On the weekend of November 22nd to 24th, Canadian Students for Sensible Drug Policy held its annual National Conference in Vancouver.
I arrived late Friday night and the first event I attended was a guided tour of InSite, North America’s first and only legally-sanctioned supervised injection site, early Saturday morning. The tour was led by Darwin Fisher, who works at the facility. He described the history of InSite and its day-to-day routine. InSite is located in the Downtown Eastside of Vancouver, which is famous for containing an exceptionally-high concentration of hardcore drug addicts. In the past, the neighbourhood had been a rooming area for many seasonal workers and contained a large number of hotels that offered small and inexpensive single rooms. As Vancouver’s housing market surged and it became an attractive city on an international level, the Downtown Eastside became the only place that people with little means could afford to live in. This, in addition to Vancouver’s status as an international port city, and a long history of opiate use, led the Downtown Eastside on the path to its current state.
InSite itself is a simple-looking facility that you wouldn’t glance at twice if passing it on the street. Facility workers welcome in clients at the door and lead them to one of twenty or so booths where they are provided with clean works so they can shoot themselves up. The booths are open so that workers can monitor clients non-intrusively. In the case of overdoses – which occur often enough – the clients can immediately be resuscitated with naloxone. In over ten years of being open, not a single client has ever died at InSite.
After the InSite tour, I headed to Simon Fraser University where the conference was being held. The first speaker was Liz Evans, executive director of the Portland Hotel Society. PHS is a community organization whose primary mandate is to find housing for residents of the Downtown Eastside, and to otherwise work to improve their quality of life. It is the organization that runs InSite. In her speech, Evans described how much dedication had been put into opening a supervised injection facility and keeping it open. In the late 1990s and early 2000s, the rates of HIV infection and overdose deaths in the Downtown Eastside were exceptionally high. To combat this, drug users and their allies banded together to bring attention to the issue. Creative demonstrations were staged, such as the planting of a thousand crosses in a Vancouver park, each cross signifying a person who had died of an overdose in the Downtown Eastside in the past five years. This attention lead to InSite being opened in 2003, but the battle was far from over. Since the Conservative Party came to power, the federal government has been trying ceaselessly to have the site closed down. In 2011, InSite’s right to exist came before the Supreme Court of Canada. The unanimous decision: the site was to stay open. Evans’ presentation was incredibly inspiring and emotional, moving many in the audience to tears. She demonstrated that even the most stepped-upon members of society can elicit change if they work together.
Following this riveting testimony, I attended a panel on drug users working together to help each other and fight for their rights. The speakers were Dean Wilson, the ex-president of VANDU (Vancouver Area Network of Drug Users), Greg Khaymov, an outreach worker with TRIP! Project (a Toronto harm reduction group), and Tera Holmes, president of CSSDP’s Vancouver chapter. Each described how they and their organizations are working to help drug users, and each was frank about their personal drug use histories. An open discussion followed, with topics such as the internal stigma within the drug-using scene (“My drug use is okay but your drug use is not”) and the potential for stimulant maintenance therapy for cocaine and methamphetamine users being touched upon.
The next keynote speaker was Dana Larsen, the director of Sensible BC, NDP member, and long-time champion of cannabis dispensaries. At the time of the conference, Sensible BC was busy collecting signatures in the attempt to trigger a referendum with the goal of decriminalizing cannabis possession in British Columbia. Larsen has a deep passion for cannabis legalization and a long history of being involved in its promotion, having previously co-edited Cannabis Culture Magazine with Marc Emery. He described the benefits that cannabis legalization would have for society, and strongly encouraged all attendees to go out and vote for politicians who are willing to support drug policy reform. He was certainly no hard-line partisan: despite being an NDP member, he commended Liberal leader Justin Trudeau’s vocal support of cannabis legalization and was critical of Thomas Mulcair’s refusal to voice the same support. However, he hinted that the NDP could be coming out with more progressive cannabis policy before the next federal election.
The following panel I attended was focused on opioid substitution therapy. Scott Bernstein, a lawyer who had worked on the InSite case, described the clinical trials for opioid substitution that have taken place and are taking place in Canada. NAOMI (North American Opiate Medication Initiative), which began in 2005, was the first study in North America to test the efficacy of maintaining addicts on pharmaceutical heroin. The results were clear: heroin maintenance worked better and was less expensive than methadone for the highly-entrenched users from Montréal and Vancouver who had been chosen for the study. This echoed the conclusions of similar studies that had previously been run in Europe, where heroin maintenance is not uncommon. Currently, a second trial, called SALOME (Study to Assess Long-term Opioid Maintenance Effectiveness), is underway. This trial is comparing the effectiveness of heroin to that of hydromorphone, and the effectiveness of oral versus intravenous routes of administration for both of these drugs. Despite the fact that NAOMI and SALOME patients have largely benefited from the heroin treatment they received during the study, the federal government recently moved to block access to heroin for patients once they had finished the study – essentially forcing people who had finally improved their lives to lose all the ground they had gained. Scott Bernstein, with the community-oriented Pivot Legal Society, is working to bring the case to court so that patients who have completed the trial can have access to the treatment that has been shown to work for them. He pointed out that with this restriction of access, the government is going against the World Medical Association’s Declaration of Helsinki, which states: “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial.” Also speaking at the panel was Dave Murray, a long-time heroin addict and founder of SNAP (SALOME/NAOMI Association of Patients). He took part and benefited from his participation in the NAOMI trial, but was forced to return to his old ways when his heroin treatment was cut off after the trial ended. He is working with Bernstein to bring the case to court.
That night, I had the chance to walk through Main and Hastings, the epicentre of drug dealing in the Downtown Eastside. At a glance, it was not hard to see how the location had gotten its reputation. Users were thickly congregated, syringe wrappers littered the sidewalks, and men openly offered “jib and down” (methamphetamine and heroin) as I walked by. It made Berri and Sainte-Catherine look like the epitome of discretion.
Sunday morning began with a panel on the direction of drug policy reform in Canada. The speakers included Michaela Montaner, communications director for the International Centre for Science in Drug Policy, Libby Davies, the member of parliament for Vancouver East (which includes the Downtown Eastside), and Phillipe Lucas, a board member for MAPS Canada (Multidisciplinary Association for Psychedelic Studies). Despite the seemingly insurmountable barrier of a Conservative federal government, the panel members seemed optimistic about the direction of drug policy in Canada. Lucas described the recent commencement of clinical trials involving MDMA (as a treatment for post-traumatic stress disorder) and ayahuasca in Canada. Davies positioned herself as unwaveringly pro-drug-policy-reform and touched on the difficulties that individual MPs interested in these reforms have when trying to make changes in Parliament.
Subsequently, I spoke at a panel on drug analysis as a harm reduction measure along with Missi Wooldridge, executive director of DanceSafe, and Chris Orbz and Greg Khaymov, two workers with TRIP! Project. Wooldridge explained the pill-testing kits that DanceSafe distributes, and demonstrated how to use the tests on a mystery powder. These reagents are inexpensive and can be used to identify MDMA and other drugs, and to identify whether certain dangerous adulterants are present in a sample. Orbz and Khaymov described the work that TRIP! Project had been doing with pill-testing reagents, and observations of drug quality they had come across. For example, every single sample of cocaine that they tested was found to contain the adulterant levamisole. I concluded the session by describing high-powered analytical chemistry methods that can be used to identify every chemical in a drug sample and measure their precise dosages. The methods I talked about – GC/MS (gas chromatography/mass spectrometry) and HPLC (high-performance liquid chromatography) – are expensive, but in Europe there are publicly-funded services that allow users to have their drugs analyzed in this way.
Missi Wooldridge headed the next keynote, which described DanceSafe’s work promoting harm reduction in the United States electronic music community. She is currently putting a lot of effort into having pill-testing booths at large electronic music festivals, where there is a reluctance to allow harm-reduction initiatives despite the rampant and obvious drug use.
The final panel I attended was led by Dean Wilson and Russell Maynard, the program director for InSite, who talked about sanctioned and unsanctioned supervised injection sites. Wilson recalled how a pre-InSite attempt to open an illicit supervised injection site in Vancouver had devolved when the people running it attempted to use it as a platform for drug dealing. There was a lively discussion on the idea of “addictive” drugs and whether it was fair to ascribe such a property to an inanimate object, considering the fact that the majority of users of any drug do not become addicted to it. Wilson also demonstrated his knowledge of the Toronto injection drug scene and gave recommendations to members of TRIP!, who have had trouble with their attempts at working towards the opening of a supervised injection site.
All in all, the weekend in Vancouver turned out to be ceaselessly interesting and inspiring. It gave me hope for positive changes in drug policy and hope that drug users can put aside their differences to work together for these changes. Everyone I met was eloquent, intelligent, and compassionate, attributes that our stereotyping society does not readily recognize in drug users.
(Samuel is a Montréal resident and head of CSSDP’s Montréal chapter. If you are interested in working with CSSDP, or have any questions, e-mail me at firstname.lastname@example.org.)