Ann Livingston opened Vancouver's first supervised injection site in 1995, an illegal facility in the Downtown Eastside masquerading as a drop-in centre for drug users. More than 20 years later, just a few blocks away, she now helps run another unsanctioned injection site.
The new "pop-up" site, which opened last month, is in response to unprecedented overdose deaths in British Columbia and an insufficient response by government, Ms. Livingston said. Insite, North America's only legal, public supervised injection site, has been "overwhelmed since the day it was opened," in Vancouver in 2003. Efforts to open additional, legal facilities have stalled – in large part because of legislation by the federal Conservatives that many saw as a deliberate attempt to impede supervised-injection services.
"If civil disobedience moves things along, great," said Ms. Livingston, adding that the pop-up site's primary purpose is to prevent drug users from dying.
"This is a crisis – an emergency."
The site is located on the same site as a vendor's market, near the intersection of Hastings and Columbia streets, facing a back alley often frequented by drug users. Several folding tables and chairs are arranged under a white tent; a string of Christmas lights helps illuminate the small space.
It is open from 10 a.m. to 9 p.m., seven days a week. Volunteer staff are on hand with naloxone, a drug that can reverse the effects of an opioid overdose within a few minutes.There is room for about six people to inject at a time; there are often lineups to get in.
Sarah Blyth, a former Park Board commissioner who helps run the injection site and the vendor's market, said the injection site was born out of necessity.
"It wasn't really anything we wanted to do," Ms. Blyth said. "It was because pretty much every day people would come running to our [market] staff, like, 'Help! Naloxone!' We're not going to let people die in front of us when we're trained [in reversing overdoses]."
Both the city of Vancouver and Vancouver police are aware of the unsanctioned site but have no plans to disrupt it. Vancouver Police Department Sergeant Brian Montague said it is a matter for health authorities.
Vancouver Coastal Health has plans to open five more supervised injection sites. The health authority is aiming to submit applications for two of them by the end of this month.
But health officials and harm-reduction advocates have repeatedly warned that a law passed by the former Conservative government, the Respect for Communities Act, will make that process far more difficult.
Among the 26 provisions in the law, prospective supervised-injection sites are required to obtain letters from health, justice and government officials; statistics and other information on crime, public nuisance and inappropriately discarded drug paraphernalia in the vicinity of the site; and a report on consultations with "a broad range of community groups."
Most recently, NDP MP Jenny Kwan, whose riding includes the Downtown Eastside, added her voice to the chorus of people calling on Health Minister Jane Philpott to repeal the legislation. Ms. Kwan wrote letters to the minister, on Oct. 17 and Sept. 26, describing B.C.'s "raging fentanyl crisis" and saying that the pop-up injection site is a "direct response" to the act.
More than 555 people in British Columbia have died of illicit overdoses so far this year, making this year's death toll the highest in 30 years of record-keeping. Fentanyl, a powerful synthetic opioid being cut into street drugs for its low cost and high potency, was detected in 60 per cent of those deaths.
Others who have called for the federal act to be repealed or amended include B.C. Health Minister Terry Lake, Provincial Health Officer Perry Kendall, Vancouver Coastal Health's chief medical health officer Patricia Daly and Vancouver Mayor Gregor Robertson.
Dr. Philpott has repeatedly voiced support for supervised-injection sites but has also said the Liberal government has no immediate plans to change or repeal the Respect for Communities Act unless it appears the law is creating unnecessary barriers. The Liberals approved Canada's second federally sanctioned supervised-injection site – which had been quietly operating in Vancouver's Dr. Peter Centre since 2002.
The law was a main discussion point earlier this week at the Pacific AIDS Network's fall conference, where health and drug policy experts spoke at length about the act's onerous requirements and its effect amid a surge in fatal opioid overdoses that has become a public-health emergency.
Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, described it as a "cumbersome, biased process that is easily tainted by misinformation and stigma."
"The law needs to be changed. It's great that this [Liberal] government is supportive, that [Dr. Philpott] is supportive, but she has inherited a piece of legislation that was drafted by a government hostile to these health services with the very deliberate purpose of defeating them," Mr. Elliot said in an interview.
Dr. Philpott has said there "should be no unnecessary barriers" to opening a new site, but currently has no plans to change the legislation. Her office reiterated this week that the minister has asked staff to find ways to reduce barriers.