Thank you very much for allowing me to be here today to address what I believe is an extremely important issue for Canada.
Growing up, I was never aware of the people who lived with severe addictions, whom I now know from working as a nurse in Vancouver's downtown eastside. When I was growing up, they didn't exist. They didn't exist within the same medical system, school system, dental offices, parks, or swimming classes I went to. But for the last 17 years, I've come to know hundreds of people who, for many Canadians, have never really been there.
I believe Canada needs a comprehensive, evidence-based drug policy in order to really “see” those suffering from addiction, a policy that understands the roles of prevention, treatment, enforcement, and harm reduction; one that is humane and defers to sound public health policies; and one that understands that death does not bring hope.
Unfortunately, like many decision-makers on this issue, 17 years ago when I arrived in the downtown eastside, I was out of touch. But I didn't realize it; I assumed I knew, and those I met taught me that things were far more complicated, that there were no perfect solutions—rather, many real-life individuals with stories.
I met Mary, who as a child spent many hours locked in a room by her foster family, emaciated, sexually abused, with a giant scar across her throat from where she had cut herself at age 13. By age 15, she was addicted to pills and alcohol, and by age 16, heroin and cocaine. To feed her habit, she worked the sex trade. She was raped, and unlike many other people, she felt she deserved what she got, that it was all her fault. For Mary, prevention failed. When she was alone as a small girl and had no one to talk to about her suffering, the expensive and poorly evaluated “just say no” ad campaigns didn't make any difference. She needed a human being. Prevention is critical, but it needs to be evidence-based and it needs to be relevant.
My father was a doctor, and as I was growing up, he always expressed the view that addiction was a tragedy. But his overriding sense was that addicts had failed. Not only was their addiction a failure, but it also spoke somehow to their moral character failing, making the criminal justice approach reasonable and necessary.
Mary, in her sex trade work and life of addiction, was arrested hundreds of times. She believed she was a criminal. Her interactions with law enforcement merely reaffirmed her self-hatred. Over the years of her life as a drug addict, enforcement failed to curb her habit. While enforcement touched Mary's life, it could not reach out to her. Policing alone cannot address the complex reality of her life and her health needs.
As a nurse, I had the naive and simplistic idea that treatment was the solution. I believed that help was just within reach and that people needed someone like me with the dedication to make it happen. I believed that people only had to ask and that health care would be there for them when they wanted it.
I realized after watching Mary and hundreds of others like her that trying to access the detox and recovery system with no long-term success was not so simple. Many hurdles exist, and if you live on the street, accessing detox and treatment feels like climbing Mount Everest. Treatment failed Mary. Treatment programs failed her because we desperately need treatment to be accessible and to work in tandem with other strategies. As a stand-alone response, treatment fails.
I have now understood that the vital piece that's been missing is harm reduction policy. Harm reduction begins by seeing the person in the context of their life and their pain, their ability, their fear, and their strengths. It starts from a place that says, I see where you are today and that's where we'll start.
Mary couldn't get counselling, because she was addicted. She couldn't find a safe house, because she was addicted. She developed HIV due to years of unsafe needle sharing, due to her addiction. She was often homeless, because she was addicted. Harm reduction says this isn't good enough. We watched Mary die of AIDS, and hundreds of others like her.
Harm reduction programs ultimately failed Mary, due to their lack of support and funds. As a result, Mary and hundreds of others became HIV-infected, reusing the same dirty needles when needle exchange programs were not supported. Harm reduction initiatives are there to see the marginalized drug addict's life as one to be helped and not to be ignored.
As we assemble the pieces of this puzzle, I understand more clearly where Insite fits. Insite, the supervised injection site, provides the vital link between the street and desperately needed support. It connects people to treatment. It acknowledges the challenges that street-entrenched addicts face head-on. Then it offers real help—help to stay healthy and help to stay alive.
Over one million injections have taken place at Insite since it opened, off the streets and away from local businesses. Not one of the “Marys” who stopped breathing during their drug use at the site died, because a nurse was there.
I wish as much as anyone else in this room today that this problem did not exist, but sticking my head in the sand will not make it go away.
Canada needs a drug policy based on wisdom and maturity, not fear and hatred. Without this, thousands will suffer, HIV will spread, violence will escalate, and thousands of needless deaths will continue across the country—deaths of citizens whom we don't see: children, sisters, brothers, mothers, and cousins who could easily have been us, and who have been with us all along.
Thanks.