Two takes on Insite and another on harm reduction

First, a columnist from the Calgary Herald says that Insite doesn’t do enough to change addicts:

Corey Ogilvie wanted to document life in Vancouver’s notorious downtown eastside (DTES) by spending 30 days living alongside the residents of North America’s poorest, most destitute and drug-infested neighbourhood. Film clips of his journey are posted on the Internet and, as one would expect, are highly revealing.

In one clip, he determines he must do drugs to understand addiction. While coming down from a crack high, he decides to try heroin. So his street buddies send him to Insite, Vancouver’s safe injection site.

Ogilvie’s smuggled camera reveals Insite staff doing everything but stick the needle in his arm as they aid him in his quest. A staff member shows him how to prepare the heroin, fill the syringe and find a vein. He’s clearly a novice and the worker asks the obvious question, “So, can I ask? Why the drug use?”

When Ogilvie fails to offer much of a response, the worker offers an upbeat, “It’s OK. You don’t have to say anything. It’s not a big deal.”

I was very impressed with the sincerity and concern that Insite staff have for those who come through their doors. They are truly kind and compassionate, and provide addicts with a very human (and humanizing) element to their day. For that, I offer kudos.

Yet I came away thinking that Insite’s main gauge of success is engagement, not treating addiction, reducing numbers of addicts or providing addicts with a way out. Maybe social interaction is enough for some, but I remain unconvinced that facilitating drug injections and perpetuating a destructive lifestyle is the best way to afford someone their human dignity. These non-judgmental interactions may make addicts feel better about their behaviour, but I didn’t sense that the Insite philosophy had any room for the notion that addicts could actually change their behaviour — at least not the addicts in the DTES.

Insite does have 12 detox beds and 18 ‘transitional’ beds for those who are hoping to get into treatment. They have daily programs such as yoga, health care or counselling for these residents. But, again, I never got the sense that they had much hope for addicts beyond the Insite facilities.

Insite leaders seemed uncertain about what treatment facilities existed and where they were located, but still insisted that they weren’t the kind of facilities that would be a good fit for DTES addicts. I’m under no illusion that there are sufficient treatment facilities available, but isn’t any addict going to be out-of-his-comfort zone in an addiction treatment facility? Since the intent is to change lifestyle patterns, I would certainly hope so.

Meanwhile, a blogger for Phoenix House gives them the benefit of the doubt:

…when I looked at Insite’s website, I was encouraged by the fact that the facility is actually part of a larger organization that provides “a complete continuum of services,” including prevention, opioid replacement therapy, residential treatment, and housing support. An addiction counselor is part of Insite’s staff and, in its second year of operation, it made 2,000 referrals to other services. A New England Journal of Medicine study found that, because Insite removes barriers to treatment, its clients—who may not be well connected to the health care system—have increased their use of detox and withdrawal programs.

If Insite’s advocates want a real shot at challenging critics, they should emphasize that it is not a stand-alone operation, but a “rung on the ladder” from “chronic drug addiction to recovery.” People suffering the devastating effects of substance abuse cannot change their lives overnight. But, getting off the street and coming to a place like Insite—where medical professionals can help them get the care they need—may be the first step in the process. I hope future media coverage of Insite offers this perspective.

Finally, the blog, The Art of Life Itself, describes ab approach to harm reduction that embraces recovery.