Editor’s Note: This is the second of a series of stories regarding a recent trip city officials took to Vancouver in Canada to learn more about drug reform. For complete coverage about Ithaca’s controversial new drug policy — called The Ithaca Plan —  visit our archives. 

ITHACA, N.Y. — In Vancouver, a person with alcohol addiction can not only work in a winery and receive drastically discounted alcohol, but can also trade in unsafe forms of alcohol — rice wine, mouth wash, hand sanitizer — for wine.

The idea behind the practice is harm reduction applied in an inclusive way that’s not being largely discussed in the United States — it is meant to hold people over to prevent dangerous detoxing and withdrawal symptoms.

“They join the co-op and they’re responsible for brewing their own wine. And then they’re able to purchase the wine at a discounted price and be able to be a part of that. And it holds you accountable for making your own supply, but it’s all safe. People are learning to brew wine and contribute back to their community in that way,” said Lillian Fan, assistant director of prevention services and harm reduction at the Southern Tier AIDS Program.

She said it creates a unique situation for people where they think, “We may not be ready to quit right now, but one day we will and here are the people that we know who can help us.”

Fan was one of several people, including Mayor Svante Myrick and Police Chief John Barber, who went to Vancouver recently to see their harm reduction facilities first-hand.

Their trip included tours of two facilities that are alone in their existence in North America: the supervised injection facility called InSite, and Providence Crosstown Clinic, which provides opiod-based maintenance to addicts in lieu of them using heroin of pain killers.  Both facilities are similarly planned to happen in Ithaca in the next few years, making the city the first in the country to take on the innovative form of harm reduction.

Fan said that the trip showed the Ithacans things they already suspected but needed to affirm, and things they didn’t quite expect. The following are four main points from her trip:

InSite did not create a neighborhood of drug users — it accepted that drug users were already in some neighborhoods

A frequent concern voiced by Ithacans is that a supervised injection facility will create an area in the city where drug users from throughout the county will flock toward.

This, Fan said, did not appear to be the case in Vancouver.

“So you’d be on one street, for instance, let’s say…you were in the Commons and as soon as you hit Cayuga, all of a sudden it was just packed with people who were using out on the street. And then you got to Geneva and then it just went back to nothing. It was just that quickly,” she said. “Just everything bled into the next really easily.”

She estimated that there was about a four block radius where drug use and related crime were prevalent. But that four blocks was a drastic reduction from the 10-bock radius where crime was rampant years before during the 1990s, she was told by locals and officials.

“It was so much worse you can’t even image what it looked like,” Fan said people told her again and again.

While it can be difficult to find out exactly how many people have been helped by the facilities, InSite reported that in 2015, they had 263,713 visits by 6,532 unique individuals, averaging 722 visits per day.

“I think that’s what harm reduction comes down to, it’s that it’s not always going to be pretty – it is not going to be the solution, necessarily, but it certainly is going to make the situation better.

An area near the InSite facility. Photo by Lillian Fan

Life can go on, even with an opioid addiction

Around lunch time, the Providence Crosstown Clinic’s traffic picks up — people go in to the facility to get their mid-day fix of opioid-based treatment, such as Diacetylmorphine and Dilaudid, which are active ingredients in heroin.

Fan said, “People were able to maintain jobs. They’d come in at lunch time get their dose and get on with their day…it’s hard to understand, right?”

She described the clinic as being sterile and very medical with stainless steel counter tops, clean needles, sanitizers, and most importantly, measure out opioids from medical professionals, given to people already in a syringe.

Fan said that about 150 people are enrolled in the program at Crosstown with three opportunities a day to get maintenance therapy. The program is meant for people who are longtime addicts who have not had success with other treatment, such as Suboxone.

The facility also operates as a hub of resources for addicts to help them find housing, medical care, jobs and any other kind of treatment they need to stay successful in the program.

SALOME from Colin Askey on Vimeo.

“If you give somebody that drug, right, think about what it takes for that person to have gotten those drugs on the street. So they may have had to spend an entire day panhandling or stealing or robing from a community member. They don’t have to do that in order to get their drugs. That’s a huge boost for public safety right off the bat,” Fan said.

Treatment and housing availability matters, is linked

An addict at a low-point in his or her life would have a completely different experience in Vancouver than he or she would in the Unites States.

In the U.S., there are obstacles for getting treatment, such as insurance coverage and availability at full-time recovery facilities. Some people are admitted into programs that last less than a month. Others are put on a waiting list where they might overdose or change their minds before being admitted into treatment.

Nicelee F. Hollenback, of the Alcohol & Drug Council of Tompkins County, said at an open forum about heroin several months ago, “The first time it came out of my mouth that ‘You’ll have to keep using a whole lot of heroin until we can get you where you need to be’…I sat there and I was like, ‘What just came out of my mouth?’”

She and others at the forum said accessibility to treatment and resources was the biggest obstacle working against addicts.

Related — Heroin forum: Treatment in Ithaca is ‘woefully inadequate’

If those same addicts seeking treatment were in Vancouver and standing in a particular alleyway, all he or she would have to do it look up.

A detox area at Onsite, located above InSite, is directly over an alleyway where people often use drugs. Photo by Lillian Fan

At OnSite, located directly above InSite and run collaboratively, Fan described a balcony with clear railing — like a window to where addicts can go to begin detoxing.

According to the Vancouver Coastal Health website:

When clients, usually InSite users, are ready to access withdrawal management, they can be immediately accommodated at Onsite.  On the second floor of OnSite people have access to 12 rooms with private bathrooms where they can detox.  Mental health workers, counselors, nurses and doctors work together to help people stabilize and plan their next steps. People can then move up to the 3rd floor transitional recovery housing for further stabilization and connection to community support, treatment programs and housing.

In 2015, there were 464 referrals to Onsite detox.

But weaning somebody off a drug — which could take years and is a lifelong obstacle for people — is only one of the services offered.

There were 5,359 clinical treatment interventions and 5,368 referrals to other social and health services last year. Among those services is accessibility to affordable housing.

Fan described apartment buildings not far from InSite where people can rent single-bedroom or efficiency units.

“Each room was made so that safety was a priority. So rooms could be washed down. Their were drains installed in the floor. The fixtures were industrial and bolted into the wall. People can come and go as they please,” Fan said., adding that residents at the homes have case managers.

It’s a place to take a shower, do laundry, put clothing and possessions down in a safe place — all things taken for granted by people who have never lived on the streets as a drug addict or otherwise, Fan said.

And it’s that bit of stability that helps people transition into recovery.

“I think often times people just need somewhere safe or somewhere people can feel safe,” Fan said.

The United States is way behind on harm reduction ideology

In Vancouver, Fan saw something she’d never seen before — people actually injecting their drug of choice.

She retold the same story that struck Myrick when he talked about the Vancouver trip: four drug addicts were found injecting drugs in an alleyway directly around the corner from InSite. Rather than ticket the people or take the drugs away, the Vancouver police sergeant sent them to the safe injection facility, which they said they mistakenly thought wasn’t open yet.

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She said that openness about drug use makes it easier for people to about drug treatment options and harm reduction.

“I think right, off the bat, it was eye opening to see just how people understood and embrace harm reduction.”

For instance, Myrick said that when he went into Canada, a customs official asked Myrick why he was coming to Canada: to see the Vancouver drug policies in action. Myrick said the woman stamped his passport and told him that treatment was a major issue and that there needed to be more of it.

On the way back to Ithaca, in the same airport, a U.S. Customs official asked Fan why she was in Canada and she told him it was to look at harm reduction facilities.

“He gave like a dirty look and just said, ‘What? Why? Okay, whatever. Have a good day. Bye” she said. “That all happened in the Toronto airport, so that’s in one building you just has this complete contradictory perspective.”

When The Ithaca Plan was announced in February, harm reduction aspects of the plan, such as supervised injection sites, were immensely controversial and continue to evoke public criticism.

But for Fan, seeing addicts in Vancouver be treated for a disease as opposed to being treated like criminals, furthers her professional and personal support for the plan and harm reduction initiatives.