Fighting to Live: Vancouver’s Battle for Safe Injection Sites

We clearly still have a long way to go. How has the government responded to this upsurge? But there may be a solution. Of course, it’s sad that it took fentanyl reaching past the Downtown Eastside and into the wealthier suburbs for the government to become proactive, but at least they finally did respond. Vancouver’s Downtown Eastside is a neighborhood with a high concentration of victims: victims of child abuse, neglect, poverty, racism, sexual violence, colonialism. JULY 11, 2018

WHEN 25-YEAR-OLD Liz Evans took over management of the Portland Hotel in the Downtown Eastside area of Vancouver, British Columbia, in 1991, she was determined to treat residents with compassion and respect. Why do you think Europe is more willing to see addiction as an issue of public health rather than as a criminal matter? “The entire hotel was hers to run as she saw fit,” writes journalist Travis Lupick in Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction (Arsenal Pulp Press); tasks ranged from fixing broken locks to caring for people in the throes of an overdose. Whenever we talk about drug use, we should take a step back and ask what caused this person to use drugs in the first place. European lawmakers listen to their scientists, so when evidence says that prescription heroin and supervised injection sites save lives, they set policy and create social programs that follow these recommendations. Hydromorphone, better known as Dilaudid, is an opioid that is readily available in both the United States and Canada, and many users say that its effect is indistinguishable from heroin. There are literally piles of studies showing that punitive responses to addiction are actually more likely to increase drug use. Bader’s work frequently appears in, Lilith Magazine and blog,, Kirkus Reviews, and Rewire.News. At the same time, it’s great that the public has recognized that users are not just hanging out on street corners, but are bankers, lawyers, and corporate executives. ¤
ELEANOR J. Then, in 2011, fentanyl arrived. But the book is not just the story of one woman’s hard work and dogged persistence. It’s an amazing, inspiring, and sometimes-harrowing read. Last year, there were 1,436 fatal overdoses in British Columbia, many in the Downtown Eastside. People like Liz Evans recognized that early and helped others see it as well. They did test runs. In addition to the fact that the drug is clean, access provides security. The people I wrote about were extremely strategic and tactically conscious. Some people even reentered the workforce after just a few weeks on Dilaudid, which is remarkable. How did they maintain their political independence? “It was absolutely, completely overwhelming,” Evans told Lupick. The organizers you showcase were really strategic and were never co-opted, even when they served on government decision-making bodies. It leads to relapse. For the first few years after fentanyl — and then the even more dangerous carfentanil — arrived in British Columbia, the government did little in response so activists set up illegal injection sites so that they could administer naloxone to revive people who overdosed. Vancouver began a small prescription heroin program in 2014, with between 90 and 100 people enrolled. In 1998, there were 400 fatal drug overdoses in British Columbia. People use drugs because of this victimization, so responding by punishing them with arrest or incarceration only further victimizes them; it’s terrible public policy. It stayed at this level for nearly a decade. About 15 additional injection sites are now scattered in other parts of the country. Nonetheless, Evans and her co-workers at the hotel got the safe-injection ball rolling, and her efforts are lauded throughout Fighting for Space. Although the government is looking to change the law to make heroin easier to procure, it takes a long time for legislative change to happen. During the crack epidemic when most users were African American, government officials introduced mandatory minimums and called dealers “super predators.” Now that the crisis has extended into white, middle-class communities, we’ve started talking about compassionate treatment for people who use, so it’s a problematic change that’s tangled in racism. I’m hopeful that we can we use this opening to discuss the futility of the War on Drugs and create policies that are humane, just, and effective. Fighting for Space also talks about why people use drugs and addresses the underlying psychological issues that need to be addressed before sobriety can be achieved and maintained. British Columbia’s government has recognized its success, but the program has hit a wall because it is illegal to produce heroin in Canada. Furthermore, they always made sure that their facts were accurate, not hyperbolic. The crisis today is over-and-above the previous crisis that Vancouver went through in the 1990s. No. TRAVIS LUPICK: A lot of Europe’s success in responding to addiction has been a result of their willingness to base social policy on evidence. Now that Insite is open, and supervised injection sites are operating in other provinces, has the situation for IV drug users improved? By 2004, after the injection site had opened, the number went down by half, to about 200. Every study confirms that incarceration does not lead to recovery. Have treatment programs begun to address abuse and other “hurts”? BADER: One of the things that struck me when reading Fighting for Space was the difference between Europe and North America in terms of how addicts and addiction are treated. People who use it no longer have to spend 60 hours a week panhandling or shoplifting for necessities. It was her vision that concluded that no one should ever lose their home because of drug use or risky behavior. There is now one clinic that imports heroin from Europe and the process is cumbersome and bureaucratic. ¤
Eleanor J. Lupick recently spoke to me about the book and the ongoing and worsening opioid crisis in the United States and Canada. A police chief from Europe, who understood how a supervised injection site reduced crime rates, would often be chosen over an activist from the Downtown Eastside, for example. We need to speak about compassion and treatment and recognize that treatment should never begin with the penal system. Sadly, things are now worse than ever. In just five days, they set up 15 overdose prevention sites throughout Vancouver, demonstrating that such facilities can be deployed quickly and cheaply. Now, doctors in Canada are beginning to prescribe the drug in an off-label capacity for the management of addiction. Canadians and Americans tend to view drug users in ways that are stigmatizing and often racist. Even when Insite, North America’s first supervised injection site, opened in September 2003, the Vancouver Area Network of Drug Users (VANDU) and the others who had pushed for it for more than a decade, never completely trusted that the government wouldn’t shut it down. What else do you think the government should be doing? In addition, the risks the activists took were very real and while Vancouver now pats itself on the back for its enlightened policies on addiction, in the 1990s, when these folks were organizing campaign after campaign, they never knew when or if they’d be arrested or thrown in jail. The sites provide people with clean needles and naloxone is on hand. Vancouver’s regional health authority now tends to take credit for Canada’s wider adoption of harm reduction. On a set dose, taken three times a day, I’ve witnessed people’s lives transform. Finally, in the winter of 2016, the provincial government in British Columbia listened to the activists and decided not to wait for Canada’s federal government to act. Singer Justin Townes Earle, a recovering heroin addict, has said that we should not ask addicts why they use, but should ask why they hurt. It also addresses Vancouver’s burgeoning IV drug crisis and zeroes in on the evolution of harm reduction — the provision of clean needles, supervised injection sites, and material support for drug users — and chronicles the groundswell of activism that arose to support these efforts. Part social history and part community organizing manual, Fighting for Space details the decade-long fight to establish North America’s first medically managed site for injection drug users. If they wanted to shout about the need for supervised injection sites, they made sure that their spokesperson was authoritative, someone people would listen to. They do deserve some credit, but we have to remember that they went along with the activists slowly and sometimes kicking and screaming. If they were holding a demonstration they would be sure that the site had a visible staging area that the press could film. Evans ended up leaving Vancouver after she and her husband were suspected of fiscal improprieties, and the book addresses how this unfolded in great detail. We demonize drug users. Bader is a Brooklyn, New York­–based teacher at Kingsborough Community College and freelance journalist. Long dubbed a “home of last resort,” the single-room-occupancy hotel was a dumping ground for society’s least respected: drug addicts, sex workers, the mentally ill, and the physically disabled. If our actual goal is treatment and recovery — like we say it is — lawmakers need to look at evidence. Do you think negative public attitudes toward addiction have begun to change? Another factor was that the activists never fully trusted the government. And although she and her husband were ultimately suspected of fiscal impropriety, it was her vision that got the ball rolling and helped people see drug addiction as a matter of public health.