InSite remains audacious given the US "War on Drugs" next door. But amid massive local support, the supervised injection site is allowed to remain open until Dec. 31, 2007.
Published: Canadian Medical Association Journal, October 10, 2006
By Deborah Jones, Vancouver
As summer ran its course in Vancouver, a 3-year experiment to provide heroin addicts with a medically supervised injection site neared its scheduled Sept. 12 expiration. Canada's former Liberal government had granted the facility, InSite, a permit exempting it from federal drug laws. To remain open, InSite required a new permit from the Conservative government — some of whose members argued it's morally wrong to aid illegal drug addiction.
InSite is in the Downtown Eastside, Vancouver's impoverished neighbourhood of concentrated HIV and hepatitis sufferers, drug addicts and dealers, sex-trade workers and criminals. North America's first and only such site, it daily serves about 600 addicts who bring in illegal street drugs and then inject themselves with syringes dispensed by InSite, under the watch of health professionals. Nurses and doctors intervene if users overdose and offer general health care, while counselors are present to offer addiction treatment.
Some 50 similar sites exist worldwide, but InSite remains audacious given the US "War on Drugs" next door. In British Columbia, however, it has massive public and political support under a popular "Four Pillars" drug strategy of prevention, enforcement, harm reduction and treatment.
During InSite's 3 years, a remarkable consensus that the facility reduces harm to users and the public developed among scientists, criminologists and even the Vancouver Police Department. Research, all positive, was published in 15 peer-reviewed journals, including the CMAJ (2004;171:731-4), Lancet (2005;366:316-8) and the New England Journal of Medicine (2006;354:2512-4).
In the spring of 2006, the province wrote to Ottawa formally applying for a 3.5-year renewal of InSite's permit.
Ottawa's response was a long silence.
Over the summer, InSite became a cause célèbre. Activists, politicians and even scientists lobbied for it, and at the international AIDS conference in Toronto researchers spoke in support while AIDS activists demonstrated in the streets. Lawsuits were threatened. Ethicists joined the fray, including Margaret Somerville of McGill University's Centre for Medicine, Ethics and Law, who said given that addicts would continue to be addicts, reduction of serious harms such as HIV and hepatitis infection is an ethical requirement. One of the few opponents was the Canadian Police Association, which in late August demanded that Ottawa close InSite and focus instead on a national drug strategy.
Less than 2 weeks before InSite's scheduled closure, on Sept. 1, federal Health Minister Tony Clement announced he was deferring a decision on InSite pending more research, but it could remain open until Dec. 31, 2007. Clement's announcement asked: "Do safe injection sites contribute to lowering drug use and fighting addiction? ... Right now the only thing the research to date has proven conclusively is drug addicts need more help to get off drugs."
The Canadian HIV/AIDS Legal Network accused the government of "playing politics with people's lives."
Dr. Evan Wood, an epidemiologist at the BC Centre for Excellence and HIV/AIDS and assistant professor of medicine at University of BC who is, with Dr. Thomas Kerr, principal investigator for evaluation of InSite, argues that science clearly shows the benefits of InSite, and seemed nonplussed to find himself one of InSite's most vehement backers.
"I am a scientist, and I hate to be referred to as an advocate," he said. "But Dr. Kerr and I ... want to see the problem improved as scientists, because the benefits have been so positive."
Wood added, "I felt like the federal government was politicizing this because the science is that strong."
Copyright Deborah Jones 2006
About this website: Text and photos by Deborah Jones except where otherwise noted.
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ONLY THE ADDICTS MISSING AS INSITE OPENS
When North America's first purpose-built, supervised site for using heroin opened in Vancouver in early February, all that was missing were the addicts.
Published: Canadian Medical Association Journal, June 24, 2003
By Deborah Jones, Vancouver
InSite, near Hastings and Main streets at the gritty centre of the city's Downtown East Side, offers 6 stalls for self-administered injections. Clean needles, spoons, sterile water and lighters are laid on steel counters. A raised nursing station oversees the stalls. The bright utilitarian look is softened by potted palms and, on opening day, thousands of tulips in memory of drug users who shot up in nearby alleys and then died of overdose or disease.
But with addicts forced to mill about outside the site because of legal barriers against drug use, the "opening" was actually a media event — part of the lobbying by health and community groups to hasten federal approval of new and radical approaches to illegal drug use.
Proposed initiatives are based on a new-to-Canada premise of harm reduction rather than law enforcement. Included are proposals for clinical trials in 3 cities to introduce heroin-assisted treatment for addicts, and for heroin consumption facilities for Vancouver.
Approval for these has been voiced in principle, says Liberal MP Paddy Torsney, who chaired the 18-month investigation by the all-party Special Committee on Non-Medical Use of Drugs. Its 39 recommendations were released Dec. 9. "Current policies are not serving us well," Torsney told CMAJ. "We have to talk about [illegal drugs] as a health issue and not a moral issue."
The committee's most daring recommendations fall under its call for "removal of federal regulatory or legislative barriers" to testing innovative methods of treatment. The committee called for consumption sites and for a pilot project in Vancouver, Toronto and Montreal to "test the effectiveness of heroin-assisted treatment for drug-dependent individuals resistant to other forms of treatment."
Dr. Martin Schechter, professor of epidemiology at the University of British Columbia, submitted a proposal to Health Canada in February for the clinical heroin trials. He said they would attempt to determine whether hard-core users who have unsuccessfully tried methadone treatment at least twice can be treated using medically prescribed heroin.
Recovery would be achieved by breaking the addicts' "cycle of crime and other things they usually have to do to pay for their illicit drugs. It would also put them in contact with the health care system."
Schechter said there are about 90 000 heroin addicts in Canada, and 20% to 30% of them would be candidates for the trials. During the trials, which would be sponsored by the Canadian Institutes of Health Research, physicians would administer diamorphine.
It's no surprise that support for the trials and consumption sites is being led by Vancouver, which is plagued not only by problems of drug use and disease but also by a crime wave attributed largely to addicts.
Last November, former coroner Larry Campbell became mayor after promising to tackle drugs as a health rather than an enforcement issue, and to open consumption sites. In April, a Vancouver group opened a temporary, but illegal, supervised injection site.
Other examples of the sea change in opinion are found among people such as Crown Prosecutor Rob Rattan, a spokesperson for From Grief to Action, a group of middle-class parents whose children became heroin addicts. The group contributed to the InSite facility.
Consumption facilities "can help protect heroin addicts from an overdose and disease," said Rattan at the opening of InSite. His son Gavin, now 21 and off heroin, had once overdosed in a nearby alley.
Copyright Deborah Jones 2004
About this website: Text and photos by Deborah Jones except where otherwise noted.
Please contact me for reprint rights. All material copyrighted