It's the last Wednesday of the month in the Downtown Eastside neighborhood of Vancouver - the day when thousands of people living on the margins in this community get their monthly social assistance checks. The streets are full of activity, much of it drug-related.
Kelli Lubbers, 38, has just used the clean and clinical facilities at Insite to inject her daily dose of speed and heroin. She's not after a 'high,' she said, just a maintenance dose to keep her from getting sick from withdrawal. Sitting on a bench in a community garden next to the Insite building, Lubbers talked about the time she overdosed on the potent synthetic opioid Fentanyl and how the nurses at Insite saved her life.
“I seized,” Lubbers said. “I had a seizure and dropped dead, I guess. And if it wasn't for Insite, I'd be dead.”
Supervised Injection
You have probably heard about the supervised injection site Ithaca proposed last winter. A place where people could inject heroin more safely. Insite is the first such facility in North America.
Despite many attempts to shut it down, it's now in its 13th year of operation. Supporters say it’s saved thousands of lives, and opened the door to health care and safety for the city's most vulnerable people.
Insite is in the toughest section of the Downtown Eastside. It’s the poorest urban area in Canada, in the heart of one of the country's richest cities. Kelli Lubbers is one of an estimated 5,000 intravenous drug users here. Operators of Insite say there will almost certainly be overdoses on any given day. But no one will die, because they're injecting under the watchful eyes of medical staff.
Lubbers said her drug consumption levels have gone down dramatically since she started coming to Insite five years ago. “I can actually say, a couple of the nurses are my real friends. They're not just doing their job and amusing me,” she said. “That means a lot to somebody's who's an addict, and who gets judged constantly, and looked down at, constantly.”
The Health Care
Dr. Christy Sutherland, Insite’s primary care physician, said they see between 800 and 1,200 people a day. There's never been a death at Insite, but there's been countless overdoses. Each of these overdoses was treated quite quickly, Sutherland said, saving the person's life.
During an interview, Sutherland wore a sweatshirt with an image of a hypodermic needle. The caption? 'Insite Saves Lives.'
Sutherland said supervised injection saves lives, reduces transmission of HIV and Hepatitis C, and brings people to treatment. Dozens of articles and studies in peer-reviewed medical journals back up Sutherland’s claims. Insite has the support of local public health officials and the Vancouver police.
But skepticism remains. The mayor of Surrey, a sprawling municipality next door, has reservations about calls for a supervised injection site in her city. In a radio interview over the summer, Linda Hepner said she wants more proof the sites actually help people get off drugs. “I have no data around how those injection sites have really moved people off narcotics and into a safer lifestyle,” she said.
The Community
On the streets outside Insite - on check day - there was a lot of drug use, police presence and chaos.
“I think people mistakenly think, when they see chaos, [Insite or] social housing gets blamed.” Sutherland said. “That chaos was there, and that suffering was there, and [our job] is to create a safe space to bring it indoors.”
With the current opioid crisis in North America, there's an urgency to find solutions. Towns and cities, like Ithaca, are looking to the Insite model. Even Mayor Hepner is re-thinking her skepticism after a recent spate of overdoses in her community.
In addition to Insite, there’s a residential detox facility on the second floor. Hundreds of injection drug users every year ask for and get treatment for their addiction, just upstairs. Kelli Lubbers was hoping to be one of them. “I'm going to pray all week to God that he gives me the strength to do it. Because I finally feel like I can start my life again.”
The Politics
Insite has managed to keep its doors open since 2003, despite years of opposition from Canada's former Conservative government. A new Liberal government under Prime Minister Justin Trudeau has lauded Insite and its work. But despite Vancouver's experience, supervised injection sites remain a political hot potato.
Federal law currently requires extensive legal proof of community support before any new site in Canada can open its doors. In spite of its vocal support, the Trudeau government has, so far, resisted calls to remove those hurdles.