This is the second part in a series about safe drug consumption spaces. Part 1, which focuses on the Insite safe-injection site in Vancouver, B.C., is here.

The need for safer spaces for people to consume drugs in Vancouver, as in Seattle, is undeniable. Insite manager Darwin Fisher, who walked me around the Downtown Eastside neighborhood during my recent trip to Vancouver, estimates that there are about 5,000 active intravenous drug users in the city, and a huge percentage of them live in the few blocks surrounding the Insite building. As we emerge from Insite onto the street, Fisher is bombarded with comments and requests—why is the community garden fenced-off so no one can get in? Can I have a cigarette? When can I talk about getting my Insite privileges back?—from clients and others hanging out in the area.

Fisher says it’s actually that sense of community—his awareness that, as fucked-up and dysfunctional the Downtown Eastside might be, people know each other and have each others’ backs—that keeps him in the area, more than two decades after he landed here as a wide-eyed kid from Saskatoon in the early ’90s. “There’s this incredibly moving thing about people knowing each other,” he says. “You work down here for a while and you get to know some of the people… There’s almost an old-fashioned idea of, ‘Hey, neighbor!’ Not to sugar-coat that or anything, but that’s really important.

“The demonization of this community, and of other communities like the tent city [in Victoria, B.C.], is why I think it’s really important to do recognize them as a community.”

Most people (though certainly not all) would agree that saving drug users from dying is a positive thing. But overdose reversals aside, do safe-injection sites work? That is, do they improve life for more people than doing nothing?

That’s a tough question, because the answers depend on what we consider “improvement.” For many North Americans, an addicted person isn’t “better” until they’ve achieved total abstinence—usually through a process that involves “hitting rock bottom,” often expedited by the “tough love” of neglect rather than the “coddling” of harm reduction. Once a person hits rock bottom, in this narrative, they can finally have a moment of clarity, followed by an epiphany which leads to a new commitment to living a clean and sober life. Since abstaining from drugs is so obviously what’s best for a former user, relapse becomes a personal failure. If you don’t stay clean, it’s because you didn’t want it enough—or you didn’t hit your “real” bottom yet.

This narrative is obviously problematic, not least of which because the ultimate “rock bottom” is death. (And as any addict will tell you, every bottom is really a trap floor concealing another bottom.) Besides, Fisher says that if you went around talking to the people we saw on our stroll around the Downtown Eastside of Vancouver, “they’d say, ‘Where’s rock bottom? I’m there.’ … And maybe I have a moment where I feel like, OK, I’m ready to wrestle this demon and start making better choices, and maybe I go to detox, and maybe, for a variety of reasons, it doesn’t take. What does it feel like then? You feel not like any systems have failed you—you feel like, once again, I am a failure. And if we think that addiction stems from anguish, from pain, from feelings of rejection and failure, what would I want to do when I felt that way? I think I would like to numb it.”

From a public-health perspective, Insite works. More than two dozen peer-reviewed studies have concluded that Insite prevents 35 new cases of HIV each year (saving more than $6 million), has decreased the fatal overdose rate in its immediate vicinity by 35 percent, has led to dramatic decreases in risky needle use and disposal practices, and has led to 30 percent more people seeking detox services, in many cases the first step on the road to recovery. (Insite offers detox in its Onsite facility upstairs from the injection site, and helps users get into long-term treatment programs).

Matt Curtis of the harm-reduction group VOCAL-NY, the forerunner to Seattle-based VOCAL-WA, told me recently that “offering people care and love and respect and dignity is a very different experience than what you’re kind of told day in and day out [as a drug user], which is that that you’re a mindless zombie with no personal agency, a criminal, a threat to society and children—that you’re so bad you might be contagious.”

When cities adopt a different approach, acknowledging that people “fail” at abstinence all the time and that drug users aren’t bad or weak or morally inferior, people’s lives generally start to improve whether they stop using or not. Whether or not a person decides they want to stop using is their business, but in the meantime, harm reduction programs like Insite provide access to services like housing, detox, mental-health counseling, and treatment, some of which drug users may need to have just to get stable before they can start dealing with their substance use. And then, when that happens, they need treatment to actually be available.

“I think it’s important  that supervised consumption spaces are not discussed in a vacuum,” Patricia Sully, the coordinator for the harm-reduction group VOCAL-WA, says. “These are not the tree that grew up to heaven and fixed all the problems; this is one tiny thing that really needs to operate in a continuum and spectrum of care. … Drug treatment itself might not be the only thing people need. Many people need connections to mental health services. Many people need connections to housing. And we know that all of those things really make a huge impact on someone’s quality of life.”

Curtis says that in his experience, “people come into harm reduction programs after hearing for years that they’re nothing but junkies or crackheads, that it’s their own failures that have kept them addicted, and a lot of times, they immediately start using less.” Unfortunately, Curtis told me, many people see harm reduction as merely “‘Meet people where they’re at.’ That’s not the motto. The motto is, ‘Meet people where they’re at and don’t leave them there.’”

The rest of this series on safe consumption spaces will focus on what a safe consumption space might look like in Seattle, and why advocates are arguing for a space consumption space for all drugs, not just heroin.