Friday, September 08, 2006

Insight on InSite

First of all, I would like to give Health Minister Tony Clement some half hearted applause for his half hearted decision to extend for one year the exemption under Section 56 of the Controlled Drugs and Substances Act for the Vancouver INSITE safe injection site. Maybe I’ll just use one hand. Did you hear that?

For weeks, the Stephen Harper and Tony Clement have been coy on the future of Vancouver’s innovative but controversial experiment in harm reduction as a component of a a “Four Pillars” approach to reducing illicit drug abuse and drug related crime in the downtown core. Under mounting pressure from the current and three former Vancouver mayors, the Premier of BC, the entire population and public health professional and academic communities, the entire Vancouver social services community, Vancouver’s chief of police, virtually all of the public sector unions, national and international HIV/AIDS and epidemiology experts … virtually every expert in the fields of public policy, healthcare, social services, public health, epidemiology and substance abuse, Harper punted, renewing the exemption and funding for the site for one more year, when researchers have asked for three more years to complete the ongoing research.

Given the fact that virtually everyone who knows anything about the related fields has spoken out in support of the site, why did Harper wait until the 11th hour and then only renew the site’s license for one additional year? It is probably due to the fact that people who live in Canada’s urban centres are not Harper’s constituents. The Conservatives did not elect a single MP in a major urban centre outside of Calgary and Edmonton. So while Harpers constituents don’t have to deal with the impact of drug abuse, overdoses, the spread of infectious diseases and the related prostitution and property crime that result from drug addiction, his constituents DO have strong opinions on so called “vices” such as drug use and prostitution. For the most part their opinions could be distilled down to “throw them all in jail”. Publicly, Harper has said that the deliberation was needed to review the research. The evidence on the results of the site is pretty clear. More likely, Harper needed to assess the political impact of doing the right thing. Harper needs to appeal to his base – suburban and rural conservative. To do so he has to come across as tough on crime, regardless of whether or not his policies result in a dozens junkies and prostitutes dying or the spread of HIV and Hepatitis B. Inner city junkies and prostitutes probably don’t vote conservative.

The research on INSITE is pretty clear. It was publicly funded under grants from the Canadian Institutes for Health Research (CIHR), has been peer reviewed and published in some of the most respected and rigorous academic journals including The New England Journal of Medicine, the British Medical Journal and the Canadian Medical Association Journal. This represents the platinum standard in academic research. For a review of the results, please look here. But this is not clear enough for Mr. Harper. We have heard musings of needed more independent and arms length research.In fact, this is exactly what (heard on CKNW radio in Vancouver) the head of the BC RCMP (the only law enforcement agency that does not support the site) has said. More independent and arms length research? What he really means is that the Fraser Institute (whose work is neither peer reviewed or subject to independent editorial review) or some other third rate, right wing propaganda machine has not weighed in yet.

To be honest, I was initially sceptical about the INSITE program. On the surface it seems to be enabling drug use. But to really understand the safe injection site, you have to view it in the context in which it was designed. It is only one component, in a comprehensive “Four Pillars” approach to reducing drug related problems in Vancouver. Outside of such a comprehensive approach, I probably wouldn’t support it. Vancouver has been at the forefront of including harm reduction - reducing the spread of deadly communicable diseases, preventing drug overdose deaths, increasing substance users' contact with health care services and drug treatment programs, and reducing consumption of drugs in the street into its policies around drug prevention. The other three pillars are Prevention, Treatment and Enforcement. For more information on Vancouver’s Four Pillars program, look here.

But all of this information was available to Stephen Harper before the last election when he said he was “not committed” to the InSite program and would be opposed to using tax payers money to fund it. So rather than allowing the best scientific evidence direct his government’s policies on drug abuse, Mr. Harper seems to be falling back on the failed “war on drugs” policies of the 1980’s and 1990’s.

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