities, including child care and support on a broad range of issues affecting women, such as domestic violence, reproductive health and pregnancy. She further emphasized that it is absolutely imperative that women participate in the design and implementation of these services and programs.

The facility also has a ways to go in terms of wider accessibility. According to Kerr, there are approximately 5000 people who inject drugs in Vancouver, but Insite (at capacity) only serves 500-600 per day. Moreover, Insite is not open 24 hours a day, and during its opening hours there is often a strong police presence outside the facility that frequently leads to police crackdowns on patrons and deters them from regular visits.

Kerr also pointed out broader policy barriers that stand in the way of offering comprehensive support to people who use drugs. According to Kerr, substance use is a health issue, and must be considered as such, not as an enforcement issue. But in Canada, our drug policy is rooted in prohibition and enforcement – the latter of which receives 95% of all ‘drug problem’ funding.

Both Csete and Kerr pointed out that prevalence rates of HIV and Hepatitis C in Canadian prisons are soaring as a result of the hyper-criminalization of drug use and of people who use drugs. They argued that safe injection facilities and further harm reduction practices must be implemented in prisons in order to curb these rates and to help prisoners get off drugs. On a broader scale, Kerr, Csete and other conference activists further demanded that the Government’s war on drugs be replaced with a more progressive policy that prioritizes evidence-based harm reduction practices.

The delayed final decision on Insite’s future has some supporters worried that a move is underway to undo progressive drug policy reform work, develop a new drug policy that will emphasize programs that reduce drug and alcohol abuse, and stand in the way of harm reduction practices. However, with harm reduction and Insite activists gaining increasing popular momentum as a movement, supporters are likely to put up strong resistance to the retraction of recent advances.

For more information about Insite and harm reduction practices, go to:

Marie-Claire MacPhee is a student and staff member at the Simone de Beauvoir Institute for Women's Studies at Concordia University in Montréal. She is the programmer and a co-host for CKUT Community Radio's program Dykes on Mykes and a contributor to www.nomorepotlucks.org. She is also a former intern for the Canadian Women's Health Network.

  1. Health Canada. News Release: No new injection sites for addicts until questions answered says Minister Clement. September 1, 2006. http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2006/2006_85_e.html
  2. Csete, Joanne. Second on the Needle: Two-level Strategy for Claiming the Rights of Women who use Drugs. August 16, 2006. www.aidslaw.ca/publications/publicationsdocEN.php?ref=559

WOMEN INJECTION DRUG USERS AND HIV INFECTION: SOME FACTS

From: Girls, Women and Substance Use by Nancy Poole (British Columbia Centre of Excellence for Women’s Health) and Colleen Anne Dell (Canadian Centre on Substance Abuse). To access the full document, visit: http://www.ccsa.ca/NR/rdonlyres/628CF348-1B92-45D5-A84F-303D1B799C8F/0/ccsa0111422005.pdf

It is estimated that approximately one-quarter to one third of injection drug users (IDUs) in Canada are women. Women are at an increased risk of experiencing physical health complications from IDU. It is a major risk factor for HIV infection in women. The proportion of positive HIV tests attributable to IDU among women 15 and older in Canada has varied between 33% and 48% from 1985 to 2002, with a slight decrease over time. In 2002, 37.2% of all positive HIV tests among women were attributable to IDU use.


VIRTUAL LEARNING COMMUNITY ON WOMEN-CENTRED APPROACHES TO HARM REDUCTION

From March 15 to July 15, 2007, the British Columbia Centre of Excellence for Women’s Health will be sponsoring a virtual learning community on integrating women-centred approaches into harm reduction settings such as needle exchanges, safe injection sites; and into drug policy and harm reduction frameworks for action.

Participants will have access to documents covering current research and practice, and the opportunity to discuss this information in videoconference(s), to contribute to a consensus document, and to plan and deliver a webcast session to share the consensus document with a wide audience.

For more information or to participate please contact: Nancy Poole and Katja Clark c/o kclark2@cw.bc.ca or 604-875-2424 extension 6488.