Larry Campbell: Bull in a China White Shop

By Neville Elder 02/26/14

The man behind 'InSite' fought hard to establish the first supervised injection site in North America. More than a decade later, he talks exclusively to The Fix about his struggle to keep the doors open.

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The man himself. Neville Elder

I met the Senator for British Columbia (B.C.), Larry Campbell, 66, at a modest chain hotel in Midtown Manhattan. The youthful and physically imposing ex-Mountie greeted me with a broad smile and a powerful handshake. I was scheduled to photograph him for a story about constitutional reform in the Senate for the Canadian national newspaper The Globe And Mail. We walked a few blocks to the stand on the steps of the James Farley Post Office near Madison Square Garden in Midtown Manhattan, New York City. I framed him amongst the broad clean lines of the imposing 1912 building and below the legend carved into the façade:

“Neither snow nor rain nor heat nor gloom of night stays these couriers from the swift completion of their appointed rounds.”

Stubbornness is a virtue for Campbell. When I met him he sported a trilby hat and dark glasses. I remarked that he bore an uncanny resemblance to another tough cookie—the mild mannered chemistry teacher gone bad, Walter White. He laughed and insisted we change the subject, he hadn’t watched the end of the final season yet.  

As the Mayor of Vancouver 2002-2005 Campbell instituted possibly the most remarkable piece of drug policy in the history of North American cities. In 2003 he established ‘InSite,' the first Supervised Injection Site (SIS) in North America. InSite is a medical clinic where intravenous drug users can go and inject drugs in a sterile monitored environment, effectively reducing the number of deaths from accidental overdose in Vancouver’s Downtown Eastside by over a third.

Later we caught up on the phone and he told me more about the struggle to set up InSite and the fight to keep its doors open. When Campbell talks about drugs he uses the language of the street, junkie talk. ‘Hot caps’ (a potentially lethal dose), ‘flaps’ (packets of cocaine), scoring (the purchasing of heroin or any drug on the street). This is a man who knows what he’s talking about. Philip Owen, Campbell’s predecessor as mayor of Vancouver (the man responsible for the genesis of InSite project), summed up Campbell’s attitude:

“He’s a shoot from the hip, rough, tough kind of a guy.” 

And he’s taken shots at most of his political opponents over the years. Some of those targets across the border in the US included George W. Bush and his drug Czar John Walters, who he has bumped heads with and disparaged on many occasions during his crusade. As an undercover cop on the drug squad with the Royal Canadian Mounted Police (RCMP) in the 1970’s and then later as the chief coroner for British Columbia, he watched first-hand the chaos of the heroin and crack cocaine epidemic in Vancouver in the 1990’s.

“The Golden Triangle was rockin’ and rollin’ Afghanistan was rockin’ and rollin’, there was just a glut [of heroin]. To the point the police were advising people to step on it before they shot it up. They were putting it (warnings) on street posts.” 

He described to me the effect the epidemic had on the community and local business in the Downtown Eastside, a district on the edge of Chinatown with a reputation as the ‘poorest postcode in Canada’.

“Every day addicts were shooting up in alleys in front of their stores and dying in their washrooms, it couldn’t get any worse, 200+ deaths a year. I was going to scenes where two people were dead and neither would have got the needles out of their arms.”

HIV infection rates went through the roof, surpassing infection rates in the same period in New York City. Then Mayor Philip Owen declared a health emergency and appointed his own Drug Czar, Donald McPherson. They came up with the concept of the ‘Four Pillars Drug Strategy’:  Harm reduction, prevention, treatment and enforcement. The new strategy, based on similar programs in Europe and Australia, was focused around supervised injection.

In April of 2001 as Chief Coroner, Campbell joined Owen the Police chief, a street nurse, and Dean Wilson, a recovered drug addict at public meetings. For six months they engaged the local community in discussion about the new drug strategy and in particular InSite itself. Opposition centered around the assumption that the ‘legal drug den’ would be a honey pot—drawing addicts from all over Canada to use drugs without fear of prosecution. But Vancouver’s Downtown Eastside had to be the location for InSite; it was ground zero for drug use and public disorder. 

“You don’t set this up because you’ve got 5 or 10 heroin injectors,” Campbell explained, “you set it up because you’ve got a critical mass.  You put it where the addicts are! This idea I’m going to be[come] a heroin addict, score, jump on a bus downtown to shoot up, thereby raising the number of addicts in the area is just nonsense,” Campbell told me.

But Campbell himself hadn’t always been on board with the idea of a dedicated shooting gallery.

“The eureka moment was when I moved from enforcing the law, which I was sworn to do, to preventing deaths. There’s a big difference. Police don’t prevent deaths except in an ancillary way. You know, it didn’t matter whether you were killed by a tree in the forest as a logger.. or you were dying as a result of heroin, didn’t matter to me, I still had to stop this from happening again.”

Owen had managed to secure $8m (Canadian) in support from Health Canada (Canada’s department of health). Similar funds were given to Montreal and Toronto but progressive drug strategies there floundered because of opposition in their more conservative legislatures. In 2002 Owen decided not to run again for Mayor of Vancouver and Campbell, who’d been waiting in the wings, stepped up. He was elected mayor with a virtual landslide. He promised the first thing he would do was break ground on InSite and within a year of taking office InSite was fully operational. He was a steamroller.

“I’m still confused as to why it’s such a big deal. It’s just one tool, like a needle exchange or handing out condoms – it’s caring about peoples’ health.”

Vancouver’s drug strategy wasn’t about legalization it was about public health. But in 2006 when a Conservative national government was elected, the new Prime Minister Stephen Harper took aim at InSite:

"We as a government will not use taxpayers' money to fund drug use," he said.

Despite the 20 + positive peer-reviewed studies including The Lancet (which reported an overall 35% reduction in overdose fatalities in the Downtown Eastside) Harper tried to shut the clinic down.  

InSite was working with an exemption under the Controlled Drugs and Substances Act (CDSA) and as the license came up for renewal, the federal government deferred a decision to extend InSite’s status. More research was needed they said, at the same time axing $1.5m in funding for the research, effectively crushing the center. 

Campbell and Insite’s supporters retaliated by taking Harper to court. Three times. The battle rumbled on in the courts for four years until in September 2011, despite the appointment of two brand new conservative judges, the Supreme Court of Canada ruled unanimously that the decision to withdraw InSite's exemption was: 

“Arbitrary, undermining the very purposes of the CDSA, which include public health and safety. It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises." 

The Court told the Minister for Health, Tony Clement, to grant an immediate exemption from the CDSA, allowing the facility to stay open indefinitely.

InSite is administered by the City of Vancouver, health care in Canada is administered by the provinces. As Campbell puts it:

“Our argument from the get-go was ‘it’s none of your business, it’s a healthcare issue, we’re dealing with it bugger off.’”  

Simply put, people are already addicted to heroin before they enter the facility. It’s is better to give them a clean place to use their drugs, with medical assistance at the ready in case they overdose than the alternative, where the risk of injury through overdose or infection is higher.

“What I’m proudest of is nobody has ever died. In 11 yrs, 700 addicts a day, 365 day (recent figures from InSite suggest this figure may have doubled.) I get choked up just thinking about it. What price is a life? I’d be ecstatic if we saved just one! And how many more are alive because they didn’t get septic?”

Campbell looks back at that time in Vancouver at the end of the 1990’s as triumph of common sense. But he thinks it’s unlikely to happen again.

“It was like the perfect storm. We had all this heroin, all of these deaths. We had a mayor saying ‘what’s going on here? We’re not doing this anymore!’ If it was now we’d never get permission with this [conservative] government."

I asked Campbell if he thought a supervised injection site could open in the US. He roared with laughter.

“You guys can’t even get your head around needle exchanges! You guys are in the Dark Ages. You guys are in total denial. The US is the problem not the solution! Because of your demand [for drugs]! And instead of waking up to that what do you do? You incarcerate. Being an addict doesn’t make you a criminal. You become a criminal because you are an addict and you have to feed your addiction. That’s just the way it is. Instead of addressing the addiction they put you in jail.”

Yet the future of drug treatment policy and its legal ramifications may come from the States themselves or indeed from the cities. Just as InSite was the child of necessity so too were syringe exchanges in the 80’s and 90’s in hard hit urban areas. Initially underground, New York City needle exchanges gained legitimacy in the AIDS epidemics of the 1980’s. Mayor Koch introduced the first short–lived exchange in 1987—the subsequent change in administration banned them.  It’s all about desire and willingness.

"To be fair,” he continues, “people are smarter than the government. We’re seeing that coming along in Washington State and in Colorado. And it’s going to be — I believe an impetus for a change in drug policy in the US.

"The most important level of government is municipal government. It’s [change] going to come from mayors.. Instead of better transit we’re putting people in jail, we're hiring more police. But it’s counter-intuitive until you actually sit down and talk to them [the mayors]. Because for years they’ve been fed these lines, that somehow this is a character fault, that you become a criminal by smoking marijuana. Shit! If that were true, three-fourths of their citizens should be in jail!”

In Europe SIS facilities have inhalation rooms for crack cocaine and other smoked drugs. Currently InSite can legally only offer addicts help with injecting drugs, but now with a foot firmly wedged in the door Campbell sees an expansion opportunity. He was already thinking towards the future as the clinic was being built. 

“Behind a wall [at InSite] there is all the equipment for an inhalation room. I said to them 'build it in,' we didn’t have permission, I said 'build it in. Someday someone’s going to wake up and I don’t want to have to rip this place up.' We haven’t got there yet but it makes no common sense, it’s like this drug's okay but this drug isn’t.”

In the last 11 years InSite has grown to include a detox and a rehab on its second floor that acts as a halfway house for cleaned up addicts trying to re-enter society. By all accounts the facility is overwhelmed by demand. Last week (Feb 14th 2014) in Vancouver, the Dr. Peter AIDS Foundation submitted a formal application to Health Canada for a similar exemption from federal drug laws. The facility has been discreetly supervising their clients' drug use for 12 years, at the same time InSite was being established. The Dr. Peter Centre specializes in providing care for people living with HIV who also face poverty, homelessness, mental health and addiction issues. Presumably using InSite as its precedent it plans to become the second supervised injection site in North America.

Philip Owen believes InSite is now safe from Federal meddling.

“The tap is turned on and there’s not a damn thing the conservatives have been able to do about it in all these years. There’d be a riot on the streets if they tried to close it. If Montreal and Toronto had moved with us when we did there’d be 6, 8,10 of them all over the country. That’s what cheeses me off that we didn’t get at least half of those opened.”

Neville Elder is a photographer and writer. Originally from the UK, he's lived in the unfashionable end of Brooklyn for 13 years.

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British born Neville Elder is a writer,photographer and filmmaker. He's been sober since 2006, lived in New York since 2001 and is in no hurry to move back to a Brexited Britain. He writes the odd murder ballad with his band Thee Shambels and teaches photography at the New York Institute of photography. Find him on Linkedin and Twitter.