Sober N Clean

Ottawa's fight to shut down Vancouver's controversial supervised injection site will be heard by the B.C. Court of Appeal next April.

The federal government is appealing a B.C. Supreme Court decision that struck down sections of Canada's drug laws as unconstitutional because they prevent the facility, known as Insite, from operating.

The judge gave Ottawa until June 30 of next year to bring the Controlled Drugs and Substances Act in line with the Charter of Rights and Freedoms, and gave Insite a constitutional exemption to stay open in the meantime.

Madam Justice Anne Rowles of the appeal court announced yesterday that three days will be set aside for the appeal beginning April 27.

But a lawyer for the federal government noted that could mean a decision might not be issued before the lower court's ruling takes effect.

"The Attorney-General asks that the appeal be heard as soon as there is available time to hear it," said Paul Riley, who had hoped for a hearing as early as December.

"The implications are significant - what we're talking about is an order declaring an important law of no force and effect."

But Judge Rowles said other lawyers' schedules meant the case couldn't be heard until the spring.

A lawyer for the Portland Hotel Society, which runs Insite and helped launch the initial court challenge, said that if Ottawa was concerned about the deadline, it should be working to update the law, not speed up the appeal process.

"The government should be doing their work as we speak," Joseph Arvay said.

Insite opened in Vancouver's Downtown Eastside in 2003 under an exemption from federal drug laws, but Ottawa now wants the facility shut down. Insight allows addicts to inject their own narcotics under the supervision of medical staff.

Mr. Justice Ian Pitfield of B.C.'s Supreme Court ruled in May that denying drug addicts access to the health-care services offered at Insite violates their Charter rights to life, liberty and security of the person.

It's not clear what will happen if the Conservative government hasn't passed updated legislation by Judge Pitfield's deadline of June 30 and if the appeal isn't successful.

Lawyers at yesterday's court hearing suggested either side might apply to have the deadline extended, though Judge Rowles said that's an issue to be decided later.

A spokeswoman for Health Minister Tony Clement said the minister had no comment about the appeal and said the timing is at the discretion of the court.

Officials with the federal Attorney-General's office and the Justice Department were unavailable.

The case involves a complex mix of appeals and cross-appeals involving the federal government, the two local groups that launched the initial court challenge and at least three intervenors.

The B.C. government is already an intervenor, and the B.C. Civil Liberties Association and the Vancouver Coastal Health Authority are expected to apply to intervene in support of Insite.

"The civil liberties association, like the plaintiffs themselves, is responding to what in essence is a health-care crisis in the Downtown Eastside," the association's lawyer, Ryan Dalziel, said in an interview. "The service is saving lives."

The health authority, which works with the non-profit Portland Hotel Society to operate Insite, plans to keep the facility open indefinitely unless a court rules otherwise, said spokeswoman Anna Marie D'Angelo.
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source: The Globe and Mail, http://www.theglobeandmail.com

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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source: The Economist, http://www.economist.com

Ottawa is determined to shut down Vancouver's safe-injection site because it's necessary to "draw a line" about which public health measures are acceptable, Canada's Health Minister says.

Tony Clement said that while the government supports needle exchanges as a legitimate intervention, providing a site to facilitate the injection of illegal drugs is going too far. He also invoked the slippery-slope argument.

"There are already people saying injection sites aren't enough, that true harm reduction is giving out heroin for free," the minister said.

"You have to draw the line somewhere and we feel we're drawing the line in a place Canadians are comfortable," Mr. Clement said in an interview in Mexico City, where he is attending the 17th International AIDS Conference.

Mark Townsend, a spokesman for the PHS Community Services Society, which helps run Insite, Vancouver's safe-injection site, called the notion "depressing silliness."

He said supervised injection sites provide better care for addicts and increase their likeliness to attend detox, so it makes little sense to throw support behind needle exchanges as a legitimate intervention.

"There's really little difference between needle exchanges and supervised injection sites, except for in a supervised injection site, there's a nurse there," Mr. Townsend said. "If you overdose, you don't die."

Earlier in the week, the World Health Organization issued a new guide for countries on how to best tackle the epidemic of HIV-AIDS that strongly endorsed a broad array of harm-reduction measures, including safe-injection sites.

Mr. Clement said that it is up to each country to decide what measures are appropriate, and "it's not my job to kowtow to orthodoxy."

The minister said intravenous drug use and its role in fuelling the epidemic of HIV-AIDS requires a mix of prevention, treatment and enforcement and he's convinced Canada has the balance right.

"I believe I'm on the side of compassion and on the side of the angels."

But Carolyn Bennett, the Liberal public health critic, balked at that suggestion, saying Mr. Clement "opposes supervised injection sites yet says he supports needle exchange, which makes no medical sense."

She said the Conservative government's stand is driven by ideology, not compassion, and accused Mr. Clement of "embarrassing Canada" on the world stage.

At the Mexico City conference, Canada has also been under fire for what some call its paltry contribution to the fight against AIDS, both domestically and internationally.

Julio Montaner, a Vancouver physician who heads the International AIDS Society, told Mr. Clement that Canada should be ashamed that it is not contributing as much, per capita, as its neighbour to the south.

Last week, U.S. President George W. Bush approved a plan to spend $48-billion (U.S.) over the next five years on AIDS programs.

Currently, Canada invests a fraction of what the United States does: $550-million over the past three years on HIV-AIDS programs abroad. In Mexico, Mr. Clement announced an additional $45-million in funding.

"I acknowledge that it's not $45-billion but it's commensurate with Canada's abilities," the minister said.

Mr. Clement said Ottawa is spending $84.4-million on AIDS programs this year, the highest amount in its history.
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source: The Globe and Mail, http://www.theglobeandmail.com

By giving drug addicts a sterile syringe and a warm place to shoot up, are we saving lives or condoning substance abuse?

To illuminate the double standard surrounding "harm reduction," Dr. Stephen Hwang, a medical researcher and associate professor of medicine at the University of Toronto, offers the following scenario:

Suppose that an innovative but controversial intervention is launched to reduce complications of Type 2 Diabetes, and 7,000 subjects take part in a trial. Researchers, funded by Health Canada to study the intervention's effectiveness, find that while not curing diabetes, the intervention improves health, reduces infections and prevents premature deaths -- with no adverse effects. The findings are published in the world's leading medical journals.

But the federal government deems the findings inconclusive and says the only acceptable therapies for diabetes are those that either prevent or cure the condition -- even though no such therapies exist. Columnists, community leaders and national organizations expound that the intervention "enables" bad lifestyle choices, and that without the dire complications of diabetes, people with the condition would eat more, exer cise less and become increasingly obese. And those who didn't have diabetes would forgo healthy diets and exercise because they'd no longer fear the disease. The government considers banning the intervention.

Sound far-fetched? Not, says Hwang, if you replace the word diabetes with drug addiction, and the word intervention with Insite, the safe-injection site pilot project that began in Vancouver's Downtown Eastside in 2003. Insite has allowed addicts to inject drugs under secure, clean conditions, and all under the supervision of a nurse.

"I wanted people to see how hypocritical we are in the way that we treat two chronic conditions that have a lot of associated harms," says Hwang. A specialist in inner-city medicine, he wrote the diabetes scenario for the peer-reviewed online journal Open Medicine, arguing that when it comes to drug abuse, ideology trumps science in a way that would not be tolerated with other chronic health conditions. Hwang's treatise was endorsed by more than 130 prominent Canadian scientists, doctors and public-health professionals.

Think there's a huge difference between drug addiction and diabetes? There isn't, says Hwang: Both arise through a complex mix of predisposed genetic and environmental factors -- triggered by lifestyle choices, behaviour and bad luck -- that result in disorders of body chemistry. Both have potentially severe complications, such as infections or premature death, that can be reduced with good medical care. Just as some addicts can kick their addictions, some people with diabetes, through weight loss, gastric bypass surgery or extreme exercise, can eliminate their symptoms and their need for medication -- though drug-free addicts and insulin-free diabetics both risk relapse. Yet do we refuse to treat the health complications of people with diabetes who cannot wean themselves off medication? Never.

"A heroin addict needs heroin as much as a diabetic needs insulin," says Norm Stamper, a former chief of the Seattle police department. "That need is real. It is physiological." After witnessing the failure of the United States' strict "war on drugs" to stem narcotic use and its associated problems, Stamper is now a leading advocate of safe-injection sites, methadone-treatment, needle-exchange and other harm reduction programs that aim to refocus efforts from policing to medical management.

Here's what more than 20 studies --all by independent evaluators, published in prominent journals -- have found: Insite has reduced instances of needle sharing and drug injecting in public places, and there has been a decrease in the amount of injectionrelat ed litter. In the Insite neighbourhood, there have been no increases in drug trafficking or assaults, and instances of vehicle break-ins and car theft have decreased. Despite almost 900 overdose events at Insite -- a common hazard of drug use -- no overdose deaths have occurred at the facility, compared with an average of 60 a year in Metro Vancouver. Additionally, since Insite began, the number of drug addicts who have entered detox programs, addiction counselling and drug-addiction treatment has increased by over 30%.

Dr. Perry Kendall, the B. C. Health Officer, says opposition to Insite is not based on evidence of effectiveness but on the notion that drug addicts have made bad choices and must change or live with their fate. "The belief," he says, "is that if health providers remove or lessen the harms of addicts' behaviour, addicts won't hit bottom and therefore won't have the motivation to go clean."

"The issue is not whether the addict would be better off without his addiction--of course he would--but whether we are going to abandon him to illness or death if he is unable to give it up," says Dr. Gabor Mate, who has served as staff physician at Insite and is the author of In the Realm of Hungry Ghosts: Close Encounters with Addiction. Mate's book is a must-read for those who reject harm reduction as "coddling" drug addicts or who believe "Just Say No" is a realistic policy. In his book, Mate shows his patients' struggles and demons, how they became addicts and how they found a way out. The book illus trates a central premise of HR: accepting those with drug addictions and trying to move them along the continuum to better health -- keeping them alive and well long enough to have a chance to quit later.

Some who were once adamantly against Insite have come to support it. One such person is George Chow, former president of the Chinese Benevolent Association of Vancouver. Chow successfully ran for city councillor on a ticket of rejecting Insite -- the centre was on China town's doorstep -- gathering some 18,000 signatures from the Chinese community. Yet, after Insite had been in operation for three years, he changed his mind. "I am keenly aware of the debate surrounding [Insite]. But I am pleased to say that the initial fears of the community -- a potential increase in crime and public disorder -- have not materialized," Chow wrote in a letter to Prime Minister Stephen Harper in the fall of 2007.

If only more of us were willing to change our positions based on evidence, we might finally begin to make progress against this terrible affliction called drug addiction.
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source: The National Post, http://www.nationalpost.com