A few months ago a rather important decision was made in the Canadian supreme court. InSite, Vancouver’s safe injection site (North America’s only safe injection site, as it happens) was permitted to continue operating.
InSite was a highly controversial project when it was first proposed. It operates as a place where IV drug users can go to self-administer their drugs in a sterile, safe environment. Trained nurses, and emergency medical supplies such as oxygen tanks, narcane and heart and blood-oxygen monitors are on hand in the event of an overdose. Sterile, fresh syringes, as well as other supplies such as sterile water ampules, sterile cookers, tourniquets, bandages, cotton and dry/sterile filters, and alcohol swabs are all available. The facility is equipped with a “chill lounge” where users can stay for a short while while high to make sure they’re safe. Coffee and juice are served, and sometimes sandwiches and pastries are provided by other charities. Condoms and other safe sex supplies are made abundantly available, bulletin boards post important messages such as warnings about especially dangerous drugs going around, the absolutely invaluable “red light alert” which shares information from sex workers about dangerous or hostile or unpaying tricks, information about shelters and free services and programs, as well as missing persons alerts. Social workers and community outreach specialists are on staff to help allow addicts to be able to access social services, health services and rehabilitative programs through the site. Finally, the upstairs portion of the building operates as OnSite, a drop-in detox center where addicts can be temporarily housed for free in a drug-free environment while they detox or simply try to move to less dangerous dependencies such as methadone. OnSite has a staff doctor and nurses.
It is without a doubt one of the most intelligent and well-designed programs in the history of harm reduction approaches to drug use.
What is interesting though is how despite the fact that InSite is entirely based upon well-documented and thoroughly researched evidence and medical knowledge, it was enormously difficult to have the project approved and up until just a few months ago its future and continued existence were very much in doubt. I’m troubled by the degree to which the skeptical community seems to have failed to acknowledge how much evidence and scientific consensus is swept aside when dealing with drug policy. Here we have a glaring disregard for evidence and reality occurring on an institutional and legislative level, with broad and severe consequences for an enormous number of human beings, but our community is curiously silent on the issue. Why?
InSite was initially proposed as a scientific “pilot project”. Its intended purpose, or at least the purpose that was required to exist on paper so as to gain the necessary parliamentary approval (and constitutional exemptions needed for it to legally operate), was as a means of testing whether or not a project such as this would indeed reduce the negative consequences of an urban drug epidemic. What’s interesting, though, is that everyone was already well aware of the fact that it would. We already had the evidence, as well as a consensus across numerous disciplines -sociologists, epidemiologists, physicians, analysts of law enforcement, etc.- that harm reduction models like needle exchanges, methadone clinics and safe injection sites work wonders and are vastly superior to models that prioritize enforcement and deterrence. However, as with other concepts around which a scientific or academic consensus exists that is politically unacceptable or inconvenient, it was painted as only a theory… “the jury still out”.
The actual results of the “pilot project” testing the efficacy of “theoretically beneficial” harm reduction strategies emerging from InSite have overwhelmingly confirmed the original hypothesis. Overdoses within the Downtown Eastside were dramatically reduced by 35%. Since opening in 2004, serving about 700 individual addicts per day, InSite has not had a single on-site fatality (despite 1418 overdoses in the first six years of the project). HIV/AIDS rates have dropped, the alleyways in the neighbourhood are no longer littered with used rigs and the dreaded “honeypot effect” (in which addicts would supposedly flock to the area) that was used as a principal argument against the opening of the site never came to pass. In every conceivable way, InSite was an immediate and overwhelming success.
So why then did it even need to go to the supreme court in order to continue its operation? Why is it still the only such facility in North America? Why are harm reduction strategies still scoffed at, and receive comparatively so little funding? Why is the data and evidence that has emerged from InSite (and similar projects in Germany, Switzerland, Australia and The Netherlands) disregarded when legislative bodies determine drug policy? Why do American politicians still enjoy claiming that Vancouver is engaging in “state sponsored suicide” and leaning heavily on our government to shut it down? (seriously, fuck those guys. It’s a Canadian city, a Canadian problem concerning Canadian citizens, a Canadian solution, and none of their fucking business).
Vancouver politicians currently like to talk about a “four pillars” approach to the city’s drug problem. The pillars are: harm reduction, prevention, treatment and enforcement. In terms of actual funding, though? The running joke in the DTES is that it’s actually one pillar and three toothpicks. VASTLY more money gets poured into the enforcement of drug policy than into the various programs designed for harm reduction, preventing people from becoming addicts, and providing addicts access to treatment. Despite the fact that enforcement/deterrence has been consistently proven the least effective of those models.
Occasionally you’ll see some kind of politician or law enforcement dude or academic or so-and-so (like the absolutely awful -and occasionally casually transphobic- professor Bruce Alexander) start claiming that the harm reduction methods haven’t successfully eliminated the epidemic of addiction in our city. The harm reduction models aren’t intended to eliminate it. They’re intended to mitigate the actual social consequences. The prevention and treatment programs are the ones designed to lessen the problem as a whole. Meanwhile, NONE of those models have been given the time and funding they need to properly see through their missions. The idea that we should cancel them and go back to the thoroughly ineffective strategy we had previously been following, just because other strategies haven’t achieved an unbridled miraculous success from the tiny little scrap of a chance they’ve yet been provided is absolutely absurd. And the funny thing is from that tiny scrap of a chance the harm reduction programs like InSite HAVE achieved monumental success, despite the ridiculous amount of opposition attempting to hinder and undermine their ability to do their job. The degree to which people are simply assuming that the enforcement/deterrence model MUST be the one we ought to pursue, ignoring all evidence and reason, is simply ridiculous.
It is more than clear at this point that we have somehow gotten to the point where drug policy in most nations, and perhaps especially The United States, is being dictated by irrational fear, prejudice, hatred, old habits, money, bitterness, and an utter lack of compassion or tolerance for addicts themselves. This is an area of legislation where reason, science and evidence has somehow been completely tossed out the window and our governments are stumbling blindly forward driven only by the hostility and emotions of its members and constituents.
The consequences of this, of allowing our drug policy to be dictated by everything but actual fact and actual thought, are staggering. The number of lives being needlessly lost or destroyed, the amount of crime and poverty being perpetuated, the implicit genocide of minorities still suffering from legacies of oppression, it all adds up to one of the darkest and most inhumane atrocities in recent human history. So long as we continue to ignore the evidence stating that this is NOT a necessary atrocity, that there ARE strategies that can help spare these lives, so long as we don’t push for it to be acknowledged that a better and more compassionate approach is available, we are complicit in this.
As skeptics we’ve committed ourselves to standing against reasonless, unfounded, and dangerous irrational beliefs, haven’t we? Shouldn’t we be most invested when those irrational beliefs start exacting a human cost?
How high does that cost have to become before we recognize this issue as one we should be addressing?