As more North American cities push for supervised injection sites to address soaring fatal overdose rates, they can find a dozen years of lessons in Vancouver, which has the only such facilities on the continent.
Health officials in several Canadian cities – including Montreal, Victoria and, most recently, Toronto – are somewhere along the path to opening their own supervised injection sites, emboldened by a Supreme Court of Canada ruling and the election last year of Prime Minister Justin Trudeau's Liberals.
As local, provincial and federal governments weigh new proposals in those cities and elsewhere, Vancouver's health agencies, experts, drug advocates and police say they should look to the West Coast city's experience as a model for what works.
Vancouver is currently home to the only two legally sanctioned supervised injection sites in North America.
The most well known is Insite, a detached facility located in the heart of the city's impoverished Downtown Eastside, which opened in 2003. Lesser known is the Dr. Peter Centre, a renowned HIV/AIDS centre in the city's West End, which has offered clients a small-scale version of the service as part of an integrated model since 2002. The Dr. Peter Centre's site was officially approved by the federal government earlier this year.
Proponents note that supervised-injection service saves lives, while also serving as a gateway to further health care, and they point to several academic studies that have found the facility reduces overdose deaths and the transmission of blood-borne illnesses while reducing open-air drug use.
At Insite, users first sign in and tell staff which drug they are planning to inject. This data are used for several purposes, including monitoring of particularly toxic drugs to hit the area and long-term drug trends. Users are then provided with sterile supplies, including syringes, water, alcohol swabs and tourniquets, which they then take to one of the facility's 13 injection booths. In the event of an overdose, a nurse intervenes immediately.
The facility does not provide drugs.
Since opening, nurses at Insite have supervised roughly two million injections; nurses at the Dr. Peter Centre, more than 15,000. There has not been a single fatal overdose at either facility. As well, a 2011 study by the B.C. Centre for Excellence in HIV/AIDS, published in The Lancet, found that the fatal overdose rate within 500 metres of Insite decreased by 35 per cent after the facility opened, compared with 9 per cent for the rest of Vancouver.
A 2014 study by the centre found that the harm-reduction policy at the Dr. Peter Centre "fostered an atmosphere in which drug use could be discussed without risk of punitive action, and thus increased openness between residents and staff." This led to decreased drug-related risks and improved health outcomes, including adherence to HIV treatment.
Andrew Day, operations director for Vancouver Coastal Health, urged skeptics to temporarily suspend any visceral reaction they may have at the idea of injection-drug use and look at the evidence.
"Drug use is an uncomfortable subject," he said. "The idea of people injecting in sort of an official capacity, and being supervised, is an uncomfortable subject – and maybe so it should be – but we have to go with what seems to work, scientifically, not what our gut instincts tell us we should do."
Maxine Davis, executive director of the Dr. Peter AIDS Foundation, advised prospective operators to engage with the neighbourhood to quell fears over what a supervised injection site actually looks like.
"If I had any recommendations, it would certainly be for health clinics to invest in building relationships with key community leaders and inviting the neighbours in," she said.
When it applied to Health Canada for its recent approval, the Dr. Peter Centre received letters of support from the local residents' association, business improvement association and church.
"They viewed the service as an asset to the neighbourhood rather than a liability," Ms. Davis said. "They talked about the fact that having that service available at the Dr. Peter Centre reduced the need for people to inject in public spaces."
She added that while supervised injection is a "serious, clinical intervention," it doesn't have to be a physically imposing prospect. Supervised injection at the Dr. Peter Centre, located across from a park and in a tree-lined residential area, comprises just three stalls in a room.
Vancouver police are also supportive of Insite, saying it has both saved lives and reduced open-air drug use in the area.
Hugh Lampkin, a former drug user who is now president of the Vancouver Area Network of Drug Users, spoke of the importance of having counselling and addiction services connected to the site.
"Over a period of time, when people's lives change, they will [use those services]," he said. "It does happen. It happens in every [addict's] life, where they hit that part and they want to stop, they need some help. You need to have these services there, so when they reach that point, you can help them."