Fighting for Space

  “We get to opening day, and there are no peers who are going to work anywhere in the whole project,” Ann Livingston explains. (“Peers” is the health authority’s term for past and present drug users.) It was actually about a month before opening day when this point of contention boiled over. VANDU threatened not only to boycott Insite, but to picket the building with drug users holding protest signs right outside its front door. Livingston issued a threat: “If there are no drug users employed on opening day, we will be picketing.”

  Asked today if VANDU was really willing to torpedo the continent’s first sanctioned supervised-injection site, Livingston shouts back: “Fuck you! We fought for this fucking place. Are you kidding me? Of course we would have.”

  No one with PHS remembers a fight with VANDU on this point. “There were issues in terms of what Health Canada would allow,” Liz Evans recalls. “They didn’t want drug users working in the injection room. And that was the compromise we had to accept in the end, that the role of peers would be in the chill lounge.”

  Buchner concedes that within Vancouver Coastal Health, there was a need for a “cultural shift.” He says, “There were people in the health authority who were less comfortable with it,” but adds that they came around.

  Today Buchner and Hay remain reluctant to point a finger at any particular source of opposition to peers working at Insite. But others say it was the nurses who were assigned to work at Insite and the union behind them.

  Meetings were convened and members of VANDU, the Portland, and the health authority collected around a table. In the end, Dean Wilson was given a chair on the hiring committee for peers at Insite. Small remembers it as a prospect he was very excited about. “I had to fight and draw the line and say we were going to do it,” he says. “We pushed hard on it in the background. I said, ‘Heather, it’s a deal breaker.’”

  PHS was already employing peers at the Washington Needle Depot and had worked with them on a few other short-term projects such as at Coco Culbertson’s “Thunder Box” supervised-injection trailer, for example. But Insite was different in that the risks were far, far greater.

  Buchner remembers thinking that if the Canadian government allowed Vancouver to open a special facility for intravenous drug users and then shortly afterwards somebody died of an overdose there, it would likely mean no similar facility would ever open on the continent again for decades to come, if ever.

  Small was cautiously optimistic. He and Wilson placed their faith in Bryan Alleyne, who was still a heavy injection cocaine user at the time. “Is it possible for someone to maintain themselves? In a hurricane of addiction, can they maintain stability?” Small recalls thinking. “Bryan was the test.”

  Alleyne was given the responsibility of managing Insite’s chill room. He never once let them down. Today Alleyne, who stopped injecting drugs in 2005, is still there in the chill room at Insite, keeping it running as smoothly as ever.

  54Wilson, Dean. In Canada. Parliament, Senate Special Committee on Non-Medical Use of Drugs. 37th Parliament, 1st Session. (January 29, 2001–September 16, 2002). Statement made on December 5, 2001. http://www.ourcommons.ca/DocumentViewer/en/37-1/SNUD/meeting-17/evidence.

  55Melissa Eror, Alan Favell, Heather Hay, Jim Leyden, Ann Livingston, Bert Massiah, Jazmin Miranda, Bud Osborn, Sharon Ritmiller, Simin Tabrizi, “Proposal for the Development of a Pilot Project to Implement and Evaluate the Use of Safe (Injection) Sites” (Vancouver, BC: Vancouver-Richmond Health Board, 1998).

  Chapter 23

  Opening Day

  Heather Hay was a reluctant supporter of supervised injection. “I never actually got why we needed to have supervised-injection sites,” she says. “And then, late one night in 1999, I was driving home from work. There was a young girl in a back alleyway, probably about fifteen or sixteen years old. It was raining and dark, and she was shooting up. And there was just a ton of guys around her. I thought, ‘I get it. I really get it.’ For health-care providers, harm-reduction can be a very hard thing to wrap your head around,” she continues. “It’s counterintuitive. But eventually, I realized that harm reduction gives us an opportunity to keep people alive, to give them time.”

  Insite was set to quietly open on September 21, 2003. PHS had done a media tour of the building one week earlier, on September 15 (which is why that date is sometimes listed as the facility’s opening). Now it was time to officially open Insite’s doors to the public.

  One detail still remained outstanding: the health ministry in Ottawa hadn’t issued the Section 56 exemption from the Controlled Drugs and Substances Act that Insite required to operate without breaking the law. PHS was promised it was coming, again and again. But it hadn’t. And so on September 21, the day that they had advertised they would open, Hay stood in a back room at Insite by herself (too nervous to sit), staring at a fax machine with the number they had given Health Canada. Finally, it squawked to life and spit out the piece of paper they’d been waiting for.

  On the other side of Canada, it was Jenny Kwan and Hedy Fry, the two BC politicians from different parties who had drafted the Vancouver Agreement, who finally convinced the health minister to support Insite.

  Kwan remembers that they were both early supporters, but Fry said to her, “I have to sell my health minister on this.” Kwan asked if she could speak to him directly and Fry, who belonged to the same party as the minister and held a position in his cabinet, said that she would set it up.

  “This is really important,” Kwan said to the minister, Alan Rock. “Here is what we need and what we need to do.”

  Rock thought about it for a moment and then said, “You know what? If you guys are all on board—the mayor, the province—we’ll give you the authority and grant the exemption.”

  With Canada’s first sanctioned supervised-injection site now truly set to open, it was time for VANDU to close the illegal injection site it was still running at 327 Carrall Street.

  Christian Owen remembers not everybody thought that was the way to go. But he was paying the rent and nobody else had any money.

  “We got what we wanted,” he told that contingent. “They’ve opened Insite. That’s what we wanted. We can’t go on being a further thorn in their side. We have to play ball. That was the agreement I had with Larry [Campbell].”

  The concern was that nobody who was injecting at 327 Carrall would use a supervised site run by Vancouver Coastal Health. Their distrust of authority was so extreme that Livingston worried they would return to the alleys before they would give their name to a nurse on their way into a building associated with the government.

  “There was no trust in this new thing called Insite,” she says. There was trust in the Portland. Over the previous decade, they had earned credibility with the community by housing the drug addicts whom no one else would. But the involvement of Vancouver Coastal Health made people suspicious, Livingston remembers. Most of 327 Carrall’s injection-drug users were homeless, she says, struggling to explain the extent to which this group had experienced an extreme degree of marginalization at every interaction with the state.

  “We had the lowest of the low down at 327 Carrall,” Livingston says. “And there was nothing indicating we would have any control over Insite or whether it was any good or not.”

  But she knew they had made a deal with the new mayor. Just after Insite opened, 327 Carrall closed down.

  North America’s first sanctioned supervised-injection facility, Insite, opened in September 2003.

  Photo: CommunityInsite.ca

  While the September 15 “opening” was a media circus, Insite was relatively quiet on the evening of September 21.

  Liz Evans and Kerstin Stuerzbecher worked as nurses in the injection room that night. Evans explains that even with the Section 56 exemption having finally arrived, everybody remained anxious. The feeling was that nobody knew what was going to happen. There was also a sense that it was all just too good to be true. “Had they actually won?” Evans remembers thinking.
It didn’t seem possible. Surely at any moment, SWAT teams would kick through the door. And when they did, better that it was she and Stuerzbecher who went to jail, Evans says, than some hapless nurse who wasn’t so invested in what they were doing.

  Their biggest fear, however, was still that no one would show. The prospect terrified everyone involved. “Oh my God, after all this, what if no one comes?” Evans thought.

  Despite her anxiety, she remembers the opening as a very special experience. “It felt beautiful and warm and cozy,” she says. “I remember feeling just amazing.”

  The facility was absolutely spotless. The lighting Sean McEwan had paid for out of his own pocket gave it a warm glow. In the injection room, classical music played over the building’s loudspeakers. Then people began to wander in.

  “That these people were coming out of the alleys …” Evans says, trailing off. “It felt like a church, it felt like a sanctuary, it felt like a very spiritual moment.”

  The media tour that they’d held earlier in the month had thinned the crowd of reporters that had set up camp outside hoping to catch the first injection. There was, however, one journalist present on the evening of September 21. Townsend had invited Frances Bula, a reporter for the Vancouver Sun who had given other harm-reduction programs fair coverage in the years leading up to Insite’s founding.

  “Vancouver’s—and the continent’s—first injection site for drug users opened quietly and without fanfare Sunday night,” begins her story that ran in the paper the next morning.

  “It drew an unexpectedly large number of users, given that there was no publicized opening and that official statements had said it would open sometime after today.”56

  In fact, Townsend had seen the Portland spend a small fortune advertising the site’s opening. But the ads—posters and leaflets—never appeared anywhere where a middle-class reporter would see them. They were inside the Portland’s hotels and the Downtown Eastside’s other low-income buildings.

  Bula wrote about how Dean Wilson was in the injection room and might have been the very first to use drugs there, had he not been preoccupied flirting with a Portland staffer who was doing intake at the front desk that night.

  While Wilson was chatting, a man named Michel Chartrand took a seat in the booth next to him. Bula described him as “quiet.”

  “Chartrand unfolded the tiny envelope of paper he’d bought on the street and carefully poured the cocaine powder into his syringe.

  “He turned to get water and found, to his surprise, that there was already a small vial of it in the plastic kidney tray he’d been handed.

  “His left leg shaking with impatience, he mixed the powder and water, tied off his right arm with the blue rubber tourniquet he’d been given, and pushed the needle into his right arm with little fumbling.”

  Evans remembers how important it was to Chartrand that he be there for the opening. “He had HIV and was very sick,” she says. “It was too late for him, he said, to get the help that he needed. But he wanted to use there because he felt like it was such a victory for so many other people who needed Insite.”

  “He was a really beautiful guy,” Evans adds.

  After Chartrand and Wilson, people began to trickle in. A thirty-six-year-old homeless man named Bradley Clark was one of the next people to use Insite. Bula wrote that after he’d injected, he hung out in the adjoining chill room for a time and talked about his hopes for the facility and what it could mean for drug-users’ access to health care. “For some people, this might be their only healthy, non-drug-related interaction,” Clark told her.

  Asked about that night, Kerstin Stuerzbecher laughs with joy while simultaneously beginning to cry. “All I remember are the faces of the people who died,” she says. “I was standing in the IR [injection room], watching the first person come in. And all I thought about were the people who had to die, who couldn’t be there, who couldn’t see that day.”

  That evening they had a few visitors to Insite who were not drug users. Liz Evan’s midwife, who had delivered their son Kes three years earlier and their daughter, Aza, the year before, came by with a bouquet of flowers. One of her own children was using intravenous drugs at the time.

  “She was so grateful because now she knew where she could come to look for her son,” Evans explains, “instead of sitting around at three a.m. or wandering the streets.”

  Evans recalls that she and Stuerzbecher spent hours on their feet, until they both were eventually overcome by emotion.

  “I sat in the corner and I wept and cried and watched people coming in and how beautiful it was,” Evans says. “It was our people, our community, opening this space. And it felt so obvious that we would be there doing that. It didn’t feel unusual or weird. It wasn’t jarring in any way. It felt completely normal.”

  That’s the official story of North America’s first sanctioned injection at a government facility designed for drug users. But Michel Chartrand wasn’t actually the first person to inject at Insite.

  Late one evening after the media opening on September 15 but still quite a few days before the actual “quiet opening,” as it came to be called, on September 21, Dean Wilson walked through the building with Mark Townsend and Dan Small.

  The three of them were standing in the chill room, taking in what they had built and what they were about to accomplish. Small looked to Townsend and said, “When do you think we should open?”

  “What about right now?” Townsend replied.

  Wilson gave an enthusiastic “Yeah!”

  Knowing where this was going, Small turned to Wilson and said, “Do you want to be the first one?”

  “Fucking right I do,” Wilson said.

  Wilson didn’t have any cash on him so Townsend and Small reached into their pockets and together came up with enough for a flap of heroin. Wilson rushed out to the street, proceeded just one door east to where a group of dealers always stands at the edge of the alley near the Washington Needle Depot, scored a flap, and then jogged the thirty feet (nine metres) back to Insite where Townsend and Small were waiting for him.

  From the chill room, they migrated over to the injection room, which was already fully stocked with supplies. Wilson grabbed a clean needle, a cooker, and a tourniquet. Townsend and Small hovered a few feet back. Wilson mixed the heroin he’d just purchased with a little bit of water, tied his arm off, sparked a lighter beneath the drugs, gave it a stir, and proceeded with North America’s first sanctioned drug injection.

  “That was a soft opening,” he says. “Then the battle started.”

  Asked about that story nearly fifteen years later, Evans says she never had any idea. “Yeah, that’s probably true,” she concedes with a laugh, and then a long sigh. “Fuck, that’s such a Dean story.”

  Why the big secret?

  “It doesn’t say that in the paper,” Wilson says, laughing, “because I was playing like I was straight back then. That’s because of Ann—I was trying to act like I was straight. But I wanted to be the first!”

  Liz Evans and Kerstin Stuerzbecher worked at Insite for its first few weeks. They were both registered nurses and the facility felt so precious that they couldn’t bear to give the responsibility to anybody else. “We just ran around pretending to actually know what we were doing,” Evans jokes.

  Stuerzbecher says the opening might not have been so successful if it weren’t for VANDU. “It was a communal effort that made that place happen,” she explains. “The VANDU peers working in the chill lounge, who are still there to this day, made it a partnership. It was the first time that community and NGO and institution and bureaucracy all came together in an attempt to be as equitable as possible.”

  Stuerzbecher recalls that, at first, not all of the nurses that Vancouver Coastal Health assigned to Insite loved the idea of working alongside drug users. But PHS insisted and very quickly, just about everybody came around. “Then, in less than a week, it had outperformed every expectation VCH ever could have imagined,” she
says.

  Many of the health authority’s worst fears never materialized. Bureaucrats initially worried that a safe-haven for drug users would attract people who might use violence to steal drugs from Insite clients. This led to arguments over whether the facility should employ private security guards. Again, PHS put its foot down. There are no private security guards at Insite nor at any of the Portland’s hotels, for that matter. Incidents requiring police have proven rare. “It can be hard for people to understand that safety isn’t about security guards or bars on windows,” Evans says. “Safety is really about knowing people, having relationships, and an understanding about what somebody is going through.”

  On Insite’s first anniversary, PHS employee Darwin Fisher took over much of the facility’s day-to-day responsibilities. “It took me a little while to sort of get into the groove there,” he concedes. “So Kerstin comes by and says, ‘Darwin, let’s go for a smoke.’”

  Stuerzbecher asked Fisher what he thought the person running Insite should be doing for the people who used drugs there. Fisher told her that staff should let people feel safe, comfortable, and accepted—and she thanked him and walked away.

  “I’m getting ready to go back to work, and I realize I had just described to her the job that I should have been doing since I got here,” Fisher says. “So I thought, ‘Okay, I’ve been schooled in worse ways. Thank you Kerstin.’ From that point, I knew what my role was.”

  Insite served as a gateway to the health-care system for people who were previously marginalized. That was an anticipated outcome that activists had used to sell the concept of an injection site since the planning stages. Immediately there were improved outcomes for users’ physical health: fewer abscesses and no risk of hepatitis C transmission, for example. But now operational, Insite very quickly revealed a host of other, unintended benefits.