Fighting for Space

  VCH did eventually pay for Insite and staff nurses there, but Daly emphasizes that PHS and the community made the injection site happen. She sums up the health authority’s role like this: “They kind of went along for the ride.”

  Chris Buchner says the Hair Salon was the catalyst for Insite. “That was really what triggered us moving forward with the application,” he says. The day they first heard it existed, he and Heather Hay jumped in a car and drove to the 100 block to take a look. Townsend was there with Evans that afternoon, and together the four of them took a walk through the maintenance team’s renovation.

  “It was clear it was just a demonstration site,” Buchner remembers. “It was all built with IKEA. But, lo and behold, they had built an injection site,” he continues. “That said, we had to rip it out and start from scratch. But it made the point that we were going to do this. It really removed any question—and removed the health authority from getting caught up in some of the things that would be more difficult for a health authority to do, like find a suitable location, like negotiate this with a landlord, and like getting building permits.”

  To redo all the work that the maintenance team had just finished, the health authority tapped a local architect named Sean McEwan, a good friend of Townsend’s who had volunteered his time and helped PHS with a number of projects before. “I was hired by the health authority, and they put together a project schedule to make Larry Campbell’s promise coincide with how they wanted to address the drug crisis in the Downtown Eastside,” McEwan says. “So we had to get this site open by September. And I started work in March.”

  That deadline was luxurious compared to the ten days that the maintenance team had had to throw together the Hair Salon. But this time, they would be building an injection site within the bureaucratic and legal frameworks of three levels of government—something that had never been done before anywhere in North America, and for which the procedures had never been written.

  “We didn’t even know if we could get a development permit for this,” McEwan recalls. “I said to the health authority folks, ‘Well, this might work. We might be able to build this thing in four months if we hire a construction manager right now and get the right guy. But what we don’t have any time for is drawings, for example.’ And they said, ‘Oh, well, just do what you can do.’”

  Here McEwan gives credit to Mayor Larry Campbell. “He phoned down to the director of planning and said, ‘I want this development permit, dammit,’” McEwan recounts. “So everything was to the letter of the city regulations but in the shortest time possible. We had a development permit and a building permit issued on the same day within four weeks of getting the process started.”

  Campbell remembers that he made it crystal clear with every department at city hall that nothing was to get in the injection site’s way. But today he’s also quick to give credit to his predecessor, Philip Owen. “It would never have happened without Philip,” Campbell emphasizes. “He really laid the groundwork. People might think I’m just saying that, but it would never have opened without Philip Owen. Period.”

  Back in the Downtown Eastside, McEwan worked with Townsend and Small on the design and got moving on construction. Meanwhile, Buchner and Hay still had to figure out how the whole thing would come together and open without anyone breaking any laws.

  How do you allow people carrying drugs to congregate inside a government-funded facility without compelling police to enforce laws prohibiting the possession of narcotics? What if a staff member at the injection site touched a client’s drugs? Could they then be charged with possession? What if a staff member touched someone’s drugs and then handed them to the client they belonged to? Would that qualify as a trafficking offence? What sort of registered nurse would take a job at a facility where they could face time in prison for accidentally picking up a flap of heroin off the floor?

  The answers to those questions were in Ottawa, where Canada’s drug laws are written.

  Bud Osborn and then Dean Wilson had worked on the drug issue at the federal level for years and then, with the release of the documentary Fix, Philip Owen and Larry Campbell became more involved. Meanwhile, Libby Davies, the MP representing the Downtown Eastside in Ottawa, had been laying the groundwork for this effort with Osborn since the late 1990s.

  “I took Bud to Ottawa and he met Alan Rock, the health minister,” Davies says. She maintains that it was Osborn’s intensity and charisma that brought the capital’s conservative politicians around. “A whole room full of people would go silent when he spoke, not only with his poetry, but just in conversation,” Davies says. “Listening to Bud, it was like people were in prayer. You could feel him reaching people. A silence in the room would fall, and he would be inside them.”

  Osborn used his gift for storytelling to make the health minister understand what was happening in the Downtown Eastside. “He pressed him on the issue [of supervised injection] and the whole crisis and communicated a sense of emergency, that people were literally dying and that he couldn’t wait on it,” Davies says.

  As Wilson became more involved in VANDU and then was made president, he similarly went to work as a lobbyist for drug users. On December 5, 2001, Wilson was scheduled to speak before a parliamentary committee, to stand in the federal legislature and share the experiences of addicts in the Downtown Eastside directly with the politicians who ran the country. Wilson obsessed over his speech. Then, that morning, his computer crashed. He lost the document.

  “I’ve been an addict since I was twelve years old,” Wilson began, speaking only from memory.

  I live at ground zero of Canada’s drug problem. The Downtown Eastside of Vancouver has been demonized as a neighbourhood filled with corruption and hopelessness, when in fact it is a community of caring and concerned people. We must be allowed to respond to the crisis in a way that will fit with our neighbourhood and not with the moral and ethical rhetoric I’ve heard some of you speak.

  I honour Ms Libby Davies, for I know her tears of pain have washed the sidewalks of the Downtown Eastside. She has spoken out many times for the need for heroin maintenance, safe-injection sites, and low-threshold methadone. It is time for you to listen. She cannot do it alone.

  HIV/AIDS and hepatitis are two diseases that are part of a declared public health emergency that has been called in the Downtown Eastside, yet you have failed to act and, in doing so, have literally sentenced me and my brothers and sisters to death. HIV/AIDS prevalence rates rival those of sub-Saharan Africa, and we’re 100-percent saturated with hepatitis C—I repeat, 100 percent. There’s nobody down there who doesn’t have it. These diseases and others such as tuberculosis will eventually cost the health-care system untold millions of dollars …

  It’s unacceptable. If you were to lose three friends a week, I think that you would be upset and alarmed and that you would start doing something about it. These are Canadian citizens. We may have the common thread of being very poor, but the fact is that we do not cause the social ills in the Downtown Eastside; we use drugs as a coping mechanism for those social ills.

  It’s time to act. It is no longer time to hide behind reports and more research. We’ve lost 3,000 people since 1993. That also means 3,000 mothers and fathers and probably untold thousands of brothers and sisters who probably still look at a picture every goddamn morning.

  I’m going to end my speech because I’m swelling up with the rage of the Downtown Eastside right now. But it is time to act with safe-injection sites, heroin maintenance, and low-threshold methadone. These have worked.

  Wilson concluded with a call for parliamentarians to follow Davies’ leadership on harm reduction.

  “Libby Davies is a hero in our neighbourhood,” he said. “You’ll be known as heroes if you act. Follow the mayor’s framework for action, and you’ll all be known as heroes.”54

  What the Portland Housing Society really needed from Ottawa to operate an injection site was a get-out-of-jail-free card. It turns out one actually e
xisted, at least for drugs.

  In 1998, Heather Hay had worked with Ann Livingston, Bud Osborn, and a few other VANDU members to draft the very first proposal for a supervised-injection site. It never went anywhere, but in that document, there’s a very brief section on how the entire idea could be made legal in Canada. In preparing that report, the health board enlisted the help of a lawyer named Linda Parsons to give a legal opinion on the proposal. Whether or not she knew it at the time, Parsons discovered the key that later became crucial to the establishment of Insite.

  “The Federal Health Minister has the authority to exempt any person or class of persons or any controlled substances (such as heroin) from the application of all or any of the provisions of the federal Controlled Drugs and Substance Act and the Act’s Narcotic Control Regulations,” this section reads, “if, in the opinion of the Minister, the exemption is necessary for a medical or scientific purpose, or is otherwise in the public interest.”55

  Buchner had gone to work with Ottawa on the idea, and eventually received back an “interim guidance document” with a mouthful of a title: “Application for an Exemption Under Section 56 of the Controlled Drugs and Substances Act for a Scientific Purpose for a Pilot Supervised Injection Site Research Project.” The seventeen-page document outlines the requirements a health-care facility must meet for the health minister to grant it an exemption from Canada’s drug laws. They had figured it out. In Canada, an injection site can exist without breaking the law by receiving an exemption for a specific location that said federal drug laws do not apply there.

  “Section 56,” Hay emphasizes. “It was the key.” But it wasn’t the only trick they used to get Insite off the ground.

  The document that the federal health ministry had sent to Buchner also stated that the Portland’s exemption for an injection site would be provided “for a scientific purpose.” Technically, PHS was not going to be given permission to establish a health-care program. It would be allowed to conduct an experiment on a trial basis.

  Shortly after Thomas Kerr had completed his proposal for an injection site for HaRAS, another young researcher appeared on his radar who had similar interests in harm reduction and connections to the Downtown Eastside. In 2002, Evan Wood was a Master’s student working at the BC Centre for Excellence in HIV/AIDS, stationed at St. Paul’s Hospital just a couple of floors above where Kerr was working for the Dr Peter Centre.

  “He approached me and said, ‘Hey, I’m doing this sort of stuff too,’” Wood remembers. “We chatted and decided to look at this as an opportunity for collaboration.”

  Over the next fifteen years, the names Kerr and Wood appeared on more than 100 scientific papers that describe Vancouver’s needle-exchange programs, supervised-injection sites, and other harm-reduction initiatives. These articles have appeared in prestigious publications including the Lancet and the New England Journal of Medicine, for example, creating a reputation for Vancouver as being at the forefront of harm reduction in North America. Their very first paper about a supervised-injection facility was published in the Canadian Medical Association Journal on August 21, 2001, two years before Insite’s founding. Its title: “Unsafe Injection Practices in a Cohort of Injection Drug Users in Vancouver: Could Safer Injecting Rooms Help?”

  Insite needed a scientific evaluator. Kerr, Wood, and the BC Centre for Excellence in HIV/AIDS were the natural picks. But Mark Townsend remembers being worried that if anything was going to keep people away, it would be the research component. Originally, it was proposed that researchers would work right inside the facility, conducting lengthy interviews with each client before they were allowed to proceed into the injection room. “It would be like running to have sex but then first having to fill out a twenty-page form for Dr Evan Wood,” Townsend explains. “We would have died on the vine immediately in the first twenty-four hours. All we needed to know is your name—whatever you want to be called—and what you are using. The rest could come later, once we had built a relationship.”

  Wood and Kerr found a way to make that work for them. “When people came into Insite on a random basis, they would be offered a referral to a research study,” Wood explains. If they were selected, they were offered twenty dollars, which they would receive after they completed a survey that BC Centre for Excellence researchers conducted down the street from the injection facility, on East Hastings just west of Pigeon Park. “Ten bucks to do the survey, ten bucks for a blood sample,” Wood says. Nine out of ten users took them up on it.

  Inside 139 East Hastings, Sean McEwan was struggling to build the facility to the specifications of three different levels of government that weren’t always on the same page with one another and that were essentially making things up as they went along.

  Generally, an injection site isn’t that complicated. Usually, it’s a room with a ring of booths around the outside where clients sit at a counter with a small amount of privacy and inject drugs. But when you get into the specifics of it, things get more complicated. For example, Vancouver police and other reluctant supporters were concerned that drug dealing would happen there. So they lobbied for measures to address that concern, such as a requirement that each booth be wide enough to prevent one user from passing anything to another. “We had a lot of decisions like that to make,” McEwan says.

  There were major differences in opinion over what sort of vibe the place should have. Evans and Townsend wanted it to feel welcoming. One of the injection sites that Stuerzbecher had visited in Europe almost felt like a coffee shop, like the sort of marijuana cafés they have in Amsterdam. But the health authority envisioned something that was clinical, with bright lights and steel tables. In the end, the Portland team was convinced that it was safer to go with what the health authority wanted. “When you build something that looks clinical or modern and slick, people are like, ‘Oh, this is supervised injection? It’s not a den of snakes?’” Stuerzbecher says.

  Still, the degree to which the facility would feel medicalized remained a major point of contention throughout its construction. McEwan recounts how this fight continued even after he thought the renovation was complete. “Mark and Liz had told me they really wanted this place to feel welcoming, so finishes were to be as warm as possible and not too much like a hospital,” he says. “Then the health folks had their walk-through and they went berserk and said it was too nice.”

  The building’s layout was designed to facilitate flow-through traffic. One enters, proceeds up a short ramp to a front desk (wheelchair accessible), and then continues straight through a second door into the injection room. It has a semi-circle of booths on the far wall and to the right of the door that connects to the lobby. On the left side is a slightly elevated observation desk where a nurse stands, supervising everything and distributing the supplies people require to inject drugs. Also on the left side of the injection room is the door to the “chill room.” In the chill room, there are a couple of tables with chairs around them and, on the left wall, a counter where a nonmedical staffer is stationed to offer any sort of assistance a client might need, serve coffee and juice, and keep an eye on everything. From the chill room, one exits out onto the street, so traffic moves through the building in a u-shape.

  Regarding details, there were major arguments over the floor, lighting, and a coffee machine. Today Hay concedes it was all about optics. “The night before we were going to open up the supervised-injection site, I got a call at two in the morning,” she says. “Our head of communications had gone to take a look at it, and she had a mini freak-out. She thought it looked too good.”

  In the middle of the night, Hay got out of bed and drove down to the 100 block of East Hastings. McEwan had selected a style of laminate for the floors that was made to look like hardwood. “They thought that was just out of control,” he says. At four in the morning, the Vancouver Coastal Health’s media relations team was demanding they cover it with garbage bags taped to the floor.

  McEwan put his foot down and told them that
the floor, which had come in under budget, was going to stay the way it was. It did. The coffee machine, however, was a bridge too far. “It was deemed to be part of some luxury service for heroin addicts,” McEwan says. “The coffee machine got chucked. That would have been coddling the addicts.

  “And then I got enormous shit for the light fixtures that I’d chosen,” he continues. Again, the lights had come in under budget. “But they were too nice.” In the end, the fixtures that McEwan had selected stayed, but he was made to pay for them out of his own pocket.

  While McEwan was wrapping up construction details, Buchner was trying to figure out how to stock an injection site with supplies. Today, Insite provides each client who enters the injection room with a tiny metal dish that’s an inch or so across, called a cooker. But those didn’t exist in 2003, so Buchner ordered a massive number of cheap metal spoons. The BC Centre for Disease Control supplied syringes as well as rubber tourniquets that intravenous drug users tie around the upper arm to increase the size of their veins, thus making each one easier to find with a needle.

  Construction of the supervised-injection facility was complete. Its shelves were stocked with clean needles. Now it needed a name.

  One afternoon, a graphic designer, Murray Bush, who had done quite a bit of work for the Portland over the years, was out walking his dog when he bumped into Townsend, who was also walking his dog. “We need a name for this place,” Townsend said to him. “It’s going to be an injection site.”

  Bush simply shortened the two words and crunched them together. Insite.

  By August 2003, it looked like everything was just about in place. Townsend and Small had found the building. McEwan, Buchner, and Vancouver Coastal Health had completed their renovation and had the place ready to go. The name “Insite” was stenciled in white on the door. And then a new, totally unexpected opponent emerged: the Vancouver Area Network of Drug Users.