Canada offers places for addicts to shoot up safely. Can the US copy the model?
North Americas first supervised injection clinic opened in Vancouver in 2003, and now several US cities are hoping to emulate its success in saving lives
Whenever Dean Wilson walks people through Vancouvers Downtown Eastside neighbourhood, he leads them past an unassuming glass door on Hastings Street before stopping at a community garden.
Its here that hell casually mention that they just passed North Americas first supervised injection clinic.
People go, What? Where? Wilson said. And thats what we wanted. We dont want some blinking sign saying junkies line up here. Its just another medical office door you can walk in and you can get well there.
Wilson, 61, has spent much of his life fighting alongside other activists to open Insite, Canadas first legal medically supervised space that provides sterile equipment to people who inject drugs and keep it open.
Since its doors opened in 2003, the small, bright space has logged more than 3m visits. A staff of 10 including three nurses are on site as people bring in their drugs and inject them in one of the 13 mirrored booths before moving to a lounge area. Others drop by to access healthcare, counselling or inquire about detox programs.
The relaxed atmosphere belies the critical role it plays in saving lives: by 2015, staff here had intervened in 4,922 overdoses, all without one death. The dozens of studies carried out on the site have yielded further insights: Insite does not lead to increased drug use or crime but instead offers a unique means of building relationships while saving lives, preventing the transmission of HIV and hepatitis C and spurring more people into detox programs.
Fourteen years after Insite opened its doors, the idea is now catching on. The federal government last year approved a second safe injection site in Vancouver and in recent weeks has given the green light to services in Montreal, Toronto and Surrey.
Interest has also been percolating south of the border; groups in Seattle, San Francisco and New York City, among others, are currently exploring the creation of similar facilities.
Much of the current attention stems from the opioid crisis that has claimed thousands of lives on both sides of the 49th parallel. The roots of Insite, however, lie in another crisis: in the late 1990s, Downtown Eastside was home to HIV rates that one researcher described as the highest outside of sub-Saharan Africa. It was horrendous, said Wilson. If you walked down Hastings Street, people were literally dying in the alleys.
Wilson and other activists pointed to western Europe, where supervised injections sites had been successfully launched decades earlier. But in North America, the debate was coloured by ideology and the war on drugs, and the battle was drawn out over years.
When Insite finally opened, Wilson was its first client. I started using drugs when I was 12 years old. Heroin was always a constant in my life, cocaine I used a bit here and there. His mother warned that if opening the first site had seemed tough, the battle for the second site would be even more difficult.
Her words proved prescient. The 2006 federal election ushered in the Conservatives and their tough-on-crime agenda, setting the stage for a court battle aimed at shutting down InSite.
What followed was a David and Goliath battle, with Wilson and another Insite user challenging the government in Canadas highest court. When we won, I thought, Well now weve got this constitutionally enshrined, said Wilson, who is now stabilised on methadone and rarely uses drugs. Then the bastards tried to regulate us out of business.
Through new legislation, the government made it more onerous to open safe injection sites, with demands that included multiple letters of support, reports detailing statistics on crime and HIV rates and background checks for staff members.
Meanwhile the opioid crisis tightened its grip across Canada. Overdose deaths soared as fentanyl a drug that is 50 times stronger than heroin and other opioid analogs began to taint the supply of illicit drugs.
The rocketing number of deaths led the provincial government of British Columbia to declare a public health emergency in April 2016. Still the number of deaths continued to climb, claiming 935 lives last year. The trend shows little sign of abating: in the first four months of this year, 488 people in the province have died of overdoses.
Across Canada, at least 2,300 people died of overdoses last year, Jane Philpott, the countrys health minister, said last month. The death toll is worse than any other infectious epidemic in Canada including the peak of Aids deaths since the Spanish flu that took the lives of 50,000 people a century ago.
Since taking power in 2015, Philpotts government has expedited approvals of safe injection sites, but has faced criticism for not doing more to address the soaring number of deaths.
In British Columbia, the result has been more than a dozen barebones overdose prevention sites, offering a place for people to consume drugs and be monitored for signs of an overdose.