Vancouver’s answer to addiction

Zach Davis

There is a room in a building in Vancouver where injection drug use is legal. The program based in that room, Insite, represents a strategy for dealing with drug addiction that might just make a whole lot more sense than America’s.
Insite is the only government-sanctioned injection facility in North America. I first saw it mentioned in an article by Matthew Power on Slate. According to the article, Insite is open 365 days a year, 18 hours a day. More than 2,000 addicts go to Insite to use drugs.
Insite, staffed at all times by four people, including two nurses, provides addicts with sterile needles, clean water, tourniquets, condoms – things your average user shooting up behind dumpsters doesn’t have access to. As Power says in the article, “The operating principle is simple: If injection drug use is going to occur regardless, why not create a space that mitigates its dangers?”
I was horrified to read this. After all, the American view of addiction is uncompromising. Drugs are illegal, period. Well, maybe you get a little wiggle room in liberal towns when it comes to marijuana. Essentially, though, our legal system deals with drug addicts by locking them up. At first blush, this approach seems to occupy the moral high ground.
But what is the high moral ground in this case? Insite is obviously a blessing to addicts. According to Power, the on-duty nurses have intervened in over 1,000 overdoses and saved the user’s life in every case. The number of overdose deaths in Vancouver is lower than it has been in 30 years.
Insite also provides clean drug paraphernalia, which prevents addicts catching and spreading all sorts of diseases. The rate of HIV infection in injection drug users in Vancouver is the lowest since researchers began tracking it.
Here’s the tricky question, though: how does Insite affect nonusers? Insite is staffed by a nonprofit social service group, but it was established using federal money. After all, paying the rent and buying syringes and condoms costs money – that’s the users’ whole problem.
Some of that money comes from the Canadian taxpayer. In fairness, some American taxpayer money goes to the prison system, which feeds, clothes and houses users. That money could pay for hospitals or schools.
Instead, in Vancouver’s case, the money is providing users a safe place to use the drugs that everyone agrees they’ll use anyway. Users in Insite stay in little stalls to shoot up – they aren’t going on violent drug rampages or having inadvisable sex.
They’re reducing the risk of transmitting disease to nonusers with their condoms and clean equipment. Perhaps this isn’t quite the PR victory a new hospital might have in mind, but it is a social good just the same. The end result is that fewer nonusers are exposed to harm.
Of course, Insite cannot control users’ behavior in the outside world. Some addicts are going to steal drug money and others are going to have unprotected sex; all Insite can do – and, by all appearances, is doing – is mitigate the harm of drug use to both users and nonusers.
The difference between America’s drug policy and Insite’s is their view on punishment and rehabilitation. The American government is like the rigid, overbearing father who shouts, “If I ever catch you doing drugs, I’ll give you the hiding of your life!” When addicts get caught using, they go to prison, but they’re addicts – their recidivism rate must be high.
Insite says, “Let’s take this one step at a time.” Research done at Insite has shown the users, thanks to the program, were less likely to engage in risky behavior like sharing needles, and more likely to seek addiction treatment.
I think a lot of people have trouble acknowledging certain ugly truths about humanity. Addiction is very easy to fall into, and very, very hard to claw your way out of.
America’s drug policy puritanically expects everyone to stay clean, and offers very little latitude to those who can’t. Insite recognizes that drugs are awful, but it also recognizes that drug users are still human, and still deserve the highest quality of life they can get.
My dad would counter by saying you’ll always get more of anything you subsidize. But take a stroll through any American prison and you’ll run into plenty of nonviolent users in there.
Running Insite might require a certain amount of moral compromise. In the long run, though, it might make the drug problem a lot less problematic, and isn’t that the greater good?