North America's first legal supervised injection site marks 20th anniversary in Vancouver

It's been 20 years since Insite opened its doors in Vancouver's Downtown Eastside.

It was the first sanctioned supervised injection site in North America and, for many years, its operation remained contentious.

Today, those involved in operating the site, and defending it against legal and political challenges over the last two decades, gathered on East Hastings Street to mark the milestone.

"Insite was a really important step forward in terms of drug policy and harm reduction, and to be here 20 years after we opened, it just feels incredible," said Jeff West, manager of harm reduction for Vancouver Coastal Health.

Insite has been co-managed by the health authority and the PHS Community Services Society since its inception, and West has been involved from the beginning.

"Not only was Insite important to the community as a safe space, a symbol of a more progressive drug policy, it also is a really important public health intervention," said West.

West said the site was a critical lifeline for people in the community in the face of overdose deaths and the spread of HIV, which he said was moving rapidly through the Downtown Eastside when Insite opened in September 2003.

PHS set up the site at 139 E. Hastings St. before it was legally sanctioned and then got the green light from Health Canada to operate. In order for that to happen, all three levels of government — municipal, provincial and federal — and the city's police and regional health authority needed to give their approval.

This enabled the facility to operate under an exemption from prosecution under Canada's drug laws, which was granted by Health Canada.

"It's a high bar and we were there first," said West.

In 2011, the site faced potential closure when Prime Minister Stephen Harper's Conservative government opposed supervised drug use and dropped harm reduction from the national anti-drug strategy.

Leona Aglukkaq, who was the federal health minister at the time, said then that the government's investments were targeted at prevention and treatment.

"We believe that the system should be focused on preventing people from becoming drug addicts," said Aglukkaq in 2011.

The issue went to the Supreme Court of Canada, where Chief Justice Beverley McLachlin ordered the federal minister of health to let Insite continue to operate.

"Insite saves lives. Its benefits have been proven," wrote McLachlin in her decision.

If Insite wasn't allowed to operate it would prevent injection drug users from accessing the health services offered at the facility, threatening their health and their lives, the ruling said.

British Columbia is currently in the midst of a toxic drug crisis and declared a public health emergency in April 2016 as fentanyl started to poison the drug supply.

Unregulated drug toxicity is now the leading cause of death in British Columbia for persons aged 10-59, accounting for more deaths than homicides, suicides, accidents and natural diseases combined, according to the B.C. Coroners Service.