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Summary/Abstract

Supervised injection rooms are legally sanctioned facilities where people who use intravenous drugs can inject pre-obtained drugs under medical supervision. Supervised injection facilities are designed to reduce the health and societal problems associated with injection drug use. These facilities now operate in dozens of cities abroad and in Canada and have been shown to reduce injection-related risks and harms like vein damage, overdose, and transmission of diseases like HIV/AIDS and hepatitis C.

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VANCOUVER, BRITISH COLUMBIA -- When Liberal Party candidate Justin Trudeau was elected Prime Minister of Canada last October, Maxine Davis breathed a sigh of relief.

Years of Conservative government, led by Prime Minister Stephen Harper, had placed the long-term future of the Dr. Peter Centre, the first facility in North America to offer supervised injections for drug users, in limbo.

Since 2002, the non-profit HIV/AIDS clinic led by Davis had, in violation of federal law, offered the controversial service in which medically-trained professionals supervise drug injectors -- typically heroin users, although fentanyl use is becoming increasingly common -- to ensure they remain safe through a strategy known as “harm reduction.”

But the Conservatives’ Minister of Health, Davis says, continuously refused to sign for the Centre what is called a “Section 56 exemption” to the Controlled Drugs and Substances Act.

“[The Conservatives] were not at all in support of supervised injections,” Davis said, which is why that crucial exemption -- which exempts nurses who observe the injection of illegal drugs from being criminally charged -- went unapproved.

To cope with the legal challenges faced by the facility, Davis said she worked out an agreement with the Vancouver Police Department so the facility could remain open.

“We have those who are choosing to use drugs, regardless of the policing,” said Sgt. Randy Fincham of the Vancouver Police Department during a phone interview with the Ithaca Voice. “And we’re asking officers to turn a blind eye to that with the ultimate goal being public safety.”

“It’s taken a number of years to have people accept that,” he added.

Two months after Trudeau’s cabinet was sworn into office, the Centre received word from Health Canada -- the Canadian equivalent to the U.S. Department of Health -- that the site was not in jeopardy of being closed and its nurses were no longer at risk of being arrested.

“The Dr. Peter Centre exemption is the first one issued to a supervised injection service which is integrated into an already existing healthcare center with a broad range of healthcare services,” Davis said.

Vancouver has two supervised injection sites -- the only two in North America. Both receive public funds, but the two sites operate in different contexts. The Dr. Peter Centre offers wide- ranging services to about 350 clients affected by HIV or AIDS. Around 50 to 60 of those clients utilize the supervised injection service, Davis says, and since 2002, the nurses at the Centre have supervised over 15,000 injections.

“If other healthcare clinics did the same,” Davis added, “then we could spread that safety net far wider.”

The other site, named Insite, received the first exemption one year after the Dr. Peter Centre began offering injections in violation of federal law. Insite is a standalone facility, unlike the Dr. Peter Centre, and provides only supervised injection and support services.

Insite reports that the facility has over 12,000 registered clients. In 2012, the last year Insite released statistics about its clients, an average of 529 injections occurred per day in the site’s thirteen cubicle-like injection booths. Clients can go to the facility at any time between 9:45 a.m. and 4 a.m. to inject drugs.

“It’s a fairly sterile environment,” Sgt. Fincham said. “Medical safety is their concern … when you go in, you’re greeted by someone, then there’s a series of cubicles, then a recovery room after you inject, with medical staff to assist you if you experience adverse effects.”

“I see the benefit of both kinds of sites,” said Neil Arao, the operations manager at Insite. The Dr. Petre Centre “is very specific to a certain demographic. To have that range of service is awesome, but for Insite, standing alone, there are pros for both.”

How do the police handle this?

Insite is located on the poverty-stricken east side of downtown Vancouver -- one of the poorest neighborhoods in the city. Sgt. Fincham calls it “a melting pot of drug users and mental illness. … definitely a unique community.”

The Vancouver Police Department’s drug policy revolves around four pillars: prevention, enforcement, treatment, and harm reduction, which is referred to by a police memo as “by far the most controversial pillar.”

Harm reduction is described by the VPD as “necessary to support public health objectives such as reducing transmission rates of HIV and hepatitis, as well as preventing drug overdoses.”

“Part of our philosophy is we know they’re going to use drugs, so we support them going to a facility where there’s less of a chance of an overdose,” Sgt. Fincham said. “It takes it out of public view.”

Sgt. Fincham said it took a few years for the media, the public, and police officers to accept the harm reduction approach, but more and more new officers are coming into the force each year with a harm reduction-oriented mindset.

“A lot of our workforce has changed in the last thirteen years, partly due to retirement. People are coming on the job with that harm reduction philosophy ingrained in them -- more than you’d see thirteen years ago” when the “enforcement strategy” was the primary strategy used by the police department.

“For the police department, it was a step up to be able to have people provided with help, rather than shooting up in an alley, a stairwell, a business corridor. There weren’t a lot of objections (when Insite opened) because it was solving a lot of challenges at the time,” Sgt. Fincham added.

“Not having the police arrest these people and clog up our court system - that’s ultimately the goal of this … drug use is not something we’re going to resolve or solve by arresting people,” he said.

In fact, there is no evidence to suggest that Insite has caused increased drug use rates, relapse rates, or crime rates in Vancouver, according to a 2008 study by the Canadian Ministry of Health’s Expert Advisory Committee.

Then why is harm reduction so controversial?

“The only risk of decriminalization in my mind would be if we allowed for the glorification or the romantification of drug use, as we did coming out of Prohibition, with alcohol,” said Robert Broadhead, Professor Emeritus of Sociology at the University of Connecticut.

Broadhead has published research on supervised injection rooms and has visited Insite and a number of other supervised injection facilities throughout Europe and Australia. He considers harm reduction to be the “public health approach.”

“Anything that’s criminalized tends to push people underground, and that’s where disease thrives,” he said. “The decriminalization approach, the medicalization approach, and the public health approach offers more to reduce the harm than anything related to criminalization.”

Broadhead said that he thinks supervised injection sites should be implemented across the United States. “People who are injecting drugs, people who identify as-self injectors have some incredible health problems,” he said. “Any safer injection facility would be better than nothing.”

Does it actually prevent crime, death and other negative outcomes?

The “galvanizing impetus” for the Dr. Peter Centre to pursue supervised injections was two overdoses -- one in the bathroom of the facility and the other in a laundry room -- in 2002.

Fortunately, Davis says, neither were fatal. Since then, the Dr. Peter Centre has been instrumental in promoting safer drug usage for its clients -- about ten of which a day use the supervised injection service, Davis said.

Although there have been over a thousand overdoses at Insite, no one has died. In fact, while Vancouver’s fatal overdose rate in the years after Insite’s opening decreased by only 3-9 percent, the fatal overdose rate in the area near Insite decreased by 35 percent, according to a study published in The Lancet.

“International and Canadian evidence shows that, when properly established and managed, supervised consumption sites can reduce the harms associated with drug abuse on individual users and communities,” reads a statement to the Ithaca Voice from Health Canada. (The newly-appointed Canadian Minister of Health was “deeply impressed” with a trip to Insite in January, reported CBC.)

Research on Insite’s positive impacts is plentiful: over thirty articles have been published in leading journals on the supervised injection facility. This body of research found that Insite has effectively reduced overdose risks, reduced HIV risk behavior, and promoted addiction treatment.

A 2007 study shows a thirty percent increase in detoxification services due to Insite; a 2006 study says the injection facility has resulted in “a large number of health and community benefits,” with “no indications of community or health-related harms.”

When nurses are able to build relationships with clients, those clients are more likely to go into addiction treatment programs, Davis said. This face-to-face contact is essential in combatting risky behaviors: “I can tell you nurses have said to me that the time after the injection is some of the most therapeutic time they have ever experienced with a client,” Davis said.

“It’s a time where there is no masking of their drug use … authentic conversation happens, and an authentic relationship builds by talking about the problems in their lives,” Davis said. “When people say harm reduction does not address the root cause, they’re simply incorrect.”