Harm reduction and supervised safe consumption sites: Ideas and policy in Toronto and Vancouver

In 2003, the city of Vancouver opened North America’s first supervised injection site, Insite. Insite presents a case where the municipal government initiated change in drug policy and responded to a health crisis. It provides a case for understanding change in the ideas that guide policy making. In Vancouver, policy-maker’s decisions were informed by the idea of harm reduction. The extent to which this occurred is unique to Vancouver, and such developments have not taken place elsewhere in North America. In order to understand how this happened, Vancouver has been compared with Toronto. Through elite interviews and analysis of primary documents, the process of policy change in Vancouver and policy stability in Toronto are traced. Ultimately, in Vancouver an alignment of the public, media, politicians and police occurred, and all actors recognized the need for an alternative to the existing enforcement approach and Insite was part of that alternative.