Safe Space, Part 1: A Haven for Drug Users in Vancouver

Through Tuesday, Seattle will be host to a series of installations in public parks across the downtown area—from Occidental Park in Pioneer Square to Victor Steinbrueck Park in Belltown—to raise awareness of the need for a safe drug consumption spaces in the city. Called “Safe Shape,” the traveling 10-by-10-by-10-foot exhibit is a mocked-up safe consumption space designed to give people a better idea of what safe consumption might look like in Seattle. Hosted in Seattle by the harm-reduction group VOCAL-WA, the exhibit will be in town from July 14 to July 20.

The idea that drug users deserve safer spaces to consume illegal drugs is rooted in the notion of harm reduction, which is based on the hard-to-refute premise that you can’t get better if you’re dead. It’s the principle behind “wet housing” for chronic alcoholics like 1811 Eastlake in Seattle, like the needle-exchange programs that sprouted across the country during the AIDS epidemic, and like the Canadian safe-injection program Insite, where injection-drug users can use in a nonjudgmental, safe, clean environment.

Harm reduction opponents are abundant in Seattle, where concerns about increasing density in suburban-style single-family neighborhoods have collided with a spike in minor property and nuisance crimes to create a wave of neighborhood opposition to any measures that might be seen as “coddling” or “enabling” drug and alcohol users whose addictions spill into the public realm. (Housed people abuse drugs and alcohol, of course, but homeless people’s use has consequences that are visible to the rest of us, so neighbors’ solution to their visibility is often to lock them up or “force them into treatment” while letting housed addicts’ similar transgressions slide.)

As the heroin epidemic has hit home in recent years, though, some policymakers and middle-class Seattle residents have started to come around to the idea of safe injection sites—places where heroin users (and users of other drugs that can be injected, like cocaine) can come to shoot up out of view, and get access to other services if they want them. Giving drug users a place to consume drugs indoors, with access to services like treatment and medical care, is gaining acceptances as a solution not just for drug users but for property owners alarmed by syringes in their parks and homeless people overdosing in their alleys. (Both are far less prevalent than you’d think if your only source of news was Facebook or Nextdoor, but even one high-profile death a year can help convince a recalcitrant neighborhood that something should be done.)

Not too long ago—a little more than a decade—the idea of safe injection spaces for heroin users seemed like a political stretch, the kind of far-fetched idea that only worked in Europe, where dozens of safe-injection and -consumption spaces have opened since the mid-1980s. Our own version of Europe, Canada, has just one safe-injection site, and that’s where I traveled on a recent weekend to find out what safe injection looked like in practice.

Via Youtube.

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via Youtube.

The Insite supervised-injection facility, tucked next to a community garden slated for redevelopment in a gritty block in Vancouver’s downtown Eastside, was founded in 2003 by Liz Evans, a public-health nurse who came to Vancouver in the 1990s and started working at a rundown building called the Portland Hotel, where she estimates that 98 percent of the residents were injection drug users.  As Evans explained it at a VOCAL-WA meeting during a recent trip to Seattle, “we were called ‘four blocks of hell,’ a ghetto, a slum, or skid row.”

Despite initial opposition, Evans says the neighborhood and business groups that initially opposed providing a safe haven for drug addicts ended up being Insite’s biggest boosters, for a simple reason: “They were actually the ones most impacted by the drug use.” Since Insite opened more than a decade ago, Evans says public support has grown from just over a third to more than 75 percent, as the neighborhood “didn’t see any adverse changes in community drug use patterns, nor … people starting to use drugs as a result of Insite.” The public health system saves about $6 million a year because of Insite, Evans says, and the rate of fatal overdoses in the neighborhood has gone down by about a third.

If you want to visit Insite by foot, you have to navigate your way through a neighborhood full of the people Evans says are derisively described as “junkies, zombies, and the walking dead”: Addicts shooting drugs into each other’s necks in alleys, amped-up dudes asking intensely for cigarettes, young, hard-up looking kids aimlessly riding BMX bikes in circles. There are three flea markets here where residents of the neighborhood’s many rundown hotels hawk DVDs, backpacks, and off-brand tubes of Cortisol, and a chained-off garden where Insite holds memorials for addicts who die from overdoses and other causes. (Evans says no one has ever died of an overdose inside the facility itself.) The corner of East Hastings and Main doesn’t strike me as especially sketchy by big-city standards, but perceptions vary: There’s definitely nothing like it in Seattle, and to folks who call 911 when they see a person taking a leak or drinking from a paper bag at the Ballard Commons,  Vancouver’s downtown Eastside would probably look like a Boschian hellscape.

Insite manager Darwin Fisher, my tour guide during a walk through the area, tells me the neighborhood used to be the seat of government and commerce in Vancouver, until everything—city hall, the stock exchange, the central library—moved further west in the postwar era, leaving hotels with names like the Ballmoral, the Orwell, and the Savoy to be carved up into single-room-occupancy (SRO) apartments for itinerant workers from the nearby canneries and stockyards, “down-and-outers,” and pensioners on fixed incomes. Men frequented the pubs in the basements of the old hotels, got haircuts at the many corner barber shops, and helped create what Fisher calls “a very vibrant, bustling neighborhood core of working-class adults.”

The neighborhood always included some opiate users—”it’s a port city, after all,” Fisher says—but saw a major influx of heroin addicts in the ’70s and ’80s, when rooming houses in the city’s now-chichi West End were torn down to make way for new development and displaced drug users and prostitutes started moving to the area where Insite is today.  In the 1980s, residents organized for better conditions in the SROs, which hadn’t been renovated in decades, holding annual “cockroach races” in the lobby of a chosen hotel and inviting the media to observe.

The SROs were eventually brought up to code, and in some case purchased by the provincial government to be run as rent-stabilized public housing.  (Private SROs still exist, and they can charge whatever they want; Fisher says you can tell which hotels are private based on whether they still have a bar on the ground floor.) In the meantime, low-income residents continued to be pushed into the lower Eastside by development and concerted efforts by the city government to “clean up” other neighborhoods, including the elimination of a red-light district that helped push prostitution more dangerously underground. In the 1990s, drug users began to organize on their own behalf, as harm reduction gained traction as a counter to the prevailing “tough-love” policies of the ’80s. Fisher says those policies told substance users, “‘It’s your fault, what the fuck, why can’t you look after yourself, these are poor moral choices,'” and led to a culture where services were contingent on abstinence from drugs and alcohol—where, as Fisher puts it, “you don’t gain humanity until you’re engaged in an abstinence-based program.”

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via Youtube.

And we all know how that turned out. Today, the Downtown Eastside represents a concentration of poverty and drug use with no equivalent in Seattle, the place where “illicit activity tends to happen,” and where pensioners drinking nickel beers in rundown but beloved pubs gave way to “the shirtless guy flailing around who’s been up for three days,” as Fisher puts it. 

Insite stepped into that fray in 2003 and has been there ever since.

What struck me immediately when I walked into Insite for the first time was that it’s smaller, physically, than all the photos I’d seen in the press (from CNN to the New York Times) had led me to believe. Inside the glass door at 139 E. Hastings St. is a compact, horseshoe-shaped facility that consists of a small waiting area where clients hang out waiting to hear their name called; a 13-booth injection room where users shoot up under the watchful eyes of staff who monitor to make sure they’re safe from a respectful distance; a small, cluttered treatment room and even smaller single office; and a “chill-out lounge” in which Morrissey’s “How Soon is Now?” (“I am human and I need to be loved, just like everybody else does”—I couldn’t make that one up) was playing on the speaker system when I visited. There’s also an upstairs detox unit, called Onsite, with 12 private rooms.

Fisher walks me through the admission process as if I was a first-time Insite client. First, a casually-dressed staffer asks each new client why she’s here, and gets a little information about their health and drug-use history. There’s no security guard, no plexiglass, and no ID requirement, all hurdles associated with clinics and the bureaucratic inhumanity of the welfare system. Next, someone calls her into an office and finds out what services she’s looking for to assess whether she’s in the right place. (As a healthy person with no obvious signs of injection-drug use, I probably would have raised eyebrows, much like a young woman who came to Insite once seeking to kill herself with heroin. As she pulled out her packets of drugs and asked Fisher whether “this is enough to kill me,” he recounts, he calmly left the room to “get us both some water” and not-so-calmly dialed 911.)

At Insite, staffers talk to clients like a family doctor might, without the clackety-clacking distraction of a keyboard, with the goal of making clients comfortable. Other agencies that deal with drug users may “assume you’re implicitly violent because you’re a drug user and not recognize the fact that, hey, when we’re in pain and when we’re under stress, we yell and we’re impatient,” Fisher says. “Just recognizing the nature of what people struggle with in this community, that ‘fuck’ isn’t necessarily a word that makes you start getting alarmed, means that you’re understanding up front.”

(Despite those cautionary measures, someone did have to “call a pink”—dial 911—on a client while I was visiting; paramedics swooped in and took the man, who was shaking and yelling in the “chill out room,”  to a nearby psych ward.)

After getting into the system and choosing a code name (mine was my middle name followed by a two-digit number), new clients go back into the waiting room until their names are called. Fisher estimates that Insite loses about a quarter of people in the waiting area at any given time “due to wait,” meaning that they couldn’t stand sitting around any longer and left to use in a nearby alley. “It may only be an average of seven minutes, but when you’re in withdrawals—the word I hear most frequently to describe the feeling is ‘despair’—seven minutes can feel like an eternity.”

Once a client’s name is called, a staffer escorts her through a locked door into the injection room, where another staffer takes her code name—”The House,” “Shakey,” and “Duly” passed through in the first few minutes of my visit—and notes what drug  or combination of drugs she’s using, coded with names like  “down” (heroin) or “up” (meth) in the computer. The client is then assigned a booth, where she can spend as long as she as it takes to to find a vein, fix, and do whatever else she needs to do. Fisher pointed out that many of the women who visit Insite are sex workers, and use the huge lighted mirrors to do their makeup and fix their hair; the mirrors also allow Insite staffers to walk up behind clients without surprising them, and to monitor them for signs of an overdose. Insite sees about 20 to 30 overdoses each month, and reverses them either by administering oxygen (used in about 70 percent of overdoses) or by giving the overdose victim a dose of naloxone, which reverses the effect of opiates and gets them breathing again.

Although much of what goes on there is undeniably grim—while I was sitting at the front desk talking to Fisher, a client struggled to find a working vein in his foot—the overall vibe in the injection room is almost peaceful. Van Morrison plays over the speakers, prompting Fisher to recall that “one time, a song from “Astral Weeks” played for three hours and nobody noticed.” Despite the clinical setting, the place does have an “Astral Weeks” kind of vibe.

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Across a narrow passageway from the injection room is a tiny exam room, where nurses can answer questions about routine health care, give pregnancy tests and diagnose STIs, and perform first aid on the abscesses and wounds that are common for long-term drug users, especially those who must do their business in dirty alleys. As Fisher is telling me about the importance of having sinks and running water, I notice that the screensaver on the computer where patients’ charts are stored is a striking pattern; on inspection, it turns out to be an artfully arranged set of needles of varying gauges, with the points meeting in the middle. This is also where Insite stores its suboxone and oxygen masks, and where clients can learn about Onsite, the upstairs detox facility, which is always at capacity.

Outside in the chillout room, where a top-hat-wearing client named Doug rhythmically sweeps the floor (Insite hires clients, called “peers,” to help create a sense of community), I ask Fisher whether Insite has any plans to expand. He acknowledges that with “maybe 5,000 intravenous drug users in the local area, 13 booths is kind of problematic,” but says despite Insite’s success, funding and public acceptance will always be a challenge.

“I think at this point there is the will to expand, it’s just that whether that expansion will be tied to existing services or another standalone site is hard to say,” Fisher says. This debate is certain to be duplicated in Seattle, where city and county officials are already debating whether safe-injection sites should be proposed as part of existing health clinics, or whether they should be freestanding facilities like Insite—and whether there should be many or just one.

In the rest of this series, I’ll talk about the evidence that supports safe injection sites; the challenges facing safe-injection proponents here in Seattle; and the radical-seeming leap from supervised injection to supervised consumption of all drugs, including those that don’t impact the children of the wealthy and influential, like crack cocaine and meth.