A Review By Dr. Mary Nelson
We are in the midst of an opioid crisis. In 2016 there were an estimated 64,000 fatal drug overdoses across the US. Our response has been inadequate and unsuccessful, but the work of activists in Vancouver provides paths for action. Travis Lupick tells the stories of those who paved that path, interspersed with insights into the effort to replicate that model in the US, in his book Fighting for Space. In 2016, I was able to visit the pioneering Vancouver treatment program, Insite, and to meet the people involved. I can attest to the power of a more humane and life-giving approach.
Lupick offers a moving introduction to harm reduction and describes how it can be a model for the US. “Our government and police have waged war on people that use drugs,” says Lupick, resulting in bloated prisons and rising death rates. He depicts the effort to find a better way in Vancouver over the period 1990-2014 through the eyes of service providers who came to understand that criminalization and abstinence don’t work for many struggling with addiction, and that new approaches need to be tried.
One of these health workers was a nurse, Liz Evans, who left a hospital job focused on the immediate medical needs of addicts to manage a last-resort housing complex, the Portland Hotel. Under Evans’ leadership, the Portland accepted drug addicts and mentally ill people as they were, asking, “How can we help?” The result was a hectic but caring “community” of residents. Other staff brought their own strengths and perspectives to this work. Mark Townsend identified creative ways to convince politicians to increase funding for alternative approaches to drug treatment. Organizer Ann Livingston, committed to engaging addicts themselves in shaping and advocating for their own solutions, facilitated their involvement in designing a more effective and humane response to addiction.
Frustrated by the indifference of politicians, and society more broadly, to the HIV/AIDS crisis and escalating deaths in Vancouver’s downtown, an organization of drug users took shape, the Vancouver Area Network of Drug Users, or VANDU. They began with a demonstration in a major downtown park, where activists and addicts bore 1,000 crosses inscribed with the names of victims of drug overdose, and a large sign reading, “KILLING FIELDS.” A year later the network organized an international conference in the same park, with speakers from Europe who ran safe drug injection sites and other humane efforts sharing their experience, expertise, and validation. Their testimony opened the eyes of some government and medical officials and created the opportunity to push for harm reduction approaches in Vancouver.
Lupick describes harm reduction as “strategies all about keeping people alive and as healthy as possible until they can arrive at a place in life where treatment or abstinence works for them.” Drug users who lived in the Portland Hotel could shoot up in their rooms, and staff became equipped to deal with overdoses. But many users were still on the streets and in dark alleys, and too many were dying. Several times temporary injection sites popped up only to be kicked out by landlords.
Slowly, HIV/AIDS activists, enlightened health care practitioners, police, and politicians frustrated by the failing status quo came together around a four-pronged approach to addiction: prevention, treatment, enforcement, and harm reduction.
Finally in 2003 a single drug injection site was approved as a 3-year pilot to test the harm-reduction approach. It provided a safe space where people who bought their drugs outside were welcomed, provided with water and sterile equipment, and supervised by a medical professional in case of overdose. A second room provided post-injection “cooling spaces,” and a friendly community coffee pot humanized the place. Statistics showed a significant reduction in deaths from overdose and HIV/AIDS. This safe haven also opened the door for connections to other forms of health assistance and care. Research on Insite validated anecdotal findings of significantly reduced deaths from overdose, people moving into more stable living situations, and healthier action. These findings have been documented and published in countless journals.
Insite and its housing components (Portland Hotel, etc) are still operating today, but expansion has been glacial. Lupick recounts how opposition from downtown business associations and, city officials have threatened the pilot model. VANDU and its allies continued to organize for decriminalization of drug possession, harm reduction efforts, and legal drug injection sites. Aided by lawyers, a court case went to the Supreme Court, which rendered a narrow decision that applied only to the existing drug injection site. The struggle continues, but there is hope, and lives are being saved in the process.
What can we learn from the Vancouver experience? It takes the selfless commitment and compassion of pioneers like Liz Evans. It takes creative efforts to raise awareness and destigmatize drug use in the minds of politicians and voters. It takes outreach to allies, including HIV/AIDS advocates, public health advocates, communities of faith, families of drug users, and politicians. It takes involving drug users in organizing and action, both for better results and to empower them to take charge of their lives. It takes persistence and resilience for the long journey with small successes along the way.
As people of faith, we know all are created in the image of God, including drug users. God calls us to work for justice for all God’s people. God gives us infinite hope that sustains us in the struggle for a more humane and life-giving approach to drug addiction.
Mary Nelson was the founding President and CEO of Bethel New Life, a faith-based development corporation on Chicago’s West Side. Over 45 years in that community and 27 years in that role, she brought a perspective of faith and hope to a community many considered beyond redemption. Nelson holds a doctorate from Union Graduate School and has taught asset-based community development to pastors and community leaders. In April 2016, she visited Insite as part of a pastoral delegation organized by Clergy for a New Drug Policy.