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

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

That's more or less official policy. "If you look at an addicted drug user, who likely has a mental illness, you have to ask, 'What's the best bang for our buck?'" says Inspector Scott Thompson, the Vancouver Police Department's drug policy coordinator. "If we lock them up, it costs between $75,000 and $90,000 per year. By dealing with it as a health issue, we'll save a lot of money and hopefully solve more problems." The department focuses instead on traffickers and producers, he says.

Efforts to keep drug use as healthy as possible are everywhere in the Downtown East Side. Free needles, tourniquets and clean crack-pipe mouthpieces are available in soup kitchens and clinics on practically every block. Blue metal syringe disposal boxes are installed at alley entrances.

The supervised injection site is the most visible and controversial of these measures. Opened in late 2003, it's a newer and much-less-tested tactic than needle exchange. So far, a flock of peer-reviewed studies has found the program has not led to increased crime or drug use in the area. Last March, a report commissioned by the Canadian federal government concluded that "(t)here was no evidence of increases in drug-related loitering, drug dealing or petty crime in areas around Insite (and) police data for the (Downtown East Side) and surrounding areas showed no changes in rates of crime." Moreover, the report noted, "(T)here is no evidence that (supervised injection sites) influence rates of drug use in the community or increase relapse rates among injection drug users."

In short, Insite is not making things worse. But is it making anything better? Studies indicate that Insite has reduced needle sharing, one of the major transmission routes for HIV. But Colin Mangham, a researcher with the Drug Prevention Network of Canada, points out that much of the data is based on injection drug users' reporting of their own behavior -- not exactly the gold standard of credibility.

The facility is, however, clearly saving at least some lives. Its staff has intervened in more than 336 potential overdoses. Rico Machado, a surprisingly healthy-looking heroin addict whom I met in Insite's check-in area, was one of those cases. "I did my normal dose, but this stuff was too strong," he says. "I hit the ground. But they gave me Narcan (a drug that reverses opiate overdoses) and resuscitated me. Before this place was open, I would have been in an alley. I would have been dead."

Moreover, Insite has provided a gateway into detox programs for a number of addicts and served as an immunization center during a recent pneumonia outbreak. The site has even added a small residential rehab facility.

A couple of blocks away, a small clinic is stashed behind papered-over windows on the ground floor of an unmarked, 1930s-era building. Here, every day for three years, nurses behind bulletproof glass handed dozens of addicts a tourniquet, a needle, an alcohol swab and a carefully measured dose of pure heroin.

The theory being tested in this program, which wound up its pilot phase in August, was that it would keep junkies from having to steal or prostitute themselves for their fixes. As a side benefit, they would have more time and energy to take advantage of the program's treatment component.

Official results were slated to be released in October, after this story was published. Dr. David Marsh, the program's medical director, says he's already seen its participants benefit. "They're eating better, getting their health problems dealt with, getting into better housing," he says. "Some are even going back to work. One guy started out homeless, got clean and now runs a business with 15 employees."

Much of what Vancouver is doing is already long-standing policy in many countries, especially in Europe. Methadone and needle-exchange programs are commonplace in many nations. Six European countries and Australia are home to dozens of supervised injection sites. Holland, Denmark, Switzerland, Germany and Spain have experimented with heroin maintenance. Even Iran, of all places, recently launched a pilot program to distribute clean needles through vending machines.

In the United States, however, conservative politics and "Drug-Free America" rhetoric keep punishment as the primary response to drug use. Mandatory minimum sentencing and "three strikes" laws have sent the number of drug offenders in America's prisons skyrocketing. There are more than half a million inmates currently locked up on narcotics charges -- more than the total of all prisoners in 1980. Each of those prisoners costs taxpayers on average more than $22,000 per year, according to the federal Bureau of Justice Statistics -- several times the price of providing them with treatment.

The U.S. doesn't seem to be gaining much from the billions of dollars it invests in incarcerating drug offenders. Perhaps the decades-long "War on Drugs" has kept illicit substance use from growing, but it certainly hasn't done anything to reduce it. The most recent annual survey of drug use by the University of Michigan found that about 85 percent of 12th-graders in America say marijuana is easy to get. Almost 1 in 3 of those teenagers has smoked up in the past year, a number that has not changed much over the last 30 years.

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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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