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The establishment of North America’s first state sanctioned supervised injection facility: A case study in culture change

Author: Dan Small, Anita Palepu, & Mark W. Tyndall
Published Date: 30 August 2005

The serious adverse health consequences associated with illicit drug use has brought international attention to the city of Vancouver and in particular to the Downtown Eastside (DTES) neighbourhood. HIV and Hepatitis C infections, fatal drug overdoses, public drug use and injection-related infections have been well documented in this community. In order to make basic healthcare contact with a group not reached elsewhere, the opening of a supervised injection facility (SIF) was planned. Similar sites were operational in numerous European cities, as well as Sydney, Australia. The aim of this paper is to provide an impressionistic account of the ideas, processes and politics that led to the opening of North America’s first SIF.

This account focuses on culture change with regard to the SIF as a public initiative that exists in a cultural “zone of friction” where different meanings, identities and levels of power encounter one another. We define culture as the process of negotiating meaning with respect to constantly changing implicit and explicit values that underpin the moral fabric of social action or inaction. The establishment of the SIF was culturally momentous, a massive undertaking, that was more like building a cultural railroad from coast to coast than establishing a local pilot project.

Aside from the importance of culture change, three theoretical concepts are useful for understanding the creation of North America’s first publicly authorized SIF. The first, Bourdieu’s (1999) concept of the habitus, has been adapted to refer to the underlying reflexive set of values associated with addiction that had to be altered in order to realize the culture change. The second, Gusfield’s (1989) notion of the cultural construction of public problems is important for framing the discussion of the healthcare epidemic that underlined the establishment of this SIF. The third concept is the notion of the deliberate use of symbols as part of the politics of embarrassment in order to garner public and government attention to the plight of people living with addictions. All three of these theoretical concepts are useful for interpreting the way in which the SIF was established in Vancouver.

Cultural transformation

The story of North America’s first SIF features key individuals who took a leading role over the past decade to realize social change. There were a number of supporters who worked from within and outside numerous political and institutional systems. Fig. 1 shows the major stakeholders that helped to establish the SIF. There was a villain in the story. However the villain was not a person but conventionality itself (embodied in the addiction habitus as we will argue shortly) and the fear of what might happen if popular thinking about drug policy was challenged. The essence of the culture change is indicated by key values that underpin how people with addiction are understood. In 2001, it was difficult to find people in authority who would publicly support SIFs and stand by the basic assertion that addiction is primarily a health and social issue, rather than principally a criminal justice issue. By the end of 2002, Vancouver was on the edge of transformation. The narrative that addicts were deserving of caring and life rather than punishment and death was overtaking the conventional narrative supporting law enforcement at all costs.

Read the report in full: The establishment of North America’s first state sanctioned supervised injection facility: A case study in culture change