Deaths from illicit drug use surged from 39 in 1988 to 357 in 1993 ().6
More than half of the deaths were in Vancouver, which had less than 14% of the province’s population. Ninety percent of the deaths were associated with heroin, two-thirds of the time in combination with alcohol and other drugs. By 1993, use of illicit drugs was the leading cause of death in British Columbia among men and women aged 15–44 years.6
Deaths from the use of illegal drugs in the city of Vancouver and in the rest of the province of British Columbia, 1988–2005. Source: British Columbia Centre for Disease Control.
This epidemic of overdose-related deaths prompted the creation of a task force led by the province’s then chief coroner Vincent Cain. Cain’s report called on government to pursue a course of legalization and decriminalization as part of an overall antidrug strategy.6
While the chief coroner’s report garnered attention in government, the residents of the Downtown Eastside were organizing in the streets. In 1997, the Vancouver Area of Network Drug Users was formed to advocate for drug users.7
Its vision included a supervised injection facility.
In September 1997, Dr. John Blatherwick, then chief medical health officer of Vancouver, declared a public health emergency in the Downtown Eastside.8
At that time, overdose-related deaths were increasing after a temporary dip, but HIV infection rates were actually decreasing ( and ). In 1998, Dr. John Millar, the then provincial health officer for British Columbia, tabled a report that called for implementation of widespread harm reduction initiatives.9
By this time, the Vancouver Health Authority was contributing financially to the Vancouver Area of Network Drug Users, the Portland Hotel Society and a number of other community agencies. The harm reduction coalition had been born.10
Incidence of HIV infection per 100 000 in the city of Vancouver and the rest of the province of British Columbia, 1989–2005. Source: British Columbia Centre for Disease Control.
The harm reduction coalition grew to include housing organizations, community service agencies, academics, journalists and some law enforcement officers. A bereaved parents group, “From Grief to Action,” was particularly effective at highlighting that deaths were occurring across socioeconomic classes.10
In 1999, Da Vinci’s Inquest
, a popular television series, served to further familiarize Canadians with the situation in the Downtown Eastside. The award-winning Canadian Broadcast Corporation production featured gruff Dominic Da Vinci as an ex narcotics cop turned Vancouver coroner who regularly dealt with preventable deaths on the drug-plagued streets of the Downtown Eastside.
In March 2000, the “Keeping the Doors Open” conference brought together politicians, academics, community members and law enforcement officials to discuss innovative approaches to harm reduction and served to cement connections between diverse groups that favoured harm reduction.10
Few opponents of harm reduction were in attendance.
In September 2000, the federal, provincial and municipal governments signed the Vancouver Agreement, which committed the signatories to work together toward urban renewal in Vancouver. The Vancouver Agreement identified harm reduction as one of four pillars of its antidrug strategy (the others were prevention, treatment/rehabilitation and enforcement.).3
In November 2000, the ruling Liberal party was reelected as the Canadian federal government, allowing them to follow through on the newly inked agreement.
The government had strong internal support for its position from four physician caucus members, two of whom were cabinet ministers during Insite’s development and implementation. There was also strong support for Insite across the political spectrum in Vancouver and British Columbia.11
Harm reduction was not without opponents. In August 2000, the Community Alliance, comprised of local business and property owners in downtown Vancouver, voiced their opposition to all forms of harm reduction.10
Not all members of the Vancouver police department were supportive of a supervised injection site, and the federal police force, the Royal Canadian Mounted Police (RCMP), was vehemently opposed. The business/police coalition organized a conference to challenge the tenets of harm reduction.10
Supporters of harm reduction were not well represented, and thus no meaningful forum existed for open debate.
By 2002, the political landscape in Vancouver had fundamentally changed. Larry Campbell, the real-life model for the fictional crusading coroner Dominic Da Vinci, was elected mayor, with supervised injection a key part of his platform. Family members of addicts had attached a human face to addiction. In June 2003, the federal government granted permission to the Vancouver Coastal Health Authority, under Section 56 of the Controlled Drugs and Substances Act, to operate and evaluate a medically supervised injection facility. In September 2003, the Insite facility opened and was operating near capacity within weeks.