Pubdate: Mon, 03 Oct 2011
Source: Globe and Mail (Canada)
Copyright: 2011 The Globe and Mail Company
Author: Andre Picard


For supporters of Insite, Vancouver's supervised injection site, and 
those who believe in evidence-based public-health measures more 
generally, Friday's ruling from the Supreme Court of Canada was a 
huge legal victory.

But the celebration should be short-lived. Now that the Champagne has 
been drained, we are left with a whopping hangover of a realization: 
Canada's drug strategy remains deeply flawed.

A comprehensive drug strategy has four pillars: prevention, 
treatment, harm reduction and enforcement.

The court has shored up one of those pillars, harm reduction. The 
government has embraced one other, enforcement. The other two key 
elements, prevention and treatment, have been starved of funds, 
leaving us with a teetering response to one of society's biggest 
public-health challenges - drug misuse and addiction.

Back to the Supreme Court ruling for a moment: In a unanimous 9-0 
decision, it upheld the federal government's right to use criminal 
law to restrict illicit drug use; at the same time, the court said 
Insite could stay open, ordering Ottawa to exempt users and staff 
from prosecution.

Why? Because the scientific evidence demonstrates incontrovertibly 
that supervised injection sites provide intravenous drug users with 
clear health benefits, along with advantages for the community. For 
instance, as a result of Insite, addicts are less likely to share 
contaminated needles with other drug users. That means there is a 
lower risk of transmitting diseases such as HIV-AIDS and hepatitis. 
There are also significantly fewer drug users injecting in alleys and 
discarding used needles.

"The effect of denying the services of Insite to the population it 
serves and the correlative increase in the risk of death and disease 
to injection drug users is grossly disproportionate to any benefit 
that Canada might derive from presenting a uniform stance on the 
possession of narcotics," Chief Justice Beverley McLachlin wrote in a 
key section of the ruling.

The court's strong support for harm-reduction measures and its 
position that law enforcement does not trump public health is a 
victory of sorts.

But did we really need the top court in the land to tell us that 
supervised injection sites save lives? The scientific evidence has 
been clear for years.

The federal government not only chose to ignore the evidence, it 
mounted a moralistic anti-science campaign against Insite. Former 
health minister Tony Clement went so far as to say that supervised 
injection sites offered "no harm reduction" but rather "harm addition."

The current health minister, Leona Aglukkaq, greeted the Supreme 
Court's ruling by saying the government was "disappointed" but would 
reluctantly comply.

Ottawa is not exactly embracing harm reduction, or evidence for that 
matter. Further, it seems to have not absorbed one of the most 
important lessons of the ruling, a reminder that governments are 
stewards and have a duty to act in ways that enhance the health of 
individuals and their communities - even when doing so is politically 

There is some speculation that the court ruling will pave the way for 
supervised injection sites to open in other major cities with large 
populations of injection drug users, such as Montreal, Toronto and Ottawa.

But having the law and science on your side is not near enough. You 
need money, you need the support of local public-health authorities, 
you need the backing of the provincial government (meaning a province 
willing to pick a fight with Ottawa at a time when federal health 
transfers are being negotiated). And you need to convince a skeptical 
public that you're not wasting tax dollars coddling "junkies."

That's not going to be easy to do at the best of times, let alone in 
the current "tough-on-crime," recessionary atmosphere.

Finally, anyone who wants to open a supervised injection facility 
still has to apply to Ottawa for an exemption and they are 
undoubtedly in for a long, expensive legal fight.

In fact, one of the most tragic aspects of the Insite story is how 
much money was wasted on lawyers and how many opportunities were lost 
to advance public health while the legal bickering dragged on for years.

Instead of using its energies fighting for the survival of a service 
with demonstrated benefits (supervised injection), Insite should have 
been expanding into other areas such as supervised inhalation 
(sniffing having become a massive problem), and other groups 
throughout the country should have been expanding their 
harm-reduction programs such as distribution of safe-crack kits, wet 
shelters, and finding innovative ways to counter the scourge of 
methamphetamine addiction.

In pooh-poohing the court ruling, Ms. Aglukkaq said that the federal 
government prefers to spend on prevention of drug addiction rather 
than on harm-reduction measures for addicts.

The sad truth is that it has done neither to any appreciable degree.

Instead, the current government treats drug addiction not as a 
sickness but as a crime. It has chosen to spend dizzying amounts of 
money building prisons instead of investing in harm reduction, 
treatment and rehabilitation.

Prisons are not tools of prevention; on the contrary, they are places 
where addictions and needle-borne infectious diseases flourish.

The other unfortunate aspect of the Insite battle is that it has 
focused too much attention on harm reduction to the detriment of 
other important interventions.

Supervised injection targets a small minority, the sickest of the 
sick. The threat of prosecution is meaningless in this group and, 
sadly, treatment options are few. So you try to minimize the harm 
they can do to themselves and others - for compassionate and economic reasons.

But most addicts do not live on the means streets of Vancouver's 
Downtown Eastside. They live in mainstream society - struggling at 
work, in school, at home. Most suffer from another form of mental illness.

The four-pillars approach - prevention, treatment, harm reduction and 
enforcement - is what they need and what governments should be embracing.

The Supreme Court of Canada has provided a timely reminder that 
putting all their eggs in the enforcement basket is a legally dubious 
approach, not to mention poor public-health policy. But it remains up 
to us - and our leaders - to act.
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MAP posted-by: Jay Bergstrom