Setting Up a Safe Injection Site in Canada Shouldn't Be Such a Nightmare

A pro-injection site banner in Vancouver. via Flickr.

The Conservative government is stubbornly standing in the way of addicts and the safe injection sites that could help them recover. If they had their way, addicts, even if the ones who are mentally ill, would be kept out of our backyards and left to fend for themselves. In June, they decided to ignore the Supreme Court and introduce Bill C-65, a moralistic piece of legislation that would make setting up supervised injection sites an absolute nightmare.

For those who don't know, a supervised injection site is a place where intravenous drug users can come to shoot up under the supervision of trained nurses and staff. They bring their own drugs, but are given clean equipment, like needles and tourniquets, and told how to inject safely to minimize the risk of overdose. If they overdose at the site, which happens pretty regularly, a nurse is there to intervene and stop them from dying.

In 2011, the Supreme Court ruled that the federal government was violating the Canadian Charter of Rights and Freedoms by denying Insite, a Vancouver-based safe injection facility, an exemption from Canadian drug laws. Insite was to be kept open because it was saving lives, and the Court ruled “where the evidence indicates that a supervised injection site will decrease the risk of death and disease, and there is little or no evidence that it will have a negative impact on public safety, the Minister should generally grant an exemption.”

I guess they were pissed about not getting what they wanted, because in response to this ruling, the government introduced Bill C-65. If passed, the law would require anyone hoping to operate a safe injection facility to meet 26 requirements, including police background checks on all potential employees dating back 10 years, crime stats on potential locations that police don't even really keep, evidence that they can sustain the site, and the views of local law enforcement, public health officials, provincial and territorial ministers of health, and municipal leaders, among other things that make it almost impossible to open a facility that only benefits public health.

I spoke with Donna May, the founder of Jac's Voice, an organization dedicated to helping drug addicts living with mental illnesses—in addition to providing coping strategies for their loved ones—about why she's been fighting for safe injection sites. She told me about her daughter, Jacquilynne.

When Jac, as Donna calls her, was 15, she fell and severely injured her back. The doctors prescribed oxys for the pain, and she was grateful; not only did they relieve the physical discomfort, but mentally they made her feel different somehow. Her mood, something she'd struggled with her whole life, was under control, the voices in her head had disappeared, and for the first time ever, she felt comfortable in her own skin. Jac could never connect to people, but the drugs made it all better. It wasn't long after, however, that the addiction spiralled out of control—growing into cocaine, fentanyl patches, heroin, and crystal meth.

Eventually, Jac ended up on the street. She was turning tricks and stealing from cancer patients to sustain her all-powerful drug habit. It was at this point that Donna told to get her act together, or else she wouldn’t be able to help her any longer. So when Jac’s addiction caused her to fall seriously ill, she didn't contact her mother. It wasn't until doctors were ready to amputate Jac's legs that Donna even found out how sick her daughter was. It was also around then that she learned her daughter was a diagnosed sociopath, which explained her recklessness, emotional detachment, and her substance abuse problems. Sociopathy is often co-morbid with substance abuse, which means the two diseases often occur together and one can make the other worse.

Jac died last year at 34, taken by the very thing she thought had saved her. But a supervised injection site could have kept her daughter alive, says Donna, speaking at a Toronto Board of Health meeting held earlier in July. Jac would've known that some of the heroin she was taking was actually home-cooked fentanyl that was cut with levamisole, an agent used by vets to deworm animals, which causes flesh-eating disease. She would've also had a clean environment to use and avoided the immune deficiency diseases she contracted. “The supervisors would have been able to see she was slipping, getting worse, and recommended her to seek other options, instead of sending her to a hospital where they drained the abscess and sent her home,” Donna says.

According to extensive research done on harm reduction, supervised injection sites positively impact public health and safety, and reduce overdose deaths and behaviours that cause HIV and Hepatitis C, like sharing injection supplies. They get more people into detox and addiction services, and reduce public drug use. There's been no indication that safe injection sites make a community more prone to crime, which is supposedly the Conservatives' biggest worry. They also save the health care system a lot of money because running these sites is a hell of a lot cheaper than paying for the treatment of expensive diseases like HIV/AIDS and Hep C, the risks of which are significantly reduced by safe injection practices.

The Canadian Public Health Association, Canadian Medical Association, Canadian HIV/AIDS Legal Network, Canadian Nurses Association, and the Canadian Association of Nurses in AIDS Care, among other organizations, support access to supervised injection sites.

In short, they are awesome, and there's no logical reason to stand in their way.

One needs to look no further than Vancouver to see an example of a successful one. Insite, located in Vancouver's downtown east side—one of the poorest neighbourhoods in Canada, home to about a third of the city's 12,000 injection drug users—averages 1,028 visits per day. In 2012, 9,259 unique individuals visited the site, and 51% of the time, they were injecting heroin. There were 497 overdose incidents that year, but not a single death; no one has ever died at Insite.

Victoria Baker has been working as nurse at Insite since 2007 and has helped countless patients who've overdosed and stopped breathing. She says almost always, after they wake up from an overdose, addicts are terrified, but they'll always refuse the hospital, where they're judged and treated like the scum of the earth. Addicts need people they can trust, and Insite provides them with that. This is why, after they've established a relationship with the addict, Insite staff can look for indication that they are ready for recovery and convince them to get help at Onsite, the detox service just upstairs. There is research to back up her claims: safe injection facilities are simply better at getting people off drugs.

Victoria, of course, thinks Bill C-65 is bullshit. “It's technically legal, but ideologically twisted. It's obviously based on [the Health Minister's] ideology, or she doesn't want it to happen on her term, but the evidence shows that supervised injection facilities have worked, not just in Vancouver, but internationally.”

Insite has done some remarkable work, and the world has taken notice. A few weeks ago, Brazil and Colombia sent delegates down to Insite to see how it works; both countries hope to start a similar harm reduction initiative.

While the federal government remains opposed, a number of cities have expressed interest in opening up their own safe injection sites, including Victoria, Ottawa, Toronto, and Montreal. Most recently, a report was presented to the Toronto Board of Health, which recommended that the board ask the provincial government to fund the integration of supervised injection sites into existing harm reduction services on a pilot basis, and that they register their opposition to Bill C-65. Not a single person spoke out against the idea, and the board passed the motion in a 6-2 vote.

But despite their glaringly obvious advantages, many people, including Toronto's beloved mayor and chief of police, still publicly oppose their establishment of supervised injection sites the city. In the grand scheme of things, Toronto's desire for safe them means very little. Bill C-65 went through the first reading stage before the House of Commons broke for its summer recess, and a lot of public pressure will be needed to challenge the Conservatives' holier-than-thou position on drugs.

At first, I was confused by the government's stance on this. Safe injection sites don't increase crime, do improve public health, and cut costs. It's kind of a no-brainer. But then I realized that if this government doesn't agree with what you're doing, they don't care about your health at all, and we know this from their similar positions on sex work and medical marijuana. It must be nice to sit in positions of privilege and pass judgment on people whose lives you don't understand.

So here's a news flash: denying addicts a place to shoot up safely with clean equipment isn't going to make them disappear. It will only push them to do it in alleys, under bridges, in playgrounds, and lead them no closer to recovery. Many of them will die this way. Addiction is a public health problem, not an issue of politics, but it becomes one when you've turned your back on a group of extremely marginalized people. When you're making decisions on matters of life and death, which drug use often is, it's time to get off your ideological high horse. It's harm reduction, not more policing, that improves health and reduces crime, and when scientific evidence says safe injection sites will reduce overdose deaths and drug-related diseases, everyone needs to step back and let them happen.

Previously: Oxycontin in Canada: Wildly Addictive and Barely Regulated