Pubdate: Thu, 7 Aug 2008
Source: Economist, The (UK)
Copyright: 2008 The Economist Newspaper Limited
Bookmark: (Insite)
Bookmark: (Supervised Injection Sites)
Bookmark: (Harm Reduction)
Bookmark: (Treatment)

Drugs in Canada


Harm Reduction, or Abstinence?

BACK in 2003 many residents of Vancouver reckoned that an answer had 
finally been found to the worsening hard-drug problem in the 
liberal-minded city's Downtown Eastside district. A reformist city 
council, borrowing a European idea, opened the first supervised 
heroin-injection clinic in North America. It was set up as a research 
experiment, with a three-year remit (since twice extended). The idea 
was that giving addicts a safe place to inject themselves would 
remove them from crime, disease and other risks, and make them more 
amenable to treatment. The Liberals who were then running the federal 
government agreed, and blessed Insite, as the project is called, with 
C$1.5m (then worth $1.1m) and a vital exemption from drug laws.

Five years on, Insite has proved a disappointment to many in 
Vancouver. It has also become the object of partisan conflict. The 
Conservative federal government of Stephen Harper dislikes the 
project. A committee set up to advise it on the issue found that only 
about 500 of Vancouver's 8,000 addicts use Insite each day, and fewer 
than 10% of those use it for all their injections. It found no clear 
evidence of any increase in treatment, nor of any fall in HIV cases. 
It did estimate that the project might have saved one life per year 
but found that overdose deaths were still about 50 a year among 
addicts. Crime continues unabated as addicts steal to feed their 
habits, something which frustrates the local police. The government 
therefore proposed to allow Insite's legal exemption to lapse when it 
expired in June.

Many health workers thereupon sprang to Insite's defence. They are 
convinced that the project's "harm-reduction" approach can work. In 
May they gained an order from a justice of British Columbia's Supreme 
Court to stop the federal government from closing the clinic. In a 
radical ruling Justice Ian Pitfield found the federal law prohibiting 
the possession and trafficking of drugs to be unconstitutional and 
said that closing Insite would deny addicts access to a "health-care 
facility". Allowing the clinic to stay open, he gave the federal 
government a year to amend its anti-drug law. The federal government 
promptly appealed against the ruling.

Health care in Canada is a provincial matter. Last month Quebec 
stepped into the drug debate. Its public-health director announced 
that he was considering plans for supervised injection sites in 
Montreal and Quebec City. This seems to have made things even 
stickier for the federal health minister, Tony Clement.

This week Mr Clement restated his opposition to Insite. "Allowing 
and/or encouraging people to inject heroin into their veins is not 
harm reduction, it is the opposite," he said while attending an 
international conference on AIDS in Mexico City. He wants to focus 
instead on treatment and prevention. But he has remained silent as to 
whether the government would grant any request from Quebec for 
exemption from drug-prohibition laws. Mr Harper's hopes of turning 
his government's minority status into a majority at the next election 
depend on winning seats in Quebec. So the future of drug policy in 
Canada may turn on a political calculation. 
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MAP posted-by: Richard Lake