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In the 1990s, Vancouver was Canada’s capital of drug-related crime and home to the fastest-growing AIDS epidemic in North America. Back then, drug users injecting were a common sight in the city’s Downtown Eastside. They were doing so against the backdrop of a changing HIV epidemic in Canada, with the concentration of the disease shifting from men who have sex with men to addicts sharing needles.

Thus, the city on Canada’s west coast was a fitting locale for Insite, the first safe-injection site on the continent. Allowing people to use pre-obtained drugs under medical supervision could potentially reduce the harms associated with this type of drug use—namely, the risk of overdose and infectious diseases such as HIV and hepatitis C.

While he was deputy chief of the Ottawa Police Service, Larry Hill fought for a harm reduction program for crack addicts – a crack pipe program – calling the prevailing view among police chiefs at the time “dark ages thinking” on harm reduction.

When Dr. Mark Tyndall moved to Ottawa from Vancouver earlier this year to take up the post of head of infectious diseases at the Ottawa Hospital, he was surprised at what he saw. The overdose rate among injection drug users seemed to be high, although it was difficult to find stats to confirm that, and the rate of HIV transmission was among the highest in the country. In Vancouver, those kinds of issues helped inspire the community to support a safe injection site, Insite, which the Supreme Court of Canada has just ruled should stay open.