A Visit to InSite: Building Community Through Harm Reduction

Rev. Katherine B. Ray Harm Reduction


Mary Nelson is Executive Consultant to the Parliament of the World’s Religions and member of Bethel Lutheran Church.  She is joined by two staff members of InSite.

I am intimately familiar with the devastation of drugs in my west side Chicago community, but I came to the Vancouver British Columbia visit as a novice to the “harm reduction” approaches of dealing with drug addiction. Our visit, organized by the founders of InSite, changed all that.

We visited this supervised legal injection site, where 1,000 people a day came in.  It is located in a small, focused area of Vancouver, alongside other facilities where drug use is permitted. One sensed the welcome, the lack of barriers, the efforts to provide respectful, clean opportunities to do one’s injections under supervision and in safety. A bright, clean place, with plenty of available needles, mirrors, clean water, spaces, medical supervision, communal rooms. The staff evinced a respectful, listening approach, and users themselves shared the hospitality, refreshments, and tasks.

Contrast this scene to shared dirty needles, users sulking behind garbage dumpsters in dark alleys, the fear of arrest and violence, the self- loathing and society’s disrespect. The shadow of death from overdose, HIV/AIDS , and Hepatitis C haunts those scenes.

A long-term drug user shared, “When someone else cared about me, I cared about myself.” Users then had time to care about other health issues, family and work.  We glimpsed the image of God in those labeled drug users, and in acceptance rather than the urge to “fix” the person.

Vancouver’s plan for harm reduction, needle injection sites, and social housing is a journey, and it is still in process. This progressive program gained support in the late 1990’s, as the daily deaths from overdoses and escalation of HIV and Hepatitis C became more dramatically public. Vancouver Association of Drug Users (VANDU), joined by InSite and some health providers, mounted a campaign with slogans and dramatizing “Vancouver Killing Fields”. A massive public park event with 1,000 crosses and speakers was pivotal.   Visiting German health officials shared their needle injection and harm reduction approaches. Some politicians supported the efforts, and the regional health authority provided funding.

First, sites not insisting on abstinence as a condition of services were opened.  Low barrier social housing got built. Yet there is always a continued struggle for funding and the need to validate a public health approach over a law enforcement approach. The partnership with the health community and the inclusion of pilot models and evidence-based strategies have helped. The statistics — deaths in any of the injection sites, reduction of infections diseases– bode well. Cooperation with the police has made some progress.  Still, drug users and alcoholics still feel targeted and harassed by law enforcement, who issue jay walking and street selling citations.

A few special impressions stick in my mind. We visited a social housing site, where users, alcoholics, individuals who had previously experienced homelessness, and their families all of diverse cultures, lived in apartments in the same building. There was a sense of “community,” of respect, of acceptance of differences. The indigenous “First Nation” population had events and wore tee shirts that said, “Culture saves lives.” We visited a church, a site for users and others, to access services and safety. There no longer was a worshipping congregation, but to everyone, it was “First United Church”… the church in action.

We in the United States can learn from Vancouver. A harm reduction public health rather than an enforcement approach makes sense all-the-way- around. Harm reduction is less expensive than enforcement, and it is life giving and affirming to individuals (and their families). It leads to a healthier society.

I am convinced our faith calls us to push for this kind of respectful, humane, and community-building approach.

Read more: Rev. Alexander E. Sharp’s reflection on the Vancouver trip