As California debates whether to allow safe injection sites, we go to Canada to see one that's been around for nearly 20 years.
Overdose deaths in the United States have risen rapidly during the pandemic. It’s a trend driven largely by the spread of fentanyl.
In California, the push to save lives and stop the fallout has led some activists and politicians to propose safe injection sites — places where people can take drugs with clean needles, without fear of arrest. There’s already one site like this operating in San Francisco.
But in Vancouver, Canada, there’s a neighborhood that has hosted a safe injection site for almost 20 years. In today’s episode, we go visit it.
Read the full transcript here.
Host: Gustavo Arellano
Guest: L.A. Times columnist Anita Chabria
More reading:
Column: Vancouver’s safe drug-use sites are wrenching to see. California should open them anyway
In a bid to stop overdose deaths, California could allow drug use at supervised sites
With overdose deaths rising, here’s how to test drugs for fentanyl
Gustavo: Overdose deaths have risen rapidly across the country during the pandemic. It’s a trend driven largely by the spread of fentanyl.
In California, the push to save lives and stop the fallout has led some activists and politicians to propose safe injection sites…places where people can take drugs with clean needles, without fear of arrest
There’s already one site like this operating in San Francisco.
But out in Vancouver, in Canada…there’s been a neighborhood that has hosted a safe injection site…a totally legal one…for almost 20 years.
Chabria: Fentanyl?
Bordas: Yes
Chabria: It’s actually kind of a pretty color.
Bordas: When people are looking for stuff, they look for it by the color. It’s like a Marker…
Gustavo: I’m Gustavo Arellano. You’re listening to THE TIMES, daily news from the LA Times.
It’s Friday, May 27, 2022.
Today…the tricky choices in setting up safe injection sites: can you give people a safe space to do drugs without encouraging addiction?
Anita Chabria is my colleague and fellow columnist. She writes about California. Anita. Welcome to The Times.
Anita: Thanks for having me on.
Gustavo: So you recently went inside a safe injection site in Vancouver. What did you see?
Anita: It was really eye opening. I didn't know what to expect when I went up to Vancouver, they've been running these sites for 20 years now. Some of the spaces are indoors. Some of the spaces are outdoors, but it really is a place where anyone can walk in with their own illegal substance and find not just a safe place with clean supplies, but really a place where no one is going to judge them for what they're going to do.
One of the people I met in particular was a young man named Geoffrey Bordas and he was in a safe consumption site that's in an alley that the locals call piss alley.
CLIP Anita: Why do you like coming here to do it
Geoffrey: It's safe.
Anita: Yeah. You really do feel, it makes a difference.
Geoffrey: Yeah, absolutely.
Anita: And it's kind of this lovely little courtyard surrounded by flowers. And I spoke to him while he was preparing fentanyl to inject. And he really was a lovely man in the grips of addiction.
CLIP Anita: Nice to be accepted to a place where the stigma doesn't follow you everywhere.
Anita: And I would love to see him out of addiction. But what it showed me is that I would rather have them have a safe place where they're going to stay alive for today. So maybe tomorrow they can make a different decision.
Gustavo: And if someone like Jeffrey was in California, what would be their options?
Anita: They would be in a gutter, right? They'd be the guy on the sidewalk. I've heard of some of the folks up in Vancouver saying that they were taking water out of the gutters. To, to mix drugs with. you know, imagine injecting that into yourself and, and the sickness and the cost that that brings to society.
Anita: So Geoffrey would be one of those guys on skid row that you see sprawled and face down. If it wasn't for these safe places.
Anita: You know, I was a convert. I didn't go up there thinking this is what I would think, but I really believe that this gives him not just safety physically, but it gives him some dignity to create a stability, to build back from.
Gustavo: And I take it that at the safe injection site of Vancouver that you went to, there was those drugs that you could do to reverse overdoses?
Anita: Everyone has Narcan in Vancouver.
CLIP Anita: Have you reversed overdoses?
Geoffrey: Yes. Many many many.
Anita: Oh, really? Wow
Anita: You walk into these facilities and there's literally just dozens and dozens of packages of it.You walk down the street and they've passed it out to everyone.
CLIP Anita: How does it make you feel to know how to do that and to do that?
Geoffrey: Thousand times better than when I first started. It was of terrifying at the beginning. Even just somebody goes down, you don't know what to do. Um, that's you gut-wrenching feeling. Yeah. So once you get the training and how to do it properly and effectively, it really, uh, I don't want to say it slows you down, but take a breath and go, okay, let's do this and just do it. And there's panic has gone.
Anita: Everyone on the street, whether they're addicts or workers or even shopkeepers has Narcan. It's almost impossible to not come across Narcan within a few minutes of being on east Hastings.
Gustavo: Wow.
Anita: You know, I think one of the problems with the safe injection site or safe consumption site debate is that there's this expectation that these facilities will stop overdoses.
Anita: That if we open them, suddenly our numbers are going to drop and there aren't going to be overdoses. I think that that's really, unfortunately, just not reality.
Anita: The fact is that drug use has gone up tremendously during the pandemic. And drugs have become more dangerous. We have fentanyl in our drug supply now in Canada, they have something called benzos mixed with the fentanyl. So overdoses are actually on the rise, even in Canada, even on east Hastings, you're seeing the number skyrocket. That's not indicative of these sites being a failure. That's indicative of society doing more drugs.
Anita: But what you can say about these facilities is over their time in Canada, they've reversed more than 40,000 overdoses. That's 40,000 people who did not die because they were in one of these centers. And so I look at it as we are not going to arrest our way out of a drug crisis. We're not stopping the flow of drugs to our street, although I greatly wish we were. I can only hope that the people making these bad choices stay alive long enough to find their way to some kind of sobriety and stability. And that's where I see these centers really playing a role. It's just keeping people alive for today so that tomorrow can be a better day.
Gustavo: And because of that, that's, what's always interested people in these safe injection sites and in California, what legislation is being proposed? And what are people saying about those bills?
Anita: We have one bill right now that's working its way through committee, it's very controversial, that would allow a pilot program in San Francisco, Los Angeles and Oakland. The truth is San Francisco's actually kind of gone ahead and it's. A little bit illegally or illicitly or however you want to look at it. There's a very controversial place called the linkage center or the Tenderloin center where people are being allowed to do safe consumption. This bill would give that probably some, legality. There's still the federal laws that prohibit this, but you've seen places like New York go ahead with it anyway. So the bill would open up statewide three pilot programs if those cities chose to do it.
Gustavo: We'll have more after the break.
Gustavo: Anita, I've heard talks about safety. For years, but it’s always theoreticals. But I was surprised to learn from reading your column that Vancouver long ago made this happen.How did that get going?
Anita: It really came out of the HIV crisis way back in the nineties, there was a movement in Vancouver to address that, the gay community, especially was being hard hit. By HIV and needed clean supplies. And like San Francisco, it really started out a little illicitly there, without all the formal approvals.But then in 2003, they opened up the insight injection facility, which was the first open consumption site. It was on East Hasting street in Vancouver. And from there they've really just grown the concept.
Anita: So that first facility started out as kind of a medical facility. With nurses and things, overlooking people are more trained people. And now they've really expanded to a peer model where neighborhood workers and other addicts can supervise. And honestly, there's dozens of these places in Vancouver. You'll see subsidized housing units where they'll have just a small space for safe consumption within the housing units. They've really embraced this as a way of harm reduction and doing business up there.
Gustavo: Coming from California. I'm sure you saw this. And you're like, where am I?
Anita: On so many levels because, you know, we think California's always at the forefront of everything, right. But we are literally 20 years behind when it comes to talking about harm reduction in this area. I don't want to sugar coat anything, and I think if you read the column, you'll see that. To walk down east Hastings street is somewhat terrifying.There is no direction you can look where someone is not injecting or smoking. I personally believe that we are not going to force people off drugs and that only they can make the choice. But as a society, there's a cost to having people with substance abuse disorders, right? There's the health costs, there's the emergency room costs, there's the ethical costs. And so what I see in Vancouver is a real attempt to address that, and to help people move towards, getting off the drugs at their own pace and while keeping them alive.
CLIP Anita: So I'm assuming the gentleman on the corner and the chairs are selling drugs. Is that accurate?
Anita: One of the people I met that was just such an impressive ambassador for the area was Trey Helton. And he was one of our guides around east Hastings.
CLIP Trey Helten: Hey Eric, how you doing?
Trey Helten: Hey man. Good bro. Where are you going? I'm going to get Smokey.
Anita: He knows everyone he's kind of keeps order and helps everyone along. And he used to be, uh, an addict for many, many years.
Trey Helten:I stopped paying my rent and stopped paying my bills and stopped going to work. And then I just decided to like, come live here. Cause this is close to the source. Right? Like I can always get dope 24, 7 even at three in the morning.
Anita: He kind of came out of the punk rock scene and he's kind of a tough guy, but at some point he realized that that was not the direction he wanted to go in life.
Anita: What was rock bottom for you?
Trey Helten: Oh shit…33rd birthday, fifth year in a row. It's like super fucking depressing. But I was like, I realized that I had failed at dying and drunk. I was like, my goal was to die drunk. I was like, I'm going to fucking burn out and fade away, like Kurt Cobain and fucking everyone's going to show, see how bad I hurt them by hurting me.
Anita: And so he got sober. He's been clean for years.
Trey Helten: I see the same thing now is like being a harm reduction worker. I see my friends that have made some poor choices that may be watching them slowly become crispy critters.He's really trying to help people figure a way out, but even he admits that options are limited.
Trey Helten: So like when I'm working as general manager and I'm talking to like sketchy Dave, and they say, you know, Trey, like, I feel fucking, like I'm done.
Trey Helten: I want to, I want to get outta here. Like I'm thinking about detox. That fucking window is like that big, right? So like I called the detox access center number and it's like, they gotta go get him methadone script first.They gotta get a TB shot.
Anita:It’s to find a place that’s safe to do drugs in Vancouver but if you really want detox -- there are bottlenecks
Trey Helten: There's no, like I can just call the number had been picked up in a safe ride, ambulance transferred and taken to a detox facility. Right—that would help a lot more people. If I had some sort of access, the unfortunate thing is like, I have to get them to lie. So I'm like, if you really want, I don't have detox. Now you can call this number you can, uh, you would call this number. They'll give you an intake date two weeks from now.
Trey Helten: You're going to have to go get a TB test and a methadone script. And then two weeks from now, if you remember the day 9:00 AM say May 22nd, do you have to be at Vancouver detox? Like that's very high barrier. I hear in San Francisco, they have detox on demand already.
Anita: I mean, sorta kind of, I mean, it's not.It's certainly not a detox bed for everyone who wants it, you know? Yeah.
Trey Helten: So what I have to tell them to do is if you really want it right now, go to the hospital use specific language, tell them I have a plan. I'm going to give away all my stuff. I'm going to walk to the lion's gate bridge and I'm going to jump off. For a while and nothing's going to change my mind. That's what you gotta do: tell them you're suicidal. They'll put you on a mental health unit. It'll be a strike on your mental health record. But from the mental health facility, you have to advocate to the doctors and nurses that you want to transfer to a detox facility from that point.
Trey Helten: That's how you get detox on demand here. It's shitty.
Gustavo: More after the break.
Gustavo: Anita, the people that you talk to near the injection site, around the injection site, were they like full fledged supporters of it?
Anita: There's people who support it and people who don't. I think most people support safe injection sites in and of themselves. It's when you get into that larger discussion of harm reduction, and the line between enabling someone and helping them out? One woman I met in particular was an indigenous woman named Winook...
Anita: And she has been down in this east Hastings area since 2008. And she really feels that it was a trap for her.
Winook: Everything is at your fingertips and you don't have to do anything to get your food in your stomach for the day. You don't have to worry about anything except for doing drugs. And there's a fine line between enabling and keeping someone safe.
Anita: She feels that it's just making it too easy for her to do drugs and to get drugs and she can't find a way out.
Winook: I used to come down here and it's the like, I've seen my family, you know, and not just first nations, everybody down here and all, is there ever a time where there's, this is going to be healed.
Winook: And I had to come to the conclusion back then that that's not going to happen.
Winook: when I came back and I ended up here this time, They sell this as a lifestyle They don't even tell us that, you know, this is a only for now anymore.
Winook: They're happy to have us here forever. there's no even hope left. That kills me.
Anita: And so I do think that there's a hard and real conversation about how you make sure that you're always helping people towards that better future, not on drugs. While not forcing them deeper into shame or denial or out of safety.
Gustavo: Who would be the beneficiary of keeping these people as addicts?
Anita: Well Winook and some other people do point out that there's an entire industry around harm reduction now,
Anita: Literally millions and billions of dollars are spent on different kinds of programs to, to help people who are homeless, who are addicted. We all know the programs. So there is some sense that, As those programs take on bigger and bigger budgets, there is incentive to keep treating people instead of moving them forward.
Gustavo: Do you buy into that?
Anita: I think bureaucracy always comes with dangers. There's always inertia in a bureaucracy, but if you ask me, if, is it better to incarcerate people? Keep our jails being the bureaucracy, keep all of our mental health and all our substance abuse // behind bars? No, I think that's a terrible idea. So if we have to move some of that bureaucracy to helping people before they get into that system then I’m all for it.
Anita: Winook really touched my heart because she's clearly someone who doesn't want to be down there, and is searching for a way out. And I think we can never, ever ignore those realities and work very hard to make sure that there are clear and easy pathways for someone like Winook to get out.
Sarah Blyth: That does happen, but it's not going to happen if they die right?
Anita: But another woman I met, Sarah Blythe. Who's kind of the mama bear of east Hastings. She founded the overdose prevention site. She lives down there. Her whole life is in that area trying to help people.
Sarah Blyth: If you see people, you know, using an alley, like unclean supplies, they get like terrible skin infections. They get sepsis, they overdose these there it's just, to me, that's much less compassionate..I don't view it as enabling at all. And I think we have lots of evidence, like 20 years of evidence here locally to support that that's the case.
Anita: I really do have to say that I see the sense in her point of just keeping people alive until they can find that way out. And that's always the problem of that line of harm reduction between how are you helping or are you enabling? And it's a gray line and it's different for every person. But I don't think that having people like Winook who feel that she's not been helped negates that there are so many people that someone like Sarah feels that they have kept alive for one more day. And maybe that there is a pathway out.
Anita: There will always be neighborhoods where drug use is more common. And that really isn’t fair to the neighborhoods. Do we go with legal crackdowns like some people are calling for right now or is there some line in between where we can do harm reduction and also really think of quality of life in these neighborhoods. Trey, who is doing a lot of this work on the front lines of this crisis, thinks we should try everything we can But that the reality is people will go to the streets looking for drugs.
Anita: So you think safe supply could ever replace street supply?
Trey Helten: Um, no, there'll be. People that don't still want to buy street supply. There needs to be safe supplies for people that aren't ready to stop.
Anita: I think it's just all so complicated. Yeah. You know
Trey Helten: There's not one clear, clear solution. You need lots of different options.
Anita: So it's complicated and it's gray. And I just don't think we can say, these sites are good or bad, or they're the cure, or they're not the cure. They're just a bandaid. While we try to figure out the rest of this mess.
Mux
Gustavo: Anita. Thank you so much for this conversation.
Anita: Thanks for having me on.
Gustavo: And that's it for this episode of The Times, daily news from the LA Times.
Rowan Moore Gerety was the jefe on this episode and Mark Nieto mixed and mastered it.
Our show is produced by Shannon Lin, Denise Guerra, Kasia Brousalian, David Toledo, Ashlea Brown, and Angel Carreras. Our editorial assistants are Madalyn Amato and Carlos De Loera. Our engineers are Mario Diaz, Mark Nieto and Mike Heflin. Our editor is Kinsee Morlan. Our executive producers are Jazmin Aguilera and Shani Hilton. And our theme music is by Andrew Eapen.
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I'm Gustavo Arellano. We'll be back next Tuesday …not Monday since that’s Memorial Day…. with all the news and desmadre. Gracias.