Supervised Injection Sites and Vancouver’s ‘Insite’ Experiment

Alexis Mulvenna

In 2003, North America’s first supervised narcotics injection site opened its doors in the heart of Vancouver’s downtown eastside. The ‘Insite’ facility allows individuals to self-administer intravenous drugs with clean injection equipment in the presence of health care workers. It also works to connect those individuals to a host of health care services, ranging from primary care to addictions counselling. Insite is operated and funded by Vancouver Coastal Health, which receives a majority its funding from the British Colombia Ministry of Health Services.

The Insite building is attached to a second facility, ‘Onsite’, a withdrawal management care provider that allows clients to detox and live in recovery housing as they receive treatment. In many ways, the establishment of these dual facilities was an experiment – a way to test if such a service model could improve the health of injection-drug users – which was to be expanded if successful.

At the time of its implementation, Vancouver’s downtown eastside was suffering from an overdose epidemic resulting from a growing use of illegal drugs. Some commentators went so far as to contend that the city was in the midst of a public health emergency, due to the presence of HIV infection rates higher than any that had been previously witnessed outside of sub-Saharan Africa.

Now more than a decade later, the Insite experiment has seen staggeringly positive results. A study conducted by the B.C. Centre for Excellence in HIV/AIDS found that after the facility was opened, the rate of needle sharing – a practice that can lead to the transmission of blood-born viruses – in Vancouver dropped from 40 per cent to 1.7 per cent. There was also a decline in new cases of both HIV and Hepatitis C. The study also found that the overall rate of injection drug use had declined, and that a greater number individuals were accessing drug treatment and methadone programs. In light of its success, both the City of Vancouver and the Province of British Columbia, along with the Vancouver police force, have expressed support of the program’s continued operation.

Yet critics of ‘Insite’ argue that its operation is an affront to the criminal prohibition of illicit drug use; others maintain that the provincial government should not facilitate drug use through their support of the Insite and Onsite facilities. On the other hand, many proponents argue that the facilities save lives, connect addicts to treatment programs, and improve the overall health and safety of the community.

Despite the success of Vancouver’s Insite experiment, the federal government has remained largely opposed to the presence of safe injection sites in Canada. In 2008, the government declined to extend Insite’s exemption from Section 56 of the Controlled Drugs and Substances Act (CDSA) in a move which, if successful, would have essentially shut down the operation. The PHS Community Services Society – who provide administrative and peer support services to Insite – launched a legal challenge in response. That challenge eventually made its way to the Supreme Court of Canada.

In September 2011, the Court released its unanimous judgment that found the federal government’s attempt to shut down the safe injection site in violation of section 7 of the Charter of Rights and Freedoms, as it threatened the lives and security of Insite’s clients. In its decision, the Court stated that,

“Insite has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada. The effect of denying the services of Insite to the population it serves and the correlative increase in the risk of death and disease to injection drug users is grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics.”

Chief Justice McLachlin, one of nine judges who presided over the case, went on to state that drug addiction is an illness, and as such the federal government should not view drug use as a matter of “choice.” McLachlin’s perspective clearly supports the provision of harm reduction services, such as safe injection sites, across Canada.

The judgment in Canada v PHS Community Services Society made clear that the federal Minister of Health must exercise his authority to grant exemptions from the CDSA. As a result, advocates in cities such as Montreal and Victoria – both of which have high rates of death among intravenous drug users – have been lobbying to open safe injection sites. Yet the federal government has continued its attempts to block the process, this time through the Respect for Communities Act, which — if passed — would require that all groups consult with municipal and provincial governments, community members, and municipal law enforcement before establishing a supervised injection site. It would also require that all municipalities formally apply to the federal government for a exemption from the CDSA. This legislation could severely hinder any replication of Vancouver’s wildly successful Insite model across the country.

The Respect for Communities Act is in line with other drug-related legislation recently introduced by the reigning Conservative government, known for its tough-on-drugs (and tough-on-crime) lens in policy-making. In 2012, the Safe Streets and Communities Act raised mandatory minimums for many drug related offences; and in 2007, the federal government removed harm reduction policies from the National Anti-Drug Strategy (a move that stood in stark contrast to recommendations of the World Health Organization). The same year, ownership over the non-medical drug file was transferred from Health Canada to Justice Canada. Canada’s approach to illicit drug use has differed greatly from that adopted by comparable jurisdictions, such as Australia and many western Europe nations, many of which allow supervised injection sites to operate with relatively few legislative constraints.

At the end of the day, the federal government appears to be waging a war-on-drugs, and viewing the services of safe injection sites such as Vancouver’s ‘Insite’ as facilitating – or at the very least, passively supporting – criminal activity, rather than working to improve public health. Yet its own approach to policy-making in this area appears to have had little effect: a 2013 report released by the Urban Health Initiative at the B.C. Centre for Excellence in HIV/AIDS found that despite the federal war-on-drugs, narcotics are still readily available at low cost on Vancouver’s streets. Increased arrests and harsher punishments have failed to curb drug use, whereas harm reduction policies have helped many individuals to receive treatment. One can only hope that, with continued study and more evidence on the positive effects of supervised injection sites on public health and safety, the federal government will reconsider the use of this powerful policy tool.

Alexis Mulvenna is a 2017 Master of Public Policy candidate at the School of Public Policy and Governance, and a 2017 Juris Doctor candidate at the University of Toronto Faculty of Law. She holds a Bachelor of Management and Organizational Studies from Western University, where she completed a double major in business management and psychology. Alexis has a keen interest in the intersection of law and policy, and in many areas of social policy.