VANCOUVER - Addicts who shoot up their own drugs at the city's safe-injection site will soon have a place to start getting clean as the facility expands to include detox beds and short-term housing.
As of mid-September, IV drug users at the supervised injecting facility called Insite won't have to wait for detox beds elsewhere, but can instead go directly into detox on the second floor of the same building where they've been getting their fix.
The detox floor will include 12 rooms, each with its own bathroom, a common area, kitchen and exam room, where a doctor or nurse will assess users and others will provide counselling.
Just like at any other detox facility, addicts won't be allowed to use drugs or they're out.
Those who are homeless or don't want to go back to living in an unsafe place where people are using can then move up to the third floor of the building to stay in one of 18 rooms for temporary shelter.
The addition to Insite, called Onsite, will receive funding from the provincial government for one year.
Recovering heroin addict Earl Crowe, 46, said he injected drugs at Insite for two years before getting into a methadone program.
Crowe, a user since his early 20s, said he may have detoxed at Onsite had the facility been there when he needed it.
"When you're a junkie and you want detox you want it right now because you don't care about tomorrow,'' he said, adding he's particularly thrilled about the bathrooms in each room.
"It's very painful to withdraw and you really don't want to be around people and you're going to be doing a lot of throwing up,'' he said, adding communal bathrooms in dormitory-style detox centres don't offer the privacy people need at such a vulnerable time.
Thomas Kerr, a research scientist at the B.C. Centre for Excellence and HIV/AIDS, said providing a treatment component for addicts was part of the plan when Insite opened four years ago as a provincially funded pilot project in the city's drug-infested Downtown Eastside.
"Some of these people were using puddle water'' to mix their heroin, Kerr said outside Insite.
Users streamed in and out of the clinic that has been reputed to cut HIV and hepatitis C rates because addicts are given clean needles instead of sharing them or picking them up in some back alley.
While Kerr talked, a determined-looking man wheeling a bicycle walked into Insite and anxiously asked the receptionist: "Is there room, is there a wait?''
With few people waiting to get high, he was quickly ushered into the injection room.
There, he got a clean needle, water, a swab and a tourniquet to fasten around his arm so he could find a vein to deposit his drugs while he sat at one of twelve mirrored cubicles in front of a nurse's station.
The tall, 40-something-year-old cyclist was soon done and moved into the chill room, where he relaxed for a few minutes before heading out.
A grandmotherly type also walked into the injecting room while a woman who fixed her lipstick emerged after her drug fix.
Kerr said when people are ready to get clean, there's a small window of opportunity and no time to wait for a detox bed that may not be available for several days.
By then, addicts ready to change their lifestyle have been lost.
"They can be gone for weeks after that, back on a drug run or whatever and it's very difficult to engage them,'' he said.
"I've certainly had the experience, when I used to be a frontline worker, where someone's very motivated to get into detox for a day, maybe two days or three days and then they get very discouraged because they can't get it. They get depressed, then they start using again.''
Vivianna Zanocco, a spokeswoman for the Vancouver Coastal Health Authority, said the city currently has 53 detox beds and that people typically have to wait between two to three days to access them.
Onsite will provide detox on demand so people can stay at a place where they've gained the trust of health providers who can support them, possibly on the road to a productive life, Kerr said.
The new facility's services are modelled after those attached to supervised injection sites in Europe.
In Frankfurt, for example, several such facilities include access to methadone programs, short- and long-term beds and addiction counsellors and social workers who connect addicts to housing and job opportunities.
"When we visited facilities in Germany we were repeatedly told that really, the injecting rooms were not only for disease prevention or to reduce overdose but a mechanism to connect with active injection drug users and to get them into the other services in building,'' Kerr said.
A total of 24 studies in major medical journals have hailed the success of Insite, suggesting the only such facility in North America has helped reduce overdose deaths, infectious diseases and crime in the 10-block area that draws drug addicts.
A May 2007 study published in the journal Addiction suggested that a third of 1,000 addicts who used the facility turned to detox and that those who began detox were more likely to start addiction treatment and reduce injecting.
Mark Townsend, executive director of the Portland Hotel Society, which helps run Insite, said the Onsite detox facility will provide addicts with food and a pair of pyjamas and that they'll later be offered massage therapy, acupuncture, art and yoga.
"The whole purpose of this is to be really flexible,'' Townsend said while touring the detox floor.
"The safe injection site below us is dealing with a very difficult group. They're a very marginalized group of injection drug users in the community and that's where the usual systems have failed to reach them.''
While Onsite is preparing to open, Insite's future remains in limbo because the federal government hasn't yet decided whether it can continue to operate.
Ottawa allowed Insite to open under an exemption of the Controlled Drugs and Substances Act, and an extension to that expires on Dec. 31.
Last week, Health Minister Tony Clement said in Vancouver the government is considering various studies on the effectiveness of Insite before making any decision.
Kerr said the scientific evidence is overwhelmingly in favour of the site that has received widespread support from the community, police, politicians and many in the medical community.
Other cities, including Toronto and Victoria, have indicated they'd like to deal with their drug problems with a similar facility.
