Vancouver’s Drug Strategy

I have a hard time seeing this as a success:

Vancouver is into its second decade of dealing with an injected-drug crisis. The city has been concentrating more and more services in its Downtown Eastside. The result? Everything seems to be getting worse.

Homelessness numbers continue to rise. There were 2,138 homeless individuals in Vancouver in 2017  — compared to only 1,364 in 2005. Theft and violent crime in the Downtown Eastside have gone up since 2002. And as an overdose crisis sweeps Canada, Vancouver is its undisputed epicentre. Even with teams of naloxone-armed paramedics addressing a nightly rush of overdosed drug users, more than 100 people have died of overdoses in 2017 — with most of these occurring within the narrow borders of the Downtown Eastside.

And yet, all across the continent planners can be heard talking up Vancouver’s success on the addiction file.

They’re usually pointing to the success of Insite, which was established in 2003 as North America’s first safe injection site. …

And Insite’s supporters are right; safe-injection sites are good at what they do. But they really only do one thing: prevent people from dying.

It does not seem to reduce crime. There is slim evidence to show that it reduces overall addiction rates. And it certainly doesn’t lead to livable neighbourhoods filled with healthy people.

“After they opened Insite, it was like a warm hug from God … I mean people used to die here from overdose almost every day,” one Downtown Eastside drug user told the authors of a 2012 study.  

Safe injection sites are designed to do away with the most nightmarish aspects of injection drug use: Addicts sharing needles, using puddle water for injections, getting robbed after a fix and dying of overdoses. A frequently cited 2011 paper in The Lancet that studied Insite’s success found a 35 per cent decrease in the fatal overdose rate in the several blocks immediately surrounding the facility. And a 2009 review by Simon Fraser University criminologist Martin A. Andresen estimated that Insite saves three lives per year

But this is only one part of Vancouver’s drug story.

For one, the drugs consumed at Insite are “pre-obtained,” which is to say that they are still purchased by users on the black market. With about 700 injections occurring on site per day, it follows that there is still a vibrant market for drug suppliers — the very ones now cutting their product with lethal doses of fentanyl.

Insite’s own website says that “supervised injection facilities can help people quit drugs” — but the data proving as much is slim. The two major studies that Insite references cover a limited time period, and only document an increase in admissions to detoxification. To date, there is no definitive, long-term data showing that Vancouver’s injection drug users are successfully getting clean and kicking drugs because of safe injection.

Meanwhile, a 2006 British Medical Journal study looked at the years before and after Insite’s opening and found “no substantial decrease in the rate of stopping injected drug use.” While Insite will provide referrals to drug treatment, they also aim to be “low barrier.” Site staff do not want to alienate patients by counselling or pressuring them to seek treatment.