Wednesday, October 17, 2007

Editorial, Globe and Mail, SAFE INJECTION SITES

Renew Insite's licence
626 words
27 August 2007
The Globe and Mail
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

Speaking to the Canadian Medical Association last week, federal Health Minister Tony Clement was non-committal on the future of Vancouver's safe injection site. But he seemed to be leaning against extending Insite's licence when it expires at year's end, telling doctors that recent research has cast doubt on the pilot project's usefulness.

Where is Mr. Clement getting his information? He hasn't said. Most likely it is from a well-publicized article published this past spring in the Journal of Global Drug Policy and Practice. The report was authored by Colin Mangham, the director of research for the Drug Prevention Network of Canada, a hard-line organization. Last year, former Reform MP Randy White, the then-head of the network, lauded what he saw as the Conservative government's tough approach on drugs. “A new National Drug Strategy, mandatory minimum prison sentences and large fines for marijuana grow operations, a nationwide awareness campaign, withdrawal of support for injection sites, a crackdown on drug crime and no marijuana decriminalization legislation is a breath of fresh air for Canadians, as well as a reflection of real leadership we have not seen in decades in Canada,” he enthused.

Unsurprisingly, much of the report put out by Mr. White's research director reads more like a rant against the “ideology” of harm-reduction and its alleged infiltration into society than a scientific study. It contains no first-hand research; the bulk of its findings consist of simplistic efforts to poke holes in the litany of more serious studies demonstrating Insite's benefits.
Indeed, virtually all serious research suggests that the program has had considerable benefits with little downside. Reports in reputable medical journals such as The Lancet and the BMJ (British Medical Journal) have shown that Insite reduces needle-sharing in the community, reducing the spread of disease. While 500 users overdosed at Insite over a two-year period, onsite medical assistance prevented a single one from dying – something that would never have been the case on the street.

Far from encouraging drug use, as its opponents claim, Insite has encouraged addicts to kick their habits. Over a one-year period of study, it made 2,000 referrals, 40 per cent of them to addiction counselling. One in five regular visitors to the site enlisted in detoxification programs – resulting, said a recent report in the British medical journal Addictions, in a 30-per-cent rise in the number of local addicts making use of such services. Similar findings were reported last year in the New England Journal of Medicine.

Last week, a group of 134 prominent Canadian doctors and health professionals endorsed a commentary by Dr. Stephen Hwang in the journal Open Medicine calling for Insite to be continued on the basis that it “provide[s] a number of benefits, including reduced needle sharing, decreased public drug use, fewer publicly discarded syringes, and more rapid entry into detoxification services by persons using the facility.” And while the RCMP has been critical of Insite, Vancouver's police department – which is on the ground and thus aware that harm reduction makes the streets safer – has endorsed it.

Unfortunately, it appears that no amount of evidence will convince the Conservatives, skeptical since the project was launched in 2003, of Insite's value. Desperate, local activists and drug users are going to court to argue that closing Insite would violate addicts' Charter rights. That seems a dubious proposition; ultimately the government will likely be free to decide whether or not to keep the program. But if Mr. Clement resists any urge to cherry-pick his information and looks at the overwhelming body of evidence, it should not be a difficult decision.

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