Insite - Not Just Injecting, But Connecting (Sub: Eng, Spa, Ger, Rus, Ser, Bul)

Vancouver Canada is home of Insite the only legally operating injecting facility in North America. Insite has supervised over a million injections for 13 thousand drug users since 2003 with the aim of preventing overdoses and infections and getting people in from the streets and connecting them to social services. The Hungarian Civil Liberties Union visited Vancouver to learn why the goverment tried to shut down this pioneer service and how scientist, activists and drug users worked together to keep it open. - Everybody talks about the drug problem of Vancouver, but it is not that Vancouver has a drug problem, it is that Canada has a drug problem But because elsewhere they do not provide the same level of services, people come here. The drug habbit is an attempt to sooth the pain, emotional pain and it is an attempt to mask feelings that are otherwise unbearable. Now why the downtown inside of Vancouver? First of all because Vancouver is a port city, so there is fairly free flow of drugs here, number 1. Vancouver is on the West coast of Canada - Canada on the whole is a quiet cold country in the winter time. - but Vancouver is relaitvely mild, so that it is more possible to survive here under bad conditions. Also of course people need a community to belong to and once people start gathering more people will come so that they can be amongst people that they feel comfortable with. - In Vancouver's Downtown Eastside there is a large number of single room occupancy hotels they were initially developed to serve people working in the resource based economies such as fisheries and forestry, however when those resource based economies dried up, it became a popular place among people looking for relatively cheap housing. As well when the goverment decided to move the mentally ill population out of pyschiatric hospitals they said they would create community care for them, but the community care never really happened, so it really also became a place where people living with mental illness could come. And unfortunately these people were very susceptible to addiction. - When the phenomena of injection drug use sort of hit the downtown Eastside in the late 80's you had a very large population of people with multiple problems anyways living in the middle of a large urban drug scene. The estimates for Vancouver for injection drug use is at that time was about 12 thousand people. - In the early 90's we had a very high rate of overdose deaths in Vancouver. Between 1988-1998 something like 2400 people died in the province of BC (British Columbia) with the majority in this neighbourhood of *** overdose related deaths. - There is a drug user group in Vancouver called the Vancouver network of drug users which was at that time a project of the Portland Hotel Society, the PHS Community Services and I run that and I was quite vocal about trying to get a safe injection site openned. - How exactly does a safe injection site help drug users, what does it do for them? It lets them - in the most incredibly subtle and thorough way - lets the know, that people care if they remain alive in order to stop using drugs one day. You can not stop using drugs when you are dead. - In 1997 roughly 19% of all drug users were infected with *** in one year that presented a whole new set of challanges for people working in the area of ***/AIDS. Over 90% of people who inject drugs in Vancouver's Downtown Eastside are also infected with hepatitis C. It became very clear that we needed a lot of innovation, we needed new policies and programs if we were going to control this epidemic. - We put together a plan that we called the four pillars drug strategy at the city we basically borrowed heavily from the Swiss four pillars... and we put out a framework that talked about treatment, talked about prevention talked about harm reduction and talked about enforcement, the role of the police there were 36 recommendations in the four pillars and you know the two that got a lot of attention were the *** prescription program and the supervised injection site. - The general public was I think supportive, recognising that something different had to be tried, so when the idea of doing a pilot safe injection site study first came about there was actually quiet a bit of public support for this, and after several years of lobbying and advocacy it eventually opened in 2003. - Here at InSite the first time that somebody comes they register I do not need you to use your real name, so right from the moment you come to InSite it's all about relationships and one-on-one as much as we can - Yo, put me down! - "Pearl", thank you! - You gonna come and use the injection room when they entered at the front it shows up here as a queue and it shows me who is waiting out in the room. -What are you using? -***. -All right! -Thank you! I have to get my stuff - When they walk through the door, they self report what they are using 'I am using ***, I am using ***, I am using crystal ***', that all gets recorded, what time you came in 'I wanna get some harm reduction supplies and leave, I wanna see a nurse about a wound I have' that goes into the database. - Yeah, I need somebody, someone to help me tie off please - Then that person tells you what booth you will be at you come here you get your supplies and you go to your booth and you use. - Filters, got everything. Going to my booth. -There! Cleanliness is so important. So you do not get an abscess. -This is ***. - The staff here, nurses, non-nurses are available to help you find the vein, any information you need about safer practices, so you should not always use for instance the same site it will irritate that site, you should rotate the sites. Basic things like that, all those opportunities, when you need me to pass you another syringe, when you need some to help finding a vein, those are all great opportunities for me and you to talk, for me to get to know you. - I need someone to tie me. - Darwin could you tie me? - I am not gonna do it too tight and then you just pull it up... - Yeah, yeah, thank you! - And that's done. - Somebody was saying, do people come to this site as a cry for help? And I thought to myself, no actually people come to this site because they want to use where its clean, where its well lit and its warm and if you build a relationship with them as they use this site, if you open yourself up to them then they may cry for help to you. They may say 'Listen, you know, knowing you for a few months, can you tell me about methadone? Or detox upstairs, or housing?' things like that. - I had a rare disease my hands got crippled I couldn't do ... I couldn't , I used to have have people 'doctor' me, you know? So I was having a lot of problems out there, people were stealing my drugs, so I finally came in here and I spoke to the director and he started helping me so that I could do it myself. It didn't take long and I learned how to, you know, do my own and... I've overdosed a couple of times here and they have actually saved my life. I have seen it a lot, this place has saved a lot of lives. - Often they will start talking about well addressing a wound, or talking about detox and then all of a sudden suddenly, bam! Their feelings in there, their story comes out and man you work here, nice middle class guy like me. I've never heard stories like this in my life, you know? Grown man like in tears, whether it was school abuse, childhood *** abuse violent abuse, homelessness as a child, serial abandonment this stuff that will curl your hair. - 70% man here and average age is about 40 probably about 18% natives, somewhere in the 80-90% range have some kind of a trauma in their history. Women that come here probably even higher 95% in the survival sex trade so the sex trade in this part of the city is referred to as the survival sex trade, because it's so dangerous. If you've just done a big smash and you are really quite high maybe it's a good idea if you do not go outside into the traffic into where it is really busy right away you just calm down here in the chill. People will stop and talk and interact, so this is really one of the key rooms at Insite. Darwin right now is working with someone trying to help them with some housing. You have a detox upstairs too so that a person has a choice. You can go, you know, you can detox, they have a third floor where you can wait if you wanna go to treatment, so it's everything right, the whole cycle. Oh you can't say 'I'm a looser' baby! Oh deadly kick! - Yeah, winner! - We are in a 3 story building, the store fronter, the street level is the injection site, the second floor is a detox centre where people stay probably 8 days, 5 to 8 days. It is the same as detoxes around the world with the big difference that everybody has their own room and then above that is what we call a transitional recovery program. Most of the places you live down here, you have to share with other people and its clean, you can keep it is as clean as you want, it hashot showers, it's a sense of security. - Many people have told me like I didn't even know that you could do detox with dignity. - You can't even describe how I was when I would come in downstairs, ...you wouldn't recognise me , you know, but they would always openly accept me and... always told me that I was worth fighting recovery. It's not very common that you finished detox and you can go straight to recovery - you often have to wait a bit for a bed to become available in recovery. So that is what the 3rd floor is, you go from Insite to the detox centre, I do well at the detox centre it's been 8 days, I wanna go on to recovery or I wanna get better housing, so now I can go to the 3rd floor and stay for 2 weeks, 4 weeks, 6 weeks, 8 weeks. - I had a slip about 2 moths ago when I started to use again, when I started again I wanted to stop really quickly and I came here. And it's been a great experience, I've been here for 2 weeks now. What works here is the human contact we have with the staff here. - Programs at Onsite are yoga, massage therapy, acupuncture and of course 12 step groups, meetings, morning check-ins, book clubs, all kinds of things. A big part of the early stages of recovery is keeping busy, to try to avoid habitual thought right away, so to give yourself a break. - They offer you a chance to grow and adapt and there is no pressure, right? Yeah it's very comforting, you know, because a lot of places don't give you that, they're really... I don't know, judgemental. - Over the years the Portland Hotel Society in Vancouver developed a range of services besides Insite and Onsite, they provide affordable and subsidised housing, different community, harm reduction and health care services. One example is CTCT where nurses give intravenous antibiotics in a home-like environment. PHS created a community bank to support people of low income, where tellers also serve as mental help workers. People using PHS's services are given employment opportunities and have even had the option to form football teams. - Shoot it, shoot it! - I come from way down below, from the gutters right? I've been homeless, using drugs, drinking, like totally abousing your body. We are now healthy, we got family, got a housing, we are a lot better now. We have been Rio and in Paris for the Homeless World Cup, where else? - We are going to Mexico next year. This program is called the Downtown Eastside central kitchen. It is a program that produces and serves, delivers on bicycles 365 days a year, a thousand meals a day to low income residents, who have been identifed as generally malnourished Never enough money for food and, we deliver them a 16 or 12 ounce portion, a very healthy meal. It's produced by community members living in the single room occupancy hotel system, who previously have had little access to employment opportunities. - I don't have a job but I always got money, people don't like it but I think it's funny Now put your hands up, put your hands up! We have been pretty lucky up to now where we roll up in front of a place we take the order upstairs, we come back and our bike and trailer and the food is still there. So lot of people on the Eastside here they know that we deliver to low income places, people with a challenge, so they don't bother this stuff. - Insite has an annual budged that tops, so the high end is 3 million dollars a year. 800-1000 visits, every single day, seven days a week, 365 days a year. Close to 30% of those visits are people enquiring about how can I get into detox how can I get into OnSite upstairs. I don't think that there is another public healthcare project in North America that sees that kind of volume of people. It is one of the most successful healthcare project in North America When InSite opened we were already following a group of people who used insite and a bunch of people who didn't. That allowed us to very quickly produce a number of studies documenting effects of InSite. Insite has really met it's primary objectives, it's improving public disorder, It's reducing the transmission of infectious diseases. It's reducing the morbidity and mortality associated with overdose. and it's connecting people to programs such as addiction treatment, and it's having no negative impacts. Lastly, we've exported our data to other evaluators, who've demonstrated that InSite is highly cost effective and is saving literally millions of dollars since the time it was opened. - People inject with clean needles and sterile water and under sterile conditions in a supervised setting. There is no disease transmission, it's much more inexpensive to prevent *** than to treat it, I think the treatment of *** in Canada for a lifetime is something like half a million dollars. For much less money than that we can prevent the transmission of ***. - Yeah, there have been more than a million injections in insite and I don't know how many hundreds of overdose events. I think, 1500 overdose events in InSite, no-one has died. Ultimately six to seven hundred injections take place every day at InSite or more. Those are injections that aren't taking place in our alleys and on the street, and whatever the case may be. 13 thousand individuals have made use of the site, many, many, many of whom are now much more stable, - A lot of people can't imagine that allowing people to use drugs and providing a place actually helps people. They think, oh and how can you argue that's helping when you are just condoning drug use and making it so much more easy to use? Well, the truth is people get well when they feel better, and we give them hope by believing in them as human beings, And so everything we do at InsIte, whether it's OnSite or upstairs, whether it's just the action of giving people clean stuff when they come into the door and getting to know individuals and developing relationships. All of that is what is terapeutic because people then start to believe that 'Oh, well someone respects me'. - You know, I see what facilitates drug use down here every day and it is shame, it is extreme poverty, it is pain, it is history of pain, it is *** in the alleys. You know, it is being outside in the freezing rain day after day after day... That promotes addiction and to take services away from drug users, like InSite or like needle exchanges, that promotes addiction and I would almost think that the federal government who is working so hard to kill InSite, actually have an agenda to promote addiction, make it more widespread. - In Canada we have a Controlled Drugs and Substances Act, but we have an exemption, called exemption 56. and that exemption is meant to support and enable scientific research and health, medical research. - Once the exemption was granted by the federal government, the drug use within certain parameters was legal on the site. - What we basicly told our police officers on the street was that from the strategic standpoint we supported the health goals of the injection site which is to save lives. Some of the police officers down here, took it upon themselves - they certainly weren't attracted to do this - when they encountered intravenous drug user, they took them to the site. With the drugs in hand and said, go in there, do your thing with health and what have you... - Insite received a 3 year exemption when it opened, for the purposes of scientific research and that exemption was extended. - The conservative government when they came in in 2006 decided that they didn't feel that the evidence was there. So they ultimately were very ideologicly and morally opposed to an injection room. - What we are up against is a culture that since the 1960's has at the minimum not encuraged drug use and often romanticised it. Romanticised it or made it cool, made it acceptable, - Harper questioned needle exchange programs and methadon centers. - …A second best strategy at best, because if you remain a drug addict, I don't care how much harm we will reduce, you will going to have a short and miserable life. - The third time it was up for extension, the federal government did not issue a permit. - The organization that I run took the federal government to court and followed the courtcase. Dan Small came to me and asked me if I would want to be one of the plaintiffs, and of course I said yes. - We had two arguments in the courtcase, one was constitutional and the other one was jurisdictional. The constitutional argument said that every Canadian has the right to life, liberty and security of the person and the drug users right is denied if they can't have access to the site and to the constitution. And jurisdictionally health is funded provincially. and so as a result because this is part of a treatment system This program should be exempted from the federal authority. We won the constitutional argument and then within about 24 hours the federal government turned around appealed that decision and so we want all the way to the BC appealcourt. At that level, we ended up winning both, so we won both the constitional and the jurisdictional argument in the appeal court. Again, the federal government decided to appeal those decisions and that took us all the way to the supreme court of Canada. We were joined in the supreme court by 11 interveners, organizations from accross the country, everybody from the Canadian Medical Association to the province of Quebec, the attorney general's office here, we had all the public health officers from across Canada, the Nurses' Association, Nurses Union, so by the time we were in the supreme court, it was full 36 robe, you know, lawyers fighting in support of InSite. - It was very interesting to see the role that scientific evaluation played in the discussion during the courtcase. The justices asked the lawyers representing the federal government if they had any research to suggest that InSite wasn't working They did the right thing and they admitted that they actually had no research showing that InSite wasn't working. - The case was heard on May 12th 2011. - We won in the Supreme Court! - Ok everybody, we won! The place was packed, the press conference was enormous, there was tremendous support all across the country, people were very-very happy, I was getting texts and emails the whole day from people from all across the country. - They instructed the federal government to use their existing legislation section 56 to issue the permit to InSite. - Although we are disappointed with the supreme court of Canada's decision today, we will comply.. - That was a huge victory. The fight in the court has actually improved the public opinion of harm reduction throughout the whole country. The harder the federal government fought, the more publicity we all got for InSite, the more understanding the public had about what InSite was. When the decision came down it was unanimous across the country, The editorials and the newspapers were unanimous saying, you know, this is the right decision. - As a doctor who worked in this facility for two years, I was absolutely delighted, by the unanimous 9 to nothing decision of the Canadian supreme court. I wish I could be happier about it, though. Because what they didn't establish is the right of other people to open up similar facilities. - The public discussion has started in Toronto, in Ottowa, in Victoria, BC within a week or two of the decision, the Quebec Minister of Health announced, that he will be asking to non-governmental organizations to submit proposals for supervising injection sites in Quebec. - I am really thrilled about the court ruling that happened recently that will allow us to stay open. That will allow us to keep doing what we do and perhaps innovate. - On the streets you will see a lot of people smoking crack, we can't take crack smokers in here because we don't have another exemption that is required from the federal government in order to allow people to smoke crack ***. We have built the ventillation system, We have submitted the request to the federal government. We also need more InSites, we are so maxed out in terms of volume here that there are people that leave because they cannot wait. Right now, everything people bring in, they bring in from the street and it could be cut and mixed with anything that is potentional lethal and kill you, so we would like to be able to give people a safe supply of heroine, we have done heroine trials, we know they work and are safer for people. - When the international narcotics control board released it's annual report, shortly after insite opened, it called on Canada to close this facility and said that it actually was in violation of the international drug control treaties. However, a report released by the Canadian ***/AIDS legal network reveals that that's not actually true at all, these facilities can legally operate within the international drug control treaty system. - I think that we are just on the cusp of fairly, I hope dramatic social changes in drug policy where we start to realise, and in 30 years we look back and say, why did we ever think it was acceptable that we did that to people who were sick. who have this horrendous livese, who are just really decent human beings but really-really struggling. and we make it harder and harder and harder for them to change. - It's not about saying it's okay or promoting you to use drugs it's about the safety and you know, and yeah, it's just saving lives. It's a lot. Gives you a chance, right? At life. Thank you. Subtitles: Péter Büki, Balázs Szigeti, István Gábor Takács