Safe Injection Sites Weren’t Enough to Spare Vancouver from the Opioid Epidemic

Vancouver is no stranger to addicts. In late 90s, the west-coast Canadian city was dealing with a dire heroin epidemic that was claiming lives in it's most underserved communities. But the city took action, and embraced a progressive harm reduction strategy that saved lives.

Now a new wave of addiction is crashing across North America due to the overuse of prescription painkillers, and Vancouver has been no exception. Luckily, the city's existing tactics for dealing with heroin—from supervised injection centers to clean needle exchanges— have eased the death toll of the opioid epidemic on Vancouver, but there's still more work to be done.

"Fortunately, Vancouver was way ahead of the curve with harm reduction," Vancouver Mayor Gregor Robertson told me last week, during the Smart Cities conference in Brooklyn. "That dates back to when bad batches of heroin will killing hundreds of people in the nineties. There was eventually enough community uproar that the city, province, and federal government agreed to open safe injection sites."

Insite, the first supervised injection site (a medical facility that provides drug users a clean environment to use drugs legally) in North America, opened in Vancouver in 2003. Though it has been a point of contention over the years, and was nearly shut down by the Conservative government in 2008, it has served as an example of harm reduction strategies that work. Research has shown that, in the area around Insite, drug overdoses have dropped 35 percent because users can inject in a supervised facility, and have quick access to healthcare if an overdose occurs. The center has not had a single overdose death since it opened.

Robertson pointed to the "four pillars" drug strategy the City has adopted: harm reduction, treatment, prevention, and enforcement. The harm reduction part—strategies to try to lower the risks associated with drug use without criminalizing users—has been the main focus with the city investing in not only supervised injection sites, but also clean needle exchanges and "low-threshold" community health services, which make it easy for users to access care if needed.

But Robertson said the other pillars have lagged behind, particularly prevention and treatment, which includes creating programs that provide addicts with prescription heroin or methadone, as well as counselling services, to help them wean off the drug and get clean.

Even with expanding supervised injection sites (Vancouver now has multiple centers like this) and enlisting community volunteers to help recognize overdose signs and get help, the province of British Columbia had close to 1,000 drug overdose deaths in 2016.

"That's just horrendous and totally unacceptable," Robertson said. "If we hadn't had these overdose prevention sites open, we would have lost hundreds or thousands of more people. But the treatment piece lagged behind for us."

There also needs to be prevention programs, specifically to make sure young people are informed about the risks of prescription painkillers before they try it, and enforcement, to get the deadly fentanyl (a dangerous synthetic opioid) off the streets. He told me beefing up these four pillars would help any community dealing with the same crisis.

But many of these strategies need support from the provincial and/or federal level to expand, and Robertson said that's his focus now.

"We have to focus on a health care approach rather than a criminal approach and help people heal, and do the prevention side by supporting kids," Robertson said. "We've got to make this shift. I think it will be a lot more cost effective, and there will be a lot less tragedy and a lot fewer deaths."

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