The Ins and Outs of Vancouver's Safe-Injection Site
The Awl interviews Tim Gauthier, who is the clinical coordinator for InSite, the only supervised-injection site in North America. He talks about all the ins and outs of this facility.
Vancouver, Canada is the only city in North America that provides a legal facility for drug addicts to push heroin, cocaine, and other substances into their veins. According to TheAwl.com, the facility is called InSite, and it is both government sanctioned and funded.
The facility is located in Vancouver's Downtown Eastside, often called Canada's poorest postal code. The supervised injection site opened as a 3-year experiment in 2003 to decrease the neighborhood's high levels of disease spread through intravenous drug use and death from overdose. After a decade of research, political debate, and public scrutiny, the Canadian Supreme Court ruled that InSite will remain open indefinitely. Montreal, Toronto, and Ottawa are considering similar sites.
Between 2004 and 2010, the facility saw 1418 overdoses, but none of them resulted in death. No one has ever died there.
Tim Gauthier, InSite's clinical coordinator and registered nurse describes the facility. He said, "It's a place where staff members and nurses supervise people's injections. The participants come in with their own drugs. In case a participant overdoses or has a heart attack, someone is there to help. If we intervene timely and quick, there's no reason anyone should die. That's our primary function."
Participants at InSite have their own booth, which is clean and sanitary. The facility offers needles, alcohol swabs, medical care, and a sink to wash their hands in. They dress wounds and address chronic health issues. The facility also links these addicts up with income assistance and housing.
At the front desk, people can get condoms, lubrication, needles, cookers, filters, and anything you might need to safely inject drugs. They give out as much as anyone needs, rather than just a one-on-one exchange of dirty needles for clean ones. They ask that participants retain the confidentiality of other participants.
Most participants have been addicted for two years or longer. Generally, they are middle-aged, heavy users from the surrounding area. In the beginning, they turned away people who were new to drugs, but that often resulted in them re-using needles or injecting alone. Now, all are welcome.
The facility is open from 10:00am to 4:00 pm, everyday, including holidays. They currently see about 800 visits a day, including repeat visitors. Some days, they see as many as 1200 visits. Thousands of participants are registered with them, and they are over the maximum expected capacity. The majority of the visitors are simply there for injections, but some come to speak with alcohol and drug counselors that are kept on staff. They also have a detox program. Sometimes, participants come to the facility to access nursing care. The center claims it is open to the community for medical needs.
The facility treats a lot of wounds and abscesses. They also do STD testing, in hopes to get these diseases under control as quickly as possible, and they get these people needed medications immediately. In addition, InSite does immunizations.
Anyone who is injecting street drugs must do it themselves. Nurses cannot poke anyone's skin with the needle or push the drugs, but they can help participants find safer veins for injections. They hope this can reduce the harm the participants are doing to their bodies.
The rules of the facility are simple. Treat each other with respect. Also, all dealing and trafficking must happen outside of the site, and no one is allowed to pass drugs to anyone else. If people are caught passing drugs or money, their access to InSite is restricted. They are not even allowed to pass a lighter to a friend because they could easily pass drugs along with that lighter. After the first warning, the participant is banned for 24 hours. If it is still an issue, the participant is banned until they speak with someone on the management team, which could take a while. Sometimes weeks or months. They try not to do that because it could cost the participant his or her life. They also bar people for threats, intimidation, or any kind of assault. Vancouver police are immediately called when safety is compromised, but Gauthier says these incidents are rare.
InSite works hard to maintain their integrity. Many people respect that. Dealers are not often seen hanging around outside, and the staff tries to move them along when they spot it.
Gauthier describes the overwhelming needs of many of the participants that are deeply entrenched in their addiction. They see people with stab wounds and severe infections, and they often have to refer those people to a doctor. There are only two nurses on staff, and that can make them feel the crunch of their limited resources. They try to see as many people as quickly as possible because many of the participants have trust issues and do not often seek medical attention.
Gauthier talks of a particular participant, telling the story of his caring and dedicated staff as well. They noticed that a particular participant was getting sicker and sicker over time, and Gauthier approached her just to check on her. One day she brought a note from her doctor, saying she was septic, had caveating lung lesions, abscesses on her spine, and endocarditis. He had to explain to her what all this meant, and in her fear of death she finally went to the hospital. One of the staff agreed to take her and spent the whole night in her room, stroking her hair and just being by her side. The participant would not stay in the hospital because of her addiction, so the staff connected her with a community program that administered antibiotics. She was really too sick to be admitted to the program, but they made an exception for fear her life depended on it. Since then, the participant has significantly improved. At InSite, the staff understands that many addicts have suffered trauma, and they approach them gently.
One of the biggest complaints about the facility is that it promotes drug use. Gauthier claims this is not the case, instead they are enabling access to better services. He said, "People use drugs anyway, and they have been since before we opened." When participants come in, the staff is eager to talk to them about detox programs. InSite participants are 30% more likely to access detox services than those who do not come to the facility at all.
Although the staff would love to see all these people get clean, they are more concerned with harm reduction and safety. They try to promote self-respect for a population that is "already their own worst enemy."
Some opposers do not believe taxpayers money should go to this site that allows people to get high. Gauthier argues that InSite actually saves taxpayers money by preventing the spread of chronic conditions like Hepatitis C and HIV, which are more expensive to treat and maintain.
Many of the InSite staff members are against the prohibition of drugs. They believe that people should have regulated access to them. With regulation, the drugs would be safer and the risk of overdose would be reduced. Prescription heroin is available in Vancouver through the SALOME project. It is a heroin maintenance program that was born in the last year.
InSite had to apply for an exemption from Canada's Controlled Drug and Substances Act so that nurses, staff, and users would not be charged with possession while on the premises.
Gauthier concludes that he hates the word "clean" to refer to a recovering user. He said, "Because it implies that when you're using you're dirty. I think it's disgusting. I don't think there's anything dirty or gross about someone just because they're sick, just because they have an addiction."
If you or someone you know is struggling with drug addiction, please contact us.