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Hep B and C

Jul20

Inside look at Insite

Monday, 20 July 2015 Categories // Hep B and C, Health, Legal, Living with HIV

In Vancouver for IAS 2015, Bob Leahy visits Insite, the supervised injection facility in the downtown east side, where every day 800+ people with addictions and multiple other issues inject drugs in a safe, clean environment that also gives them a hand up

Inside look at Insite

It’s hot in Vancouver today. The morning sun beats down on a ramshackle but busy stretch of street. There is a shabby “Adult Novelties” store next door that looks like it’s permanently closed. Street people are everywhere, at times almost clogging the sidewalks, clustered together by the dozen with heaps of tattered belongings and treasured who-knows-what, the brick-a-brack of surviving on the streets. It’s Vancouver’s downside east side, sometimes described as the most infamous area in the whole country. It’s also the site of the only supervised injection site in North America, one of just nine world-wide. It’s called Insite. 

Inside, once you go through the breezy looking reception area, through locked doors and are inside Insite’s inner sanctum, you are in a large high-ceilinged room – it looks like a converted industrial space – with a black concrete floor and calming, surprisingly trendy beige and black finishes. Minimalist cubicles, twelve in all, line the right-hand wall, each equipped sparely with a large mirror, a five-foot stainless steel counter and a bright yellow sharps container. That’s it. Injecting supplies are piled on the counter of a kitchen/nursing station off to the left. It all looks squeaky clean.

The lights are dim in this room, except for those pooled over each booth. It’s both friendly and sterile here. People with addictions would feel good about using it though, I can tell. Good about themselves too, even when shooting up and dealing with the hardest of hard lives. 

We’re here, before opening hours, for a tour of Insite, twenty of us from all over the world who signed up for this conference “extra” We are glad we did. This place is fascinating. No clients around right now – the place opens at 10am, and stays open until 4am every day, 365 days a years. But at 9am on a Sunday we have the place to ourselves. 

Our affable staffer/guide Russel Maynard sits us down and weaves a tale of a glut of cheap and accessible heroin which hit the streets in this west coast city in the 1990s. That in turn led to a health crisis that peaked at 413 overdoses a year in BC, most of them within a hundred yards or so of where we are right now.  HIV and Hep C were booming in an era where sharing needles was the norm. (Now cheap disposable plastic needles developed for the insulin trade have revolutionized the tools of the trade.) In any event, back then before there was Insite, community advocates like VANDU (Vancouver Area Network of Drug Usersj joined forces with harm reduction and sexual health advocates to persuade city council that a supervised injection facility would address the overdose problem, provide for a reduction in HIV and Hep C infections and link users to much needed services like detox, housing, addiction counselling, mental health programming and a whole lot more. 

       

It worked. The facility has been open since the fall of 2003. For the majority of this time it has been under attack, right up to the Supreme Court of Canada, a constant target of Canada’s (conservative) federal government. Simply put, Insite buts up with Canada’s (federal) Controlled Drugs and Substances Act.  The place has stayed legal by obtaining an exemption from some of the provisions of the act, but only after the Supreme Court ruled against the federal government, insisting that Insite is an important part of the continuum of HIV/Heo C prevention and care. 

“You don’t have to be tough to work here” we are told, but it takes a certain skill set. There are no security guards. Overdoses - they are not infrequent - can sometimes be dealt with by the staff, sometimes not, in which case an ambulance is called. The police are never involved in this process; nobody wants that. If there is unruly behavior, violence or the threat of it, staff are trained in violence intervention but will call 911 if matters escalate uncontrollably.

      

We meet some of the staff. Young, friendly, hip. They are nice people. I suspect clients like them and respect this place as much as they are able to. 

It’s almost 10am and staff are starting to arrive. There is a gaggle of street people at the door waiting to get in too. So we all troop upstairs, for over Insite sits Onsite, a 12-bed detox centre where those who need it have a place of respite from the storm. Stays range from a few days to much longer. Staff seem kindly, committed and sympathetic. But they need, we are told, “an ability to manage chaos.". 

The place we are shown on the second floor is a large communal recreation/dining/activity/meeting room next to the bedrooms, which we do not see, for they are occupied. This room has coloured, almost childlike, paintings on the walls, poems handwritten on loose-leaf sheets, official notices. It’s an odd but not unfriendly space. 

It's gone 10am now and definitely time to go as clients start to come through the doors, shuffling purposefully towards Insite’s inner sanctum for the first fix of the day. Time for us to clear out and leave them to their peace. For this above all does seem a place of peace from the storm, at least today when business hasn’t yet painted the space with chaotic lives coming and going. 

We are shepherded towards our bus. I want to take photos, however awkward this may feel, so I do. But the teeming street people down the sidewalk hardly look our way. Seems like they are used to tourists, even our kind. We are, after all, the very least of their concerns.  

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