Liz Evans And InSite’s Insightful Story
By Brian Houlihan
Occasionally you meet someone whose life seems like a script from Hollywood movie. The inspirational Canadian woman Liz Evans is one of those people. One can’t help but find her story fascinating and be moved by her compassion for others. For over 20 years she has worked with members of society who are largely overlooked or looked down upon.
Liz Evans is arguably one of the world’s leading experts on the topic of medically supervised injection centres (MSIC). These MSIC’s are legal and medically supervised facilities where drug users can use in a more hygienic and safer environment.
Liz is the co-founder of InSite and has worked in the area harm reduction for over 20 years. InSite, which opened in 2003 and is based in Vancouver, Canada, is North America’s first legal medically supervised injection centre.
InSite has 13 injection booths where users can consume under medical supervision. InSite also provides clean equipment such as syringes, cookers, tourniquets and other items required. There is also medical care available should an injury or overdose occur. Addiction counselors, health workers, peer staff and others are on site to provide assistance with accessing housing, treatment and other services.
I recently got the chance to see Liz at an event she collaborated on with Help Not Harm in Dublin. At the event she gave a presentation about her journey and the experience of InSite. It was a wonderful opportunity to hear her remarkable story. Yet, it’s not just her story but also the story of the countless people she has helped over the past two decades.
Liz’s early activism addressed the area of housing, an issue which is often linked to substance misuse. “In 1991 I started a housing project which housed people that were told they were unwelcome elsewhere”. She doesn’t mince her words and says “these are people who were told they were junkies, shit and other expletives”. She adds that what made the project unique is that “we had a no eviction policy”.
The early days of her harm reduction activism saw her receives numerous threats of arrest for using Narcan (Naloxone), which is drug used to reverse the effects of an opioids overdose. She learned from these experiences of working with drug users and InSite was launched in 2003 in order to continue her vital work.
Liz tells us “our story began in Vancouver in a low income community”. The area is widely affected by substance misuse and Liz highlights that “of a population of 15,000 in a small inner city area, we have about 6,000 injecting drug users”. However she proudly tells us “that after years of struggles we were able to bring drug users indoors”
While InSite is a valuable and much needed service Liz knows it’s not a complete solution. “It’s still only one tiny intervention. We have never tried to sell it as something that would solve all the issues.” However she feels such services are important for an array of reasons. Liz says “it sends the message that the victims of the drug war matter”. She also believes that InSite “is a place where we are able to reverse the social inclusion”.
Of course establishing and maintaining such a service is never an easy task. While there was political support initially a change of government brought a change of mood. In 2006, following the election of a conservative government lead by Stephen Harper, the project faced stiff political opposition. Liz believes that “the new government was opposed to the concept of harm reduction” as they viewed it as enabling drug use.
Feeling they had little choice users of InSite filed a suit in 2007 against the Stephen Harper government. “It was a huge risk for us” Liz outlines. The aim was to argue that the constitution protected drug users. They won the case, however as Liz laments “48 hours later the government appealed the decision”.
In 2010 the case went before the Appeal Court where InSite won. However the case didn’t end there and before the Supreme Court a year later. Unsurprisingly Liz and the plaintiffs found the proceedings exhausting. “We put all our eggs in this basket. It was very stressful”.
In 2011 the Supreme Court ruled in favour of InSite and the plaintiffs in what was a significant victory for drug policy reform activists. Liz tells us that “the judges found it was unconstitutional for the minister of health not to grant protection”. “All 9 judges ruled in our favour” she happily tells a now enthralled room who are listening intently to her story.
Interestingly research in 2007 indicated that 76% of local residents approved of the centre. This research was conducted during period the attempted crackdown by the Stephen Harper government on the project.
Since opening InSite has provided valuable services to individuals whose options tend to be limited. The stats behind InSite are fascinating and tell their own tale. Between 700 and 800 people use the service daily. There have been over 2 million injections on site since it opened and not one death has occurred. Liz highlights that the service has “reduced needle sharing” and that within the drug using community “safer injection practices have been witnessed”. Liz states that you are “33% more likely to use detox if you use InSite”.
On the impact within the local community Liz highlights that there’s been a “45% decrease in open drug use” and “no adverse changes in community drug use patterns”. She argues there has been “no uptake in use and that some studies suggest the age of users has increased”. Another important factor is that there has been no increase in drug related crime.
Liz argues that InSite has saved the healthcare system money. She highlights that “one study says 14 million over 10 years, while another study says 6 million a year” depending on the criteria used. Liz tells us that some research shows that “for every dollar spent on InSite four dollars is saved”. She highlights that there “are over 40 peer reviewed studies by government which showed InSite made a difference”.
Alongside providing services InSite and individuals like Liz Evans play a vital role in presenting the voice of drug users. She repeatedly states during her presentation that much of her work has been to “amplify the voices of drug users”.
Her visit to Ireland was quite timely as the foundations for Ireland’s first MSIC have been laid. Thus any expertise and insight Liz provides can hopefully help policy makers in the near future. Liz already met the outgoing Minister for Drugs Strategy Aodhán Ó Ríordáin in London last November at a London School of Economics event.
With the election counts currently underway the political future remains unclear. However there appears to be a commitment to launch the first MSIC within the next 12–18 months. Liz is aware the debate around MSIC is a controversial one. But she feels that “the controversy should be about how we have allowed the status quo to continue for so long”. She argues that “the reality is people are suffering terribly here in Dublin and across the world. We need to do things differently”
Liz is critical of the language sometimes used in the debate. “The negative language we use eradicates their humanity”. She outlines we often see drug users as “someone who needs to be clean because their dirty”. She argues that “simplistic narratives are used to address complex problems”.
Liz suggests that the issue of MSIC is one “many would rather shy away from”. She believes the issue is full of stigma that “many people are afraid about even having a conversation”.
Thankfully Ireland is having this conversation and hopefully we can learn from the insight provided by services like InSite. As long as we have individuals like Liz Evans amplifying the voices of users then there is hope yet for policy change.
As Ireland prepares for its first MSIC the story of Liz Evans and everyone at InSite is a shining example of what dedication and persistence can achieve. Liz states “I’ve spent 25 years doing this and I don’t know what the answer is for Dublin, but I know InSite works for Vancouver”
Perhaps as Liz powerfully states “we convinced people that the lives of addicts matter”. Arguably that is where we need to begin in Ireland.
