A Safe Place

Photographs and Text by Ed Ou

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VANCOUVER, British Columbia – The addicts sit in mirror-backed cubicles along the wall, like an assembly line of workers, intently piecing together their next hit. A nasty odor of antiseptic solution and the smell of urine and unkempt lives mixes in the air. This is INSITE, a controversial center in Vancouver that has attracted a lot of attention as the only “safe injection site” in North America.
“Heroin, Morphine, Cocaine" croaks a man who siddles up to the reception table. He looked haggard like he had been sleeping along a curb all night – perhaps he had.
The nurse behind the desk types it down on a computer, and assigns him a booth. The arrangements are out, neatly divided assortments of vacuum-packed syringes, alcohol swabs, candles, and rubber ties – condoms to take on the road. The rapport is casual, like a trendy bar. Every user has a handle: HornDog, Crystal, Mjackson, Nipper. Aliases, for addicts that are no longer who they were.

In front of the mirrors, they are injecting. Roaming nurses offer polite advice on
which veins to use. Drugs are methodically filtered, and prepared in a syringe. As the needles go in, there is a sigh of relief. Sometimes people pass out, before they make it to the plastic chairs and free coffee in the "chill room". Everyone is in the throes of their own high. One of them is Lawrence Golden-Brooks, who starts to mumble quickly. He uses INSITE, but his brother didn’t.

“My brother died of AIDS,” he speaks slower now, “he got it from sharing needles, or water or a rig with a little blood in it and from not having place like Insite to go and do it cleanly, where you can’t share them and stuff. That’s what happened. That’s how he got it.” Lawrence chokes down a sob. “If there was a place like Insite twenty years ago my brother might still be here.” INSITE is British Columbia's answer to drug addiction. Opened in 2003, the government run health care facility provides a safe place for intravenous drug users to shoot up, under the watchful eye of nurses and health care workers. They are offered free counseling, AIDS tests, medical checkups, and the ability to go into rehab. It has become a de facto community centre for one of the city’s most marginalized populations, where addicts can find respite from the streets.

The site is fraught with controversy. Critics point out that INSITE enables drug addicts and condones their destructive behavior. Others argue that the site attracts drug users and criminals into the neighborhood – but according to the police, crime has neither increased nor decreased. Often when the officers of the Vancouver Police Department find addicts shooting up on streets and in the alleys, instead of being arrested, they are escorted to Insite to do their hit there. Canadian narcotics laws do not apply inside the facility. There are between 800 to 1000 addicts a day who come through to use.

Outside these doors, it's a world apart. The perpetual Vancouver rain pounds down on drug addicts as they roam the streets, scrounging through dumpsters and alleyways for food, pawning off stolen goods, selling anything they can, including their bodies, for their next high. A single hit is almost a unit of currency here. Drug dealers make no attempt to hide their transactions, operating with impunity in the middle of the streets as police officers march by, paralyzed by the futility of stopping their trade. There are over 5000 drug addicts concentrated in the Downtown East side, a small neighborhood the size of a few city blocks. Crime is rife. In the alleyways, emaciated figures shoot up behind dumpsters – rainwater mixing with urine and feces.

"There's extreme poverty, extreme poor heath, addiction, mental health issues, HIV, AIDS. It's filled with people who have had often really, really painful lives. Often their lives have been really painful right from the start." says Darwin Fisher, a manager at INSITE who works daily with addicts. "Childhood abandonment, serial abuse, violent abuse, sexual abuse, broken lives. This is where a lot of them end up. People who are entrenched in homelessness and addicted in alleys, they’re living in survivor mode. You can barely think a couple of hours ahead. So a lot of health-concerns, whether that’s overdose or death or contracting HIV and AIDS or Hepatitis C or Osteomyelitis, all these health outcomes become abstract compared to the desperation to get unsick, to take care of the desperation of their addiction in the moment.” Before INSITE opened, the spread of AIDS in the Downtown East Side rivaled many Sub-Saharan African countries. Now, through education, the ability to diagnose AIDS quickly, and clean needle exchanges, the spread of AIDS has been significantly curbed in the eight years the facility has been functional. "The Downtown East Side was described as the most explosive HIV epidemic that's ever been observed in the developed world" says Thomas Kerr of the British Columbia Center for Excellence and HIV and AIDS. He is responsible for evaluating the scientific effectiveness of INSITE. "Just to put the decline in HIV infection into perspective, in 1997 about 18% of all injection drug users in the Downtown Eastside were infected with HIV whereas in 2008 this number declined to less than 1%. So clearly we've seen a dramatic reduction in HIV transmission in the community"

"You have this paradox where the criminal justice system is chasing these people because they are doing illegal things, so you're pushing them into the alley ways and into hiding," says Dr. Julio Montaner, an doctor who treats AIDS patients and one of the most vocal advocates for the site. "We tried to make a supervised environment so they can be educated on ways to reduce the harm associated to drugs."

He argues that it is not only a moral imperative to help the most marginalized communities in the city, but it is also an economic one. Universal healthcare in Canada means treating one AIDS patient costs the government approximately $750,000 throughout their lives. By preventing just a few infections, the $1million per year budget of the facility is covered several times over.

That has not stopped the Conservative government currently in power from continually threatening to shut down the site. Prime Minister Stephen Harper once told reporters that "we as a government will not use taxpayers' money to fund drug use". Despite the efforts of opponents, the Canadian Supreme Court recently ruled to keep the facility open, citing that denying basic healthcare to addicts is a violation of the Charter of Rights and Freedoms. Since the landmark ruling, other Canadian cities have been eyeing supervised injection sites of their own.

Health care workers see the site as a health care facility like any other. 25-year-old nurse Sammy Mullally specifically asked to be posted to INSITE. According to her, "addiction is not an issue of morality. I think addiction has to with like a giant host of things, like abuse and history and genetics and poverty, so I think that it's really easy to write off, people who use drugs as immoral people and not give them the kind of care that I think that they deserve."

Needle litter has decreased in the neighborhood, as has the rate of overdose deaths. Bodies of overdose victims would routinely be discovered behind alleyways or decomposing inside dilapidated apartment buildings. Inside the facility, nurses are constantly on the lookout for addicts who overdose, and are equipped to revive them. While over a thousand addicts have overdosed at INSITE, there have been no deaths.

Lawrence prepares himself another syringe, rambling while adjusting the rubber tie around his arm. He claims every hit will be his last, and that soon he will ask the counselors at INSITE check him into rehab. He muses, "all of a sudden, the years started to go faster than the days. Twenty years went past like a blink of an eye. I don’t want to lose another twenty."