By Walter Cavalieri,Director Canadian Harm Reduction Network.
In the mid 1980s, I had the opportunity to accompany a street outreach worker in Calgary, handing out condoms to women working in the sex trades. We struck up a conversation with a middle-aged man, a local minister known to my host, who was doing the same thing. Alas, my inner wise-ass kid asserted itself, and I decided to challenge him – just a bit – about how he, a man of the cloth, could openly condone a sinful activity when his role should be saving these women’s souls. He told me it was more important to him to keep these women alive now, so that later he could save their souls. Humbled and enlightened, I backed off. He had given me my first real lesson in harm reduction, one which has guided me ever since. Harm reduction is not just about the “now” but about the future.
This, to me, is an excellent reason for setting up three small Safe Injection Sites (SIFs) in Toronto. With SIFs, we can save lives now, and worry about “rehabilitation” – whatever that may mean – down the road. Working to help the living is full of possibilities, but it is impossible to help those who are dead.
Overdose deaths – at levels in Toronto which surpass even motor vehicle deaths – are an epidemic, and we are responsible for this. All of us. Counterproductive laws, inaccurate information, misguided leadership, institutional stigmatisation, fear … they all play roles in keeping drug overdose deaths high in all populations – not just in “disposable” street persons.
SIFs are one important program for addressing this. They are not a new idea. In the mid 1990s, the Goethe Institut brought a large delegation of people from Frankfurt to share with Toronto, its sister city, Frankfurt’s success in addressing its open drug scene, one of the most deadly in all Europe. One tactic they employed was to set up sites where people could inject their drugs in a clean, well-lighted place, with sterile equipment and a knowledgeable staff to help out in emergencies. Alas, Toronto wasn’t “ready” to do anything different about its drug problems, and we have seen the results of this year in, year out. A missed opportunity.
We cannot miss the opportunity now. There is too much need and too much evidence that SIFs are successful.
Getting to know what actually goes on at a SIF, and why they work as well as they do, will help you appreciate the need for SIFs, and their wisdom.
Short of visiting Insite, Canada’s only public SIF, or talking with Insite’s staff or people who use it, take a look at any of the many videos available on the Internet, for example: https://www.youtube.com/watch?v=xlLnhes5nqs.
Insite is a large, free-standing SIF. Toronto’s safe-use sites will resemble the SIF at the Dr. Peter Centre in Vancouver (please see photo), and will be embedded in local needle exchange programs. Each will have only three places where people can inject.
As an ethnographer, I had the opportunity to observe about 30 people in Toronto injecting crack cocaine. Remaining the “objective” observer was impossible, and I struggled to keep tears and anger at bay. Using drugs desperately, covertly and under duress is a matter of course for people without homes or safe places to use, and shooting up in laneways, abandoned building, parks, garages, janitors’ cupboards, washrooms, etc., sometimes with minimal light, does not provide safety. No wonder there are so many illness and deaths. That said, the people I observed wanted to be safe, and they did their best to do so and to protect the safety of their partners and friends.
Not everyone who uses drugs is addicted, but many feel they cannot live without drugs. They use them for a variety of reasons, most quite valid. However, as long as the drugs they use have unpredictable levels of strength and purity, overdoses and damage to health are inevitable, and we – all of us – who support the so-called War on Drugs – share in the responsibility for the drug-related deaths and damage. For 100 plus years this War has failed. It has, in fact, made things worse for everyone. It’s time for another approach, and SIFs in Toronto offer us that opportunity.
Will SIFs increase drug use, crime, illness? NO. They have not done this anywhere.
What SIFs offer is a way to bring back into society people who have been pushed to the edges of it and a place where they can connect with good and dedicated healthcare workers and get a lifesaving service without judgment and stigma.
Johan Hari, author and journalist, says that the opposite of addiction is connection. Safe Injection Facilities prove this.
Safe injection Facilities will be discussed and voted on in the Toronto City Council this summer. If you are a Toronto resident, please contact your City Councillor to inform her or him of your support. If you live in other parts of Canada, please urge your city officials to address the growing tragedy of accidental drug overdose deaths. Most of these deaths are preventable.
This article first appeared at Canadian Harm Reduction
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