Pubdate: Wed, 09 Sep 2009
Source: McGill Tribune (CN QU Edu)
Copyright: 2009 The McGill Tribune
Contact:  http://www.mcgilltribune.com/
Details: http://www.mapinc.org/media/2672
Author: Matt Chesser
Bookmark: http://mapinc.org/topic/Insite
Bookmark: http://www.mapinc.org/find?142 (Supervised Injection Sites)

INSITE: VANCOUVER'S DRUG DILEMMA

When I was 12 years old, my dad took me for a walk through the 
Downtown Eastside of Vancouver. I think he was trying to scare me 
away from ever taking hard drugs - as if the Tamagotchi-toting 
preteen me needed any such urging - by showing me the worst examples 
of addiction. It worked - I was horrified.

The Downtown Eastside is brutal. Take a five-minute walk east from 
the steam clock (a popular tourist trap in the chic Gastown district) 
and the patio dining and designer boutiques of the city The Economist 
called "the most livable in the world" give way to an open drug 
market where alleys double as public restrooms and thousands of the 
city's homeless wander the streets.

More than 5,000 drug users (about one-third of the 10-block area's 
population) reside in the Downtown Eastside - Canada's poorest postal 
code. The prevalence of HIV in the neighborhood is the highest in the 
industrialized world, and an estimated seven out of 10 Downtown 
Eastside residents have Hepatitis C. In 2007 the United Nations 
Population Fund called the area a "crisis zone" with UN spokesperson 
Patricia Leidl saying "It's one of the worst areas of urban blight 
that I've ever seen."

Insite, a clean modern facility, looks somewhat out of place amongst 
this despair. While the Downtown Eastside looks better than it has in 
past years - efforts to "clean up" the area have intensified as the 
2010 Winter Olympics draw closer - the neighbourhood is still mostly 
made up of rundown businesses, boarded storefronts covered in posters 
and bills, and narrow alleyways in which dealers surreptitiously 
sling product to anyone in need of a fix. With its heavy glass door 
and modern minimalist interior design, Insite stands out from its 
surroundings, and with good reason - the facility is perhaps the most 
important and controversial project in the country.

Launched in 2003 by the B.C. Ministry of Health and the Vancouver 
Coastal Health Authority under an exemption from federal drug laws, 
Insite is a supervised injection site. It's a place for drug users to 
obtain sterile needles and to inject their drugs under the watchful 
eye of a team of nurses - free from worry that they'll be arrested.

It's an odd situation: heroin and cocaine (the two most common drugs 
injected at Insite) remain illegal in Canada, yet users are urged to 
bring them to Insite and given clemency within the walls of the facility.

"There is no silver bullet to deal with the scourge of addiction," 
says Mark Townsend, executive director of the Portland Hotel Society, 
which operates Insite. "If drug enforcement really worked then we 
wouldn't have situations like we do in the Downtown Eastside . Insite 
is about working in the reality of the situation, and most 
importantly about preventing overdose deaths."

According to Townsend, the 12-seat supervised injection room is just 
one part of the facility. After injecting, the 600 drug users who 
visit Insite on an average day are asked to move to a post-injection 
room where they can rest and rehydrate before going back onto the 
street. Townsend says that this time is used to make contact with the 
users, to educate them about safe injection practices, and to refer 
them to medical care for treatment of wounds or to detox facilities 
if the addict expresses interest in getting clean. In fact, staff can 
refer addicts directly to Onsite - a 30-bed detox facility located 
above Insite.

"We have a detox right above our heads, so people know that they can 
always ask to be admitted there - it's really about making things as 
easy as possible," says Townsend. "But the first step is just making 
contact with people who have traditionally been alone in the alleys 
or in hotel rooms injecting drugs on their own. These people don't 
usually have any contact with health services, so that's why we've 
seen that going to Insite makes users 30 per cent more likely to seek 
treatment for drug addiction."

As the first project of its kind in North America, Insite is also a 
subject of constant research. The B.C. Centre of Excellence in 
HIV/AIDS has conducted over a dozen studies on Insite and has yet to 
uncover any detrimental effects caused by the facility. Furthermore, 
some of the positive effects revealed by their peer-reviewed research 
are extremely encouraging: Insite has reduced the overall rate of 
needle sharing in the area, led to increased enrolment in detox 
programs, and has not led to an increase in intravenous drug usage.

"The scientific evidence in favour of Insite is overwhelming," says 
Dr. Mark Wainberg, director of the McGill University AIDS Centre at 
the Montreal Jewish General Hospital. "All indications are that this 
approach towards harm reduction works."

The critical view

Some critics, however, remain unconvinced. Most prominent among them 
is former federal Health Minister Tony Clement, who at the 2008 
International Conference on AIDS called Insite an "abomination." 
(Correction appended)

"Allowing and/or encouraging people to inject heroin into their veins 
is not harm reduction . we believe it is a form of harm addition," 
said Clement, according to the Vancouver Sun.

While serving as health minister, Clement had granted Insite two 
extensions - in 2006 and late 2007 - on its original three-year 
exemption from Section 56 of the Controlled Drugs and Substances Act, 
but the federal government is now is in the unusual position of 
having no power over Insite. In May 2008, the Vancouver Area Network 
of Drug Users and the Portland Hotel Society won a constitutional 
challenge of the federal government's power to close the facility by 
arguing that the site addresses a public health crisis. Justice Ian 
Pitfield of the B.C. Supreme Court found that sections of the federal 
Controlled Drugs and Substances Act are inconsistent with Section 7 
of the Charter of Rights and Freedoms, and granted Insite a 
constitutional exemption until the government remedies the Act.

"While there is nothing to be said in favour of the injection of 
controlled substances that leads to addiction, there is much to be 
said against denying addicts health care services that will 
ameliorate the effects of their condition," Pitfield wrote in his 
decision. "I cannot agree with the submission that an addict must 
feed his addiction in an unsafe environment when a safe environment 
that may lead to rehabilitation is the alternative."

In effect, Pitfield found that addiction is an illness, and that if 
they were to close Insite, the federal government would be denying 
users the right to treatment and to the right of "life, liberty and 
security of the person" guaranteed by Section 7. The federal 
government is currently appealing Pitfield's decision.

Among the supporters of the appeal is the Canadian Police Association 
- - a union representing over 54,000 Canadian police officers - which 
has called for Insite to be closed, citing the facility as a 
"well-intended but failed experiment."

"Supervised injection sites were supposed to be a starting point for 
users to get rid of their drug addiction," says CPA President Tony 
Cannavino. "The fact that [there] has not [been] an improvement in 
the rate of addictions [in the Downtown Eastside] shows that the $3 
million operating cost for Insite would be better spent on treatment 
that will have more meaningful results and save more lives."

The Drug Prevention Network of Canada - a right-wing organization 
opposed to drug legalization and harm reduction - has also been a 
vocal opponent of Insite, with formerpresident Randy White claiming 
in The Globe and Mail that "the objective [of programs that deal with 
drug addiction] must be prevention and treatment. An injection site 
does neither, as treatment must have the objective of abstinence." 
The DPNC has also claimed that research into the benefits of Insite 
has been biased and has uncovered insufficient proof to justify the facility.

"When you have about $3.5 million of research on your side saying 
that Insite is generally a good thing, you think everyone would 
listen," says Townsend. "Unfortunately, you can always find people 
that will tell you that the world is flat. But science tells us the 
world is not flat and that Insite is a success."

The "Four Pillars" Approach

In the media much has been made of the so-called "Four Pillars" 
approach to drug addiction - prevention, treatment, harm reduction, 
and enforcement - but in actuality the current approach is very much 
one-dimensional. Seventy per cent of the federal government's 
spending on drug addiction is earmarked for enforcement, with 17 per 
cent going to treatment, four per cent for prevention, and two per 
cent for harm reduction. The remaining seven per cent of national 
anti-drug money is spent on coordination and research.

"All evidence is that harm reduction is a successful strategy for 
dealing with drug addiction, but the government is more interested in 
focussing on enforcing drug laws," says Wainberg. "Instead of feeling 
pressured by the United States or other people that have backwards 
approaches on these issues, we should embrace harm reduction. When 
you use it in concert with the other [Four Pillars] it can be 
extremely helpful for dealing with drug addiction."

One of the biggest initial concerns expressed over Insite was that it 
would adversely impact the "enforcement" pillar by acting as a magnet 
for drug users and crime - attracting even more unsavory characters 
to the neighborhood. However, a 2008 study commissioned by the 
federal government and conducted by Neil Boyd, a professor of 
criminology at Simon Fraser University, found no such negative effects.

"Insite has had no impact on crime rates," says Boyd. "Furthermore, 
we found that we are only just scratching the surface of the benefits 
that Insite can provide."

Cost-effectiveness was among the benefits that Boyd's study 
uncovered. Using conservative estimates of Insite's benefits, Boyd 
found that Insite produces an annual return on investment between one 
and four times its cost.

"The most significant savings for the public come through preventing 
the spread of HIV infection . but it's important to note as well that 
our evaluation of cost-effectiveness clearly underestimates the 
benefits of Insite," says Boyd. "We were limited to just data on HIV 
infection and the prevention of overdose deaths, and yet we still 
found Insite was extremely cost-effective for taxpayers."

Boyd's study also gauged community support for Insite and found that 
80 per cent of respondents from the Downtown Eastside thought Insite 
should be "expanded, retained, or modified." A similar study by Angus 
Reid Strategies in May 2008 found that 65 per cent of Vancouver 
residents support Insite.

"I haven't noticed a big difference [since Insite opened]," says 
'Mark,' a storeowner in the Downtown Eastside who requested his real 
name not be used. "But if it stops people from [overdosing] in my 
alley then that's great . It's not like [allowing drug-users to 
inject themselves at Insite] is a big deal anyways. You can't stop 
them from taking drugs - they're either going to do it there or 
they're going to do it somewhere else - you can't police that."

The future of Insite

The future of Insite is still very much up in the air. Although 
Insite has support from the vast majority of the medical community, 
the mayor of Vancouver, Gregor Robertson, and B.C. Premier Gordon 
Campbell, among others, the federal government seems intent on 
shutting Insite down, or at the very least, ensuring that similar 
projects will not be launched in other Canadian cities.

"It's consistent with their ideology which is to punish people who do 
things that they don't agree with - that do things that don't fit 
with their view of how the world should operate," says Boyd. "But the 
line between legal and illegal drugs has no logic to it . If we were 
going to criminalize the drugs that were most likely to kill you we 
should probably start with tobacco, seeing as that causes over 35,000 
deaths per year."

Clement and Prime Minister Stephen Harper appear to view Insite as an 
ideological issue - in their opinion, drugs are immoral and by giving 
addicts a safe space to inject intravenous drugs, Insite is condoning 
immorality. It's likely that no amount of scientific evidence in 
favour of Insite could change their minds.

"[The government is] not prepared to allow people to die . I believe 
I'm on the side of compassion and on the side of the angels," says Clement.

But for Townsend - questions of morality aside - the most compelling 
argument in favor of Insite is simple.

"The most important aspect [of Insite] for me is that people aren't 
just going to overdose and die for no reason - all the other things 
are a bonus," he said. "It just seems really unnecessary and brutal 
that, with all the resources we have available to us in this day and 
age, people should die because they have an addiction."

Correction: The article "Insite: Vancouver's drug dilemma" originally 
referred to Tony Clement as the current federal health minister, when 
in fact he was transfered out of that position in late 2008. He is 
now the Minister of Industry.
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MAP posted-by: Jay Bergstrom