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It has long been an oddity that Vancouver, Canada's temperate coastal paradise (and perhaps answer to San Fransisco), which usually ranks in the top 5 of various "World's Best City to live in" lists is also home to arguably Canada's worst pocket of abject poverty and endemic drug abuse.
Vancouver's lower east side is a little pocket of the third world 2 blocks from affluent downtown Vancouver (I was shocked at how quick the transition is when I drove through last year). The area has become synonymous for heroin use, and has been the locus of much drug policy discussion in Canada for many years now.
In 2003, Vancouver became home to a North American first, "Insite", a medically staffed, clean, secure and legal safe injection site for needle drug users. These things are not new in Europe, but such ideas are always delicate in Canada because there is a widespread belief that the US will punish us somehow for deviating too far from its War on Drugs orthodoxy. Insite was made legal under a special permit allowed in Canada's federal drug laws issued by the then ruling Liberal government. Surprise, surprise the Conservatives hate it and have wanted to close it ever since they've taken power in 2006. They've backed away before, and even lost a legal battle over it but they're taking another run at it as Canada gears up toward a likely election in the fall (with luck, Obama will have Prime Minister Dion among his congratulatory phone calls in November).
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I'm writing about this for two reasons:
1) Progressives well know US drug policy is in the dark ages and needs to change, so I hope Insite provides some use in that aim.
2) More generally to the things we write about at OpenLeft, it is also a useful example that counters the notion that US conservatives are some unique breed. Not so. The denial of reality, sophistry, anti-intellectualism, fearmongering, and willingness to trample on the prerogatives of lower orders of government despite having stated principles in favour of same you know and love from Republicans is all on display here in Canada, the land of supposedly sane conservatives.
By all accounts, the facility is a great success. Vancouver's city council, led by its Mayor, Sam Sullivan (who is wheelchair bound and a remarkable story himself) support it. The Vancouver Police Department proudly proclaim their "number of progressive positions over the years with respect to drug policy," including Insite (though the city's police union opposes it). Conservative Federal Health Minister Tony Clement commissioned a panel of experts to look at the site, and here's what they found:
* Similar to the findings associated with SISs in other countries, users of INSITE rate the services as highly satisfactory. They view the staff as helpful, trustworthy and respectful and they appreciate having a safe place to inject drugs and pick up injecting equipment.
* Letters of support and surveys show that health professionals, local police, the local community and the general public have positive or neutral views of INSITE services and the majority wish to see the service continue. Some local police are neutral, but not antagonistic. Opposition to the service tends to decrease over time.
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* INSITE encourages users to seek counseling, detoxification and treatment. Such activities have contributed to an increased use of detoxification services and increased engagement in treatment. VCH has now increased access to detoxification by opening a number of beds for detoxification in rooms above INSITE.
* The existence of INSITE facilitated the immunization of injection drug users in the DTE during an outbreak of pneumoccocal pneumonia in 2006.
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* INSITE staff have successfully intervened in over 336 overdose events since 2006 and no overdose deaths have occurred at the service. Mathematical modelling (see caution about validity below) suggests that INSITE saves about one life a year as a result of intervening in overdose events.
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* There was no evidence of increases in drug-related loitering, drug dealing or petty crime in areas around INSITE.
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* There is no evidence that SISs influence rates of drug use in the community or increase relapse rates among injection drug users.
* Mathematical models (see caution about validity below) showed cost to benefit ratios for the INSITE service of one dollar spent on INSITE providing 0.97 to 2.90 in benefits. That is, the total cost of preventing each HIV infection is between $52,000 and $155,000. When these mathematical models included estimates of the number of overdose deaths prevented (1.08/year), they showed cost-benefits ratios that ranged from 1.5 to 4.02.
So the City government likes it, the Police approve, the users like it, people who initially didn't like it find it bothers them less over time, it saves lives, prevents HIV, helps addicts get intervention, doesn't increase crime around the site and doesn't increase relapse or general drug use. Oh and it saves the tax payer between $1.50 and $4 for every dollar spent.
So what does Canada's governing party think? Here's Tony Clement at a World Health Organization summit earlier this month:
"Allowing and/or encouraging people to inject heroin into their veins is not harm reduction, it is the opposite. ... We believe it is a form of harm addition,"
He was at odds with his WHO host:
Teguest Guerma, associate director of the HIV-AIDS department at the WHO, who was clearly uncomfortable about the exchange between the minister and reporters about the apparent contradiction in Canada's position, would only say: "The WHO supports harm reduction."
She repeated the phrase more than a dozen times, only once adding "including all interventions that benefit injecting drug users."
His ill considered reactionary stupidity drew some fire from an unexpected quarter, the normally fairly conservative Sun newspaper chain's Vancouver local published this OpEd, Conservatives' attacks on Insite need to stop.
Well, not satisfied putting one foot in his mouth in front of the WHO, Clement has continued his assault, embarrassing himself now in front of the Canadian Medical Association (80% of whom support Insite):
Federal Health Minister Tony Clement says ethical concerns raised by supervised injection sites for drug addicts are "profoundly disturbing," and he questions doctors who support the practice.
"Is it ethical for health-care professionals to support the administration of drugs that are of unknown substance, or purity or potency - drugs that cannot otherwise be legally prescribed?" Clement said Monday in a speech at the Canadian Medical Association's annual meeting in Montreal.
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"Imagine for a moment a doctor that has a patient with a serious but treatable case of cancer. Would it be ethical for that doctor to automatically give that woman morphine and otherwise make her comfortable until she died of her disease, rather than offering the patient an attempt at treatment, and a chance at recovery?"
So here we have the tack shifting a bit. Clement is up against a rock solid factual case that the usual conservative nonsense like "the site will just encourage drug use" and the more parochial types of "would you want to live next to one of these?" style tactics aren't able to overcome. But at root, is the conservative devotion to the "abstinence only" approach to drugs (familiar phrasing with Sex-ed intentional on my part). So he's trying to turn it into some bizarre case of medical ethics (the man is not a doctor I will add) where it is somehow more ethical to push addicts into the alleys and parks where their risk of HIV infection and fatal overdose rises and the non-drug using community gets to deal with used syringes left about.
His latter example is (bleakly) laughable. I suppose it might apply if we can imagine a cancer patient who wasn't eager to have every available treatment, one who was addicted to having cancer or who wouldn't admit they had a problem with cancer. Also this would require that Insite staff did not try to get addicts to seek treatment, while in fact they do. I'm sure the random strangers quickly fleeing addicts shooting up in the park must offer competent addiction treatment advice in Clement's world. That's much better than having a Registered Nurse provide sound medically competent advice.
So what is the real Conservative purpose here? I don't think Clement really cares about 12,000 drug addicts in Vancouver one way or the other in and of themselves. Speculatively, what makes most sense (aside from keeping in lockstep with US drug policy) is that the War on Drugs is enormously useful as a domestic "law and order" issue for conservatives to hyperventilate about. Canada doesn't have much of a prison-industrial complex that I'm aware of, having luckily missed the prison privatization train. In the absence of a foreign threat to run on, the "enemy within" is ever a favourite stand-by. Insite is too successful, and if it caught on, it could be the thread that unravels the whole sweater of addiction criminalization.
It's already happening though: In late July, Quebec announced it was considering opening several safe injection sites, which is likely what has Clement in such a panic. As it stands, a BC court ruling in May took away his ability to just close the site by edict, and with all three opposition parties in the minority parliament supportive of the harm-reduction approach, a legislative fix is unlikely so he's running out of options. So demagogy and sending mailers targeting "junkies" it is.
Feel free to join Insite's Facebook group. American drug addicts need harm reduction programs too. I don't know where the War on Drugs will end, but losing Insite would be a major sign that it will continue for many more years. |
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