Vancouver safe-injection site gets positive federal review

When I last wrote about Insite, the experimental safe-injection site in Vancouver, a Health Canada spokesperson told me the government was still unsure of the facility's benefits.

Health Canada continues to repeat that more research is needed on Insite to determine how safe-injection sites affect crime, prevention and treatment.

But extensive research has shown Insite is successful at reducing crime and overdoses, getting addicts into treatment and saving money.

Asked what research [federal Health Minister Tony] Clement still needs to see in order to make his decision, Erik Waddell, a spokesman for Mr Clement, answers, "To see if Insite is getting people to programs to help them get off drugs."

Well, the verdict is in: Insite improves drug addicts' access to treatment and counselling, doesn't increase crime, and although the question of prevention still remains unanswered, it shows an overall "positive cost/benefit ratio." That's according to a report released Friday by the Expert Advisory Committee drafted by Health Canada to look at the effect of safe-injection sites.

The Health Canada panel's report came to seventeen conclusions, as follows:

1. Over 8,000 people have visited Insite to inject drugs. 18 per cent account for 86 per cent of the visits, and less than 10 per cent used Insite for all injections.
2. The average user has been injecting for 15 years; 51 per cent inject heroin and 32 per cent, cocaine.
3. The injections at Insite account for less than 5 per cent of injections in the Downtown Eastside.
4. Insite provides a clean environment for drug use.
5. Insite provides nursing services to a large number of users.
6. The general public has positive views of Insite.
7. Users rate the service as highly satisfactory.
8. Insite encourages users to seek counselling and treatment, which has resulted in an increase in treatment engagement.
9. Insite facilitated vaccination during an outbreak of pneumonia in 2006.
10. Mathematical modelling shows that Insite saves about one death by drug overdose each year.
11. The assumptions that researchers make about HIV prevention may not be entirely valid and are therefore inconclusive.
12. Between 6 weeks before and 12 weeks after Insite opened in 2003, there were reduced numbers of users injecting in public.
13. There is no evidence of increased loitering, dealing or petty crime in the area around Insite.
14. Analysis of police data shows no change in the crime rate in the Downtown Eastside.
15. There is no evidence that SISs influence rates of drug use in the community or increase relapse rates among injection drug users.
16. Insite costs $3 million per year to operate, or $14 per user visit.
17. Insite shows a positive cost/benefit ratio (with cautions as to the validity of the mathematical model used).

If the federal government is looking for an excuse to kill the Insite experiment, which only has two and a half months left on its current exemption from federal narcotics laws, then the panel's inability to find that the facility improves prevention of drug addiction may prove fatal.

But I'd like to suggest that perhaps given the unimproved poverty in Vancouver's Downtown Eastside, where Insite is located, it should come as no surprise that prevention hasn't improved. Perhaps the prevention of further harm and more death should be prevention enough, and we shouldn't expect one single intervention to solve the problem of drug addiction itself. After all, this is a "harm reduction" project we are talking about -- not harm prevention. (Insite itself recognizes this concept: its goals include access to health, harm reduction and improved public order, but not prevention of drug addiction.)

Given the panel's 17 conclusions, BC chief medical health officer Perry Kendall told the Canadian Press, if the government fails to grant an extension to Insite's licence to operate, "you might have to think that it's ideological or political."

But that's not entirely out of the question, of course, as I wrote last year of the current federal government's agenda:

Stephen Harper's attitude about how society should treat drug addicts was outlined in a 2003 essay he wrote about the Left called "Rediscovering the Right Agenda," published in Report magazine:

"This descent into nihilism... leads to silliness such as moral neutrality on the use of marijuana or harder drugs mixed with its random moral crusades on tobacco. It explains the lack of moral censure on personal foibles of all kinds, extenuating even criminal behaviour with moral outrage at bourgeois society, which is then tangentially blamed for deviant behaviour."

In the meantime, before the Insite licence expires on June 30, two lawsuits are headed to the British Columbia Supreme Court, arguing firstly that the federal government has no jurisdiction over a provincially funded healthcare facility and secondly that canceling Insite would violate users' constitutionally guaranteed "security of the person."


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