One of the simplest ways to describe North America’s first supervised-injection facility, Vancouver’s Insite, is to say that it brought people out of the alleys.
Marginalized people who were previously forced to inject drugs in hiding, where sometimes only filthy puddle water was available, were given a safe space, clean supplies, and the caring supervision of a nurse.
But due to federal drug laws, Insite was forced to leave some of Vancouver’s most marginalized drug users outside: Insite has never allowed assisted injection. And so, for the 15 years since Insite opened in 2003, anyone who cannot inject themselves—people with physical disabilities, for example—have never been allowed to utilize the supervised space.
Finally, that might change. This month, Health Canada initiated a trial that allows six supervised-injection facilities to make assisted injection available. However, none of these sites are in B.C. (Although six are allowed, only three have begun offering the service.)
In a telephone interview, Michelle Boudreau, director general of Health Canada’s controlled-substances directorate, described the experiment as a response to a gap in harm-reduction services deployed thus far.
“The concern for us at Health Canada was that there was perhaps a population that was not accessing the services provided at supervised-consumption sites,” she told the Straight by phone. “We want to ensure that this service is there for all people who use drugs.”
The three locations currently offering assisted injection are ARCHES in Lethbridge, Alberta, and the Fred Victor Centre and South Riverdale Community Health Centre, both in Toronto.
According to Boudreau, the trial should conclude this December. Decisions on whether to make assisted injection available at other locations will follow shortly after.
"The type of people who could benefit are women, primarily," she added. "It's been shown in the literature that this can be quite a gendered issue."
Insite’s operator, PHS Community Services Society, and its funder, Vancouver Coastal Health, both declined to grant interviews on assisted injection.
Ronnie Grigg is general manager of the Overdose Prevention Society’s overdose-prevention site (OPS) on the unit block of East Hastings Street; he previously worked at Insite for nine years as the facility’s night-shift coordinator. In a telephone interview, he explained the need for assisted injection, an echoed Boudreau's focus on women.
“Some people have a variety of challenges finding a vein. They might have tiny veins or they might have large veins that roll,” Grigg told the Straight. “One of the most consistently marginalized groups that might need this kind of support is young women.
“Often when young women are injecting, they are injected by their partner,” he continued. “That can create power dynamics around dependency for that individual. And that can create vulnerabilities, such as around quantities of drugs injected. If the dynamics of that relationship are negative, it can frequently become abusive.”
Where assisted injection is offered, young women can be freed from such relationships and given a greater degree of power over their drug use and addiction, Grigg said.
According to Health Canada, Insite can apply for an exemption that would allow assisted injection but, so far, neither Insite nor any government-sanctioned injection site in B.C. has done that.
Grigg praised Insite for the harm-reduction services it does offer but added there are shortcomings.
"Doing an injection safely is an important part of disease management. So, obviously, using a clean rig is a fundamental. Safe-injection practices also involve having the site clean, having the bevel up, locating a vein, rotating your veins, and things like that. That's what Insite has been able to help with. That sort of basic harm reduction," Grigg explained. "But one of our limitations at Insite has been that we [staff] can't pierce the skin. We can't flag the needle and we can't plunge the injection."
Grigg said that has left some drug users out in the alleys.
As a supervised-injection site, Insite requires an exemption from federal drug laws. As an overdose-prevention site, the Overdose Prevention Society does not. Health Canada told the Straight that B.C.’s overdose-prevention sites are therefore free to offer assisted injection. OPS director Sarah Blyth confirmed assisted injection happens there. “We generally do whatever it takes to make sure that people receive the best care and the least harm,” she said. At an OPS, individual staff members are not required to perform assisted injection but can if they feel comfortable doing so. Assisted injection can also occur between two clients.
In August 2017, Marilou Gagnon, president of the Harm Reduction Nurses Association and an associate professor at the University of Victoria, published an essay in the Canadian Medical Association Journal that noted the portion of intravenous-drug users who require assisted injection is estimated at between 25 percent and 50 percent.
“Why is this important?” she asked. “It comes down to discrimination. Supervised injection as a service needs to be available to everyone.”
Gagnon, a registered nurse who recently relocated to UVic from the University of Ottawa, told the Straight that assisted injection aligns with a central tenant of harm reduction: meeting people where they're at.
"For a lot of people, we're creating barriers for them to access a service," she said. "Even putting them in a situation where they are at increased risks of complications.
"The bottom line is that everyone should be able to safely inject," Gagnon maintained.