Pubdate: Tue, 10 Oct 2006
Source: Canadian Medical Association Journal (Canada)
Copyright: 2006 Canadian Medical Association
Contact:  http://www.cmaj.ca/
Details: http://www.mapinc.org/media/754
Author: Deborah Jones

INJECTION SITE GETS 16-MONTH EXTENSION

As summer ran its course in Vancouver, a 3-year experiment to provide 
heroin addicts with a medically supervised injection site neared its 
scheduled Sept. 12 expiration. Canada's former Liberal government had 
granted the facility, InSite, a permit exempting it from federal drug 
laws. To remain open, InSite required a new permit from the 
Conservative government -- some of whose members argued it's morally 
wrong to aid illegal drug addiction.

InSite is in the Downtown Eastside, Vancouver's impoverished 
neighbourhood of concentrated HIV and hepatitis sufferers, drug 
addicts and dealers, sex-trade workers and criminals. North America's 
first and only such site, it daily serves about 600 addicts who bring 
in illegal street drugs and then inject themselves with syringes 
dispensed by InSite, under the watch of health professionals. Nurses 
and doctors intervene if users overdose and offer general health 
care, while counselors are present to offer addiction treatment.

Some 50 similar sites exist worldwide, but InSite remains audacious 
given the US "War on Drugs" next door. In British Columbia, however, 
it has massive public and political support under a popular "Four 
Pillars" drug strategy of prevention, enforcement, harm reduction and 
treatment.

During InSite's 3 years, a remarkable consensus that the facility 
reduces harm to users and the public developed among scientists, 
criminologists and even the Vancouver Police Department. Research, 
all positive, was published in 15 peer-reviewed journals, including 
the CMAJ (2004;171:731-4), Lancet (2005;366:316-8) and the New 
England Journal of Medicine (2006;354:2512-4).

In the spring of 2006, the province wrote to Ottawa formally applying 
for a 3.5-year renewal of InSite's permit.

Ottawa's response was a long silence.

Over the summer, InSite became a cause celebre. Activists, 
politicians and even scientists lobbied for it, and at the 
international AIDS conference in Toronto researchers spoke in support 
while AIDS activists demonstrated in the streets. Lawsuits were 
threatened. Ethicists joined the fray, including Margaret Somerville 
of McGill University's Centre for Medicine, Ethics and Law, who said 
given that addicts would continue to be addicts, reduction of serious 
harms such as HIV and hepatitis infection is an ethical requirement. 
One of the few opponents was the Canadian Police Association, which 
in late August demanded that Ottawa close InSite and focus instead on 
a national drug strategy.

Less than 2 weeks before InSite's scheduled closure, on Sept. 1, 
federal Health Minister Tony Clement announced he was deferring a 
decision on InSite pending more research, but it could remain open 
until Dec. 31, 2007. Clement's announcement asked: "Do safe injection 
sites contribute to lowering drug use and fighting addiction? ... 
Right now the only thing the research to date has proven conclusively 
is drug addicts need more help to get off drugs."

The Canadian HIV/AIDS Legal Network accused the government of 
"playing politics with people's lives."

Dr. Evan Wood, an epidemiologist at the BC Centre for Excellence and 
HIV/AIDS and assistant professor of medicine at University of BC who 
is, with Dr. Thomas Kerr, principal investigator for evaluation of 
InSite, argues that science clearly shows the benefits of InSite, and 
seemed nonplussed to find himself one of InSite's most vehement backers.

"I am a scientist, and I hate to be referred to as an advocate," he 
said. "But Dr. Kerr and I ... want to see the problem improved as 
scientists, because the benefits have been so positive."

Wood added, "I felt like the federal government was politicizing this 
because the science is that strong."
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