Activists Plan 'Safe Site' for Drug Smokers

Addicts who smoke hard drugs will have an indoor place to get their fix if a Vancouver drug users group is able to open North America's first safe inhalation site later this year.

"We're on the hunt for a space," said Ann Livingston, who directs the Vancouver Area Network of Drug Users, which is better known as VANDU. "We've got to find a robust landlord who won't completely crumble when the city starts applying pressure. And we've got to either find a space we can afford, or find someone to donate the rent for a few months."

Such an unsanctioned facility would provide a supervised location for addicts to smoke crack cocaine and heroin, in much the same way that Insite -- Vancouver's legally sanctioned three-year-old safe injection site -- provides services to addicts who inject the same drugs.

Livingston told The Tyee that inhalation is overtaking injection as a primary activity at safe-use sites in Amsterdam and other European cities. She said the European shift toward inhalation has been driven in part by an AIDS-awareness campaign that encouraged heroin users to eschew needles, and in part by a recent surge in the use of crack cocaine. She said many European sites now offer both injection and inhalation areas.

"Here in Vancouver, more addicts are using on the street than ever before, because more addicts are homeless than ever before." Livingston said that one in four VANDU members now describe themselves as homeless, whereas only one in 10 did so as recently as 2002. "Getting them off the streets would save their lives, and it should please Mayor Sullivan and others who just want them out of view."

Insite unable to expand

"We're among the first to acknowledge that there is a need for more capacity, be it an inhalation room or an additional injection site," said Laurie Dawkins, a spokesperson for Vancouver Coastal Health Authority, which funds and oversees the operation of Insite. "But we're not in a position to talk about expanding services."

After months of loudly threatening to shut down the Hastings Street injection site, Prime Minister Stephen Harper's conservative government quietly granted Insite limited approval to operate until the end of this year. That limited extension expressly forbade Insite from expanding its services.

"The 18-month extension was strictly for the site as it stands today," Dawkins said. "The Federal government was very clear that we were not to add services."

Insite is staffed by a team of 16 registered nurses, four alcohol and drug counsellors, and several peer staffers. The site is open 18 hours a day, from 10:00 a.m. to 4:00 a.m., seven days a week.

Mark Townsend is a community worker for the Portland Hotel Society, which operates Insite in partnership with Vancouver Coastal Health. Townsend agreed that Insite is not enough.

Inhalation room exists

"Clearly, within the Downtown Eastside you need two or three sites. And clearly, those sites need to support inhalation as well as injection," Townsend said. "Regardless of whether they are smoking their drugs or injecting them, getting addicts off the street is not only good for the addict, but provides a real benefit to the community as well, yeah?"

Townsend added that Insite is ready to expand as soon as government will allow it. He said an inhalation room was constructed within the existing facility, but has not been opened because Health Canada refused to authorize it. And he said that Insite has identified another location at which it would add capacity: "We have architectural drawings for another facility in the Downtown Eastside."

Townsend expressed concern for the plight of VANDU's homeless members, but suggested that it would be irresponsible for Insite to become involved with any unsanctioned activities.

"Insite is legal and it's funded by the government," Townsend said. We supervise an average of more than 600 injections each day. There have been more than a quarter of a million injections in our facility. It we hadn't been here, most of those injections would have been done in doorways, or on the street."

Legacy of 'guerrilla' sites

Livingston helped launch three unsanctioned injection sites in the years before Insite opened its doors, and she said that another such "guerrilla site" is needed to pressure governments to act on inhalation.

"The discussions that go on in back rooms are only to solve problems. They won't have a discussion to do what's needed next," Livingston said. "So we need to have another period of civil disobedience."

Livingston opened an unsanctioned safe injection site at 356 Powell Street in the fall of 1995, using her own money. That small site operated for a year, during which an epidemic of overdoses swept through the Downtown Eastside. She also funded a site at 213 Dunlevy, which operated from the summer of 2000 until January 2001. VANDU operated the most recent guerrilla site at 327 Carroll St. from April through October of 2003.

"I had this naivety that Insite would creep forward. What I believe now has to happen is we have to have more guerrilla sites," Livingston said.

"Overdose is more rare with smoking, and no piercing or removal of blood is going on. So an inhalation room is less of a medical facility." Livingston said VANDU can staff such a site with volunteer labour.

Funding such an operation, however, presents a challenge for an organization whose members are increasingly homeless. Livingston funded her first two guerrilla sites out of her own pocket. But Downtown Eastside rents have risen significantly in the past decade. She figured VANDU will need about $3,000 a month to rent a storefront and stock basic supplies. And, more problematic, the neighbourhood's new generation of landlords are far more solicitous of city hall.

'Like Dickensian England'

Livingston warned that until the surging rate of homelessness is addressed, disease rates will continue to escalate in the Downtown Eastside, and provincial taxpayers will continue footing the bill for the cost of hospitalizing critically ill citizens.

"We know how to stop the spread of diseases like hepatitis, syphilis, and AIDS," Livingston said. "But I don't think that when people take shits in alleys, that they use a clean syringe every time. I don't think they're using a condom every time. They're degraded. They learn to hate themselves. We see them, walking in this neighbourhood. Most of them are ill. Many have AIDS.

"It's like Dickensian England," she added. "The health authority wants to talk about liver transplants. And we're trying to say, 'Can we at least have a place for people to use the restroom and wash their hands?'"

On these points her counterpart at Insite agreed.

"Drug addiction has always been with us. We can either have it a mess, with people shooting and smoking on streets. Or we can keep alive and stabilize them for their good, and for the good of community," Mark Townsend said.

"What we're doing now is a tragic waste of resources," he added. "Moving inhalation indoors would save money, save lives and visibly improve the community."

Related Tyee stories:

• Insite Clinic: Out of Harm's Way (series)
• The Deal that Killed Superman
• The Americas on Drugs