Canada's only supervised injection site celebrated its 10th anniversary this weekend with advocates calling for the creation of similar facilities across the country.
InSite workers and clients, along with health officials and community members, marked the 10 year anniversary Friday morning during a ceremony at the facility -- which is located in Vancouver's troubled downtown eastside.
Some of the participants had mixed emotions.
"It's a little bit bittersweet because 10 years after we've started, despite all the very good scientific evidence of the benefits of supervised injection, InSite is still the only place in North America where supervised injection can be provided legally to people suffering from addiction," Dr. Patricia Daly, chief medical health officer of the Vancouver-Coastal Health Authority told CTVNews.ca in a phone interview.
"That's a disappointment. We would have hoped that we would have seen these services offered elsewhere, at least in Canada by this time."
Since opening in 2003, InSite -- North America's first supervised injection site -- has had more than 2 million visits and, it proudly states on its website, zero deaths.
The site offers a safe place for drug users to inject drugs, as well as clean needles to do so. It also offers referrals to counselling and drug treatment programs. Nurses are onsite if an overdose occurs and immediate medical attention is needed.
The facility said it saw an average of 1,028 visits a day last year, including an average of 529 visits to its 12 injection booths. It also said it made 4,564 client referrals to other social and health services.
While InSite has been heralded as an example of a successful harm reduction initiative that helps to save lives through preventing overdose deaths and reducing HIV and hepatitis C transmission, it has also faced stiff opposition.
It continues to operate on an exemption it was granted by the Supreme Court in September 2011, despite attempts to have the centre shut down.
In the ruling, the court was convinced InSite was saving lives without increasing crime. Since the ruling, advocates in Toronto, Ottawa and Montreal have expressed an interest in establishing local supervised injection clinics in their cities.
But they may be facing new hurdles.
The Conservative government proposed new legislation last June that, if passed, would add additional requirements for new applicants. These include the requirement that they consult with law enforcement officials, provincial and municipal authorities and the local community before setting up a new safe injection site.
The Canadian Medical Association has denounced Bill C-65, saying it is based on ideology rather than clinical evidence.
Daly agrees with the CMA. She said the bill will make it more difficult to get an exemption and will require more public resources in the application process.
She said that InSite will continue to renew its exemption and is encouraging other health agencies to apply. "What I want to do is support our colleagues across the country who may be considering submitting applications as well."
Supporters of InSite are working to bring a safe drug consumption site to Ottawa, potentially located near the ByWard Market - a popular tourist attraction in the city's downtown core.
Ottawa Police Association President Matthew Skof told CTVNews.ca that creating a supervised drug consumption site near the market would turn it into a "no-man's land."
"What you'll end up having is a full square-kilometre of a neighbourhood lost," he said, adding that he believes the site would attract more drug users along with sellers. "If you build it they will come."
Skof, a former police sergeant who served in the ByWard Market for 17 years, added that Ottawa already has a number of "excellent" services in place for drug users, including needle exchanges and methadone clinics. He questions how offering a supervised injection site will help.
He welcomes the new requirements outlined in Bill C-65.
"I think that's an important step that the community is consulted and the police…. because in the end we're talking about our society, our city. Who should be the ones consulted? It should be the people who live here," he said.
But Dr. Mark Tyndall, a professor of medicine at the University of Ottawa and the chief of infectious diseases at the Ottawa Hospital, said the proposed site needs to be located near the market because that's where drug use in the city mostly occurs.
"That's where all the action is," he said, adding that estimates peg between 3,000 and 6,000 active drug users in Ottawa, mostly concentrated around the market area.
Tyndall is currently working on an application to bring a supervised injection site to the city with a group from the Sandy Hill Community Health Centre. The proposed site would be operated on the health centre's premises, which are located close to the market.
He dismissed the claim that a site would draw more drug users to the area, as studies have shown that people don't travel long distances to seek supervised drug injection services.
"The people are there now," he said. "We're providing a service where people, instead of using drugs in restaurant washrooms and parking lots and alleys, have an alternative."
Tyndall added that he supports community consultation, and said when residents and businesses learn more about what safe injection sites involve, they usually become supportive of the idea.
Meanwhile, grassroots group "Campaign for Safer Consumption Sites in Ottawa" said they've spoken with area residents and businesses and there appears to be support for a safe drug injection site.
CSCS Ottawa organizer Greg Cameron said that the group recently canvassed the area and spoke with 115 residents and 78 business owners. It found that over 70 per cent of residents and business owners believed a site should be opened in the city. A full report of the survey will be released later this month.
"We heard a lot of people saying that it's an issue they see every day. There's public drug use in the area, there's people finding needles on their doorstep and in their back alley," he said. "If you're running a business in the market, it's unsightly to have public drug use."
He added that as the city already has a needle exchange program in place, it makes sense to have a supervised injection site to move the drug use indoors. "It's just a natural extension to me."
The group will be hosting a public event on Sept. 30, featuring a number of speakers on the issue. Interested community members will also be to look at a mock injection site to see what it would look like.