"People higher up in the government already understood," Townsend says.

One of those people was Philip Owen. First elected mayor in 1993, Owen was businessman of the centre-right NPA, hardly the politician one would expect to stake his career on harm reduction. But Owen's first term also coincided with the intensification of the public health crisis in the Downtown Eastside. Looking at the HIV epidemic and the overdose deaths in the Downtown Eastside, this much was obvious to him: "You can't incarcerate your way out of this problem."

In 1996, Owen created a committee tasked with researching alternative drug policies. The following year, he invited MacPherson to city hall, installing him as drug policy coordinator. In 1999, MacPherson self-financed a trip to Europe. He wanted a firsthand look at the best practices at work in harm reduction. The Netherlands had opened the world's first supervised injection site in the 1970s. Since then, dozens of sites had sprouted up across the continent.

"I knew what I was going to see there," MacPherson says today. "But I was still surprised at the thoughtfulness and the experimental approach. It was very different from the thinking in North America, where the primary objective is to punish drug addicts."

Upon his return, MacPherson was asked by the mayor to get to work on a report. In October 2000, A Framework for Action: A Four Pillars Approach to Drug Problems in Vancouver was presented to city council. Under the plan, the city would focus on four areas of drug policy: prevention, treatment, enforcement and harm-reduction. Though harm reduction -- which entailed supervised injection sites and a heroin maintenance program -- was only one of the four pillars, it received the most attention and generated the most controversy. The strategy was endorsed unanimously by city council, but behind the scenes, there was dissent within the mayor's ranks.

"There was a great element of Stephen Harper-types on council," Owen says now. "They didn't understand addiction and they didn't want to learn."

Tensions between Owen and his caucus built until 2001 when Owen lost his party's endorsement for re-election. Despite the best attempts of the NPA to sweep the issue under the rug, the Four Pillars plan had received enormous national attention upon its release, much of it positive.

When Larry Campbell, the outspoken former coroner and cop ran on a harm-reduction platform with COPE, he beat the NPA's Jennifer Clarke in a landslide. This was the moment, says MacPherson, when Vancouver "inverted the political risk" of drug policy. In any other city in North America, he says, running on a pro harm-reduction platform would end your political career. In Vancouver, it had become a political necessity.

The way forward

When Insite finally opened in September of 2003, it was permitted to do so under the condition that it serve the purposes of research. From its inception then -- through the election of the first Harper government in 2005, to the court battle that ensued between PHS and Health Canada in 2007, to the Supreme Court ruling last September in favour of Insite -- the impact of the facility has been rigorously documented.

The results are unambiguous. Needle sharing, overdose deaths and the transmission of HIV and Hepatitis C are all down in the vicinity of the site. During its first year of operation, nearly 500 users overdosed within the facility. None of them died.

Of equal importance, says Russ Maynard, program director at PHS, is the role that Insite plays in bringing drug users into a network of other services. Those services include Onsite, the detox and treatment facilities located upstairs from the injection room. Each year, says Maynard, over 400 users climb up those stairs.

Given those numbers, it's hard not see last year's legal victory as a conclusive vindication of harm reduction policy. In some sectors, the momentum for further policy innovation seems to be there. Vancouver Coastal Health (VCH) is now working to secure the authorization of a second, albeit currently operational, supervised injection site at the Dr. Peter Centre. But later on, says Patricia Daly, chief medical officer at VCH, she hopes to see supervised injection incorporated into community medical services across the Lower Mainland.

A heroin-maintenance program, proposed off and on by reformers since 1952, was finally tested in 2005. The results of the North American Opiate Medication Initiative (NAOMI), published in 2008, showed, maybe unsurprisingly, that heroin addicts are more physically and psychologically stable when given heroin over methadone.

But for all that, Mark Townsend of PHS says he finds the political focus on harm reduction -- the enthusiasm and demonization alike -- "kind of annoying." It oversimplifies the issue, he says. And the debate over its merits distracts from a larger issue.

"The debate should really be about something more complicated," Townsend says. "The real issue is how people have gotten to where they are. How is it, for example, that a human being can start to drink hairspray?"

But sitting in the back office at Insite, looking at statistics with Maynard, it's impossible not to feel optimistic. Admittedly, a mirrored booth, the watchful eye of a nurse and some jazzy mood music piping over the injection room sound system will not make a person whole again. It is a very small step, but it is, one can't help but think, a very small step in the right direction.

"This has been a huge success so far," says Maynard with a wave of his hand. "But if that day ever comes when there aren't enough people coming in to warrant this place, we will throw a huge party before shutting it down."

Tomorrow: Reporter Jackie Wong investigates the state of harm reduction strategies on the national scene.

[Tags: Rights + Justice.]