In the United States, there's perennial controversy surrounding harm-reduction programs -- the idea that governments should try to mitigate the dangers of certain behaviors, even if those behaviors are inherently risky. Free condoms may reduce teen pregnancies, but critics argue that they encourage more kids to have sex. Needle-exchange programs might decrease drug addicts' risk of contracting HIV and other diseases, but opponents say they're a government-approved greenlight to shoot up.
In Canada, there's one public health facility that makes the debate over needle exchanges seem quaint. This year marks the 10th anniversary of a government-run facility in Vancouver that provides drug addicts a safe place to use heroin, cocaine and other illegal substances under the supervision of medical professionals. The facility, called Insite, is located in Vancouver's Downtown Eastside, one of the poorest parts of Canada. Funded by the British Columbia Ministry of Health, Insite is run by Vancouver Coastal Health, the regional health authority, in conjunction with the Portland Hotel Society, a nonprofit serving people with mental health and addiction issues. It was opened largely in response to rising HIV rates among intravenous drug users that were approaching developing-world levels.
The inside of the facility is simple, clean and well-lit, something like a cross between a test-taking facility and a dentist's waiting room. There's a central nurses desk and 12 booths where visitors can inject themselves. The facility doesn't provide illegal substances, but it does give drug users clean syringes, filters, tourniquets and other paraphernalia. Nurses and doctors don't inject the drugs, but they closely monitor visitors while they do. In 2010, the most recent year for which statistics are available, more than 12,000 people made 312,000 visits to the facility. There's typically a line to get in before the site opens its doors at 10 a.m.
Read Governing's first-ever International Issue.
Safe injection sites have been around for a couple decades, mostly in Europe. But for years they operated largely in a legal gray area -- funded perhaps by local health authorities and ignored by police, but lacking outright legal approval. In the past 10 years, that's begun to change. Starting around 2000, countries including Germany, Norway and Spain began granting full legal sanctions to safe injection sites. Today there are roughly 90 such facilities in Europe and Australia.
Insite has been controversial; Prime Minister Stephen Harper is a critic. There have been repeated efforts to shut it down. In 2011, however, a Canadian Supreme Court ruling essentially cleared all of the legal hurdles facing the facility.
Officials describe Insite as the "first rung on the ladder" from chronic drug addiction to recovery. Once drug users enter the facility, they may be likelier to take advantage of counseling, housing assistance, addiction services and mental health treatment -- all of which Insite staff helps to arrange. No users have ever died at Insite, and in 2010 the staff helped intervene in 221 overdoses. "These are marginalized people," says Anna Marie D'Angelo of Vancouver Coastal Health. About half the patrons are homeless, living in shelters or suffering from untreated mental health conditions. "They've been disconnected from society in lots of ways for many years. The idea is to slowly build up their trust."