Changing the Metrics of Addiction


It’s the rare tourist to southwestern British Columbia that doesn’t return home awed by the experience. The region boasts some of the most stunning topography and seascapes on the continent; a high standard of living and; Vancouver, a progressive city whose cosmopolitan ways rank it high on every credible list of the world’s best metro areas.

Yet the forward-thinking Vancouver is not without its dire problems – a reality too often manifested in the part of the city known as the Downtown Eastside (DTES), where high rates of poverty, crime, homelessness, mental illness and disease make for a more nuanced and vexing understanding of Canada’s third most populous municipality.

Add to this index of suffering an epidemic of addiction. Provincial and federal studies on the city describe the DTES as awash in some of the most potent drugs on the planet.

To its credit, Vancouver has become an urban test-tube for addressing chemical dependency in North America, applying evidence-based theories and practices gleaned from venturesome European societies.

With the DTES as the sight for their latest foray, some of the city’s vanguard service providers are challenging the canonical assumption that abstinence is the only reliable rubric for measuring treatment outcomes.

Instead a program named Insite (North America’s lone legally sanctioned injection center) adds a second bell weather by which to gauge success: harm reduction – initiatives that seek to minimize addiction’s individual and systemic toll with multi-tiered responses.

In a treatment of harm reduction that appeared in the August 30 issue of The Christian Century, Alexander Sharp, United Church of Christ minister and director of Clergy for a New Drug Policy describes how Insite works:

“Every day … anywhere from 600 to 1,000 drug addicts enter a nondescript building where they can—under medical supervision—inject themselves with illegal drugs they have brought with them, usually heroin, cocaine, or methamphetamine. They know that while at the site they will be neither arrested nor judged, and as long as they are in the building they will be safe.

Once inside the center, first-time clients are interviewed by staff, who ask for identification and about the nature of their drug use. They are supplied with clean needles and syringes and enter one of 12 stalls surrounded by mirrors on three sides, which allow clients to be observed by nurses, who are available to minimize risk of injury. Clients then enter a lounge area. The second floor of the facility houses a detox unit and the third floor has an 18-bed long-term recovery unit. Individuals are not required to ask for these services, however.”

Sharp goes on to describe Insite’s origins in the frustrations of Vancouver recovery professionals tired of the dehumanization of active drug users, as well as the ethos that was brought forward as the program developed. In an interview with Insight’s current project director, Sharp traces the organization’s human element:

“We provide community space for people who do not have any community space. We bring them indoors. We provide running water. Sometimes a person comes in three times a day. They don’t inject three times, they just want to talk. Health care is generally delivered from the top down. Not with us. We are happy to see someone that no one else is happy to see.

At the beginning … the only thing we can do is be present. We provide effective intervention in the lives of people who have been beaten down. They have infections, abscesses. They’ve just been evicted. They haven’t slept in three days. We’re open to treatment, but we can’t impose our goals. If we did that upfront, they wouldn’t [be here]. We meet people where they are.”

For all its emphasis on meeting people where they are – and despite independent research that indicates a 30 percent increase in the number of people turning to Insight versus life on the street – the organization has been opposed all the way to Canada’s supreme court, where Insight and harm reduction were deemed both legal and effective.

Sharp gives hope to harm reductionists this side of the border. There are burgeoning programs taking shape in Vermont, Upstate New York and Seattle as city officials driven by desperation consult the data and find that controlled injections save lives and resources.

The article concludes by noting the American bent to consider drug use a moral and legal, not medical matter. But confronted with decades of failed policies and data supporting alternative responses, we need to regroup and refocus.

And change our metrics for success.

Don Rollins is a Unitarian Universalist minister and substance abuse counselor living in Blacksburg, Va. Email

From The Progressive Populist, October 15, 2016

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