It’s a dark and drizzly January afternoon in Vancouver—an afternoon entirely typical of the British Columbian winter—and I’m sitting in a dimly-lit back-office with Eric, a regular user of methamphetamine.
Eric is 40 years old, articulate and unshaven, with a heaving mop of black and brown hair. A little over 12 months ago, his life fell apart. He had an apartment in the city and straddled two jobs, one in construction and another as a session musician. Things were going well.
Then, one day, in the room just across the hall from his, two of his bandmates fatally overdosed on fentanyl, the lethal heroin substitute currently carving its way through Canada and the United States.
One of the overdoses, he says, might have been intentional—a suicide: “We’ll never know, but I wasn’t real comfortable hanging out in my room after that.”
In the months that followed, Eric struggled to cope with the trauma. He dropped out of work and lost his apartment. His drug use escalated from the recreational to the addictive—“ as a way to not sleep,” he says.
When he wasn’t high, he would walk the streets or kill time in the 24-hour coffee shops and dingy burger joints scattered around downtown Vancouver. Slowly and inescapably, he could feel himself slipping away.
It was at this point—somewhere very close to rock-bottom—that Eric decided to visit InSite, the first legally-sanctioned, supervised drug consumption facility anywhere in North America.
InSite was established in 2003 after years of relentless lobbying and activism by drug users and advocates of drug reform in BC.
It operates under a temporary rolling exemption from Canada’s drug laws and remains an occasional source of controversy in Canadian politics. But for Eric, its services have been life-saving.
Not only does InSite allow him to manage his habit in a controlled environment—within eyeshot of expert medical support and, therefore, free from the threat of fatal overdose—but it’s given him a fresh sense of structure and stability.
Eric is now a ‘peer worker’ at InSite, meaning he works paid shifts at the clinic, interacting with other users, serving them coffee, and, where possible, helping them through the rehabilitation process.
“From my own personal experience, not being alone every day helped monumentally,” he tells me. “There’s no judgement. The clients don’t judge each other. The staff doesn’t judge the clients. It’s a good place to come and feel safe.”
Eric’s experiences aren’t unique.
Since 2003, four million ‘clients’ have visited InSite in order to use one of the 13 mirrored consumption booths that sit behind the small, cluttered office Eric and I are talking in.
None of them—not one—has suffered a fatal overdose within the facility.
Moreover, after InSite opened and began distributing clean injection equipment as part of a broader, city-wide strategy, rates of HIV and Hepatitis C in the surrounding neighbourhood of Downtown Eastside—a longstanding flashpoint for poverty, homelessness, and addiction on the Canadian West Coast—quickly started to fall.
InSite’s supporters believe the initiative has been massively beneficial for the province, which has faced a number of drug-related health crises in recent decades.
“During the peak year of [BC’s first heroin] crisis in 1998, 400 people died,” Travis Lupick, a local journalist and the author of ‘Fighting For Space’, an acclaimed book about the history of Downtown Eastside, told me.
“Shortly after InSite opened, that number was reduced to an average of 204 fatal overdoses a year and that average was maintained for an entire decade … It’s one of the greatest health success stories in North America.”
InSite has its critics.
Between 2006 and 2011, it was subject to a sustained—but ultimately unsuccessful—legal challenge from the then Conservative government in Ottawa, which argued that the facility encouraged illicit drug use without tangibly improving health outcomes.
For programme manager and long-time staff member Darwin Fisher, however, InSite—which is publicly funded by the provincial health authority—owes its longevity to the support of the community in which it is based.
He argues that the mainstream Canadian healthcare system tends to treat addicts quickly and impersonally, before churning them back out onto the street.
But InSite treats the worst affected residents of Downtown Eastside in a different way—as individuals suffering, in many instances, from compound disorders, including mental illness and homelessness, as well as addiction.
Locals can drop in for a housing referral, access to detox, or even just for a hot cup of coffee.
“We wanted to make sure it was a space where people felt welcome and people felt recognised,” Fisher says. “This is a population that needs healthcare as badly as any other group in Canada, and probably has the worst uptake in the clinical system.”
The past few years have been challenging for InSite.
Many of its achievements have been brutally rolled back as fentanyl—a synthetic opioid 50 times more potent than heroin—has swept through North America, causing a surge in drug-related deaths.
Last year alone, more than 1400 people died in BC in incidents linked to fentanyl; in 2016, the provincial health minister was forced to declare an official public health emergency.
Yet, despite the devastating effects of the opioid crisis, the clinic’s progressive approach to drug treatment continues to attract attention from around the world.
Campaigners in Scotland are among those hoping to replicate InSite’s success.
Last year, with the support of the Scottish Government, Glasgow City Council tried to open what would have been Britain’s first safe injection site.
NHS Scotland even identified a property—reportedly somewhere between Trongate and the Clyde—that would act as a base for a trial programme.
But the initiative was vetoed by the Home Office on starkly legalistic grounds. “There is no legal framework for the provision of drug consumption rooms in the UK and we have no plans to introduce them,” a spokesperson for the UK government said in April.
SNP Councillor Mhairi Hunter is one of the most vocal proponents of drug reform in Glasgow, a city that only recently lost its status—to Dundee—as the overdose capital of Europe.
She told me that the evidence in favour of a Scottish safe consumption site was overwhelming, and that it was now just a matter of time before Westminster was forced to concede the case.
“There have been over 100 evaluations of these sorts of facilities, which show not only that they reduce harm but also that they increase engagement in treatment and support services,” she said.
“The evidence base is so strong that it will become untenable for the UK government to continue to oppose it.”
Here in Vancouver’s struggling, battered but defiant Downtown Eastside, Eric is one of many living, breathing testaments to the effectiveness of safe consumption—at least as practised by the team at InSite.
“Not a single death in this building in 15 years,” he reflects, as our conversation draws to a close. “1437 deaths in one year, but not one in this building. That’s gotta say something.”