Pubdate: Wed, 05 Oct 2011
Source: National Post (Canada)
Copyright: 2011 Canwest Publishing Inc.
Author: Barbara Kay
Referenced: Supreme Court Judgment:

The Insite Decision


The Supreme Court's Ruling in Favour of Harm Reduction Was Based on 
Possibly Faulty Research

In 2003, Insite, the first experimental supervised injection site in 
North America, was installed in Vancouver's Downtown Eastside (DTES), 
Canada's poster district for entrenched substance abuse and 
addiction. At Insite, addicts may legally shoot up illegal drugs in 
hygienic, medically protective and non-judgmental circumstances. The 
controversial clinic instantly became, and remains, a crucible for 
passionate social and legal debate about public policy in dealing 
with drug addiction.

Those who argue for Insite believe that its governing philosophy of 
"harm reduction" for what they regard as an incurable affliction, is 
both ethical and efficacious in reducing disease and deaths. Opposed 
to Insite are those who support what one might call the "moral 
agency" model. This redemptive perspective, which favours pro-active 
strategies of treatment and prevention, has the support of the 
federal government, which has tried to close Insite down since 2006.

On Sept. 30, the Supreme Court of Canada ordered the Minister of 
Health to permanently exempt Insite from the provisions of the 
Controlled Drugs and Substances Act and, by implication, all other 
applicants for drug injection sites elsewhere in Canada. In their 
ruling, the Supreme Court justices explicitly linked the decision to 
their belief that, "Insite saves lives. Its bene-fits have been proven."

How did they come to that understanding? Well, the Insite hearings 
were held on May 12. On April 18, a population-based study conducted 
by University of British Columbia (UBC) researchers and published in 
the leading medical journal The Lancet was conveniently distributed 
to the media. The study claims that over the period 20027, drug 
overdose deaths within a 500-metre radius around Insite reduced by 
35%, while the rest of Vancouver reduced by 9%. Lead researcher Dr. 
Thomas Kerr announced that, "the evidence is clear, Insite saves 
lives." His words were immediately hailed by Insite's many supporters 
in the media as proof of the site's success.

However, an anti-drug watchdog group vigorously contests these 
findings. In an analysis of The Lancet study commissioned by the Drug 
Prevention Network of Canada and Real Women of Canada, an 
international team including three Australian doctors, B.C. 
drug-prevention expert Colin Mangham and Dr. Robert Dupont, president 
of the U.S. National Institute of Drug Abuse, allege that The Lancet 
study's findings of decreased deaths in the Insite area are not 
supported by data from the British Columbia Coroner's office, which 
indicate that deaths from drug overdoses in the area around Insite 
not only did not decrease, they in fact increased between 2002-2007 
(see graph to the left).

Amongst other allegations, the watchdog group contends that the 
Lancet researchers, some of whom have advocated for Insite since the 
1990s, manufactured an appearance of overdose mortality reduction by 
including 2001 data in their pre-Insite comparison years, without 
stipulating that 2001 was a year of unusual heroin availability. They 
were well aware of the anomaly, since it was the subject of two 
previous journal articles by three of The Lancet article's 
researchers. The analysts further maintain that the UBC researchers 
failed to note that 41% of B.C.'s overdose fatalities are not even 

More significantly, they affirm, is the UBC researchers' disclaimer 
of any knowledge of "confounder" policing changes around Insite 
between 2001 and 2005 that might have affected the rates of overdose 
deaths. But according to the analysts, the researchers had to have 
known that since April 2003, 50-66 police officers were added for 
patrol duties, specifically to a 12-block radius of Insite, where the 
contested 35% decrease is alleged to have occurred. As evidence, they 
point to a 2004 journal article, a "detailed analysis of the effects 
of the changed policing," on which three of the UBC researchers 
collaborated, which showed a 46% evacuation of drug users from the 
area as a consequence of the police crackdown.

The analysts conclude that Insite, hosting about 144,000 opiate 
injections annually, saves 1.08 lives per year, a statistically 
negligible outcome, but a figure that is proportionally consistent 
with a 2008 Canadian Government Expert Advisory Committee's 
international review of injecting sites worldwide. In Germany's 25 
injecting rooms, hosting 500,000 annual opiate injections, for 
example, the cumulative number of lives saved is estimated at about 
10 per year.

A complaint about The Lancet study research has been filed with UBC. 
The question now arises: If it is found, as their critics charge, 
that serious errors undermine the credibility of the research, 
invalidating The Lancet study's claims, then the Supreme Court's 
justification for their ruling in favour of Insite, that it "saves 
the life and health" of addicts, is also void. In that case, unless 
the court can point to another source of credible evidence to support 
it, it should take the honourable course of action and annul its ruling.
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