Pubdate: Wed, 01 Apr 2015
Source: Globe and Mail (Canada)
Copyright: 2015 The Globe and Mail Company
Authors: Perry Kendall, Patty Daly, John Carsley
Note: Perry Kendall is Provincial Health Officer of British Columbia. 
Dr. Patty Daly is Chief Medical Health Officer for Vancouver Coastal 
Health. Dr. John Carsley is Medical Health Officer for Vancouver 
Coastal Health.
Page: A11


If it becomes law, this legislation may cause the closing of 
Vancouver's Insite and prevent other sites - we fear the worst for 
addicts and our cities, write Perry Kendall, Patty Daly and John Carsley

O n March 23, federal Bill C-2 - the "Act to Amend the Controlled 
Drugs and Substances Act" - passed in the House of Commons. 
Vancouver's supervised consumption site, Insite, was recently granted 
a one-year extension under the existing legislation, but if Bill C-2 
eventually becomes law, then it may well cause the eventual closure 
of Insite and make it almost impossible for new sites to open in 
other communities. The Conservative government has labelled this law 
the "Respect for Communities Act," but "Contempt for the Health of 
Communities" would be more accurate.

The act lays out the requirements for an application to the federal 
Health Minister for an exemption to operate a supervised consumption 
site such as Insite or the injection room at The Dr. Peter Centre, 
both in Vancouver. It's short, as legislation goes. Once you strip 
away the definitions and explanatory notes, you are left with more 
than 25 clauses listing the information an applicant must provide.

Based on our clinical experience of more than 10 years and the 
results of numerous peer-reviewed studies on Insite published in 
prestigious medical journals, we can say with absolute confidence 
that virtually all these requirements are unnecessary and excessively 
onerous. The requirements of the act are oriented toward building a 
case for denying exemptions rather than approving them.

For example, if there is a demonstrated need for this public health 
service, it's not clear whether opposition by a single group could 
prevent the granting of an exemption, or whether scientific evidence 
of clear benefit and lack of societal harm for such services carry 
greater weight than such opposition.

To give another example, for any staff working in the facility, the 
applicant must provide police records going back 10 years showing 
that the potential worker has not had a conviction for a drug 
offence, conspiracy, money laundering or terrorism. While most staff 
will be registered nurses who have already passed police checks just 
to work as nurses, others may well be recovered addicts who have 
succeeded in treatment. Scientific literature shows that such people 
are among the most successful peer educators - is it the intent of 
this bill to bar them from this work?

The act is also inconsistent with the Supreme Court of Canada's 2011 
ruling that the Health Minister's failure to extend Insite's Section 
56 exemptions was not in accordance with the principles of 
fundamental justice, and violated Section 7 of the Canadian Charter 
of Rights and Freedoms. The court ruled that on future applications 
for such exemptions, the minister must exercise discretion within the 
constraints imposed by the Charter "and aim to strike the appropriate 
balance between achieving public health and public safety goals." 
Further, the minister should generally grant an exemption where "the 
evidence indicates that a supervised-injection site will decrease the 
risks of death and disease, and where there is little or no evidence 
of a negative impact on public safety."

Our experience in Vancouver shows these sites do not increase crime, 
do not divert drugs and do not threaten the safety of their 
neighbourhoods. These are health services. They prevent overdose 
deaths, open a door to drug detox, keep HIV and hepatitis from 
spreading and used needles off the streets, treat wounds and 
infections, and decrease the use of police, ambulance and emergency 
medical services.

This law is a thinly veiled attempt to end supervised-injection 
services. Period.

If any legislation at all is required, it needs very few elements: 
applications endorsed by local and provincial public health 
authorities, the municipality, local police and the provincial health 
and justice ministers. If these approvals are in hand, the federal 
minister should be required to grant an exemption. It's that simple.

At present, a number of Canadian cities are considering seeking 
exemptions for supervised consumption sites. The passage of Bill C-2 
will effectively curtail these needed services. We fear the worst for 
the health of our cities.

Last October, there was a brief but intense surge in injection 
overdoses in Vancouver when fentanyl, the powerful prescription 
narcotic, was sold as heroin. While deaths occurred in the community, 
all those who overdosed at Insite were successfully treated and 
survived. We can only imagine the death toll among some of our most 
vulnerable citizens if Insite were closed. Do we really want our 
alleys and hotel rooms to fill up with bodies again?
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MAP posted-by: Jay Bergstrom