Pubdate: Tue, 1 Apr 2008
Source: BC Medical Journal (CN BC)
Vol: 50, No. 3, April 2008, Pages 132-134-Premise
Copyright: 2008 BC Medical Journal
Contact:  http://www.bcmj.org/
Details: http://www.mapinc.org/media/4691
Author: Jamie Graham
Bookmark: http://www.mapinc.org/find?142 (Supervised Injection Sites)
Bookmark: http://www.mapinc.org/topic/Insite (Insite)
Bookmark: http://www.mapinc.org/people/Tony+Clement
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/topic/mandatory+treatment
Bookmark: http://www.mapinc.org/topic/Downtown+Eastside

SUPERVISED INJECTION SITES - A VIEW FROM LAW ENFORCEMENT

People have every reason to be confused about Vancouver's supervised 
injection site. It's been up and running since 2003 and has as many 
detractors as it has supporters. The only sure thing is the 
entrenched debate about what it has accomplished, the alleged bias of 
the medical research, and what goes on inside.

As former chief of the Vancouver Police, it fell on me to decide 
whether we should support the continued operation of Vancouver's 
supervised injection site, Insite. The competing interests were 
intense and no matter what one's personal views were, every comment 
garnered immediate rebuttal from an expert. The addiction issues, 
crime concerns, and moral obligations of those in leadership 
positions received continual headlines, so we learned over time to 
stick with what we were good at-public safety.

The medical issues were better left to physicians. The Vancouver 
Police have tried to do the right thing for all the citizens of this 
city within the funding provided by city hall - all under the 
umbrella of never-ending suggestions that the police take an even 
harder line with the sad reality of what was going on outside the 
front door of the site.

Background

The Vancouver Police Department (VPD) supported the opening of the 
supervised injection site in 2002 as a research project, not as a 
concept, and that support continues to this day. The Vancouver Police 
letter of support to the federal health minister has been 
inaccurately used by harm reduction proponents as a blanket 
endorsement for a wide variety of initiatives and projects 
surrounding the supervised injection site (SIS).

One should remember that no matter the direction and views of the 
politicians at the time, our position was straightforward - follow 
the law. Any injection facility for Vancouver would have to comply 
with the law. We didn't hesitate to prosecute offenders and shut down 
illegal sites, and there have been some.

Former Mayor Phillip Owen understood the dilemma for the police. He 
pursued the exemptions under federal drug legislation to allow the 
SIS to open because he knew it could not run without the cooperation 
of the police, especially those frontline officers who patrol the 
streets and alleys nearby.

Once the exemptions were granted by the federal government, to resist 
or block the legal operation of the SIS would put the police in an 
untenable situation - should the SIS fail, the police would be blamed 
for its demise. So our role became a supportive one, waiting for the 
pilot project research results, which we were promised would be 
complete in 2 or 3 years.

Health Minister Tony Clement has since advised the Vancouver Coastal 
Health Authority, which operates Insite, that their exemption under 
Section 56 of the Controlled Drugs and Substances Act has been 
extended until 30 June 2008. His comments have been clear: "This 
extension will allow research on how supervised injection sites 
affect prevention, treatment, and crime to be continued for another 6 months."

Vancouver Coastal Health Authority brought in an independent project 
leader to lead the research. There were some logistical and personnel 
issues and the person has not been replaced as yet. Everyone is 
waiting for the results of the research.

Some say the research is in and clearly shows success while others 
say sympathetic evaluators, who support open access to drugs, have 
overstated their positive findings of the site, downplayed or ignored 
negative findings, or reported meaningless findings in order to give 
the overall impression that the facility is successful.

Police in the Middle

There have been many voices of complaint about the value of the SIS 
and the peer reviews of certain addiction experts. There have been 
magazine articles, medical research, newspaper stories, and letters 
to the editor all proclaiming the success of the SIS.

Then there are others who suggest the real purpose of the SIS is to 
use it as a foothold for the further expansion of drug use in Canada. 
Medical experts (Drs Davies and Mangham) take an educated research 
approach contrary to the findings of the SIS proponents.

That is our dilemma. There is a wide variety of medical opinions 
about what is right. The problem for the police is that we are not 
medical experts and we can only read and try to follow the debate. 
The Vancouver Police appointed Inspector Scott Thompson to be the 
lead on the debate/discussions, and he values the Carrado/Cohen 
review from Simon Fraser University given their qualifications and 
relative neutrality.

In the end this will be a decision of government and lawmakers. Our 
job will be to enforce what that final decision turns out to be. I 
believe we should remain supportive of the research objectives and 
the principles behind the original agreements.

Harm Reduction

The supervised injection site is based on the controversial ideology 
of harm reduction, which views drug use as inevitable. Thus it is 
suggested that the government's role is to reduce the consequences of 
that choice, based on the perspective that since individuals are 
going to use drugs anyway, why not enable them to do so in a safe 
medical environment? It is not clear to me whether harm reduction 
supporters want to reduce the incidence and volume of drug use.

I give little credence to active drug users' views on how best to 
solve the drug problem, but I do listen to addicts who have gotten 
clean. I was told once by Dr Ray Baker that the solution to curing 
drug addiction is not complicated. He and his colleagues have done it 
for years, and successfully. Support, treatment, abstinence, and 
counseling are all part of the solution.

It seems that harm reduction tries to reduce harm to the drug user 
while not being judgmental about their actual drug use. This lack of 
judgment allows the addict to "freefall through society," as former 
VPD Constable Al Arsneault once said, with addicts dropping out of 
school, losing jobs, being alienated from their families, committing 
or being themselves victims of crime, and making them vulnerable to 
disease and death. In fact, the focus of harm reduction is actually 
the worst-case scenario for a drug user - total inability to quit and 
eventual death.

Recommendations

Abstinence

A lifetime of policing has led me to believe that getting off drugs 
should be the first step for addicts, not the last. In locations 
where supervised sites have had positive outcomes there has been 
accompanying strong support from the police and the courts for those 
areas surrounding the site. This means that if an addict chooses to 
inject outside the SIS, there are immediate repercussions by the 
police and the courts.

This is not the case in Vancouver due to the chronic police shortages 
and a liberal attitude toward drug use in general. Police are 
naturally suspicious about the positive image of Insite. This image 
is undeserved - what goes on in the SIS is abhorrent. My respect goes 
to the police officers assigned to the challenging beat of District 2 
in which the SIS continues to operate.

Mandatory Treatment

There must be mandatory and compulsory drug treatment for addicts, 
especially prison inmates. Treatment must trump individual human 
rights when a person's addiction causes problems. Britain and Sweden 
are good examples of where tough en-forcement in partnership with the 
courts, treatment facilities, and rehabilitation programs really work.

Sweden has among Europe's lowest crime, disease, medical, and social 
problems stemming from drug addiction, ac-cording to the United 
Nations Office of Drugs and Crime in its 2006 analysis. I would be 
interested in the many major European cities on record against 
supervised sites. Many facilities have closed, and the reason why 
should be part of the research.

Education

If there is to be support of the SIS, there must be the right 
accompanying message of the big picture. There must be condemnation 
of illegal drug use with no glamorization of the drug culture. 
Educational material must be clear, pertinent, and designed to have impact.

The so-called war on drugs commentary may be dated, but the 
underlying message is important and valuable. Education is the key. 
There must be respect for the rule of law. Use the SIS if you must, 
but it is not a free ride; there are certain things you must do and 
you must participate in whatever program is available and required.

Has Any Good Come of It?

The casual observer might look at Vancouver's Downtown Eastside 
(DTES) and wonder if things are better since the opening of the SIS. 
They are better - not a lot, but better than they were 5 years ago. 
It is not entirely because of the SIS, but that may have played a 
small part. Police crackdown on street level dealers and a focus on 
addicts who use or fix in or near parks and schools are prosecuted, 
and this has made a huge difference. Enforcement works.

What is lost in many of the discussions about supervised injection 
sites are the uniformed officers who patrol the areas around the 
sites. I am very proud of their efforts in the DTES and their 
continued professionalism in the face of such heated debate and 
criticism from both sides. The officers continue to do their job. 
There is a huge untold story here.

People have become used to thinking of the DTES as a centre for 
public urination and defecation, prostitution, open sex, panhandling, 
drug trafficking, assaults, and violent crime. It is not fair. This 
is a great neighborhood, a unique community made up of many fine, 
law-abiding citizens.

It was never more obvious when 40 additional officers patrolled the 
DTES in 2003. People walked the street in safety, baby strollers were 
commonplace, and officers were stopped on the street and thanked for 
their dedication to make things better.

- ------------------------------------

Jamie Graham was the chief of the Vancouver Police Department from 
2002 to 2007. He is currently consulting on security, leadership, and 
crisis management issues. He is also a member of the National Speakers Bureau. 
- ---
MAP posted-by: Richard Lake