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What happened when Vancouver opened a supervised injection site

In a move to reduce opioid overdose deaths, Vancouver became home to North America’s first legally supervised drug injection site in 2003.

A man rests after injecting heroin at the Insite safe injection clinic in Vancouver, B.C., in 2011.DARRYL DYCK/The Canadian Press via AP

Nestled by the Pacific Ocean, Vancouver, British Columbia, is an idyllic city of glass high rises, rain forests, and coastal mountains. It’s also the epicenter of the opioid overdose crisis in Canada.

In 2015, as the strong synthetic opioid fentanyl began to flood into Canada from overseas, effectively out-competing heroin as the opioid of choice in both price and availability, our city quickly became a community in crisis. Responding to overdoses is not new to firefighters, we’ve done it for years. The Downtown Eastside, home to Vancouver Fire and Rescue Services Firehall #2, is a 12-block area that is ground zero for opioid overdoses. Almost without warning, call volumes in this area doubled in under a year, and crews struggled to keep up with the constant calls to attend to someone who had overdosed. A sense of hopelessness began to take hold as firefighters routinely found themselves resuscitating patients in back alleys and dilapidated buildings, seeing the same faces time and time again lying lifeless as a result of these powerful opioids.


In a move to reduce deaths, Vancouver became home to North America’s first legally supervised drug injection site in 2003. It was done through a constitutional exception to the Controlled Drugs and Substances Act, by order of Health Canada.

Since its opening, Insite, a professionally run nonprofit operated in conjunction with the local health authority, has seen over 3.6 million visits, hosting 340 injection visits a day, and treating nearly 1,500 overdoses a year.

Most important, there have been zero deaths since opening its doors.

What safe injection sites offer is a place to use opioids under supervision. When an overdose goes unnoticed in private residences, homeless encampments, or other hidden locations, firefighters respond, but by the time we reach them, it may be too late.

Safe injection sites allow some of the most vulnerable to come together and support each other. Without these sites, emergency response services would not be able to keep up, and the loss of life would increase as people in our community continue to struggle with mental health issues, drug dependency, and the stigma that compelled them to use these powerful drugs hidden away and alone.


By 2016, the first safe injection site could not keep up and neither could we. Community activists panicked as overdose deaths climbed to nearly 400 each year in our city of 650,000. Pressure began to mount on the local government, and a decision was made to implement a 0.5 percent property tax increase aptly coined the “fentanyl tax.” This forward-thinking move put more firefighters on the front lines and added greater support to community initiatives to prevent and treat overdoses.

Safe injection sites began to pop up on street corners staffed with volunteers and naloxone, a drug that reverses the effects of opioid overdose. In 2019, we now have eight safe injections sites within a 2-mile radius. The track record remains the same: there have been zero deaths at any of the injection sites as the number of overdose reversals continue to rise during this sustained crisis.

As firefighters, we appreciate the lifesaving benefits supervised injections sites have brought to our community and the epidemic. While governments work on issues of drug trafficking, access to treatment, and meaningful advancements in mental health services, we can see that overdose deaths in our community have plateaued.


Prevention sites are certainly not the long-term answer to this public health emergency, but when it comes to saving lives, there is no doubt they make a meaningful impact. All communities across North America are dealing with the challenges of addiction and mental health issues and the strategies necessary to protect their neighbors from this horrible epidemic. It takes true leadership to incorporate safe, supervised environments into a comprehensive treatment plan for those addicted to opioids.

To the uninformed, safe injection sites may appear to encourage drug use. In Vancouver, we’ve proved that supervised injection sites save lives. As firefighters, that’s what we care about most.

Lee Lax is the public engagement chair for Vancouver Fire Fighters IAFF Local #18.