Vancouver's Radical Approach to Drugs: Let Junkies Be Junkies

By Vince Beiser, Miller-McCune Magazine. Posted November 18, 2008.

The critique of harm reduction best supported by actual evidence is that it doesn't do enough.

"The harm reduction approach within the UK appears to have had only modest success in reducing the breadth of drug-related harms," University of Glasgow researcher Neil McKeganey wrote in a recent overview published in the journal Addiction Research & Theory. "Despite a plethora of initiatives aimed at increasing drug (injectors') awareness of the risks of needle and syringe sharing, and of providing drug users with access to sterile injecting equipment, around a third of injectors are still sharing injecting equipment."

That's a weighty objection to Insite, considering the facility costs $3 million a year to operate. On a typical day, only about 5 percent of all injections in the Downtown East Side are done in the facility's relative safety, according to the federal government's study. I found discarded syringes in the alley right behind Insite.

Creating a safe place to shoot up may make good sense, but that's not necessarily relevant to people whose cravings regularly trump their judgment. Watching Liane Gladue, a longtime junkie, searching for a vein under a streetlight in a Downtown East Side alley, I asked why she didn't go instead to the injection site just a few blocks away. "It's too crowded in there," she answered. "I didn't want to wait."

Though Vancouver is cutting the collateral damage caused by hard drugs, the city is making far less progress in reducing the number of users. Surveys report that drug use is higher in British Columbia than in the rest of Canada. A recent poll found that almost half of all Vancouverites consider drugs a major problem in their communities -- a figure double that for residents of Canada's biggest cities, Toronto and Montreal.

With serious drug users come rip-offs, break-ins and holdups for fix money. So it's no surprise that Vancouver's property crime and bank robbery rates are higher than most of Canada's. The city also has more gun-related crimes per capita than any other in the nation, a fact at least one criminologist has linked to the number of substance abusers.

All of this underscores why widespread drug addiction is ultimately everybody's problem. Obviously, getting street addicts to clean up takes more than free needles. It takes affordable housing, mental health services, counseling and treatment, all of which are in short supply, even in Vancouver. For some addicts, it might also take the threat of jail.

But it doesn't have to be an either/or choice. As the American Medical Association states in its official position on the issue, "Harm reduction can coexist, and is not incompatible, with a goal of abstinence for a drug-dependent person, or a policy of 'zero-tolerance' for society."

Advocating anything that sounds "soft on drugs" is generally considered political suicide for elected officials in most parts of the U.S. But as Vancouver has proved, a coalition of health care officials, activists and courageous politicians armed with solid data can change that equation. "No one in the U.S. wants to touch this stuff because they're afraid they won't get elected if they do," says Philip Owen, Vancouver's former mayor. "Well, I was re-elected three times."

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Vince Beiser is a Miller-McCune contributing editor based in Los Angeles. He has hunted down stories from the Balkans to the Middle East on assignments for Harper's, Wired, The Los Angeles Times Magazine, The Village Voice, The New Republic, The Nation and Rolling Stone.

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