A Conduit for Conversation

The Downtown Eastside (DTES) of Vancouver, BC, is home to over 10,000 marginalized individuals, many of whom are transient drug users. 'Insite', Canada's first legally supervised injection site, has endured countless political hurdles while saving literally thousands of lives since first opening its doors in 2003. In 2009, The Portland Hotel Society, which operates Insite, posed a question: What would a supervised inhalation site look like?

While Insite is able to provide a safe and health-focused location for injection drug use, primarily heroin, cocaine, and morphine, they are not able to address the needs of those who choose to use inhalation drugs, such as crack cocaine. My design partner and I initiated a year-long research and design challenge to determine what a supervised inhalation site would look like. 

Based upon the model of Insite, we explored the similarities and unique challenges that this facility would face - structurally, environmentally, and socially.  

After an extensive survey of the history of the organization and it's current relationship to the community at large, We dove into the work flow at Insite, mapping it's many parts and stakeholders. While interviews with staff followed standard research procedures, interviews with participants required unconventional techniques and strategies to gain trust and develop open lines of communication. 'Conversation Painting' nights, where participants were given a canvas and a variety of mediums to express themselves visually,were set up at the site during peak hours. While providing a pathway to dialogue, the paintings themselves served as valuable empathy tools. Warm socks and footwear were provided as compensation for interviews. All research methods were approved by both a research ethics board and the entrenched healthcare providers prior to the event. 

Our research with participants at Insite opened our eyes to powerful differences between hyper-localized drug-specific communities within the DTES. Not just in the ritual of use, but in how injection drug users perceived and related to inhalation drug users. This was significant in the ecology of the community and how health resources may or may not be combined. 

Once outside the doors of Insite, our research strategy once again required unconventional means and strategies. Developing health services strategy for a population that is both homeless and transient meant that we needed to locate those individuals on their terms in their environment. It was out of this necessity that we looked at the way in which these individuals navigated and utilized the public space. We examined the ritual of inhalation drug use and developed a strategy to augment their space without imposing, inviting them into the research-led design process. Over the period of several weeks my partner and I began building a small bench in an alley just a block away from Insite. The bench itself was very simple - hard mounted to an exterior wall, floating just a couple of feet off the ground. Inevitably, locals passing through would stop to ask what we were doing. We openly communicated that the bench was there for anyone to use and that it served as a moment of reprieve for those who called the neighbourhood 'home' and conversation starter to introduce the idea of an inhalation site. 

Naturally the bench and our pitch were met with mixed reviews, but it also signified that we were already investing in their environment and valuing their opinion. To build upon this, we asked for feedback on the bench itself and how it could be made more suited to their needs. When those individuals came back a few days later and saw those changes implemented, it validated our intentions to help and began to build trust between ourselves and the community. Our approach led to a tremendous network of research participants, sub-communities, undocumented maps of zones, and guides through the community.  

The reason our research was so crucial to our design process was that we were designing for a population that was not able to access healthcare services in the same way the average individual could. Individuals struggling with compound issues of homelessness and addiction are in extremely vulnerable positions, often untrusting of styles and models of service that many of us are familiar with. A uniformed security guard, a waiting room, or even the gender of a healthcare worker are just a few of the obstacles that must be considered differently. We were developing unique services for a unique community. The physical environment and service model would ultimately end up being substantially different from the injection site model, due to the differences in ritual of use, psychological and cognitive effects of the drugs consumed, health and security of staff, and variety of other factors. 

The outcomes from this project were a comprehensive report and architectural blueprint, intended for the design and implementation of the space, including strategic locations within the community, service models, suggested services programming, interior layout, and the inhalation units themselves. An exhibition of our research and design strategy was presented at Emily Carr University and to the Portland Hotel Society.

Collaborator: Angela Henderson