Monday, April 14, 2008

Safe-injection site a provincial responsibility, court to be told

GREG JOYCE

The Canadian Press

April 14, 2008

VANCOUVER -- As the deadline approaches for a federal government blessing for Vancouver's supervised injection site, supporters are preparing to head to court to argue that the controversial place is a health-care facility and, therefore, the sole preserve of the province.

And British Columbia Health Minister George Abbott leaves no doubt that the province wants the site to continue to operate.

Regardless of the outcome of the coming court cases, Mr. Abbott has strongly indicated that the facility might operate even if the federal government withholds its blessing.

Should they not renew that exemption I would hope we would be advised with a little notice. We will then be turning the discussion intensively in another direction. I do not want to see Insite closed.

Mr. Abbott declined to state whether the B.C. government would operate it in defiance of federal drug laws.

This is an opportunity for us as a society to reach out to them [addicts], to provide that measure of security and stability, to remind them that mental and physical health supports are available to them.

He said he recently spoke with federal Health Minister Tony Clement.

I suggested to the Health Minister that we would like them to renew the exemption and we have formally asked for that. He said he'd give full and serious consideration to my case.

Insite opened in 2003 as a pilot project in the Downtown Eastside for intravenous drug users to inject their own heroin and cocaine with clean needles and under the supervision of a nurse.

Addicts who get their fixes at the site, instead of in alleys and decrepit hotels, can also get referrals to detoxification and rehabilitation services, including one that recently opened atop the Insite facility.

Ottawa has twice exempted the site from federal legislation that would otherwise see operators charged under federal drug laws.

The current exemption expires June 30, when Mr. Clement must decide whether to grant another exemption to the Controlled Drugs and Substances Act or amend legislation that prohibits the safe-injection site.

But two lawsuits scheduled to be heard by the B.C. Supreme Court beginning April 28 will argue that the federal government is overstepping its jurisdictional bounds.

Lawyer Monique Pongracic-Speier, who will represent a group of addicts and the Portland Hotel Society in one of the legal challenges, said they will argue that the services provided at Insite are essentially health care and, therefore, the exclusive jurisdiction of the province.

It is our contention the feds don't have a role to play in regulating Insite through section 56 of the [Controlled Drugs and Substances] act or otherwise, Ms. Pongracic-Speier said.

The second part of the challenge is a Charter argument that asks: If the services were removed, would it violate the security of the person of those using the site?

In addition to the lawsuit by the Portland society, which operates Insite along with the Vancouver Coastal Health Authority, another by the Vancouver Area Network of Drug Users will also challenge the federal jurisdiction.

Thomas Kerr, a research scientist at the B.C. Centre for Excellence in HIV/AIDS and an assistant professor of medicine at the University of British Columbia, has conducted or overseen many studies of the injection site and said there are few, if any, other novel public-health interventions in Canadian history that have so many published studies supporting their effectiveness.

Dr. Kerr said a letter in Open Medicine - a peer-reviewed, international journal - was endorsed by more than 130 prominent researchers and practitioners, including the medical health officer of B.C. and the medical health officer of Montreal.

Studies have appeared in, among other publications, the New England Journal of Medicine, The Lancet, the Canadian Medical Association Journal, the British Medical Journal and the American Journal of Public Health.

These are the best medical journals in the world, Dr. Kerr said. You can't publish junk science in these journals.

But support is not unanimous, and the RCMP and the Canadian Association of Chiefs of Police remain steadfastly against injection sites.

Chief Superintendent Derek Ogden, the RCMP's director-general of drugs and organized crime, said he would like further research.

I absolutely cringe when I hear people talk of a safe-injection site, he said in an interview from Ottawa.

He said the RCMP position focuses more on enforcement, prevention and treatment, which can result in harm reduction without injection sites.

Colin Mangham, the director of research for the Drug Prevention Network of Canada, wrote in his 2007 critique that other studies' findings of a reduction in public disorder were questionable and so limited in scope as to be misleading.

The Insite evaluations as reported in various research journals include considerable overstating of findings as well as under-reporting or omission of negative findings, and in some cases the discussion can mislead readers, Mr. Mangham wrote.

A Health Canada spokesman said by e-mail that after the last exemption was granted in December, Mr. Clement determined that additional research was needed to identify the extent to which supervised injection sites affect crime, prevention and treatment.

A report released Friday by an expert panel appointed by Mr. Clement found mixed results in its review of the many studies of Insite.

James Morton
1100 - 5255 Yonge Street
Toronto, Ontario
M2N 6P4

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