Reducing harm, raising hope North America's oldest legal supervised drug consumption site offers a blueprint for hope and dignity, saving lives By: Katrina Clarke Posted: 12:00 PM CDT Friday, May. 26, 2023

VANCOUVER — Guy Felicella gestures toward the floor behind booth No. 5 at Insite, Canada’s oldest supervised drug consumption site, in the city’s Downtown Eastside. That’s the last place he overdosed, he says.

Then he points upstairs — that’s where he got sober.

Insite is well-known as North America’s first legal supervised consumption site — this year marks its 20th anniversary — but it’s the site’s lesser-known counterpart, Onsite, a drug detox centre on the second floor, and transitional housing on the third floor, that allow the space to fully cater to those suffering amid a national toxic drugs crisis.

Felicella knows some think it’s “crazy” to have a place for people to get off drugs in the same building they’re given space to use them. But it’s the definition of harm reduction — meeting people where they’re at without judgment, be it a clean needle or a clean room.

And it’s this “full-package” model, he says, that saved his life.

And if Manitoba politicians are smart, he adds, they’ll replicate it.

In April, the Free Press travelled to Vancouver, the epicentre of Canada’s toxic drugs crisis in a province with some of the country’s most progressive approaches to harm reduction, to better understand what works and what doesn’t when it comes to caring for those with substance use disorders and tackling the public health emergency.

The lessons learned there have been hard-fought, and those who run Insite and Onsite say they’re still forced to work within government constraints that prevent them from fully meeting the needs of those they serve. But they know their efforts, rooted in compassion and building trusting relationships, are helping those in need.

“I was lying on the floor, dead,” Felicella says, recalling the day he last overdosed, Feb. 18, 2013. The person who revived him was a nurse who knew him well.

“I just looked up and she was crying,” he says. “I was like, ‘What the hell are you crying for?’ And she goes, ‘Because I care.’”

From there, staff brought him upstairs to the detox centre on “compassionate grounds.”

“They knew if I left the site I would die,” he says. “And here I am today.”

“They knew if I left the site I would die. And here I am today.–Guy Felicella”

Felicella has a long history with Insite and that was far from the first time he’d tried to get sober.

He was one of the first in the door two decades ago and used drugs there more than 4,000 times, according to his file at Insite. His time in the Downtown Eastside predates Insite — he lived there for 20 years, selling and using drugs, going in and out of jail and earning a reputation as a guy not to be messed with.

Contrast that with what his life is like today: a wife, three kids, a house and a job as a peer clinical adviser for Vancouver Coastal Health and the B.C. Centre on Substance Use.

He credits his success — and life — to the efforts of those he built relationships with at Insite and Onsite. But it took a slew of overdoses, attempts at detoxing, relapses and 10 years of establishing trust to get there.

Early on a grey Vancouver Monday morning, a dozen or so people congregate outside Insite, waiting for it to open. Every few minutes, someone knocks at the door. They ask for harm reduction supplies, like clean needles, or just a glass of water.

Whatever they need is handed over.

Jeff West, manger of harm reduction and substance use services with Insite, says the organization seeks to be as low-barrier as possible in helping people meet their needs and goals, no matter what they may be.

For some, that’s accessing a safe supply of drugs. About 30 people who meet certain requirements and who typically haven’t had success with other opioid medications are able to access substances not tainted by the toxic supply, including fentanyl, prescribed by an on-site nurse practitioner.

Others might need wound care or to have their drugs tested.

Others want to inject substances in a space where they know they’ll be revived if they overdose.

“It’s a community centre,” said Liz Farge, program operations manager with Onsite’s detox, transitional housing and supportive independent living services.

Farge says those who have faced roadblocks or stigma in accessing care feel comfortable and welcome here.

After being greeted at the front desk by staff Farge affectionately refers to as “punk kids,” clients can use drugs or access other Insite services, then head to the “chill-out room” for a chat with a peer worker (someone with lived experience using drugs) or, if they want, they can ask about heading upstairs for detox.

The detox floor, where Felicella stayed a decade ago, offers withdrawal management services and care from nurses and doctors. Intake can happen same-day or within a few days, which is key for those who need help as soon as they ask for it, or might otherwise walk away.

There are 12 rooms with private bathrooms — this is important for clients’ dignity as withdrawal can be “shitty, literally,” West says.

While detox means they can’t use drugs, health-care professionals ensure those who have opioid dependency aren’t going cold turkey, which can leave them at a higher risk for future overdose, HIV and Hepatitis C infection and relapse.

Rather, they are prescribed medication such as methadone to help manage withdrawal.

Once clients are stablized in detox, they can move to the third floor where an 18-bed transitional housing is located. There, they access further community support, treatment programs, housing, connecting to family and getting a job.

Nothing like Insite/Onsite exists in Manitoba — but it could.

“In Manitoba, sadly, there is this polarized ‘it’s either treatment or it’s harm reduction’ approach,” says Kim Bailey, director of prevention, testing and wellness at Nine Circles Community Health Circle in downtown Winnipeg.

Bailey says Insite serves as an “inspiration” in that it offers support “no matter where you are on your substance use journey,” meeting people “where they’re at without judgment using a harm reduction lens.”

“Just because you’re into harm reduction does not mean you’re not into treatment — it should be a continuum, it doesn’t have to be one or the other,” she says. “Insite shows us it’s possible.”

“Just because you’re into harm reduction does not mean you’re not into treatment; it should be a continuum.”–Kim Bailey

The closest thing Manitoba has to Insite is Sunshine House’s mobile overdose prevention site, an RV operated by people with lived experience who offer those using drugs a safe space to consume, Bailey says.

Still, other sites, including bathrooms at centres like Nine Circles, are operating as de facto supervised consumption sites; staff acknowledge the reality that people will use drugs and as such, they monitor clients, ready to provide care in the event of an overdose.

Manitoba’s Progressive Conservative government has largely opposed supervised consumption sites, saying it is instead focused on treatment. Notably, last year, former Minister of Mental Health and Community Wellness Sarah Guillemard said her experience visiting supervised consumption sites in Vancouver’s Downtown Eastside left her convinced the sites are wrong for Manitoba. The Free Press later revealed she never went inside Insite.

Asked last week if the province has a position on the full-service model at Insite/Onsite, a provincial spokesperson for Mental Health Minister Janice Morley-Lecomte said Manitoba is committed to providing supports “across a continuum of care,” including prevention, early intervention, treatment and recovery.

“It’s not rocket science. With the right people, (Insite) could be could be happening here, easy peasy.”–Arlene Last-Kolb

“It’s not rocket science. With the right people, (Insite) could be could be happening here, easy peasy,” says Arlene Last-Kolb, Manitoba’s regional director with Moms Stop the Harm, a group of advocates who have lost children to drug overdoses.

Last-Kolb thinks True North’s proposed redevelopment of Portage Place could be a perfect opportunity for such a site. Currently, plans for the struggling mall include a $300-million health-care tower with walk-in and primary-care clinics, a renal dialysis centre and supports for mental health and addictions.

Last-Kolb thinks it should also include a supervised injection site and connections to other forms of support for Winnipeg’s most vulnerable.

“Make it a community space,” she says.

True North suggests it isn’t ruling anything out.

“Community engagement continues, as does work with the various health authorities and community partners to determine the right fit of health programming for the community,” said True North spokesperson Krista Sinaisky in statement.

Meanwhile, Last-Kolb says she has lost faith in the Conservative government but knows such a model would likely need provincial funding (Insite is fully funded by the B.C. government).

If a future Manitoba government is on board, she has a message for them: “support, not involvement.” Any successful harm reduction-treatment project would need to be led and run by community experts and those with lived experience — not bureaucrats, she says.

Back in Vancouver’s Downtown Eastside, Guy Felicella is taking a stroll through his old haunts.

Poverty and addiction here is on full display, with people nudging passed out friends to make sure they haven’t overdosed, and others injecting and smoking drugs on sidewalks. Not everyone is going to choose to use Insite as their preferred place to ingest drugs, he says.

He also wants to make clear: the reality of the Downtown Eastside is what it is because of a range of factors, including poverty, addiction and trauma.

Insite hasn’t brought that to the area, he says. Felicella knows.

The streets here were his home for two decades, long before Insite came on the scene in 2003. That was a period of time when a number of crises overlapped: the spread of HIV, deadly opioid overdoses and the horrific murders of sex workers in the area, later found to be at the hands of pig farmer and serial killer Robert Pickton. Felicella says people in the community looked out for one another then, as they do now.

“Hey!” shouts an older man named Dale coming up to shake Felicella’s hand.

Felicella says the two go way back. Dale laughs, recalling how everyone used to cross the street when they’d see Felicella. No more, he says. “He’s peaceful now, thank God!”

They chat for a minute about a mutual friend who is sick with cirrhosis. “He’s accepted it,” Dale says of their friend’s poor prognosis.

Felicella knows there’s no straightforward path that takes people from where he was 10 years ago to where he is today.

Before he got sober, he’d tried detox more than 50 times, treatment more than a dozen times. He speaks of the stigma that comes with relapse — no one wants to be seen as a failure. What Insite and Onsite offered him was a non-judgmental space during relapse.

If one day you’re on the detox floor and another day you’re on the safe injection floor, that’s fine, the staff are there to help you no matter where you’re at, he says.

Days after the Free Press visited, Felicella tweeted a photo of himself standing in front of Insite’s booth No. 5.

“Supervised consumption sites don’t ‘enable’ drug use, they provide health care for people who are already using drugs. You shouldn’t have to be drug free to access health care! My last overdose was at booth 5 and I’m now over a decade sober. That wouldn’t be possible without harm reduction.”

It got over 10,000 likes.

katrina.clarke@freepress.mb.ca

Katrina Clarke
Investigative reporter

Katrina Clarke is an investigative reporter with the Winnipeg Free Press.

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