Pubdate: Fri, 30 Oct 2009
Source: Vancouver Sun (CN BC)
Copyright: 2009 The Vancouver Sun
Author: Larry Campbell, Neil Boyd and Lori Culbert


Canada's First Supervised Drug Injection Site Took Time, But Finally
Opened Its Doors In 2003

This is a condensed version of Chapter 12 of the new book A Thousand Dreams: Vancouver's
Downtown Eastside and the Fight for Its Future.

Just before the voting booths closed on the evening of November 16,
2002, Larry Campbell slipped out of the hotel room where his campaign
team and friends had gathered to watch the results roll in. He briskly
walked to the Four Seasons Hotel, where he knew out-going NPA mayor
Philip Owen was having a quiet dinner with his family and close staff.
Campbell simply wanted to say, again, that he was sorry for how
everything had worked out: Owen was ending a career in politics, and
Campbell was worried he was about to start one.

Eleventh-hour polls had predicted a victory for Campbell and his COPE
team, and the neophyte politician was having last-minute pangs. When
Campbell got back to his hotel, he was greeted by his handler, Stephen

"Get dressed. It's over," Leary said to Campbell, who was wearing
jeans and a T-shirt.

"It can't be all over," Campbell replied.

"Larry, you're the mayor. It's all over."

The election marked a sea change in Vancouver politics. COPE had not only had its first
mayoral candidate elected, but it now dominated city hall, winning eight of ten council
seats. The boisterous victory party was at the Vancouver Public Library, and among the
crowd of enthusiastic supporters was a trio of supervised injection site supporters from
the Portland Hotel Society: Dan Small, Liz Evans, and Mark Townsend. It seemed
Vancouver's voters had finally endorsed the harm reduction strategies the society had
been preaching for so long.

Evans cried that night. "How did that happen? The entire city of
Vancouver had supported the injection site. It seemed to be a sign
that things could change," she recalls today.

Dan Small sought out Campbell during the victory party, gave him a
card, and told him the Portland group had already found a location for
the controversial project and had renovated the space.

Campbell had heard rumours a site was being prepared; now he learned
it was ready to go. It would be up to the new mayor to get permission
to get it open and it was suddenly, he recalls, "the most important
thing on my plate."

As soon as Owen "got knifed" by his NPA party, Dan Small remembers, he
and his colleagues at the Portland had gone looking for a building to
house the injection site, fearing a new NPA mayor would not continue
to back the concept. No one had any idea at that time that Campbell
would end up running.

The group knew it would be difficult to find a landlord willing to
rent to them, and without any government endorsement or funding, it
seemed unlikely that any of the usual suspects--hospitals, churches,
or non-profits--would be keen to take the risk.

Finding space

Small and Mark Townsend were walking one day in early 2002 along
Hastings, just west of Main, when they met a man sweeping the sidewalk
in front of a sandwich shop. For 20 years, the man said, he and his
wife had run the business. They had raised their two children in the
second-floor apartment above the shop, and they had rented out 18
single rooms on the third floor to hard-to-house tenants.

Small and Townsend thought the building was perfect and asked the man
for a meeting. They showed him videos of injection sites in Frankfurt
and Zurich, to convince him that such facilities improve the health
and long-term fate of drug users. Then they made the man an offer: the
Portland Hotel Society would sign a lease for the building's main
floor, with an option to eventually take over the top two floors. The
society didn't yet have funding to pay the rent or the legal
permission to run such an operation, but Small promised this brave man
that he would personally take responsibility should anything go wrong
and that the site would be shut down immediately if it wasn't working

The building owner thought about the proposition and, against all
odds, said yes. He told Small he had been a silent witness to the
neighbourhood's growing problems, and he decided to trust the Portland
group. He and Small toasted their new partnership over glasses of the
man's hand-squeezed orange juice.

"He told me, 'I've made my living off the people in the community for
20 years. It's time to give back,'" Small recalls today. "That was

The sandwich shop was closed, and the PHS spent $30,000 on
renovations, installing six mirror-lined injection booths, some sinks,
and low-level lighting. The 1,200-square foot ground-floor space,
code-named "the hair salon," had high, dark ceilings, white walls, an
observation platform for staff, and a waiting room.

The site was ready, but when Larry Campbell announced he would run for
mayor, the group decided to back off its renegade plans to open the
place on their own. Both Campbell and NPA mayoralty candidate Jennifer
Clarke had said publicly that they endorsed a supervised injection
site for Vancouver.

It would be preferable, the Portland group knew, for the site to be
properly funded and staffed with the appropriate number of health care
workers. Ideally, the PHS also wanted their injection site to offer
security to users, without the police bursting through the door at any
minute. Eventually, Small says, they wanted it to be a full-service
medical facility, too--one that could offer detox on demand and
recovery beds.

The Portland bet that Campbell would win the election and, if so,
believed he would have both the personality to sell the site and the
panache from Da Vinci's Inquest to get it open. "It seemed like the
battle was over," Liz Evans recalls of that time.

In the midst of election-night excitement, Campbell promised the crowd
that the injection site would be open seven weeks later--by January 1,
2003. "It was naivete on my part," Campbell now concedes; nothing
moves that quickly in government

Taking on Ottawa

Nonetheless, shortly after he was sworn in as mayor, Campbell went to
Ottawa with a delegation from Vancouver to discuss with Health Canada
draft guidelines for opening supervised injection sites in the
country. There were representatives at the meeting from five cities,
and Vancouver's large contingent included two senior police officers,
regional and provincial health officials, VANDU (Vancouver Area
Network of Drug Users) president Dean Wilson, and Donald MacPherson,
the city's drug policy coordinator.

"It was very unusual that a politician would show up at a meeting like
that," MacPherson says with a chuckle. "But Larry made it very clear
to Health Canada that we were going to move ahead with this."

MacPherson remembers the meeting going relatively well until two RCMP
officers paid a surprise visit, explaining they did not think the site
should be approved until the system for treatment was better funded.
"Larry's blood started boiling," MacPherson recalls, and the second
the officers were done talking, Campbell pounded the button that
indicated he wanted to say something. "The people of Vancouver have
spoken. They want this to happen," MacPherson remembers a frustrated
Campbell blurting out.

Before granting the site temporary approval, Prime Minister Jean
Chretien's Liberals decided they wanted rigid protocols around issues
such as how used needles would be disposed of and what medical action
would be taken in case of an overdose. The feds also wanted the
Vancouver site to be a research project, and they agreed to pay $1.5
million over three years for the research.

That the federal Liberal government would be relatively supportive of
the contentious plan was not that surprising. A national task force on
reducing the harm associated with injection drug use had recommended
to federal and provincial ministers of health in 2000 that they should
consider a medical research project involving a supervised injection

Upon his return from Ottawa, Campbell confidently told Vancouverites
that an injection site would open very soon -- March, he thought. But
the new mayor was getting a very public crash course in politics. No
longer a chief coroner who could make his own decisions, Campbell was
at the mercy of multiple layers of government needing to reach agreement.

Finding support

Ottawa was not prepared to provide any funding beyond the research
dollars, so the site would require B.C.'s Liberal government to
provide money for operating and capital costs through the health
ministry. Premier Gordon Campbell had endorsed the city's first needle
exchange in 1989, while he was mayor of Vancouver, and Larry Campbell
says the premier needed no convincing to ante up funding for the
injection site, which had a $1.4-million budget in its first year.

"I never felt a sense of hesitation on Gordon Campbell's part. He
could have easily said it was a federal issue, but he didn't. He saw
it as a health care issue," Larry Campbell says today.

In early 2003, the health board submitted an application to the
federal government for an exemption from Section 56 of Canada's
Controlled Drugs and Substances Act, allowing them, for the purposes
of scientific research, to implement a pilot supervised injection site
for three years.

International experience

Although Vancouver was applying in 2003 to run the first supervised
injection site in North America, it was not the first such facility in
the world. Several sites had opened in the Netherlands during the
1970s. The Dutch had wanted to draw heroin users into treatment, but
traditional drug services and an insistence on abstinence had
demonstrated little success. So, the purpose of the supervised
injection site was to provide users with an alternative to street drug
use and to initiate contacts that might improve their physical and
psychological health.

The new facilities also offered access to medical care, counselling,
food, laundry, and syringe exchange machines.

Frankfurt followed the Dutch example, creating injection and
inhalation rooms in the late 1980s. By 2000, there were 16 sites in
the Netherlands, 17 in Switzerland, and 13 in Germany.

In a 2006 article in the prestigious medical journal Lancet, two
researchers would report that supervised injection and inhalation
rooms in Switzerland had "changed the image of heroin use as a
rebellious act to an illness that needs therapy."

Polls of the Swiss population at risk have indicated a decline of more
than 80 per cent in Switzerland since 1990, for reasons that appear to
be at least partly attributable to the provision of injection rooms.

Vancouver's supervised injection site finally opened in September
2003, ten months after Campbell was elected. The former sandwich shop
chosen by the Portland folks had been approved by health officials as
the location for the government-sanctioned site, but the health board
spent another $1.2 million to expand to 12 the number of injection
booths and to build a nursing station and a post-injection "chill out"
room complete with a food bar.

When Insite finally opened its doors, it was an emotional event. VANDU
president Chuck Parker, who had been using drugs for 37 years, had
been lobbying for a long time for that day.

"I never ever thought they would have a place for people to go, to
safely inject, under the supervision of a nurse. No longer using a
dirty old needle you hid under the shrubs one night. No longer using
water dropping from a drain pipe to make my fix," he says today.

Six hundred people came through Insite on the first day. The number of
injections rose to average between 700 and 1,000 daily, and was even
higher on "Welfare Wednesdays," when the monthly social service
cheques were dispersed. Each client was asked if he or she would be
using up (cocaine) or down (heroin), and then was given a tray
containing an alcohol swab, a vial of sterile water, a clean syringe,
a spoon, a rubber tourniquet, and a "cooker" to liquefy the drug.

A critical part of the initial funding for Insite was attached to a
three-year, arms-length, scientifically rigorous evaluation of the
facility by the B.C. Centre for Excellence in HIV/AIDS, which produced
dozens of papers that were published in esteemed peer-reviewed journals.

The research team looked at whether Insite reduced overdoses and
studied its role in lowering the transmission of HIV, Hepatitis C, and
injection-related infections. Researchers also considered Insite's
impact on public order and the extent to which the facility served to
increase access to other addiction and health care services. The
research findings were extremely positive.

After the long philosophical and legal battle to open Insite's doors,
some Vancouver skeptics were starting to embrace the benefits of the
facility. However, on the national stage, its future would remain uncertain.

A Thousand Dreams: Vancouver's Downtown Eastside and the Fight for Its Future is
published by Greystone Books, an imprint of D&M Publishers Inc., and available in
bookstores Saturday.

- - - -

A Thousand Dreams: Vancouver's Downtown Eastside and the Fight for Its Future, written
by Larry Campbell, Neil Boyd and Lori Culbert, reaches book stores on Saturday. The
book, which chronicles the history of this neighbourhood and makes recommendations for
its future, is a collaboration by Vancouver's former chief coroner and mayor; oft-quoted
Simon Fraser University criminologist Neil Boyd; and Vancouver Sun reporter Lori
Culbert. The Sun is publishing condensed versions of three chapters from the book.


Chapter 3 is set in the 1980s and early '90s, when drug addiction
began to escalate in the neighbourhood.


Chapter 12 looks at one of the key harm-reduction initiatives to
combat drug addiction.


Chapter 17 calls for solutions to make the neighbourhood healthier and
raises crucial questions for other large North American cities.
- ---
MAP posted-by: Richard R Smith Jr