On a chilly, overcast morning in downtown Vancouver, British Columbia, a steady trickle of sallow-faced drug addicts shambles up to a storefront painted with flowers and the words “Welcome to Insite.” One by one, they ring the doorbell and are buzzed into a tidy reception area staffed by smiling volunteers.

The junkies come here almost around the clock, seven days a week. Some just grab a fistful of clean syringes from one of the buckets by the door and head out again. But about 600 times a day, others walk in with pocketfuls of heroin, cocaine or speed that they’ve scored out on the street; sign in; go to a clean, well-lit room lined with stainless steel booths; and, under the protective watch of two nurses, shoot their drugs into their veins.

Welcome to North America’s only officially sanctioned “supervised injection site.” The facility sits in the heart of Vancouver’s Downtown East Side, 10 square blocks that compose one of the poorest neighborhoods in all of Canada. The area is home to an estimated 4,700 intravenous drug users and thousands of crack addicts. For years, it’s been a world-class health disaster, not to mention a public relations nightmare for a town that is famous for its beautiful mountains and beaches (and is gearing up to host the 2010 Winter Olympics). Nearly a third of the Downtown East Side’s inhabitants are estimated to be HIV-positive, according to the United Nations Population Fund, a rate on par with Botswana’s. Twice that number have hepatitis C. Dozens die of drug overdoses every year.

Largely in response to this nightmare neighborhood, Canada’s third-largest city has embarked on a radical experiment: Over the last several years, it has overhauled its police and social services practices to re-frame drug use as primarily a public health issue, not a criminal one. In the process, it has become by far the continent’s most drug-tolerant city, launching an experiment dramatically at odds with the U.S. War on Drugs.

Smoking weed has been effectively decriminalized. The famous “B.C. bud,” rivaled in potency only by California’s finest, is puffed so widely and openly that the city has earned the nickname “Vansterdam.” A single block in the Downtown East Side hosts several pot seed wholesalers, the headquarters of the British Columbia Marijuana Party and the toking-allowed New Amsterdam Café.

But that’s nothing next to the city’s approach to drugs like heroin and crack. Impelled by the horror show of the Downtown East Side, prodded by activists and convinced by reams of academic studies, the police and city government have agreed to provide hard drug users with their paraphernalia, a place to use it and even, for a few, the drugs themselves.

More than 2 million syringes are handed out free every year. Clean mouthpieces for crack pipes are provided at taxpayers’ expense. Around 4,000 opiate addicts get prescription methadone. Thousands come to the injection site every year.

On top of that, health officials just wrapped up a pilot program in which addicts were given prescription heroin. And it doesn’t stop there. The mayor is pushing for a “stimulant maintenance” program to provide prescription a lternatives for cocaine and methamphetamine addicts. Emboldened advocates for drug users are even calling for a “supervised inhalation site” for crack smokers.

Vancouver has essentially become a gigantic field test, a 2 million-person laboratory for a set of tactics derived from a school of thought known as “harm reduction.” It’s based on a simple premise: No matter how many scare tactics are tried, laws passed or punishments imposed, people are going to get high. From winemaking monks to coca-leaf-chewing Bolivian peasants to peyote-chomping Navajos to caffeine-fueled office workers to the junkies of Vansterdam, human beings have never been willing to settle for our inherently limited palette of states of consciousness.

If you accept the notion that people aren’t going to stop abusing drugs, it makes sense to try to minimize the damage they inflict on themselves and the rest of us while they’re at it. Harm reduction is less about compassion than it is about enlightened self-interest. The idea is to give addicts clean needles and mouthpieces not to be nice but so they don’t get HIV or pneumonia from sharing equipment and then become a burden on the public health system. Give them a medically supervised place to shoot up so they don’t overdose and clog up emergency rooms, leaving their infected needles behind on the sidewalk.

Give them methadone — or even heroin — for free so they don’t break into cars and homes to get money for the next fix.
These aren’t just theoretical notions. Some harm reduction tactics have been researched extensively — and the findings are often impressive. In recent years, no fewer than eight major studies in the U.S. on needle-exchange programs — probably the best-known and most widespread harm reduction technique — have concluded that they work. As then-Assistant Surgeon General David Satcher summed up in a 2000 report, “There is conclusive scientific evidence that syringe exchange programs … are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.”