I’ve spent the last few days with 13 lovely ladies from Estonia’s prison service who were visiting Scotland to find out more about take-home naloxone and healthcare within the Scottish Prison Service. I have left them in the capable hands of my Scottish Government colleagues to head over to Glasgow to catch Liz Evans from Vancouver who is here to tell us the story of North America’s first and only supervised injection site – Insite.
It’s a grim drive that takes over 2 hours due to the rush hour traffic from Edinburgh but by some small miracle I make it just in time.
Liz has been in Glasgow all day and has met with Turning Point Scotland and partners, and has also been on BBC Radio Scotland (listen here from 13:03). Around 20 people have turned up tonight with a variety of backgrounds, interests and knowledge on the subject so we are very grateful to hear the experience of Insite first hand.
Liz trained as a nurse. She worked in a low-income inner city community in North America where, for years, she operated housing for people who were poor, mentally ill and addicted. She watched as a wave of disease and death spread across the community among injection drug users. Looking for a more humane way to approach this situation she worked with her community and organized to open a space where people who were struggling to survive in the face of their addiction could find hope to live another day.
In a precedent-setting case that was ruled on in 2011, Liz and a dedicated team took this battle all the way to the Canadian Supreme Court–where a legal right was enshrined for this site to be granted an exemption from the criminal code. Here, Drug Users can come inside, inject illegal drugs under the supervision of a nurse, and find access to support and life saving care. This Centre has been operating since 2003.
I was inspired by her story of the early days when she operated the hotel that catered for some of the most marginalised people in the community. The project had a strong inclusion policy, did not exclude people from help and the emphasis was on creating a space where people could just ‘be’. It was not focussed on drugs, the level of the person’s drug use or drug using patterns – the main focus was on the person.
“Wherever you are right now, we accept.”
Between 1988 and 1998 there were 2413 deaths from heroin overdoses and the crisis peaked in 1998 when 413 people lost their lives to preventable deaths.
Strong advocacy and activism commenced and a conference ‘Out of Harm’s Way’ was held with international speakers encouraging new ways of thinking. Harm Reduction was added to create a four pillar drug strategy approach from the existing Prevention, Treatment and Enforcement with eventual support from all parties to introduce a safe space for people to inject drugs.
The drug users union, VANDU, were incredibly influential in this process and were given practical support to assist them to amplify their voices. The stories of family members who had lost loved ones also helped to highlight the need for change.
After 6 years of lobbying, Insite finally opened in 2003.
There was a huge sense of ownership of the service from drug users, mostly due to the fact that they had been heavily involved in the process.
Insite was heavily evaluated over the coming years and despite all of the positive evidence, the Federal Government battled to close the project but lost in a unanimous Supreme Court decision on September 30th, 2011.
You can view the video of the Insite story here.
The celebration of this success was not about celebrating drug use, but was about celebrating drug users and the rights of people who use drugs to be treated with dignity and respect. The message from this decision was clear;
“The sentence for being a drug user is no longer death”
Liz described Insite as so much more than just a place for people to inject. Families know it’s a safe place for their children. People feel welcome, cared for. Time and time again people say ‘the staff are so nice to me, it made me want to start caring more about myself and start to reduce my drug use.’
Following the presentation, questions were invited from the audience, which resulted in a great discussion about what needs to be done in Scotland.
One of the main pieces of advice was to try to open a site that provides many different services in addition to an injecting room, such as an inhalation facility, opiate replacement therapy and heroin assisted treatment.
Insite – the numbers;
- ZERO overdose deaths
- 2667 lives saved through overdose intervention (2003-2011)
- 2 million injections
- 3416 referrals to detox (residential treatment directly above Insite)
- 2047 estimated HIV infections averted
- $1.8 million estimated annual savings from the prevention of HIV infections alone
- 905 average number of visits to Insite each day
- 587 average number of daily injections
- 35% decrease in overdoses in the neighbourhood around Insite (9% in the city overall)
So the evidence is yet again clear, supervised injecting has no negative consequences.
In our efforts to reduce drug-related deaths and improve the lives of people who use drugs we need to utilise ALL evidenced-based strategies to produce positive outcomes.
You can find out more about Insite by viewing the HCLU film – Insite, Not Just Injecting, But Connecting here.