Thursday » October 11 » 2007
Insite legal for the next nine months
Conservative stall tactics on supervised injection put politics ahead of saving lives: critics
Wednesday, October 03, 2007
VANCOUVER - It has become the most controversial medical experiment in Canada. That is quite an achievement for a place with 12 chairs in a nondescript building on East Hastings Street.
That's where, since September 2003, thousands of Vancouver heroin and cocaine addicts have been injecting their street-bought drugs under the watchful eyes of a small team of government-paid nurses and drug counsellors. On Tuesday, the controversy intensified as the federal government issued a terse statement.
It said, in full: "Health Minister Tony Clement has advised the Vancouver Coastal Health Authority which operates Insite, a supervised-injection site, that their exemption under Section 56 of the Controlled Drugs and Substances Act has been extended until June 30, 2008.
"This extension will allow research on how supervised injection sites affect prevention, treatment and crime to be continued for another six months."
The extension, the second the Conservative government has reluctantly given the site in the past year, wasn't greeted with expressions of relief the way the first, 18-month extension was last August. Instead, it has prompted a torrent of blistering criticism.
Scientists say the short extension represents political interference in medical research. Community advocates say it's a case of ideology trumping human lives. And some B.C. politicians are critical because they resent the federal government sticking its nose into something that has been supported by local governments.
"To be honest with you, it's time that we call things by their name," said Dr. Julio Montaner, an internationally respected AIDS researcher at Centre for Excellence in HIV/AIDS, whose team has done extensive research of Vancouver's drug-using population for a decade.
"The time has come for uncovering the plot that is emerging on the part of the federal government," Montaner said.
'ALL POLITICS AND NO POLICY'
That plot, he said, is a deliberate effort to keep changing the way the site is evaluated and keep stalling on a long-term decision about it, in order to get it out of the way until an election victory -- presumably later this year -- gives the Conservatives the opportunity to close it entirely.
Montaner's team has already done 25 studies looking at the impacts of the site. They have shown the site has reduced the numbers of syringes on the street in the area, reduced syringe-sharing and therefore infection-causing behaviour among users, dramatically increased rates of entry into detox and treatment, and eliminated drug-overdose deaths for people who use the site.
Three studies by other groups found the site did not lead to increases in crime, didn't lead to increases in people starting to inject, and didn't have any negative impact on community drug-use patterns.
But the research goalposts keep changing, Montaner says.
"Now, it seems if the supervised-injection site doesn't solve all of the problems of mankind in B.C., then it's a failure."
Montaner's view was echoed by many. Former Vancouver mayors Philip Owen and Senator Larry Campbell, who both championed the site, were outraged by the announcement.
"It disgusts me," said Owen. "They're not serious at all. This is all politics and no policy."
Campbell said it's an example of gross interference in both health and the province.
"Butt out. This is a health issue, this is a provincial issue," said Campbell, who vowed earlier to to the injection site and personally help keep it running if the federal government rescinded the exemption.
NDP MP Libby Davies and Liberal MP Ujjal Dosanjh both said they were concerned that ideology seemed to be overruling everything else.
"It's reprehensible for a government to be putting partisan politics ahead of saving lives," said Dosanjh.
For Mark Townsend, director of the community group that manages the site's operation for the Vancouver Coastal Health Authority, the news is especially discouraging because it means other initiatives remain stalled while everyone focuses on the injection site.
"There's a comprehensive strategy that needs to be built for prevention, treatment and harm reduction," said Townsend, whose group just opened a 12-bed detox facility above the injection site.
"The federal government has already spent $1.5 million on research, the research is in, but they want someone to say the world is flat," he said.
THE ETHICAL DILEMMA
The injection site was already controversial when it started, since it pits two passionately held ethical beliefs against each other.
One holds is that it is unethical to allow sick people to take powerful, addictive drugs that are ruining their lives, and the only moral course of action is to use whatever means available to convince them to stop.
The other says it is unethical to allow sick people who are addicted to powerful, addictive drugs essentially to kill themselves unless they agree to treatment, and the only moral course of action is to use whatever means are available to keep them alive and healthy so they can get treatment when they are ready.
The injection site also, unsurprisingly, pits federal political parties against each other. What has been remarkable, as the debate has gone on for the past four years, is how it has pulled many other groups into the conflict. B.C. Premier Gordon Campbell came out solidly in support of the site this week, highlighting the gap that has opened up on the issue between local, urban-based politicians and federal, rural ones.
More than 150 scientists wrote a letter to the federal government in May, protesting the terms of its research requirements, an unusual example of conflict between science and politics.
FEDS WANT MORE EVIDENCE
And Vancouver police have given their official support to the site, while the RCMP remain as disapproving as they can be without openly criticizing local government.
The RCMP position is that the force is opposed to any new sites opening "until we see convincing evidence that such sites can help people get off street drugs," said local RCMP spokeswoman Const. Annie Linteau.
The Conservative government has adopted that kind of approach, saying it wants more research to show that the site isn't only helping people using it stay healthy, but also reduces drug use. What is unclear now about the federal government announcement is how extending the deadline to June 2008 will contribute to improved research.
A Health Canada representative said she was not able to provide any further information.
The 150 scientists noted that the extension was so short no meaningful research could be done.
The whole process has been an unusual one in the annals of medical research, says UBC health professor Sam Sheps, who added that he can't think of another health issue that has become so political.
"The question is, do you consider this a legal issue only, or a health issue? We consider it a health problem if people smoke or drink, but a legal issue for people who take drugs. It doesn't seem very consistent."
YEARS OF CONTROVERSY MARK VANCOUVER'S SUPERVISED-INJECTION SITE
What began as a recommendation that addiction be considered a health issue instead of a criminal one eventually developed into the well-used Insite, which has just received another six-month extension.
B.C. chief coroner Vince Cain issues a major report on drug overdose deaths and recommends that addiction be treated as a health issue instead of a criminal one. He even advocates giving out free heroin.
Downtown Eastside organizers put up 1,200 crosses in Oppenheimer Park to mark deaths from drug overdoses, the beginning of a street-level campaign for sanctioned injection sites.
A report by B.C. public health officer John Millar says the province has an "epidemic" of death and disease caused by drugs, as overdose deaths spike and HIV and hepatitis C infection rates reach Third-World levels.
Vancouver mayor Philip Owen launches a draft drug strategy called the Four Pillars approach, focused on harm reduction, prevention, treatment and enforcement. It refers to injection sites, but doesn't endorse them.
Former coroner Larry Campbell is elected mayor on a promise to clean up the Downtown Eastside and get an injection site opened by the end of the year. He heads to Ottawa in December to twist arms.
Insite opens its doors, with a three-year exemption from Health Canada. Within six weeks, it is getting 500 users a day and the Centre for Excellence in HIV/AIDS begins to evaluate the site's effects on health and public disorder.
Health Minister Tony Clement approves an 18-month extension, but the site will no longer get money for research. Clements said the only thing research had proved was that addicts need more help to get off drugs.
The federal government issues a proposal call for new research. It wants new studies on the site's impact on community overdose rates, users' progression to treatment, public injection and drug-related litter.
A B.C. poll shows that 63 per cent of people in B.C. support the site. Among Conservative voters, 50 per cent support it, 41 per cent are opposed. In Vancouver, 76 per cent of people say they support the site.
Oct. 1, 2007
B.C. Premier Gordon Campbell expresses public support for the injection site.
Oct. 2, 2007
Clement announces the site will get a six-month extension, to June 2008.
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