"Why I Help Addicts Shoot Up"

This is the title of an article written by nurse Meera Bai, with help from her supportive Regent College professor, which is a Christian apologia for harm reduction on Vancouver’s downtown East side. (And bravi, I say, to my friends and erstwhile colleagues at ChristianWeek for publishing it.) Meera and fellow Christian Bethany Jeal, the clinical coordinator of InSite, have set us all a powerful, provocative example of obedience and love in an otherwise desperate situation. And they have suffered frequently from fellow Christians who have condemned them for their mission of mercy.

The disgusting and perplexing complication, however, is that the Harper government–whom I have supported on many issues–are determined to shut it down. They have tried and tried, and are trying once more at the level of the Supreme Court of Canada.

So I hope you’ll read the article, support what Meera, Bethany, and her colleagues are doing, and write to your MP and to the PMO to back off and let these courageous people do what most of the rest of us really, really wouldn’t want to have to do–and someone must.

UPDATE: Meera talks about InSite on YouTube here.

0 Responses to “"Why I Help Addicts Shoot Up"”

  1. Chris Miller

    Thank you John, Meera and Bethany for a contemporary example of the “be-attitude living” of Matthew 5:7. I’m beginning a message series and will discern how to use this example of Christ’s mercy.
    Also, you have changed my mind re Insite.


    • Meera

      Thank you for writing this, Chris. It’s so encouraging for me to see that you are being blessed by the same stories that blessed me every time I pass through the doors of InSite. Thank you also for re-telling this story in your church as part of God’s story in our world.

  2. Andrew Tsai

    I shall classify myself as one who opposes such project, though I can see that people who do this job have a genuine heart to helping people.
    My main difficulty lies in the idea that Christians can help those who are engaged in sinful behavior to engage it at lower risk. Yet, it is for harm reduction, but which is more important? To abstain from sinful behavior, or to decrease the negative consequences of such behavior?
    Yes, the clinic does successfully persuade certain percentage of drug users to get into rehabitation treatment, but this article does not address the possibility that some drug users, learning that they can take drugs at low risk of health damage, find no compelling reason to withdraw from such toxin. So the final outcome may not be as optimisitc as the article describes it to be.
    Furthermore, to avoid double standards, should Christians now support legalization of prostitution (or any other vice that people engage in regardless of its being legal or not)? If prostitution is banned, people will still go to prostitutes, with higher health risks. Should not Christians, for the purpose of harm reduction, also ask the government to open a “clinic” in which people can engage in safe sex with prostitutes who go through regular screening for STDs? The participants may very well thank them for being loving and kind! And they may in a long run, after being shown mercy, start to love themselves, and withdraw from visiting prostitutes.
    There are many ways to do harm reduction, and helping participants to engage in it with low risk may not be the best option. I would suggest that the clinic can still operate, but solely for the purpose of counseling addicts, and treating them in the episodes of overdose.
    There are many more arguments I can make against such “help ’em shoot up!” program. The most I can do is to concede its exisitence, but it will be going against my conscience to actually support it.

    • John Stackhouse

      Brother Andrew, and everyone else: Arguing from analogies is perfectly appropriate, of course, but also dangerous. The blogosphere is littered with conversations that got ‘way off track because someone said, “A is like B, and I don’t like B, so I’m against A”–and then everyone starts arguing about the merits of B, or whether A is actually like B, or whether C is a better analogy, or about how D is like A and I like D so I guess I’ll like A…ad infinitum.

      So I’m going to restrict comment on this issue to the actual issue: harm reduction for addicts on the Downtown East Side of Vancouver. The real choice Meera and her colleagues make is NOT about legalizing prostitution or anything else. It’s about whether they will use their skills, time, and caring in this particular way. And good ethical decision-making stays tightly focused on the actual options available in a given case.

      So, Brother Andrew, you do say you would prefer to offer counseling to addicts and treat them when they OD. Two practical questions–real questions, to which I do not know the answers–come to mind (and I will encourage commentators not to do what Andrew does, namely, employ rhetorical questions in lieu of actual arguments, since in this case I would actually answer at least some of his questions differently than he is clearly expecting I would, so they don’t work):

      (1) Others already counsel addicts. Is there a present need for another counseling place that offers no other incentive for entering than getting counseling?

      (2) Who is going to be present when an addict OD’s somewhere else? InSite offers medical help on the spot. EMTs offer services to other addicts, and they obviously have to be contacted (a major factor in this situation) and have to arrive in time to assist (another one). And those are the options, so far as I know. Am I missing something in this scenario?

      Deciding to support InSite is a decision I have come to only by being forced to eliminate every other option as worse. That’s why I insist on a strict focus upon this situation. And I’ll ask Meera or others familiar with the situation to help us with questions and issues such as Andrew and I have posed.

      • Meera

        Hi John, and Andrew.

        It’s encouraging for me to hear your discussion on this issue because it raises the same questions that I had before I began working at InSite.

        One of the realities that I was faced with when I began work is that my assumptions about addictions were false. I had thought that the alternative to InSite was to stop using drugs. Unfortunately, what I found is that the alternative to using at InSite, is using in the streets. InSite (as was pointed out by the B.C. Supreme Court), is the only way that many of these addicts have access to health care or addictions counseling. The sad reality is that nobody else is out there doing what we do. That big hole is Christian-shaped.

        It is true that on first glance, InSite seems to encourage drug use. This is a totally valid concern – and you’re not alone in having it. That’s the last thing InSite staff want too. Believe me, you can’t possibly work with drug users and think that injecting drugs is a healthy way to live. A number of studies on this specific question – does InSite make people shoot up more – have been published in journals like the British Medical Journal, the American Journal of Public Health, and the New England Journal of Medicine. Of course, the results show that InSite has not increased drug use in the DTES. It is a big sigh of relief, knowing that what we do is not damaging the people we are trying to help.

        You can find summaries of all these articles here: http://uhri.cfenet.ubc.ca/images/Documents/insite_report-eng

        Finally, I would like to challenge the notion of having InSite only provide treatment for ODs and addictions counseling. Of course that is the general idea of what we do, but let’s try to work it out practically. So lets say addicts come in to inject using their own needles – we might simply watch and wait for them to OD. What if, through building relationships, you know one person is HIV positive and another is not. They start sharing a needle. Do you intervene? What about if one of them starts trying to inject into a vein in his neck, because he is long past the point of self-worth that might tell him to stop? Could you live with yourself if he bled out through his carotid artery because you didn’t speak up when you saw him trying to get his jugular vein? I argue that InSite does exactly what you want them to – addictions counseling and OD management – as best as they can.

        Thanks to you both for being willing to have this discussion – for talking and thinking it through. It’s a lot more complex than we first thought – but in a way, it’s also a lot simpler. And that’s a relief.

        • Andrew Tsai

          Basically, the question can be boiled down to this: Can participation in the vice be justified in the name of harm reduction? When I think about a certain action, I can’t help but think in categories. That is why I give analogies. Because what is often at stake is not that the action itself is bad, but that when you compromise a certain standard of ethics (in this case, aid IDUs to inject drugs), what does it do to other kinds of behavior? When you legalize gay marriage, it will never stop at gay marriage, but will go on to polygamy. Why? Because by legalizing gay marriage, you have compromised the idea of one-man-one-woman marriage. And therefore, it will be more difficult to keep other forms of union illegal.
          Therefore, the concern is not just practical, but also ideological, or ethical (instead of moral).
          Essentially, when Christians oppose programs such that Insite offers, it is not only because they think it will encourage more people to use drugs or other practical concerns, but because they think it is wrong to help other people to engage in sinful behavior.
          So the struggle is: can practical benefits trump ethical standards?
          And if you say yes, it is ok to help people to engage in bad behavior if you are reducing the harm they are doing to themselves, then how do you stand in other areas of similar scenarios? Yes, it is essential to keep the argument to only this issue, but you can’t avoid the concern of double standard when you consent to this one, and you may not consent in other cases.
          To give just a possible example, besides the one I gave earlier. I can think of making a pornographic-like film, but one which does not involve devaluing of female, or other kinds of perverted behavior, and encourage people who struggle with pornography, or people who see no problem with it, to watch it. The purpose is to reduce the harm that regular porn may cause to the viewers’ mind. What will make a person say no to such idea if he/she already consents to the way Insite operates?
          I am not sure if I have expressed this thought correctly, but hopefully you get my idea. And I shall stop here.

          • John Stackhouse

            Andrew, I sympathize with your take on this matter. It does seem very odd, from some points of view, to assist people in doing evil. (Worse than odd: It sounds like sin itself!)

            I have come to a different ethical outlook, however, that gives me grounds for believing that the sort of harm reduction Meera and Bethany practice is a good thing for them to do–even as it certainly isn’t all that we all should do. As Dan Oudshoorn hints, we should be doing MORE, much more, to deal with the several facets of addiction, including changes in our economic practices, changes in our mental and medical healthcare policies, changes in our funding of charities and more. But what Meera and Bethany do is still a Very Good Thing to Do in the face of the immediate problems addicts face.

            (I asked us to refrain from analogies and I understand the compulsion to revert to them, but here’s just one reason why your analogies don’t work: drug addiction is importantly different from porn addiction, not least because the former is often fatal and I haven’t heard of a fatal case of the latter. But I won’t pursue this, because I said we all shouldn’t!)

            I argue the Christian ethical theory behind this different point of view in my (big) book, Making the Best of It: Following Christ in the Real World (OUP, 2008). For now, I can simply say that I do get where you’re coming from and used to be there myself. Now I look at things differently, and believe that in many real-world instances, harm reduction is the best we can do–or, at least, the best some of us can do while others of us need to use what gifts we have to do our part as well.

    • buddyglass

      For what it’s worth, I don’t think it’s a foregone conclusion that the correct position for a believer is to oppose the legality of prostitution. Just sayin’.

  3. Steve K

    Hi Meera,
    I do struggle with accepting something like InSite. (Or, maybe I struggle with accepting the reality of the despicable circumstances that make InSite necessary?)

    I have a few questions:
    I assume, being in Canada, there is a high level of ‘secularism’ at InSite.
    Are you allowed to share your faith/hope (You obviously share love)?
    Is the Long Term treatment offered/referred encouraging to you, as a Christian?
    Is ‘not-using’ the best hope most addicts have/are offered?


    • Meera

      Hi Steve,

      I think you hit the nail on the head, breaking your heart and mine, when you said that the struggle is with the reality of the circumstances that make InSite necessary. I long for the day when we will shut down because we won’t be needed. This is the kind of job where you wish that you could get laid off from lack of demand. Thank you for sharing the pain of this reality.

      Like nurses and doctors all across Canada, those of us in the healthcare profession are not permitted to share our faith explicitly unless the patient begins the discussion, and even so we only really encourage them rather than provide them with new information. This is a characteristic of health care, and not specific to InSite. I challenge you on calling this secular though – if we do not explicitly talk about God, does that mean He is not present? What about the Book of Esther?

      As a nurse, I am also free to refer people to chaplains and Christian agencies or churches that I trust – and I do this as needed. If anything, because of the relationship-building characteristic of InSite, which is different from other more anonymous forms of healthcare, I am more inclined to be open about being Christian because it’s part of who I am.

      I am encouraged by the long term treatment offered to InSite users, but I do accept the reality that many participants will not make it to a healthy place in society. This is that reality that we both despise. I wish it were different. I also wish that the treatment facilities were better. What we lack in funding, we try to make up for in relationship – so InSite nurses are cross-trained at different facilities in the DTES including detox and a community infection care program. I think the reason that InSite has such a high rate of getting people off of the street is because of how we value relationship.

      I think your last question refers to whether or not we promote abstinence from drug use, but correct me if I’m wrong. The thing that we as Christians miss, is that people don’t need to be told not to use drugs. Their lives are simply awful. But after a lifetime of drug use, they don’t know how to get out. This is the heartbreak of addiction – sometimes it’s been fed so deeply that it has control over us in ways we never expected. Physiologically, emotionally, and spiritually, drug addiction is powerful. Sometimes, stopping cold turkey is impossible (and can lead to physiological damage).

      What we provide is reachable steps towards an ultimate end goal of self-worth – which of course includes valuing yourself enough to stop injecting drugs into your system. This is part of the Kingdom of God – which is coming, but not yet here. InSite simply acknowledges the reality that not everyone is able to reach that high, and tries to go one step at a time. The answer to your question, then, is that not using is an ultimate hope, but not always a realistic one. It’s the direction we head for sure, but the unfortunate reality is that not everyone will make it there.

      Thanks for sharing the struggle of InSite – it is encouraging for me to hear that you care.

      • Steve K

        Thanks Meera.
        For lack of a better description, your answers were soothing. (Is that odd?)

        Re: ‘secular’, I definitely agree that we do not need to talk about Him for God to be present. (In fact, while writing my original comment, the Assisi quote about “if necessary, use words” flashed through my mind).
        I know this is complex and I think I was trying to work out how we meld our past, present and future (as Christians) into our work with others.
        My last question is therefore related to my bringing up secularism. Your discussion of relationship is key, I think. And I think… I think… self-worth is achievable without mentioning God, but not without God. I will be praying for you – that you will be Christ to these broken ones.

        It must be very difficult to see people day in and day out going through such struggles. And I hope that my heart is opened more to show some of the compassion you have.

        Is prayer and contacting our MPs the best thing for us non-medical-field Christians to do? Anything else?

        • Meera

          Hi Steve,

          Thanks for your input. I think you and I are coming from the same place in this. It is hard, but thank you for caring.

          Prayer, absolutely, is essential. And yes, contacting your MP is so important even though it seems unusual. Another thing that you can do is raise this discussion in your own social circles. Being transparent about your own struggle to accept this reality is enough to start discussion and thought on a level that many have not yet considered.

  4. Josh Cramer

    Thanks for the link, John, and the beautiful article, Meera. I pray God’s blessings on you as you minister with the least of these brothers of his (and mine). – Josh

  5. Keith Shields

    Thank you for a brave article. Thank you for helpful discussion. May we all continue to hunger and thirst for righteousness in these complex systems.

  6. Chris C.

    Thank you, Dr. Stackhouse and Meera, for the great article. We need more people like you speaking out to the conservative Christian community regarding this issue. I wish one day we could host an event in Vancouver where all the churches would be invited to hear a panel of Christians holding the various positions to speak on the topic and, hopefully, Christians would come to a deeper understanding of the issue and would make a more informed position on InSite.

    • Meera

      Chris, it would be wonderful to have that panel discussion and discuss this issue among Christians. You say the word, I’ll be there… 🙂

  7. Jeff K. Clarke

    Thanks for posting this, John. I am in awe of the courage and love displayed by Meera and those who assist her. I support your work and encourage you to continue in it.

    • Meera

      Thank you Jeff. If you are supportive of InSite, please write your MP and let them know. Hopefully together we’ll raise enough of a stink that the Harper government will start to realize that harm reduction has Christian values.

  8. Ross Banister

    Meer: So glad that while all the theololgy is being debated, your faith is at work!

    • Meera

      Thank you Ross! Insite is a great place to work while at Regent because it contextualizes all the learning. No point to studying God if we don’t act on what we know.

  9. Benjy

    Out of pure curiosity, I was just wondering if any financial studies had been done. It might make the government change their mind if it was fiscally better to keep InSite open than to pay the hospital bills of users who have AIDS or overdosed or what-have-you.
    On a different topic, thanks for sharing. I can’t see how offering hope in these people’s lives is a bad thing.

    • Meera

      The cost-effectiveness of InSite has been pointed out through multiple reports and research, the most recent being CMAJ in September. Unfortunately the Harper government does not take this into consideration, as they are willing to spend exorbitant amounts of money simply trying to shut InSite down at a Supreme Court of Canada level.

      Thank you for the encouragement.

  10. Beth

    Meera and John,

    Thanks so much for the time you put into writing this. I was pretty sold on Insite after I heard a colleague say, “You can’t love or help people with addictions if they’re dead.” But it was still great to hear from an “Insite insider”. I was really moved by the foot-washing account. I know how much physical touch can mean to my friends on the DTES.

    Meera, I think you’ve come to Jacob’s Well’s colleague lunch once or twice before (that’s one of the places I work), but I wanted to remind you that you’re always welcome on Wednesdays for lunch. As a Regent grad and colleague in the neighborhood, I’d love to get to know you better.

    Send our love to your colleagues at Insite!

    • Meera

      Hi Beth,

      The work you do at Jacob’s Well is amazing. There are not many Christian organizations in the DTES that I would endorse – but Jacob’s Well is one of those that really gets it. Love, and more importantly communicating that love, is something that you guys do well. I’m so glad that you understand InSite.

      Unfortunately I’m back in Calgary right now so won’t be able to make any of the colleagues lunches anytime soon. I am praying for you guys though, and I hope to see you there again!

  11. Fiona McGregor

    Thank you Meera for a refreshing look at In-site and the work done there and thanks John for using your blog to bring this work to your attention.

    You do an excellent job of showing the horrors of drug addiction and the desperate straits the individuals who use your services find themselves in.
    You also clearly remind us that users of Insite do not choose this lifestyle and indeed do not choose to become addicts.

    As you point out most addicts have enough self loathing; they don’t need the reminders of their shortcomings from others. The population of addicts as you point out is disproportionately taken from those who have already known indescribable neglect and abuse growing up, before they started the pathway of addiction and in my experience and from all that I have read from the literature of addiction; the experience of feeling accepted is an essential prerequisite to any form of healing. Acceptance is not the same as a sentimental blindness to the consequences of abuse, but does acknowledge how difficult it is to challenge the distorted brain pathways that have developed with addiction.

    Thanks for a thought provoking article.

  12. Dan

    Having spent over ten years trying to follow Jesus and journey alongside those who struggle with various forms of substance misuse, John and Meera are “preaching to the choir” when I read the article and post above.

    I am very glad Christians are doing this sort of important work but I don’t find it particularly extraordinary (I think it’s the default position Christians should take in our context). However, what I do find extraordinary is Meera’s patience and willingness to graciously engage in dialogue with other Christians who disagree with what she is doing.

    These days, I find that I get too frustrated or too angry to be a very fruitful dialogue partner. I wish I were otherwise, but I’m so weary of Christians who are blind to that which is life-giving and who, therefore, continue to contribute to that which is death-dealing.

    So, hey, big kudos to you, Meera, not just for your work in the DTES but for you patience, grace, and love for all.

    • Meera

      Hey Dan,

      It’s hard, and I get it. There are days that frustration and disappointment in others overwhelms me – especially when it comes to something I am so passionate about.

      A hard lesson that I’m still in the process of learning is that it is hypocrisy for me to love one group of people and hate another. I could piously claim to love addicts and work at InSite, but do I really believe in equality if I then respond with bitterness to people who disagree with my work? Don’t get me wrong – I still often lose my temper. But there is something in me that speaks to a deeper understanding of grace – where love is extended to all.

      What if we took your comment: “I wish I were otherwise, but I’m so weary of Christians who are blind to that which is life-giving and who, therefore, continue to contribute to that which is death-dealing,” and we substituted ‘addicts’ with ‘Christians’? All of a sudden, you would have more grace for them. This is the hypocrisy that I often find myself battling.

      It is common for those of us on the front lines to get jaded by the callousness of people who have not had the opportunity to experience what we have. This is a sin that we must fight against. The people of God have been called to work together, and we’ve got to do everything in our power to make it so.

      Thank you for the support, and for saying that what we do at InSite should be default for Christians. I could not agree more. May God bless your work.

      • Dan

        Yes, of course, this whole loving all parties is another one of the basic elements of Christianity.

        After all, as Jurgen Moltmann reminds us, in the context of oppression both the oppressors and the oppressed are dehumanized — the oppressed because they are not permitted to attain to fullness of life, and the oppressors because they lose something of their humanity by oppressing others. Thus, any commitment to overcoming oppression — or any situation that is death-dealing — is simultaneously a commitment to liberation for both parties.

        So, to be clear, I’m not hating on anybody. It’s just after all these years I don’t have the energy to invest in everybody equally. Kudos to you for still having that strength.

        (That said, there’s nothing wrong with a message that will sometimes strike others as “angry.” God’s offer of liberation sounds very different to Pharaoh than it sounds to the Hebrew slaves… but salvation was being offered to both parties.)

  13. richard

    Meera, I believe I shared a class with you earlier this year. I learnt a lot from your questions then, and even more from you and Bethany in reading about InSite for the first time.

    Thanks so much for ‘going public’ in the Christian community/press with this. It speaks volumes of your love for those InSite serves but also of you in being willing to take the inevitable critique from Christians who may not agree with you, and to engage them with grace.

    I hope I learn and the Christian community can learn all we can from InSite and your example.


  14. Tony

    Thank you for posting this most stimulating article Dr. Stackhouse, and thank you Meera for composing your article as well. But mostly I want to thank you Meera for answering what you believe to be God’s call on your life. I can tell you serve Him and His creation with the love, compassion, and grace that He has blessed you with. I praise God for that and for you as well!

    I certainly am undecided how I feel about this issue ethically and morally as a Christian, but whether we see eye to eye or not, I will support another Christian in their endeavors to reach the lost and hurting. I believe that there are good points and arguments on both sides of the fence concerning this issue. It is one that I have tragically not thought much about. So I just wanted to write in to thank you for bringing this to the forefront of my thoughts, and for challenging my beliefs both ethically and morally. That’s why I read your blog. I will continue to read and meditate on this issue, and will be praying for you Meera and the group at InSite. Thanks and God bless!

    • Meera

      Thank you, Tony, for your support. I don’t want you to isolate me as the one who is especially answering God’s call on my life, because I am so grateful to John Stackhouse for his obedience to God as well. Without John, this article would not have been written, submitted, or published – and he has put in an incredible amount of work for no gain whatsoever. So I’m very grateful that God is at work in His people as one body – those of us who work at InSite, and those who don’t but support us.

      I find that the difficulty with InSite is that people are undecided – obviously because it is a controversial ethical question. However, because InSite is unfortunately facing being shut down by the Federal Government, we need to act now regardless. Uncertainty can lead to a lack of willingness to act, but the two do not necessarily go hand in hand. This may mean writing to an MP to say that you are unsure of your ethical stance on InSite, but you realize that right now, there is nothing better and no place for addicts to go for counseling and health care, so we must keep InSite open until a better alternative can be found.

      Thank you for your encouragement and your prayers!

  15. AL

    I’m a political science student who has tried over the years to reduce personal dissonance and determine an absolute answer to Insite — whether I support or oppose it. Yet, I still do not know. This continues to be an issue of very contentious for me as I am also one of those undecideds out there. Meera’s story was very touching and makes a convincing argument as to why InSite should remain. However, I still cannot figure out if it is moral to harm patients (injecting them with drugs) for the sake of preventing more harm (diseases, improper injection, injury, etc.). It comes down to: WWJD? I just cannot see Jesus helping addicts to inject drugs, even if it would prevent more harm. I believe there must be a way of providing compassionate, loving, non-judgmental and self-esteem building care without having to actually aid those in the DTES to inject drugs.

    On a side note, the article suggests that the Harper government is more concerned with “locking up addicts.” That is a huge accusation to be throwing around, and it also misses the mark when one considers that there are many other reasons (besides “locking up addicts” as the article claims) to invest funding in policemen, correctional facilities, and rehabilitation programs. I do not want to delve into this issue too much, but the federal government has maintained and in fact expanded funding for some poverty initiatives in this country, while empowering individuals and private charities to help the disadvantaged too. While the government does not support InSite per se, I feel that the article is too harsh and hyperbolic on the Harper government’s approach to homelessness and addiction.

    Nevertheless, I thank Meera for sharing with us her experiences working in InSite. It is always encouraging and inspiring to know that there as followers of Christ working in the most desolate parts of our community. God bless.

    • John Stackhouse

      Thanks for this gracious note, AL. Two quick responses:

      1. You say you’re a political science student wrestling with this issue, but it sounds to me like your sticking point is theological only: WWJD? So I encourage you to continue to work on your understanding not only of Jesus (who might well do exactly what Meera does, I believe), but also on your theologico-ethical assumption that the question is, “What can I imagine Jesus doing?” It isn’t, I daresay, but instead is something like this: “What does Jesus–as he teaches us in the entire Word of God–want us to do in our situation, not his?”

      2. The Harper government comes in for criticism NOT because it has this or that argument for or against InSite but because it is spending thousands and thousands of taxpayer dollars TRYING TO SHUT IT DOWN. There’s a huge difference between people having honest differences of opinion, as some of us here seem to have, over whether InSite should continue or not. That’s not at all what’s happening in the government’s case: Having lost at previous levels of the courts, they yet are persevering to the Supreme Court. I find that reprehensible, and I hope you will, too.

      • Meera

        Hi Al,

        I think that perhaps I can help clear up a misunderstanding for you. At InSite, we never, ever, inject patients with street drugs. The users at InSite are primarily long-term injection drug users (IDUs) and InSite is a new venture to reach out to them by assisting them to care for themselves more than they have been. This means we provide counseling, wound care, clean needles and supplies, and we help them find a vein if their other alternative is shooting into their necks. They use their own drugs, and they inject themselves – the same way they would have done outside on the street, using puddle water instead of our sterile water. We watch them, and if they overdose, we treat them. Through this, we build relationships that are key to change.

        Although Jesus would be able to miraculously cure somebody of an addiction (and I have heard of this happening with friends), He doesn’t always choose to act that way. God seems to prefer to work through His body – His people in the world. It is thus our responsibility to learn how to love in a way that will help addicts take steps towards a healthier life. God works through us in doing so. I believe that it is because InSite follows such Christian values – love, relationship, grace – that InSite has such a high rate of getting people off of the street.

        As I mentioned to Tony in the comment above, now is the time to act, regardless of uncertainty. There is certainly not enough evidence to show that InSite is doing a bad thing, and there is a lot to show that shutting it down would be harmful. Christians understand all too well the need for grace for all of us – and so it is our responsibility to be a prophetic voice in the world speaking out for those who nobody else speaks out for. It is up to us to protect the addicts that use InSite from having to OD alone in an alley instead.

        Please join us in our fight by speaking to your MP and continuing to raise awareness on this issue.

  16. Luke

    I would say that appealing a decision to the Supreme Court of Canada should not be considered disgusting or reprehensible. It’s fairly standard on significant decisions involving government policy, and especially the interaction between federal and provincial powers (here the federal authority over criminal law, and the provincial health care authority). When the provincial court of appeal is divided as they were here, I think the government is entitled to seek the view of the highest court.

    • John Stackhouse

      Wrong end of the stick, there, Brother Luke. What is appalling about the Harper government is their opposition to InSite and trying (and trying and trying…) to shut it down. Yes, there is nothing legally inappropriate about their pursuing it to judicial exhaustion, but the more they persist in opposing the good, the worse their culpability–that’s my point.

      • Meera

        Hi Luke,

        I agree in that I think the government has every right to take this case to the Supreme Court. I just don’t understand why they would. The fact is that InSite is doing good work – so attempting to shut it down, despite being legal, is immoral. The people are what hold governments to standards of morality. I would go farther and say that it is the church’s role to speak out for the marginalized in society, and this can mean speaking out to those in government, lobbying for change.

        Unfortunately, my MP’s response to my lobbying has been less than appropriate. This response can be found on my blog:


        When the church speaks loudly for minorities and the marginalized, perhaps we will have fewer responses like the one I received, and we will not need to rely on the letter of the law as much as we do now.

  17. Jeff Loach

    John, I wonder if you might make some comment to our edification as to what it was that enabled your cranial peregrination on this subject. What was it that made you favourable toward the work that InSite is doing, if you weren’t before?

    Grateful in advance for your comments.

    Passionately His,

  18. Robert Plante

    To my perspection there’s more relationship between poverty and drugs and between loneliness and prostitution than most people think.
    I think taht evry parent shouls start really early by sharing difficult matters with children and not keep them from thinks like sex, drugs and alcohol.
    When softdrugs are legalized in a limited way and prostitution is legalized in a taxable way it will be way more easy to help people in a descent way.
    Who dares to throw the first stone?
    Charlatans like Patterson or the Pope are definitely not the people I’m thinking off.

    • Meera

      Hi Robert,

      I agree that there is an obvious relationship between poverty and drugs. The questions of legalizing drug use and prostitution I will leave aside for another day, but I think what we can all agree on is the need to provide compassion, grace, and care, for all who have fallen prey to drug addiction. It is our humility in recognizing that all of us are broken people, that will allow us to see drug users as brothers and sisters. Christians know this better than anyone – that we are all made in the Image of God. So it is up to us to speak up. Thank you for joining the discussion.

  19. Robert Plante

    ..we agree on this matter John!
    Some friends of mine were/are addicted.
    To Alcohol, Cocaine sometimes, sex, work, sleepingpills, anti-depression medication, etc.
    I feel sorry for them. They were/are my friends and I love(ed) them!
    Some people forget that it can happen to them also. Pretty easy and devistating as well.
    For instance, when my wife and kids would die in a carcrash there would be just two options left for me.
    Commit suicide or take a bottle of scotch (wich I don’t like at all actually) twice a day. I would be dead inside anyway wouldn’t I?
    And this is why I admire heroes like Meera and Bethany and the work they do dearly.
    They don’t judge, they’re just there for people in need. We should honour them for the work they do and the love they share.
    And that’s also why I despise ,for instance, a ‘Christian’ like Pat Robertson. Always judging, always knowing better when it comes to ethical matters. But also showed several times that he is not worth it to tell others how they should live theír lives anyway.

  20. Ross Banister

    Addiction is not a choice! Its roots are neuro-biological and genetic predisposition; with lack of attunement in development, and cultural and social dislocation all contributing to a spiritual void and lack of identity. The addict already knows his poor moral choices while using- he is plagued with guilt and shame. Jesus has compassion for the poor in spirit. For example, we should also have compassion for the prostitute on Hastings as she was sexually violated growing up.

  21. Paul

    Having worked with addicts since the early ’70’s in places like Afghanistan, Pakistan, India, and Nepal, I have struggled long and hard with many of the issues raised here. While I agree with the sentiment to reach out to those who are suffering, at some point what starts out as helpful compassion, can, if unchecked, lead to destructive, dehumanizing enablement. It has been my experience dealing with many addicts that they always have a choice, and the moment we deny that we deny their humanity, and make them things. I’m not denying that those choices can be very hard in many circumstances, but it seems to me that an important part of being a significant being, made in the image of God, means that we can rightly be expected to do the right thing, even when circumstances are not entirely conducive to doing so. From another angle, if we constantly mitigate the negative consequences of people’s irresponsible behaviour, why should we be surprised when they are not motivated to change their behaviour. Having worked in the downtown east side, near Main and Cordova, the net result of insight has been to increase the addiction rates, rather than reduce them. One only needs to look at Copenhagen which is the epitomy of the “hard reduction” model and also the overdose capital of the world to realize that there are significant pieces missing to this approach. As I understand it, we are exhorted to “Do Jusitce, and love Mercy” when all there is is mercy, and Justice is ignored, we can end up being more destructive in the end.

    cheers, Paul

  22. Paul

    p.s. My apologies for the typo’s in the above, hopefully that thoughts, rather than the spelling will be considered.

  23. Meera

    Hi Paul,

    I appreciate the concern that you have for people suffering with addictions. I just wanted to clarify, however, that the statement you have made about InSite increasing the rate of addiction in the DTES is false. Please refer to the research that I cited in my response to Andrew (comment # 2) above. The last thing that InSite staff want to do is increase the number of people using drugs in the DTES, so it was a huge relief for us to have so many research studies be done on InSite showing that InSite has not increased the rate of addiction.

    I think one of the fundamental issues that comes up whenever InSite is discussed is the tension between addiction and choice. By its very definition, addiction supersedes willpower. Initial choices to use drugs were made (although we do not know and cannot judge the circumstances they were made under), but by the time many users have made their way to InSite, drug addiction has taken control of their lives. This is a reality that I wish could change with simple persuasion, but unfortunately that is not the case. Because addiction has such power over human beings, harsh words or judgment only have the effect of contributing to an addict’s helpless downward spiral of decreasing self-worth. It is love, and grace, that have power over addiction. InSite’s success is based in this truth.

    Thank you for your opinions, and your willingness to engage in this discussion.

  24. Paul

    Hi Meera,

    I wish what you are saying was true. It flies in the face of the face that drug use hit a 30 year high in 2007, and the lack of proper controls, self selecting samples, and other methodological problems with the studies you cite does not enhance confidence. Your caricature of those opposed to your position eg. “harsh words. . .” Is also unhelpful. The denial of responsibility such as you espouse, has never, in my experience helped anyone live more responsibly. As I mentioned earlier, it is not an either or proposition, but must include both. As someone said, truth without love is barbarity, love without truth is sheer sentimentality. Sadly, in my experience those who promote programs such as InSite, deny some fundamental issues critical to seeing addicts truly deal with their issues.

    As to definitions, your definition of addiction does not fit any of the hundreds of addicts I have known. Every one that I have known when you took the time to walk with them to the core of who they are admitted that what they did was a consequence of their choices. They loved those who let them off the hook by denying their responsibilities, because it allowed them to blame others for their issues. Every recovery I have seen began when the blaming of others or circumstances stopped, and they took responsibility for themselves.

    Thank you for your time and attention.

    cheers, Paul

    • Meera

      Hi Paul,

      I think we may have to agree to disagree on this one. So far all of the research done on InSite that has been published in peer-reviewed journals (CMAJ, New England Journal of Medicine, the Lancet, BMJ, etc) has all showed that in fact, InSite has not increased the rates of addiction in the DTES. These journals are of the highest standards, and I trust that since so many studies have been done, they are accurate.

      Far from attempting to caricature those who believe differently, the purpose of this article is to shed light on what really goes on at InSite, and allow people to decide for themselves if what we do is in line with Christian values. It is my hope that all who read it will see Christ in the work that happens at InSite.

      Thank you for your comments.

  25. John Stackhouse

    Brother Paul, I find your logic difficult to follow. (That’s academese for “I think you’re wildly wrong.”)

    You actually think that the small portion of kindness InSite is able to give these people makes them say, “Wow, I think I’ll just keep being a heavy IV drug user, since my life is otherwise free of negative consequences of addiction”?

    You actually think that closing down InSite and the care these people get from it will cause any one of them to say, “Well, I thought drug addiction was not too bad before, but now that InSite is closed, I’m going to have to reassess my life”?

  26. Paul

    Hi John,

    Thanks for the response. If I am wildly wrong, it won’t be for the first or last time. InSite is part of a cultural phenomenon which sees the addict primarily as victim rather than responsible agent. I could be more in favour of things such as InSite if it were coupled with things such as mandatory treatment etc, but the problem with the Vancouver implementation of harm reduction, is that it takes only one portion of the larger concept utilized in other areas. The terrible fact of the matter is that many addicts simply adjust to those other negative consequences, and InSite is just one more piece of that bigger puzzle. As to your hypothetical, I am talking about actual people for whom the things you might perceive as negative consequences are of no consequence to them. Unlike my experience in Asia where addicts were often confronted with the choice of either I get myself straight, or die, here we have taylored our environment to support our survival in spite of or often because of our irresponsible choices. The more we trivialize their irresponsible choices the less likely they are to make different ones. Also, your final paragraph begs the question. Is InSite providing care, or enablement? In my view, in many cases, it is the latter.

    While I share your dislike for arguments by analogy, try this one on for size. In the case of InSite we are helping people break the law more safely, if that is an appropriate thing to do, why don’t we have designated lanes for drunk drivers?

    cheers, Paul

    • John Stackhouse

      I think your analogy nicely makes the case for why analogies aren’t helpful in this discussion. The differences between the InSite staff offering what they offer to the people they offer it to in the circumstances in which those people live versus a city council building a lane to accommodate anyone who chooses to drive drunk are so obvious and so many as to beggar my time.

      Otherwise, I appreciate your making your point of view quite clear, and Meera and I have had the chance to do the same, so I think we’ve reached an impasse.

  27. Richard

    Hi John and Meera,

    Thanks so much for your article on InSite. You are doing great work.
    I have worked in the area of HIV & AIDS for the past ten years and recently completed my Masters dissertation on HIV Prevention and Western Evengelicals. This included looking at the ethics of harm reduction including Needle-Exchange Programmes. One source I used was the landmark book Catholic Ethicists on HIV/AIDS Prevention (ed. James F. Keenan) which looks at the role of Catholic manualists in applying the principle of cooperation (Cooperatio ad Malum) and the principle of the lesser of two evils (sub specie boni). I also looked at the place of narrative theology in forming ethical positions in this area and even managed to fit in a bit of “Making the Best of It”! Basically I believe there is a consistent ethical position which can be taken by evangelicals which affirms a role for harm reduction measures such as these. In addition there is a positive health benefit in harm reduction measures and cities around the world have seen thousands of lives saved when they are appropriately implemented. Many of the comments above opposing the work of InSite rest, in some ways, on the “it’s sending the wrong message” argument. I love this from William Martin of Rice University in response to that argument:
    “Though some sincerely question the scientific evidence supporting various forms of needle exchange, the major opposing argument continues to be, “It sends the wrong message.” Before we accept that rationale, we need to think about the message we currently send: “We know a way to dramatically cut your chances of contracting a deadly disease, then spreading it to others including your unborn children. It would also dramatically cut the amount of money society is going to have to spend on you and those you infect. But because what we believe you are doing is illegal, immoral, and sinful, we are not going to do what we know works. You are social lepers and, as upright, moral sincerely religious people, we prefer that you and others in your social orbit die.” “

  28. Meera

    Brilliant, Richard. I’d love to read your dissertation. Can you send it to me or John? I fully agree that narrative theology supports harm reduction and that in fact God works with us to reduce the harm from our own sins.

    Paul, in a comment above, claimed that an analogy to InSite’s work would be to create an extra lane of traffic solely for the use of drunk drivers so that they would not harm other people. Although I know that John does not like analogies, I think that your quote demonstrates the importance of clarifying this one.

    We have ALREADY created the extra lane for addicts. It’s called the Downtown Eastside. It’s where society isolates people with addictions so they won’t infiltrate our blissful suburban neighbourhoods. That is NOT what InSite does. An appropriate analogy for InSite is that we are the paramedics that show up when a drunk driver hits a tree. As the paramedics, we could watch the drunk driver slowly bleed out, knowing we can save him. Acting to save his life is what InSite does. Refusing to act, and instead letting him die, is the logic behind “it sends the wrong message.”

    You and William Martin are absolutely right. Thank you for your response and your support.

  29. John Stackhouse

    Regarding #31, I want to make sure we’re all clear that the argument here is “reductio,” not “ad hominem.” To translate: “Here is what your argument ultimately entails, or reduces to, if analyzed far enough” rather than “You’re a bad person who doesn’t care about addicts.” The quotation attributed to Martin is about the message he thinks some are sending, and NOT about what he thinks is actually MEANT by those sending it.

  30. Leighton Knapp

    I’m glad to see this exposure. The people who work at injection sites are doing incredible work, and saving lives. It’s a statistical fact that harm-reduction methods work immeasurably better than abstinence approaches. As a social worker myself, I simply do not have the courage (nor the aptitude) to do this sort of work. I’m so grateful that others can.

    I think it’s especially important for Christians to be educated about the success of safe-injection sites, and harm reduction approaches in general. Harper is really out to lunch on this one.

  31. Joshua

    Just stumbled across Stack’s blog, dont live in Van. anymore so forgive me for my ignorance regarding this issue. Just wanted to offer two cents, tentatively:

    InSite touts that it saves and improves lives, but what’s the measuring stick for that? InSite has a share in keeping international drug trade in business for another day! Jeepers! For every one heroin buyer, there are hundreds of hands employed to deliver User X’s heroin from Afghanistan or Pakistan probably – the proceeds they use, you know, to fund terrorism against Western civilization – to North America. Keeping User X on heroin keeps these people in business, keeps guns in childrens’ hands and families terrorized in places far more destitute than Vancouver; it keeps drug dealers on the streets of Vancouver who no doubt center their businesses around InSite (regardless of how patrolled they say InSite’s surroundings are) and make a tax-free living selling H to drug-user X. For every ONE person YOU see ‘saved’ or ‘helped’ by InSite, it harms countless others you can’t see, something to consider the next time you mention how many lives you’ve ‘saved’ (a word Christians should use carefully).

    Next, I see InSite’s endeavor as harming the user it claims to help. The cartoonish logo with a syringe and a flower? Bizarre, Orwellian. ‘Why I Help People Shoot Up’? A little too casual of a title for something you claim is heart-wrenching. For those actually in the heroin subculture, at least in many parts of the U.S., the syringe is commonly referred to as a ‘gun’, which is ‘loaded’ in the ‘barrel’ with the drug. The button at the top is called the ‘trigger’ which the user pulls back and then ‘shoots’. Look no further than the language of the subculture itself. Those more intimately involved with heroin culture than politically-influenced folks in the laboratory call it a gun; shooting it is like suicide to your soul.


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