Keep Insite Open

Staying Alive, The Fifth Estate

2010-02-10T09:27:00.000-08:00

CBC television aired the documentary "Staying Alive" on The Fifth Estate back in March (let me know if it is not available to viewers outside Canada). It's excellent. It is apparently the first time the inside of Insite has been documented in the media (though a video has always been available on Insite's own webpage).

Here's the preamble for the documentary from the CBC website:

"It has been called "an abomination" by a minister of Stephen Harper's government. Its staff members claim it "saves lives." A regular client calls it "a community centre for junkies." Whatever you might call it, Insite is the only one of its kind in North America — a supervised injection site for drug addicts.

Insite, located in Vancouver's notorious downtown eastside, has been controversial since it first opened its doors in 2003. An exemption from federal drug laws was granted to allow addicts to bring their drugs onto the premises and inject them; Insite provides clean needles and medical supervision. It's funded by British Columbia's government and championed by community leaders, but Harper's government is openly hostile to it and is trying to shut it down.

Now, for the first time, cameras have been allowed to record the daily dramas at Insite. Inside is a world not many have seen before. In Staying Alive, reporter Hana Gartner introduces us to some of those who work there, including Darwin Fisher, the intake manager, and Dr. Gabor Mate, who has been caring for addicts, prostitutes and the homeless for the past 10 years. You'll meet three addicts doing their best to survive. There is Dave, a user for half of his 40 years who has been coming to Insite since it first opened and who speaks to the harsh realities of life on the street. And Taz, who comes to the centre to detox and, in the process, confronts her past sexual abuse as she struggles for a better life. And finally, Shelly, who, despite her addiction, wants us to know: "I'm somebody's kid. I'm somebody's sister. All I want is for people just to say ‘hi' sometimes and remember I have a heart that beats."

Insite's future is uncertain. In this CBC exclusive, for the first time, viewers can see inside Insite and make up their own minds."

I Believe.....

2010-02-10T09:17:00.000-08:00

... that the Harper government is going ahead with this now, 2 days before the Olympics start so that the masses are well and heartily distracted. Kinda like a prorogue at Christmas:

Ottawa takes injection battle to top court

Justice Minister announces decision to appeal B.C. ruling that says provinces, not the federal government, have jurisdiction

Camille Bains
Vancouver — The Canadian Press
Published on Tuesday, Feb. 09, 2010 1:12PM EST Last updated on Tuesday, Feb. 09, 2010 9:35PM EST

The federal government is heading to the Supreme Court of Canada to try to shut down Vancouver's supervised drug-injection site, but British Columbia's Health Minister says Conservative politicians should get past their ideological opposition to the facility.

Justice Minister Rob Nicholson said yesterday that the recent B.C. Appeal Court ruling affirming Insite provides addicts with health care, which is a provincial jurisdiction, opened the door to an appeal to Canada's highest court.

“There was a dissenting opinion in the B.C. Court of Appeal, and the government of Canada believes it is important that the Supreme Court of Canada be asked to rule on this matter,” Mr. Nicholson said in a statement.

The Jan. 15 ruling said the site that allows addicts to shoot up their own drugs under a nurse's supervision provides health services and that the provinces, not Ottawa, have control over health care and therefore Insite as well.

“This case raises important questions regarding the doctrine of interjurisdictional immunity and the division of powers between the federal and provincial governments,” Mr. Nicholson said.
He said the federal government agrees that addicts need help but believes the approach of the safe-injection site, called Insite, is not the right solution.

“Our national anti-drug strategy focuses on prevention and access to treatment for those with drug dependencies,” he said.

But supporters of Insite say the federal government is wasting its time and taxpayers' money by trying to close down a facility that helps addicts.

Kevin Falcon, British Columbia's Health Minister, said Ottawa's decision to file another appeal against Insite is the wrong way to go.

“I'm disappointed because this is a program that has received very widespread independent medical journal support for the outcomes and the efforts they are making on a medical basis to treat some of the most difficult addicts you can imagine,” he said in an interview.

Mr. Falcon said he was once a skeptic of Insite and considered it a licence for addicts to use drugs but that the medical literature he read in highly regarded journals such as the Lancet persuaded him to change his mind.

He said he hopes Mr. Nicholson would also make his judgments after considering the evidence.
“I would really encourage him to read the medical journals that have independently evaluated the program and have shown, in a very comprehensive way, that it is achieving results,” Mr. Falcon said.

“As ministers of the Crown I think we ought to, as best as we can, be guided by the evidence and the facts. And I understand the ideological hesitation, no question about it. I've been there.”
Insite opened as a pilot project in 2003 under a federal exemption of Canada's drug laws. Last year, the provincial government spent $2.9 million on the program.

Dr. Julio Montaner, director of the B.C. Centre for Excellence in HIV-AIDS, said Ottawa's ongoing court battles against Insite are taking away from a program that should be expanded to other areas.

“Here we have another instance of serious interference on the part of the federal government, which is actually not trivial because what this is doing is inhibiting our ability to build on the success of Insite,” he said.

“It's particularly disappointing that the Minister of Justice and the Attorney-General of Canada, Rob Nicholson, specifically stated the government recognizes the need for assistance for injection drug users. I would like to remind him that this is exactly what we are trying to do.”

Dr. Montaner questioned the timing of Mr. Nicholson's announcement, noting it comes at a time when Parliament has been suspended and most Canadians aren't paying much attention to federal government announcements days before the Olympic Games begin.

Mark Townsend, executive director of the Portland Hotel Society, one of the organizations that runs Insite, said he felt “sick and depressed” when he heard Ottawa was starting a third court battle against Insite.

“We're not set up, really, to fight the Prime Minister,” he said.

“Addiction, in Canada, is a huge scourge and yet (the government) does is nothing. We're here trying to do something while they've been attacking us. We've opened detox beds, we're running this thing,” he said.

“Every time they've gone to court with us they've lost more and more. and we told them we don't want to go to court. We see this as not a legal, jurisdiction thing, not a political thing. This is just about public health.”

“ We see this as not a legal, jurisdiction thing, not a political thing. This is just about public health.” Mark Townsend, executive director of the Portland Hotel Society.

It's Liz Evans day...

2008-09-08T21:02:00.000-07:00

Here's an article from the "Full Comment" section of the National Post from back in June. In it Ms. Evans describes addressing the House of Commons Health Committee. The article is from June, my personal crazy month, and got missed in the round-up.

Liz Evans: The Harper government is ignoring the evidence about Insite
Posted: June 03, 2008, 5:16 PM by Marni Soupcoff Liz Evans

I am trained as a nurse, not a lobbyist, so perhaps I was naive to think when I was invited last week to address the House of Commons Health Committee, along with a team of health and policy experts from Vancouver, that Prime Minister Stephen Harper’s government would listen to the facts about Insite. Instead we were lectured by federal Health Minister Tony Clement about how those supporting Insite, not the government, were ideologues. Apparently, Tony Clement and Stephen Harper really care about drug addiction, whereas we are the ones who endorse suffering.
I have never been so offended on behalf of so many people. I wanted to weep at the implications of our government’s collective ignorance. The committee offered statement after statement that was plain wrong and a huge affront to the legions of researchers, public health officials, medical scientists, nurses, doctors and numerous international bodies (such as the United Nations and the World Health Organization) who have long endorsed harm reduction strategies as essential to assisting those with drug addictions.
OK, so they didn’t have to listen to me. But what about listening to one of the world’s most renowned doctors and researchers in the treatment of HIV and AIDS? Or the federally funded researcher who has produced more than 30 peer-reviewed scientific papers? What about the officer from the Vancouver Police Department, who explained that Insite and local police work together to limit public disorder? What about B.C.’s premier and minister of health, or Vancouver’s mayor and chief of police? And If not any of them, then what about the three out of every four people in the region surveyed in a recent Angus Reid poll who support Insite?
When first questioned about Insite, the Prime Minister said he would wait for word from the RCMP before commenting. When those results came in, they were not released because they were deemed to be too positive. Last year, Stephen Harper’s politically appointed expert advisory committee concluded that InSite causes no adverse affect on drug use or crime, that it acts as a deterrent to drug use and that Insite encourages users to seek detox and treatment. Eighty per cent of people interviewed thought the site should be expanded or retained and more than half of the police officers interviewed thought that Insite should remain open. How is it possible that the voluminous amounts of research and policy written over the years could be completely ignored?
Judge Pitfield of the B.C. Supreme Court, in his wisdom, understood something that Stephen Harper seems incapable of grasping: Addiction is a complex, chronic and relapsing disease. Justice Pitfield’s ruling to protect InSite under the Charter recognizes its essential role as a primary health care facility and a necessary access point to treatment for people who are clearly sick. The fact that Stephen Harper wants to appeal this decision shows he is continuing to ignore the evidence. The Harper government is displaying arrogance in the face of an issue they are clearly out of touch with.
— Liz Evans is a nurse and the executive director of the PHS Community Services Society, which operates Insite, Vancouver’s supervised injection site, in co- operation with the B.C. government.

Liz Evans responds to Clement's remarks to the CMA

2008-09-08T11:57:00.000-07:00

Liz Evans of PHS writes to the Ottawa Citizen about Insite:

The facts are in about Insite
The Ottawa Citizen Published: Wednesday, August 27, 2008

Prime Minister Stephen Harper told the Canadian public he would make a decision about Insite, Vancouver's supervised injection site, after all the research is in.
The research is in and indicates Insite saves lives, saves tax dollars, reduces public disorder, deters drug use, has not attracted new drug users and helps users of the site find detox and treatment options. Insite has taken one million injections out of our back alleys, and no one has died.
For Health Minister Tony Clement to question the moral judgment of health professionals who support Insite ignores millions of dollars' worth of research and evaluation.
Peer-reviewed, non-partisan researchers, unbiased medical professionals and the people who make use of Insite all tell the same story: supervised injection sites work. They reduce deaths from overdoses, giving users another day to seek treatment; they help keep needles off the streets; they help prevent the spread of blood-borne diseases associated with drug use.
Mr. Harper and his health minister are using fear in an attempt to cloud the facts. Mr. Harper, we at Insite again extend to you, or any member of your government, the opportunity to see our facility and the work that is done here, so you can understand the importance of our work.
The reality is: Insite provides one piece of the complex puzzle needed to help some Canadians overcome drug addiction. To be rehashing the same old arguments against harm reduction is depressingly immoral and unethical. What Canada needs is a real comprehensive strategy to address drug addiction.
Liz Evans,
Vancouver nurse and Executive Director of the PHS Community Services Society which operates InSite.

**Update**

For clarity, here is a similar letter that was published in the National Post:

Insite criticism based on ideology, not science

National Post Published: Saturday, August 23, 2008
Stephen Harper said he would make a decision about Insite, Vancouver's supervised injection site, after all the research was in.
The research is in and it shows that Insite saves lives, saves tax dollars, reduces public disorder, acts as a deterrent to drug use and helps users of the site find detox and treatment options. Because of this evidence, 80% of health professionals support Insite. Why, then, is Mr. Harper's Federal Health Minister calling this support for Insite "unethical"?
Mr. Harper and his Health Minister are using fear in an attempt to cloud the facts. The people Tony Clement calls junkies and who he thinks should be jailed are our brothers, sisters, sons and daughters. Ask any mother whose child survived addiction because of Insite and they will tell you about the importance of this facility.

The reality is that Insite provides one piece of the complex puzzle needed to help some Canadians overcome drug addiction. To be rehashing the same old arguments against harm-reduction is depressingly immoral and unethical. What Canada needs is a comprehensive strategy to address drug addiction.
Liz Evans (executive director of the PHS Community Services Society which operates Insite), Vancouver.
© National Post 2008

Open Letter to Minister Clement from Libby Davies, MP, Vancouver East

2008-08-26T09:07:00.000-07:00

August 21, 2008

Hon. Tony Clement
Minister of Health
House of Commons
Ottawa, Ontario
K1A 0A6

Dear Minister Clement,

I am writing to express my grave concern regarding your misleading and irresponsible attacks on harm reduction and Vancouver's InSite supervised injection site at the recent World Health Organization XVII International AIDS Conference in Mexico City and again at the 2008 Canadian Medical Association conference in Montreal.

At both of these conferences, you persisted in representing harm reduction and drug rehabilitation/treatment as two mutually exclusive, alternative approaches to problems associated with drug addiction. As has been explained to you on numerous occasions by health researchers, medical professionals, drug treatment experts and others, this is an entirely false dichotomy. Harm reduction is one component of a comprehensive "Four Pillar" approach, which also includes prevention, treatment and law enforcement. Low-threshold programs, such as supervised injection sites, are essential in the Four Pillars approach for reducing overdose deaths and the spread of diseases such as HIV/AIDS and Hepatitis C, and also for drawing hard-to-reach users into treatment and rehabilitation. Harm reduction is part of a continuum of care that includes treatment and prevention, and the only voices in Canada portraying it as a "substitute" are you and your government.

Unfortunately, your recent comments in Mexico City and Montreal are only the latest episodes in a well-established pattern of putting ideology and partisan politics ahead of rational public policy on this issue.

The Conservative government's National Anti-Drug Strategy has essentially abandoned the Four Pillars approach for a "One Pillar," US-style "war on drugs" that puts almost all resources into law enforcement. As of 2007, law enforcement accounted for an overwhelming 73% of spending in the National Anti-Drug Strategy, while treatment only received 14%, research just 7% and prevention and harm reduction a pitiful 2.6% each.

The Conservative government delayed a decision on the status of InSite for more than two years, claiming more research needed to be done. Now the research has been done, and it is absolutely clear. More than 20 peer-reviewed studies by internationally recognized researchers have demonstrated the health, safety and cost benefits of InSite. Even the criminologist hired by the government to evaluate the existing research said that InSite contributes to public order and saves lives. The response from the government in the face of this overwhelmingly favourable body of research was that the decision on InSite would not be based on scientific evidence alone.

At the XVII International AIDS Conference in Mexico City, you called supervised injection sites "harm addition," contradicting the official policy developed by the World Health Organization in conjunction with the world's leading addiction and health researchers.

At the 2008 Canadian Medical Association conference, you attacked the CMA's support for InSite and harm reduction generally, even going so far as to question the ethics of the 80% of Canadian doctors who support supervised injection sites.

Given the weight of evidence and the time that you and your government have had to digest it, I can only conclude that this continuing opposition to the Four Pillars approach is not because of an honest lack of comprehension, but is instead driven by the partisan political concerns of the Conservative Party. At a time when a comprehensive approach to the problem of drug addiction is so desperately needed, it is frustrating that you and your party have chosen cheap partisan political games over rational, evidence-based public policy.

My concern about your statements is compounded by your party's recent use of public money to mail leaflets containing dehumanizing language into East Vancouver and other communities across Canada. People with addictions are amongst the most desperate and vulnerable in our society, and referring to them as "junkies" is simply bullying and has no legitimate place in public discourse. While your party was clearly attempting to fear-monger and appeal to people's safety and security concerns, the Conservative Party has instead simply displayed the mean-spiritedness and lack of compassion that underlies so many of its policies. Will future Conservative Party leaflets begin referring to Canadians with mental illnesses as "nutcases"? Or maybe call people with physical disabilities "cripples"? Canadians have moved beyond this sort of stigmatization and dehumanization of vulnerable and ill people. I have received numerous letters and phone calls from constituents and people across Canada outraged by this mailing.Based on the above concerns, I strongly urge you and your government to take the following actions:

1. Abandon the time- and money-wasting appeal of the BC Supreme Court's decision on InSite, and start work on implementing a well-funded, comprehensive, evidence-based and effective Four Pillars strategy for dealing with drug addiction. This government must recognize that harm reduction programs like InSite are a necessary component of a broader strategy that includes prevention, treatment and enforcement.

2.Commit to basing drug policy decisions on scientific evidence and the informed opinion of the mainstream medical and research communities. History is full of tragic examples of governments and other institutions ignoring evidence because of ideological bias and short-term political concerns. In the case of drug policy in Canada, the price of Conservative ideological purity and political partisanship will be paid in lives ruined and lost. That’s too high a price to pay for political games.

3. Respect, support and strengthen effective, locally-developed initiatives dealing with addiction related issues. InSite grew out of the experience of groups and individuals working on the frontline of Vancouver's health and poverty crisis. There is broad community consensus in support of the project, including local residents, community groups, social service providers, businesses, law enforcement officers, municipal and provincial politicians, and people coping with addiction themselves. Your government's efforts to disregard the will of the community on this issue shows arrogance and poor judgment.

4. Stop wasting public money distributing dehumanizing, fear-mongering material on this issue to Canadians. Instead, Canadians need access to realistic information on addiction-related issues, both to inform public policy and for use in prevention and harm reduction campaigns. This issue is far too important to be manipulated for cheap, partisan political purposes.I look forward to your reply on this serious matter.

Sincerely,

Libby Davies, MP (Vancouver East)
NDP Spokesperson for Drug Policy Reform

CC:
Jack Layton MP, NDP Leader
Judy Wasylycia-Leis MP, NDP Health Critic
Joe Comartin MP, NDP Justice Critic

B.C. vs the Feds over supervised injection site.

2008-08-26T08:59:00.000-07:00

Globe and Mail: Legal arguments
ANNA MEHLER PAPERNY
August 25, 2008

The B.C. government will be fighting its federal counterpart in court when the
case of Vancouver's safe-injection site goes to appeal in April, arguing it has
final say over health care within the province.
The province plans to file a formal argument in October, when the federal government and the Portland Hotel Society, which runs Insite along with the Vancouver Coastal Health Authority, file their arguments.
"We will be arguing that the Constitution grants provinces the right to make decisions about how health-care resources are allocated and delivered," B.C. Health Ministry spokesman David Karn said in an e-mail.
"The Attorney-General will appear to speak to the exclusive provincial jurisdiction over the delivery of community health services and the importance of permitting provinces to experiment and innovate in response to local health concerns.
"Mr. Justice Ian Pitfield awarded Insite a legal victory in May, ruling that federal drug laws preventing it from operating were unconstitutional, and giving Ottawa until June 30, 2009, to rewrite the laws. B.C. is including itself in both Ottawa's appeal and a cross-appeal opposing Judge Pitfield's ruling that the province doesn't have sole jurisdiction in health-care cases such as this.

A spokeswoman for federal Health Minister Tony Clement declined to comment because the case is before the courts.

Breakdown of the Conservative's "junkie" flyers

2008-08-26T08:55:00.000-07:00

Conservatives' tough talk on drugs is a cheap political ploy

Barbara Yaffe, Vancouver SunPublished: Friday, August 22, 2008

The Harper government's escalating rhetoric on drug policy will turn off as many voters as it turns on.

Health Minister Tony Clement on Monday ramped up an attack on Vancouver's supervised injection site, questioning the medical ethics of health care workers who support harm reduction strategies such as Insite.

Conservatives have also mailed flyers to people across the country, equating drug pushers -- who clearly are criminals -- with junkies, who are addicts with huge social problems. It pledges: "The Conservative government will clean up drug crime."
A new Angus Reid poll reveals that, in B.C. and Alberta, arguably the region where people might be most inclined to consider the injection site when deciding which party to support, a majority of people in fact endorse Insite.

Specifically, 53 per cent of British Columbians and 56 per cent of Albertans say they strongly or moderately support the Downtown Eastside harm-reduction clinic.

Across Canada, nearly 40 per cent support it, even as 19 per cent also mistakenly believe that Insite hands out free drugs. Insite, of course, provides no more than a safe setting, clean needles and some nursing oversight.

The World Health Organization, as well as the medical establishment domestically, support harm reduction and supervised injection sites.
And a B.C. Supreme Court ruling this summer decreed that access to Insite constitutes a Charter right, to life, liberty and security of the person.

The idea is to reduce the dangers for addicts who doubtless would shoot up whether a supervised injection site existed or not. At such a site, users are resuscitated if they overdose, and have access to rehabilitation referrals.

Insite should not be considered nearly as big a problem as B.C.'s prevailing shortage of rehab facilities to help addicts get clean.

If the government were sincere in its efforts to address the drug problem, it would be putting cash into the establishment of more drug rehabilitation beds.

Instead, it's using addicts to advertise a highly political get-tough on crime approach.

The pamphlet the Harperites sent out pledges that Conservatives "will keep junkies in rehab and off the streets."

But Conservatives have been in power for 2 1/2 years and have made little if any visible headway in getting Downtown Eastside addicts -- including the ones who never use Insite -- into care or off the streets.

Indeed, the federal government has yet to respond to a plea from a Vancouver charitable foundation seeking $2 million toward capital costs for a new treatment facility for young people, in Keremeos.

The pamphlet also promises to "punish drug pushers with more jail time." This is totally non-controversial; it's hard to imagine any political party objecting to a renewed effort to keep pushers behind bars.

The text of the pamphlet further asserts: "Thugs, drug pushers and others involved in the drug trade are writing their own rules. For too long, lax Liberal governments left gangs and drug pushers to make their own rules and set their own criminal agenda. Those days are over."

"Who do you think is on the right track on crime?" concludes the message, featuring an arrow pointing to Harper's name.

In truth, the current government has only lately started seriously fussing about the Downtown Eastside. And the potential solutions to the prevailing problems there are well known, having been discussed going back to the time Philip Owen was Vancouver mayor.

What's required is a multi-pronged approach that would bring to bear more resources for education, prevention and rehabilitation services as well as beefed-up penalties for pushers and drug smugglers.

What Harper and the Conservatives are really doing is deploying an emotional, high-profile public issue to attract support at a time when the prime minister is toying with the idea of triggering a federal election.

The Harperites have a largely empty basket in terms of a political agenda and have seen much attention focused on Liberals who've gotten significant press play in the wake of their Green Shift environmental announcement.

But this particular strategy isn't terribly clever because a lot of voters support harm reduction and many others will see it as a political gambit.

© The Vancouver Sun 2008

Conservatives enhance stigmatization of addictions

2008-08-26T08:54:00.000-07:00

[photo credit: Vancouver Sun]

MPs' illegal drugs flyer violated rules, opponents say

Randy Shore Vancouver Sun Monday, August 18, 2008

Flyers sent out by the federal Conservative party last week violate rules that forbid Members of Parliament from using their free postage privileges to send out campaign material, opposition MPs say.

People in east Vancouver, Richmond, Port Alberni and across the country were blitzed last week with pamphlets touting the Tories' tough-on-crime approach to illegal drugs.

According to rules distributed to every MP by the office of the Speaker of the House, such flyers may not contain "provincial, municipal or local election campaign material." Nor can the flyers request "re-election support."

But the Conservative flyer includes a depiction of an election ballot with the names of four federal party leaders and an arrow pointing to Prime Minister Stephen Harper. The question above the ballot reads "Who do you think is on the right track on crime?" The flyer asks the recipient to fill out the ballot and mail it back to the House of Commons, again free of charge.
NDP ethics critic Pat Martin has lodged a formal complaint with the Office of the Speaker after reviewing the drug-crime flyer for The Vancouver Sun.
"That is way over the line," Martin said, adding that the New Democrats have never depicted a ballot in MP mail-outs. "The Conservatives are really thumbing their nose at the rules."
MPs are allowed to use franking - free postage - to send out four householder flyers each year to their constituents. They are additionally allowed to send out a number of flyers up to a maximum of 10 per cent of the number of households in their constituencies, so-called "10-percenters."
Most MPs would be allowed to send 4,000 to 5,000 10-percenters under the rules. The 10-per-cent flyers have been historically used by opposition MPs to promote their parties' policies and agendas, but were not often used by governing parties that had large majorities in the House and large advertising budgets, according to Ted McWhinney, a former Liberal MP and constitutional law professor.
In recent years all the parties assumed some control over the content and distribution of 10-percenters by having MPs pool their 10-percenter franking privileges once a month to send out large-scale mailings outside the MPs' constituencies.
McWhinney calls that practice a by-product of the "increasingly imperial nature of the prime minister's office."
The parties have taken so much control over the message that MPs deliver to their constituents that it renders them "ineffectual," he said.
"When Canadians realize that communications from their MPs are really just junk mail they will simply throw them away," warned McWhinney, who wrote all of his 10-percenters personally during his two terms as MP for Vancouver Quadra.
Liberal MP Mark Holland has also launched a complaint about the flyers, claiming they are too partisan.
"The Conservative Party is using taxpayers' money to fund the printing and mailing of electoral material," said Holland in a release from the Liberal Party of Canada.
But complaints about partisan content may not go far, according to Colette Dery, a spokeswoman in the Office of the Speaker.
"It is expected that the content will be partisan," she said. "What it can't be is a solicitation for a membership in a party or for fundraising or for re-election."
The Conservative drug-crime flyer was distributed across the country, according to Conservative party spokesman Ryan Sparrow. He did not know how many of the flyers were printed.
Sparrow, who was responding to a Sun request for an interview with Conservative MP Rick Dykstra, dismissed the opposition complaints.
"Everything that goes out from the House of Commons goes through House of Commons Printing Services," Sparrow said. "They would not print anything that violated the rules."
He says the rules governing 10-percenters are not as "black and white" as the opposition suggest and that many of the Tories' flyers employ the ballot motif.
"The drug crime flyer doesn't ask who you would vote for; it asks who is on the right track," he said. "MPs are free to communicate with their constituents and Canadians any way they want."
© Vancouver Sun

Transcript of questions from Clement at Canadian Medical Association meeting.

2008-08-26T08:53:00.000-07:00

This is the transcript from the floor of the Canadian Medical Association meeting where Clement gave his uneducated & misinformed views of harm reduction, smoking cessation, palliative care and strangely, pot luck dinners.

My thanks to my source, here's his: Excerpts from the official transcripts that HC prepares... thanks, mystery person!

***
Question: Thank you, Minister. Albert Schumacher from Windsor. Just to correct your example in smoking reduction, Minister, we do ask our patients to smoke less on the road to quitting. We ask them not to smoke in their home, around their family. We ask them not to smoke in their cars with their children. This is sometimes a very long process in getting them smoke-free. Any legislation that the government puts forward as far as smoke-free public places obviously assists us so in smoking, harm reduction is indeed a long cycle and it does take many efforts to get there. So I would hate for you to use that example again. (Applause.)

Hon. Tony Clement: Well, thank you. Thank you, Dr. Schumacher. I think my point though was we don’t -- we don’t try to convince people to stay on cigarettes but have less -- fewer cigarettes. Ultimately the goal is the same: to be smoke-free. And that should be our goal when it comes to injection drug use as well. That’s my point.---Question: Grant Friesen from Alberta. Mr. Minister, I’m a public health physician. I am disappointed by your comments related to harm reduction. I would want to emphasize that harm reduction is a continuum and there are certainly elements of harm reduction that are very important in terms of to clinical practice, not only in public health but across all areas of medicine.

***
Question: Thank you very much. I’m Bonnie Cham. I’m a physician from Winnipeg and I’m chair of the CMA Ethics Committee. I rise not to ask a question but to respond to your emphasis on ethics in your discussion on harm reduction.I found the use of medical ethics to justify a political decision which will affect social policy to be troubling at best and misleading at worst. Ethics consists of a balancing of rights and harms as do all medical decisions that physicians in this room help their patients reach every day.

IV drug users, as the rest of us, have the right to compassion and to access and care which is proven to be beneficial and those physicians who are affiliated with this type of care need to balance the harm of ongoing IV drug use versus ongoing exposure to non-supervised injection.By all means, consider all the issues and facts but please don’t use medical ethics. Supporting harm reduction programs is not a breach of the CMA’s Code of Ethics and medical ethics should not be misused in this way to support and justify a political decision. (Applause.)

Hon. Tony Clement: There’s no question there. I don’t believe there was a question there so the debate continues.

***
Question: Chris Mackie, new physician working in public health in southern Ontario. And my question is around the way government works. And I’ve been fascinated with the federal government and how decisions are made and I’m wondering

Hon. Tony Clement: You’ve got to get a new hobby, but anyway. (Laughter.)

Question continues : in terms of policy like around Insite, it seems to me that the evidence is clear that Insite has medical benefits for the patients as well as benefits for the community. And I’m thinking both of the primary articles published, reviews done by your government and I’m wondering what would it take for your government to change its position on Insite? If the Kirby Commission, for example, concluded that Insite was of benefit, would your position change?

Hon. Tony Clement: Well, certainly I’m always open to new research and to new insights into Insite, if I can use that term. I did -- I would be happy to send you a copy of my remarks where I go over the Expert Advisory Panel’s review of the research and some other comments that have been perhaps marginalised by some but I think are valid comments about methodology. So I’ll leave it at that because I’ve already mentioned that in my remarks but we’d be happy to share those with you.

***
Question: Thank you, Madam Chair. Minister, I’m Lloyd Opal. I’m a physician in Vancouver. I’d like to ask you a question about enforcing standards of truth in advertising for health products. As you know, Bill C-51 is now before us and contains important elements that protect consumers against false or misleading health claims and I hope you know, Minister, that when you’re standing up for reducing misleading advertising, you’re certainly among friends here at the CMA. This bill contains an element that does protect against advertising, selling, producing products that are less than forthcoming and honest about their benefits. This I know has provoked a furious reaction directed towards your department

Hon. Tony Clement: And me.

Question continues: --- from the natural health products industry. Oh, not you.

Hon. Tony Clement: No, a few.

Question continues: And, frankly, you know I think you’ve been very courageous in holding the line. I hope that you can assure us, Minister, that there will be no compromise on the consumer protections afforded in this bill and that you will act to continue to enforce and strengthen consumer protection against health fraud and false health claims.

Hon. Tony Clement: Thank you for your comments. It’s been a tough file because of the false and misleading attacks on the bill and me personally and so on so it has been a difficult file. But Bill C-51 had as its genesis the fact that Canadians need modern legislation to protect them on a whole range of issues and when I started to look at that legislation, to my horror, I found that the legislation really hadn’t changed very much in 50 years and that we really were driving a jalopy while other countries, our major trading partners — USA, countries in Europe — are, you know, in the latest version of the BMW but we’re still in our jalopy. And so that had to change to protect Canadians properly. Imported products, domestically treated products, you name it, all across the range, vaccines, pharmaceutical drugs, for the first time I’m proposing a mandatory adverse drug reaction registry so that we all know simultaneously across the country if a prescription drug that had hitherto been approved by Health Canada actually is having an impact that we should be aware of. These are all important things that -- we’re going to be tracking food from the farm to the fork, as I say. And these are all important things in terms of the public safety.

On natural health products, you’re absolutely right, there isn’t a week that goes by that I do not issue warnings about a certain natural health product, this is or that that is either mislabeled or has deleterious harmful health impacts and all I can do is warn. I have no power to recall right now — none, zero. I cannot recall a single -- I cannot recall a single drug and I cannot recall a single natural health product. That’s got to change. And certainly we are looking at some amendments because some people are taking advantage of the fact that you have to read that bill in conjunction with several other bills, several other acts in order to get the whole framework and we want to try to fix that to alleviate some of the more outlandish claims that I’m going to be banning vitamin C tomorrow, that Tony Clement is going to be banning potluck dinners. I mean you know for a guy from Muskoka to ban potluck dinners, that would be a death knell. (Laughter.) But I can tell you that we’ll do those kinds of things that will make crystal clear the intention and make sure that the administration of the bill is correct. But the purpose of the bill is to protect the health and safety of Canadians and that will not change.

Follow up to the CMA rant by Clement

2008-08-26T08:34:00.000-07:00

L-girl over at We Move To Canada (wmtc) followed up her original post with letters to the editor (LttE) from the Globe and Mail.

In the first she reprints the seven letters printed the day following the initial story.

In the second she gives a little insight of her own on the normal processes of the LttE page: usually there is one day for one side, the next a response; letters are printed in numbers roughly proportional to the response the paper recieved on either side of the issue. Good news here then: the second day had one letter against Clement's statement and Tory "health" policy on this issue and one in favour. She reprints the one against.

Many thanks to L-girl for covering the issue so well and in this detail.

Clement lectures MDs (erroneously)

2008-08-19T14:38:00.000-07:00

I haven't got time to blog on this properly yet, but luckily the excellent blog stylings of L-Girl at We Move to Canada has done a great job.

The errors seen on the first read (and responded to emotionally here. Rational response to follow):

Clement uses that ol' palliative care analogy again. Yo, Minister: Palliative care IS given to people who aren't dying. Sad to have a minister with poor knowledge of basic definitions.

The campaign by the Conservatives in Vancouver to make drug users the "evil other" includes a slogan that says "Junkies and pushers don't belong near children and families. They should be in rehab or behind bars." Nice. This is how your government feels about a fair portion of it's constituents, your fellow citizens. No thought that there's a reasonable chance the folks their vilifying HAVE children &/or ARE in families. No, they're evil and you should be afraid.

By this point I was seeing RED.... rational response after I go run off some of the venom.

Clement at International AIDS conference.

2008-08-19T08:49:00.000-07:00

At the International AIDS Conference in Mexico City earlier this month. http://www.aids2008.org/

[Thanks to Tim Meehan]

Clement "I believe I'm...on the side of angels"

2008-08-12T11:23:00.000-07:00

Clement's rant at the WHO event last week has launched much backlash: from media, from unions, from the public (and of course the naysayers, sadly in Mr. Clement's riding).

This editorial from the Vancouver Sun does a fine job of breaking down the poorly reasoned and illogical arguments of the minister [emphasis added].

Closing down Insite will bring out the angel of death

Vancouver Sun
Tuesday, August 12, 2008

At the 2006 International AIDS Conference in Toronto, many people were puzzled by federal Health Minister Tony Clement's refusal to make any public comment about the future of Insite, Vancouver's supervised injection site.

Now the reasons for Clement's silence seem perfectly clear, as he managed to embarrass himself, Canadian scientists and health workers, the World Health Organization and the Joint United Nations Program on HIV/AIDS with his comments at the 2008 International AIDS Conference in Mexico City.

Speaking ostensibly in support of the WHO's guide on fighting HIV/AIDS -- which includes an explicit statement of support for injection sites -- Clement launched into an incoherent and contradictory diatribe against Insite and harm reduction measures in general.
So bizarre was Clement's rant that it's necessary to take it line by line:

"Allowing and/or encouraging people to inject heroin into their veins is not harm reduction . . . we believe it is a form of harm addition."

Clement failed to provide any evidence for this belief, which isn't surprising since there isn't any.

Indeed, all of the evidence points the other way: In addition to educating users about safer injecting and providing them with a safe, clean place to do so, use of Insite has been associated with increased uptake of detox and treatment.

Insite therefore represents a powerful method of reducing harm and, better yet, it reduces harm among some of the most vulnerable and marginalized individuals, people who would otherwise be unlikely or unable to seek treatment.

And this is to say nothing of the incoherence of supporting needle exchanges -- as Clement does -- while attacking injection sites.

The government is "not prepared to allow people to die."
While Clement failed to expand on this statement, it's clear he was attempting to create an association between Insite and death. Once again, the research suggests that, if anything, Insite saves lives, which means that shutting the site down is more appropriately associated with allowing people to die.

"It's not my job to kowtow to orthodoxy."
This is a trick that's increasingly used by harm reduction opponents: Convince people that harm reduction is orthodoxy and that opponents are intrepid folks who wish to blaze a brave new path.
Of course it's quite the opposite. While harm reduction has gained adherents thanks to the evidence in its favour, the orthodox position is, and always has been, that drug problems are best dealt with through enforcement.

This is certainly true in Canada: Researchers from the B.C. Centre for Excellence in HIV/AIDS found that for the years 2004-05 -- before the Conservatives announced their anti-drug strategy -- the feds spent 73 per cent of anti-drug money on enforcement, compared to 14 per cent for treatment, and three per cent each for prevention and harm reduction. The remaining seven per cent was allocated for coordination and research.

In October 2007, the Conservatives announced the $64-million National Anti-Drug Strategy, and managed to convince some people, and some news outlets, that it was all about treatment.
Yet when that money is added to the base, the new percentages are as follows: Enforcement receives 70 per cent of the total, with 17 per cent going to treatment, four per cent for prevention and two per cent for harm reduction. The remaining seven per cent is again allotted for coordination and research.

The Conservatives are therefore following tradition -- orthodoxy -- by relying on enforcement to solve the drug problem despite overwhelmingly evidence that it has been a failure, and could, therefore, rightly be called a form of harm addition. Clement is not merely kowtowing to orthodoxy; he's a slave to it.

The numbers also show that for all their talk about treatment and prevention, the Conservatives are little more interested in them than any previous government was. Yet Clement somehow managed to tell the world, with a straight face, that Canada has achieved the right balance among prevention, treatment and enforcement.

"I believe I'm on the side of compassion and on the side of the angels."
Clement must be using a very odd definition of compassion here, because his "compassionate" strategy involves removing from vulnerable people a scientifically proven public health measure.
And instead of spending the considerable anti-drug funds on treatment, he supports the orthodox position of wasting them on enforcement.

Many people assume Clement's opposition to Insite stems from a desire to appeal to the Conservative base. So perhaps his compassion is directed toward them. Yet since drug addiction costs everyone, throwing taxpayers' money away on failed methods can hardly be construed as being compassionate toward anyone.

Finally, given that Insite might well prevent the spread of disease and save lives, the only angel who could support its elimination is the angel of death.

“We need to stop arguing about the merits of harm reduction and just do it”

2008-08-06T08:54:00.000-07:00

From today's Globe and Mail (front page) we get a lesson in diplomacy from Mr. Clement entitled "Diplomacy: It's not about tact and skill anymore". Very short lesson really:

At press conference endorse the program/document/agency up for discussion so as to look like the good guy for the cameras.
At the actual conference deride the program/document/agency up for discussion.
Ensure maximal embarrassment of all other officials involved.

Clement's Insite attack leaves WHO red-faced

ANDRÉ PICARD
From Wednesday's Globe and Mail August 6, 2008 at 1:00 AM EDT

MEXICO CITY — The World Health Organization has strongly endorsed safe injection sites like Vancouver's Insite as one of the “priority interventions” that countries should implement to slow the spread of HIV-AIDS, a view that was swiftly and firmly rejected by Canada's Health Minister.
“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,” Tony Clement said Tuesday in Mexico City, where he is attending the XVII International AIDS Conference.
While the minister's views on Insite are well known, Mr. Clement repeated them Tuesday at an event where he was endorsing and promoting a new WHO “how-to” guide on battling the epidemic, which promotes needle exchange and safe injection sites. The Health Minister's comments left officials from the agency flummoxed and red-faced.
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.”
The WHO document, prepared in Q&A form, is far less equivocal. It asks: “What is the WHO position on safe injection sites?” The answer: “Safe injecting sites are not a new intervention but simply a repackaging of existing WHO-recommended interventions such as needle exchanges, etc.”
“They enable known, WHO-recommended harm reduction interventions to be delivered and used in a safe environment with the aim of reaching the most marginalized and vulnerable of injecting drug users.”
Mr. Clement, at a press conference held Tuesday in Mexico City, initially praised the new document and noted that “Canada is proud to be the largest contributor to the WHO.”
He also said that the federal government supports various forms of harm reduction for intravenous drug users such as needle exchange, methadone treatment and rehabilitation, but rejected safe injection as illegitimate. “We're not prepared to allow people to die” by condoning their continued drug use, Mr. Clement said.
Mr. Clement has never clearly stated why the government supports needle exchange and rehab programs but so sternly opposes the existence of a facility where drug users can actually use the safe needles and be encouraged to enter rehab. The sticking point appears to be that, at Insite, drug users cannot be arrested and prosecuted.
Worldwide, an estimated 33 million people are infected with HIV-AIDS. Some 2.7 million people were newly infected last year.
Outside of sub-Saharan Africa, the epicentre of the epidemic, intravenous drug users
account for almost one-third of new infections. In Canada, there are 58,000 people living with HIV-AIDS, including 12,110 current and former intravenous drug users – 21 per cent of the total.
Drug users, because they are often marginalized and treated as criminals, are among the least likely people with HIV-AIDS to get treatment and among the most likely to infect others, making them the focus of much research.
Abeeda Kamarulzaman, head professor of infectious diseases at the University of Malaya in Kuala Lumpur, said harm reduction measures such as needle exchange, methadone treatment and safe injection sites have all been shown as beneficial in slowing the spread of HIV-AIDS.
She said 77 countries have needle exchange programs, and 63 countries have drug substitution treatment programs. There are 49 safe injection sites across Europe, Australia and Canada, including Insite in Vancouver. The Quebec government has announced plans for a similar facility in Montreal.
“We need to stop arguing about the merits of harm reduction and just do it,” Dr. Kamarulzaman told the conference.
Asked specifically about the merits of Insite, she said the “benefits of safe injection sites have been well demonstrated,” but added that governments are reluctant to endorse such measures because “it may seem like they are legalizing heroin and other drugs, which they are not.” (At Insite, drug users can inject themselves with clean needles under the supervision of health professionals should they require medical assistance, but they are not provided with drugs.) Peter Piot, the executive director of UNAIDS, was also clear in his backing of harm-reduction measures, including safe injection sites. “It is high time every country in the world resolutely embraced the full spectrum of harm reduction among injecting drug users. Not doing so will only perpetuate the spread of HIV,” he said.
Insite opened as a pilot project in 2003 under a special exemption from federal drug laws, but Ottawa had refused to say whether it would extend the exemption when it expired in June.
Before the deadline arrived, the B.C. Supreme Court ruled that parts of federal drug laws related to trafficking and possession are unconstitutional and gave the government a year to rewrite them. Mr. Justice Ian Pitfield said laws that prevent people suffering from the disease of addiction from accessing such a service infringe on their right to life, liberty and security of the person.
Mr. Clement said Ottawa will appeal the decision, meaning the fate of Insite will likely be decided by the Supreme Court of Canada.

There are over 400 comments here: Comments

Wente: "As a columnist, my job is to express a point of view, not to present all points of view". No kidding.

2008-08-05T09:23:00.000-07:00

I've gotten some personal e-mails asking why I didn't link to Margaret Wente's "indepth" 4 part series on harm reduction and Insite. My initial draft post on it had been in the works for weeks and was very, very lengthy. What it boils down to though is that her 4 columns are crap. Not crappy writing, no, it's written all interestingly with catchy little thought-provoking one-liners and set-ups to make readers with no real knowledge of either side of the issue think "Well, of course I don't agree with harm reduction! Who would?!" No, in that sense, the columns are very, very well done.

In terms of being balanced, in-depth, investigative journalism they are, as I've said, utter crap. I guess the argument is that as a columnist she only has to present one point of view. She's not doing investigative journalism, she's creating discussion and presenting an opinion. Sadly, Wente makes no bones about not having done key research such as, say, talking to the people at Insite. No, they apparently have the power here and are over exposed in the media as she claims in the follow-up "Margaret Wente Answers Your Questions":

Matthew Elrod, Vancouver: Why did you not offer the Insite researchers an opportunity to defend themselves?
Margaret Wente: Matthew, Insite and its supporters have ably defended their position in these pages and elsewhere, and I am sure they will be given the chance to do so again. Also, as a columnist, my job is to express a point of view, not to present all points of view.

Wente clearly also didn't consult "Basics of Addictions Medicine" as is obvious when she says, 'Drug addiction is 100 per cent curable through changing your personal behaviour"

She didn't do their fact checking then, even for their own argument. She supports "tough love" measures such as AA & NA and similar programs throughout the columns and on line questions. Yet the position of those and similar organizations is that you are always an addict. You are never cured, and you will have to fight this fight for your entire life. The neurological research backs this up.

Elsewhere in the on-line questions Wente states: "One thing I heard from addictions doctors is that they really want more facilities for people who are still using — which AA-type programs won't accept." Apparently Insite and Onsite (which has had very little media coverage) a short term recovery centre at the same location just slipped her mind then. Or perhaps she doesn't consider them facilities for people who are still using....

One regret I have from this ongoing saga is that I was pretty sidetracked by reading and commenting and fuming over the columns that I neglected to copy the Letters to the Editor from the series. I haven't yet gone back to the G&M website to search for these. I'm certain that, like the example below from the comments to the on-line questions , the letters to the editor will respond in a much more accurate and succinct way than my initial response to Wente's series.

Dan Shortt from Toronto, Canada writes: Ms. Wente states that no addiction is benign, and says that the addict not only hurts themselves, but society, their families, and their communities. I wonder would she consider the opposite hypothesis, i.e. that the current 'war on drugs' leaves addicts being hurt by society, their families, and their communities? Ms. Wente has spoken out strongly on favour of the 'tough-love' approach to addiction, i.e. that the addict be given a choice between rehabilitation or jail. I wonder would she advocate the same approach to alcohol and cigarette addiction. No? Is it because these products are legal, making their abuse more socially and morally acceptable, despite the obvious harm they do to society?
Finally, it's interesting that in all of her articles, Ms. Wente doesn't once mention Dr. Gabor Mate, a physician with extensive experience working with addicts in Vancouver's East Side. Dr. Mate has been a contributor to the G & M in the past, and recently written a best-selling book about addiction. He reports in his book that a story that appeared in the G & M in January 2007 stated that of a 245 million dollar budget for a national drug strategy, 73% of the funds were directed towards law enforcement, while only 3% of funds went to prevention and harm reduction. Is it any wonder that the '4 Pillars' model is not working, when 3/4 of the funds available are used to prop-up just one of the 4 pillars?

Food for thought

2008-07-09T07:34:00.000-07:00

This post started life as a response to ernurse and her post, The Usual Suspects, about prevention and health promotion reducing numbers in the ER. It's a great post and you should read it.

Hey there ernurse,

ERnurse journal is a great blog. I haven't been by in a while, but I really liked this post [The Usual Suspects] I agree that prevention and health promotion could go a long way to reducing numbers in the ER. I wish there was a quick fix way to turn the system on it's head and make public health and primary care the driving force rather than the secondary & tertiary care in the hospitals.

Anyways, re: your quote "For the drunks and drug users that we have to cater to every night, I really don't know what to say" I just wanted to offer a couple of suggestions to help you formulate what you might want to say (knowing full well you may come down against, which, of course, is fine too). Below are some prevention & promotion ideas & resources for this segment of the population.

Harm reduction is a big, scary idea for a lot of people, which is [kinda] understandable given how addiction in our society is seen as an issue of criminality rather than of mental health/ illness.

It's funny though, when I've talked to the average Joe/Jane and asked well, what do you think about seat belt programs, bike helmet programs, smoking/drinking cessation programs that don't require you to go cold turkey, condom & safer sex programs, even needle exchange programs, people are all for those.

Change from those programs though to a program for drug addicts to use their drugs safely and people are dead set against it. Even after you explain that a harm reduction program such as Insite doesn't exist in a vacuum but with programs for prevention of addiction, treatment, and enforcement. Even after you explain that it treats & prevents disease spread & abscesses & sepsis and thereby prevents long hospital stays and ultimately saves the system money. Even after you explain that at Insite there have been nearly 1000 overdoses prevented. Even after you explain that despite those overdoses there has not been one single fatality. Even in the face of all of these arguments, some people just see the addicted as the disease, not the addiction.

My own blog is all about a harm reduction approach in Vancouver, Canada, the Insite Safe Injection Site. Here's an intro.

Here's a link to a similar program for street living alcohol users in Ottawa. The Shepherds of Good Hope is a church run ministry that makes it's own wine and gives it out in a controlled manner to prevent binge drinking, drinking of unsafe substances, etc.

Lastly though, if you only do one thing, I would recommend reading the book "In the Realm of Hungary Ghosts" by Dr. Gabor Mate. Mate looks at legal addictions of affluence (shopping, gambling, work) and contrasts them to addictions of poverty (drinking, smoking, illegal drugs) in a unique way. He asks many excellent questions for reflection of your own beliefs (which I am working on as a future post).

Cheers, Jen

Link Love

2008-07-07T10:05:00.000-07:00

Here's a long overdue link to a great essay on Insite by Mark Rabnett, hospital librarian extrodinare.

Injecting doubt: the rhetoric of harm reduction and the fate of Insite

Attention people in/around Ottawa, Montreal & Toronto: PUBLIC FORUMS

2008-07-04T10:27:00.000-07:00

So, 3 posts in 2 days, pretty good, pretty good...

So thanks to Friends of Insite (a Facebook group reachable here), word on the social networking sites is that there are 3 upcoming forums (fora?) in Ontario and Quebec. Speakers will be:

Liz Evans, founder and executive director of the Portland Hotel Society, which operates InSite
Tony Trimingham, an Australian advocate for supervised injection sites whose own son died of an overdose.

Please let people know about, and please attend at the following locations and times:

Ottawa: Monday July 14, 6:30pm Ottawa Public Library, Main Library Branch
Montreal: Tuesday July 15, 7:00pm Leacock Building, McGill Campus
Toronto: Thursday July 17, 7:00pm City Hall

Here to is a video (also courtesy of Friends of Insite) featuring Tony Trimingham and discussing the importance of supervised injection sites.

Dr. Brian Day (Pres. Cdn Med. Assoc) on Insite

2008-07-04T10:16:00.000-07:00

Missed an article in yesterday's round up. This appeared in the Toronto Star and is by Brian Day, President of the Canadian Medical Association (CMA).

Ottawa's bad prescription on addiction

Jun 08, 2008 04:30 AM
Brian Day

When the federal government announced it would appeal the B.C. Supreme Court's decision on Vancouver's safe injection site, it chose to dismiss growing scientific evidence of the positive role harm-reduction programs can play in society.

It is hardly a surprise, however, that the Conservatives would favour a "law-and-order" approach. They made their position pretty clear when they rejected harm-reduction programs in the new national drug strategy.

While the federal government rejects scientific evidence that harm- reduction programs are successful, health-care professionals and public-health experts know they are an important part of the puzzle in addressing illegal drug use. Harm reduction, along with treatment, policing and prevention are cornerstones of a comprehensive, integrated public-health strategy.

Conservatives contend that money could be diverted away from Insite into treatment and rehabilitation programs for addicts. Money does need to be diverted, but it's not from facilities like Insite.

Of all the money that Canada spends to combat illegal drug use, less than 10 per cent is spent on treatment and rehabilitation. The vast majority of the money goes to interdiction and law enforcement. While law enforcement has an important role to play, it is obvious we need a rebalancing of resources and focus.

Not unlike mental illness, there exists a negative view and stigma around addiction, that these members of society are somehow weaker than others, that it is acceptable for us to turn a blind eye to their suffering. It's time to clear the air – addiction is a disease and those who suffer with it need medical assistance just as those who suffer from heart disease or cancer.

We know that stigma prevents individuals with an addiction from seeking help. We are now concerned that this stigma may also be affecting the development of appropriate public policy in this area.

Evaluation of safe injection sites show that they help prevent overdose fatalities. They help reduce needle-sharing, which is an important contributor to the spread of HIV and other infectious diseases. They encourage users to seek counselling and treatment. They do not increase the rate of injection drug use or crime in surrounding neighbourhoods. In fact, the government's own Expert Advisory Committee confirmed many of these facts.

Programs such as Insite are often the first and only contact people have with mainstream health and social services. It can also act as an important door into other areas of the health-care system for those who likely wouldn't or couldn't access the care they need.

Instead of closing down this site, the federal government should be working with public-health officials to see if such sites might work in other areas.

Health Minister Tony Clement has stated that "science is one of the issues that must be taken into account when it comes to a public policy decision." In this matter, the science is clear: Harm reduction is a proven and effective tool.

Marginalizing an already vulnerable population and leaving them at even greater risk of disease and death is bad medicine and, as the polls show, even worse politics. And with the B.C. government's plans to intervene on behalf of Insite, Canadians should rightly wonder why their tax dollars are going to be financing both sides of this argument.

They also should wonder why the federal government seems to be opposed to safe injection sites in British Columbia, but is willing to consider them in Quebec. Clement's public hedging on Quebec's proposal is further proof that his decision appears to be based on political science and not the real thing.

When it comes to safe injection sites, Conservatives need to consider the health of all Canadians, not just those who agree with the government's ideological bias against drug-addicted patients.

Dr. Brian Day is president of the Canadian Medical Association.

An eventful 6 weeks

2008-07-03T09:21:00.000-07:00

Well, I've gotten behind on blogging and it's been about the most eventful 6 weeks possible (for InSite and my private life, so bad timing there). Anyways, here's a timeline of the most recent events at InSite:

On May 28th the B.C. Supreme Court ruled that it would be unconstitutional for the Federal Govt to close InSite and further exempted InSite from federal drug laws until June 30, 2009. (CTV story here).

In a May 29th speech to the Parliamentary Health Committee, Tony Clement, Minister for Health, in a mind boggling political spin on addiction, hope, dying and palliative care

"called Insite "a failure of public policy... [and] ethical judgment." More focus should be on prevention and treatment and not on "palliative care," he said, referring to Mayor Sullivan's description of Insite's purpose. "Palliative care is what you give someone when there is no hope," Clement said. "It is end-stage treatment when every other solution has failed and we just wait for people to die. But injection drug users are not dying. There is still hope for them." (Vancouver Courier article here)

[Rant: There is so much wrong with his quote, I don't know where to begin (luckily others are more knowledgable and suscinct than I). My $0.02: That the Health Minister is unaware that Palliative Care extends beyond the dying and thinks it is devoid of hope (for either the dying or the ill) is shameful. That someone who still claims to have hope for those with addictions would take away life-saving resources is atrocious. Anyways, he also said that more treatment beds were needed. No kidding. No one (at InSite or otherwise) thinks differently. Harm Reduction works WITH treatment. It facillitates and leads to treatment. Four Pillars not one. More on that below...]

June 3rd : The Attorney General of Canada filed an appeal of the Supreme Court of BC ruling (Vancouver Courier article here).

June 3rd to 5th: Ipsos Reid conducts a national poll asking Canadians if safe injection sites were a "good thing", a "bad thing" or if they weren't sure. A majority of Canadians (55%) said they were a good thing. Province by province a majority voted "good" except in in Ontario (49%)Saskatchewan and Manitoba (both at 45%). A majority (57%) of urban dwellers went with good (no surprise there), as did a half of the rural dwellers polled. The second question asked Canadians if they thought InSite should be expanded to other Canadian cities. 49% said yes, 46% no and 5% didn't know. (Montreal Gazette article here).

June 4th: In that Ipsos-Reid poll, Quebeckers were the most favourable to safe injection sites (66%). No shock then when they announce that they are considering a safe injection site(s) also. (Canada.com article here, Montreal Gazette article here).

June 5th: Demonstration on Parliament Hill with the planting of crosses on the lawn to represent the 868 overdose interventions to date at Insite. (Georgia Straight article here, Rabble.ca articleby Libby Davies (MP in whose riding Insite sits) here). [Jen's excuse for not having a picture/participating here, it was at the exact same time as the ceremony]

June 8th: An interview with Liz Evans on Worldpress.org (here) in which she discusses the private member's bill in the BC legislature to designate InSite a provincial responsibility and the rally where the government and opposition gave the attending Downtown Eastside residents a standing ovation. She also comments on how governments heel-dragging over InSite has obscured debate and movement on the other 3 pillars of the Four Pillars Approach

July 2nd: Although the Vancouver police chief is known to support InSite, the official word from the VPD on whether InSite is a "good thing" or "bad thing" is "we're not sure; we'll sit on the fence" (Canada.com story here).

And lastly, the most recent news item deals with the likely next step: the appeal of the BC Supreme court ruling in the Supreme court of Canada:

[Vancouver] safe-injection site case headed for Supreme Court of [Canada], lawyer predicts (from The Canadian Press here)

VANCOUVER — The future of Vancouver's controversial supervised-injection site is likely headed for the Supreme Court of Canada, says the lawyer representing a group fighting to keep the facility open.

Ottawa has filed its appeal of a B.C. Supreme Court decision that struck down sections of federal drug laws and ensures Insite will remain open as a constitutionally protected health-care service.

But lawyer Monique Pongracic-Speier predicts the case won't be settled at the B.C. Court of Appeal, regardless of the outcome.

"I think there is a realistic chance that this will go up to the Supreme Court of Canada," Pongracic-Speier said in an interview Wednesday.
"It's an extremely important constitutional issue and it is an issue that I believe the Supreme Court of Canada would find has a national interest."
Insite opened in the city's troubled Downtown Eastside as a pilot project in 2003 under a special exemption from federal drug laws, but Ottawa had refused to say whether it would extend the exemption after it expired at the end of last month.
In a May 27 decision, B.C. Supreme Court Justice Ian Pitfield ruled that federal drug laws prohibiting drug trafficking and possession are unconstitutional and gave the federal government a year to rewrite them.
Pitfield said laws that prevent people suffering from the disease of addiction from accessing such a service infringe on their right to life, liberty and security of the person.
Within days of the decision, federal Health Minister Tony Clement announced his intention to appeal and made it clear Ottawa wants the facility shut down.
Documents filed with the B.C. Court of Appeal last month don't list the government's specific reasons for seeking to overturn the decision, but ask that the Supreme Court ruling be set aside.
In the meantime, Pongracic-Speier said the facility will remain open.
"Insite's operations will not be affected unless and until the decision of the B.C. Supreme Court is overturned by a higher court," she said.
The two groups who initially launched the court challenged filed their own appeal of the decision.
While Pitfield ruled that it would be unconstitutional to force Insite to close, he rejected the plaintiffs' arguments that the facility should be exclusively under provincial jurisdiction because it is a health-care facility.
The site, which sees an average of 600 users each day, allows addicts to bring their own drugs to inject under the supervision of medical staff.
The site has a long list of supporters, including the city's mayor and police chief, but opponents claim the site promotes drug use by facilitating addiction.
New Democrat MP Libby Davies, whose riding includes Insite, said the federal government's appeal is purely political.
"It's not based on any evidence or any public policy issue, so I think that it's a colossal waste of time," Davies said.
"Insite is part of the solution, it's not part of the problem. Why would the federal government spend all of this time and money to fight a battle they're going to lose
anyway?"
Thanks for joining me for the news; stay tuned for sports and weather.

Insite gets another year's reprieve

2008-05-28T08:05:00.000-07:00

Hey there, my 12 regular readers, and various random visitors. Insite has gotten another year of operation. For a miriad of reasons, I have no time to post or ponder the pros and cons of another short window to operate. However, L-Girl, author of the ever-insightful, always thought provoking "We Move to Canada" has posted an excerpt from... a newspaper. Seriously, I have no time. Anyways, here's the link:

L-Girl's recent Insite post

A Plea for Harper & Clement to Follow the Route of Good, Solid, Scientifically Supported Public Health Policy

2008-04-23T10:30:00.000-07:00

From today's National Post:

Harper urged to save safe injection site
Vancouver Addicts; Insite's operating permit expires on June 30

Meagan Fitzpatrick, Canwest News Service

OTTAWA - Supporters of Vancouver's supervised drug injection site were in Ottawa yesterday asking Stephen Harper to put politics aside and keep Insite open.

The facility is legally allowed to operate because the federal government granted it an exemption from narcotics laws. That exemption is due to expire on June 30, and the government has not indicated whether the facility will be allowed to continue operating.

"At this juncture, we believe [Mr.] Harper has a clear decision to make -- is he going to go the route of ideology or is he going to go the route of good, solid, scientifically supported public health policy?" said Liz Evans, who runs Insite in partnership with Vancouver Coastal Health. "We believe that is his decision that he has to make today, to take it out of the realm of politics and put it in the realm of public health, which is firmly where it belongs."

A recent report by a government-appointed expert advisory panel said the controversial site in Vancouver's Downtown Eastside doesn't affect crime rates, saves at least one life a year from overdose, provides nursing services to users, is generally supported by the public and has increased the use of treatment services.

Ms. Evans, joined at a news conference on Parliament Hill by members of the Canadian Association for Nurses in AIDS Care (CANAC), said enough research and studies have been done to prove that harm-reduction strategies, such as safe injection sites, are effective and worthwhile.

Insite has its critics, including the Canadian Police Association, but Ms. Evans said the facility has virtually everyone on side and just needs the approval, not even funding, from the federal government.

"Please listen to the nurses that are here today and do the right thing. We are begging the Prime Minister to make a decision that's right for the people of British Columbia, and for Canada," Ms. Evans said.

Health Minister Tony Clement, the minister responsible for Insite, was not available for an interview, but his office provided a statement saying, "We are carefully reviewing the research. No decision has been made."

Mr. Clement's office did not provide a response to CANAC's criticism that the government's anti-drug strategy, announced in 2007, failed to include support for harm reduction.
The anti-drug plan involves preventing illegal drug use, treating addicts and going after drug producers and dealers, but harm reduction is the missing link among those approaches, CANAC said.

"People who use drugs need to be given options and those options include harm reduction, and they also include treatment," said Greg Riehl, CANAC president. "If we don't have harm reduction, if we don't have Insite, those people will be dead. Dead people cannot enter into treatment."

Ottawa was put under pressure last month when the UN drug control board warned Canada is flouting treaties aimed at curbing illegal drugs. A report from the International Narcotics Control Board said Insite contravenes a 1961 treaty signed by Canada that says countries should pass laws ensuring drugs are used only for medical or scientific purposes.

The Ontario POV

2008-03-09T15:05:00.000-07:00

From the Globe and Mail: lots about crack pipes, not much about Insite. Disappointing from "Canada's [Ontario-centric] National Newspaper". Anyways, the Ministry of Health and Long-term care points out UN contridictions; stands by their harm reduction programs.

UN rebukes Canada over drug programs:
Injection sites and 'crack kits' defy treaty

UNNATI GANDHI
March 7, 2008

The United Nations drug control board has slammed three Canadian programs that provide safe crack pipes and injection sites to drug addicts.
The government-funded programs in Vancouver, Ottawa and Toronto are in contravention of a worldwide anti-drug convention that Canada signed in 1988, the
International Narcotics Control Board said in its annual report, released Wednesday. The INCB is the independent and quasi-judicial monitoring body that implements the UN's drug-control conventions.
"The Board calls upon the Government of Canada to end programmes, such as the supply of 'safer crack kits,' including the mouthpiece and screen components of pipes for smoking 'crack,' " the control board's report says.
"The distribution of drug paraphernalia, including crack pipes, to drug users in Ottawa and Toronto, as well as the presence of drug injection sites is also in violation of the international drug control treaties, to which Canada is a party."
Article 13 of the 1988 UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances reads, in part, that the parties should take measures "to prevent trade in and the diversion of materials and equipment for illicit production or manufacture of narcotic drugs and psychotropic substances."
But the Ontario Ministry of Health and Long-Term Care, which in December stepped in to help fund a safe inhalation program in Ottawa that the city's council ended,
says that article contradicts findings by the World Health Organization - the UN's governing authority for health - that support the use of safe injection sites.
The Ottawa program provides drug users with rubber-tipped glass tubes to smoke crack in an effort to reduce the spread of disease through pipe-sharing.
"It's interesting to note that one branch of the United Nations is supporting safe injection sites while the other branch is saying to get rid of them," said Laurel Ostfield, a spokeswoman for Health Minister George Smitherman.
She said the ministry stands by its programs.
[emphasis added]

Advocates speak out against UN report

2008-03-09T14:55:00.000-07:00

From the Vancouver Province [emphasis added]

Harm-reduction advocates outraged at UN call to shut Insite
By Christina Montgomery, The ProvincePublished: Saturday, March 08, 2008

Supporters of Canada's harm-reduction approach to drug addiction are livid that a United Nations monitoring body wants Ottawa to slam the door shut on Vancouver's safe-injection site -- and put an end to distribution of "safe" crack kits to addicts.

In an annual report by the International Narcotics Control Board released this week, the UN board said distribution of the kits in some areas of Canada contravened part of the UN's Convention against Illicit Traffic in Narcotic Drugs.

The board said the drug programs violate international drug-control treaties to which Canada is a party.

A UN report recommends Vancouver close down Insite and stop handing out clean crack pipes to addicts.

The disposable crack-pipe mouth pieces -- usually rubber-tipped glass tubes -- are given to addicts to avoid the spread of blood-borne diseases, including HIV and hepatitis, when addicts share pipes.

Vancouver's Downtown Eastside safe-injection site, known as Insite, allows addicts to inject their own heroin and cocaine under the supervision of a nurse, who provides them with clean needles.
Medical journals report that Insite, the only facility of its kind in North America, has reduced overdoses and blood-borne infections.

But five years into operation, the site's fate is uncertain. It operates under an exemption from Canada's Controlled Drugs and Substances Act, which runs out in June.

The Conservative government has not said whether it will extend the exemption.

But the UN report incensed supporters of Insite.

Sen. Larry Campbell, a former mayor of Vancouver and a former coroner, called the narcotics board "stooges for a failed U.S. war on drugs" and told reporters he would personally block Insite's doorway if officials tried to close it down.

Vancouver Mayor Sam Sullivan also dismissed the board's report by insisting it simply didn't understand Insite's success.

"The way we've approached drug addiction worldwide has been a failure," Sullivan told reporters. "We need new approaches. We need to be open to innovations."

Thomas Kerr, a research scientist at the B.C. Centre for Excellence in HIV-AIDS, voiced concern that Ottawa would seize on the report as an excuse to close Insite.

Richard Pearshouse, speaking for the Canadian HIV/AIDS Legal Network, told
reporters the report was "driven more by ideology and a war-on-drugs ideology than the research and the scientific evidence that supports these as a public-health intervention."

Different branches of the UN can't agree on Insite, Cdn Drug policy

2008-03-09T14:46:00.000-07:00

My question is: How is the UN approaching other countries with safe injection sites? Are they signatories to the same treaties? Is their compliance also being questioned?

From The Vancouver Province, [emphasis added]

UN drug czar wants Insite closed
Is B.C.'s safe-injection site legal or not?

Canwest News ServicePublished: Wednesday, March 05, 2008

UNITED NATIONS -- The head of the United Nations drug-control agency wants Insite, Vancouver's safe-injection site, closed.

The International Narcotics Control Board is calling on Canada to ban various community-backed programs that enable illicit drug use, including Insite. It also wants to stop "safer crack kits" being handed out.

"We want the government of Canada to be in compliance with [its] treaty obligations, but there is an internal problem, and we would urge the government of Canada to sort [it] out," agency head, Dr. Philip Emafo, said The UN body says Insite
contravenes a 1961 treaty Canada signed that says countries should pass laws ensuring drugs are used only for medical or scientific purposes.

Last year, Insite was granted a special exemption from federal drug-enforcement laws, to last until June 30.

Insite has appealed to the B.C. Supreme Court to rule it is a health facility that is therefore constitutionally under provincial jurisdiction.

Insite has argued that the UN narcotics-control board itself called for a legal opinion from the UN Office on Drugs and Crime, which found that harm-reduction programs do not violate treaties.

"It's clear from the legal brief that Insite is in compliance, and all it's doing is providing an intake bridge to recovery for users," said Insite spokesman Nathan Allen.

The Vancouver Island Health Authority focused its "Safer Crack Kits" program on Nanaimo last year, but suspended the pilot project after community opposition.

However, the province's Centre for Disease Control is looking at adding similar kits for distribution throughout B.C., along with other "harm-reduction" supplies such as condoms and syringes.

Health Minister Tony Clement could not be reached for comment.

Book reading about addictions & the Downtown Eastside.

2008-02-25T13:26:00.000-08:00

Click the book cover to go to Gabor Mate's website, click here to purchase the book

[Reading info from http://www.collected-works.com/pages/events.htm

Thursday, February 28 @ 7:30 p.m

Gabor Maté

talks about his new book on addiction at the Ottawa Public Library Main Branch Auditorium

(The Ottawa Public Library Auditorium is located on the lower level of 120 Metcalfe (at Laurier). Admission is free and there is no reserved seating).

In his new book, In the Realm of Hungry Ghosts, bestselling writer and physician Gabor Maté looks at the epidemic of addictions in our society, tells us why we are so prone to them and what is needed to liberate ourselves from their hold on our emotions and behaviours. For over seven years Gabor Maté has been the staff physician at the Portland Hotel, a residence and harm reduction facility in Vancouver’s Downtown Eastside. His patients are challenged by life-threatening drug addictions, mental illness, Hepatitis C or HIV and, in many cases, all four. Beginning with a dramatically close view of his drug addicted patients, Dr. Maté looks at his own history of compulsive behaviour and weaves the stories of real people who have struggled with addiction with the latest research on addiction and the brain. He proposes a compassionate approach to helping drug addicts and, for the many behaviour addicts among us, to addressing the void addiction is meant to fill.

Gabor Maté, M.D. is the author of the bestselling books "Scattered Minds" and "When the Body Says No"–published in ten languages on five continents–and co-author, with Gordon Neufeld, of "Hold On To Your Kids". Former medical columnist for the Globe and Mail, where his byline continues to be seen on issues of health and parenting, Dr. Maté has had a family practice, worked as a palliative care physician and, most recently, with the addicted men and women in the Downtown Eastside of Vancouver.

Terry*

2008-02-11T20:49:00.001-08:00

Here's a great post

The entertainment section

2008-01-29T15:18:00.000-08:00

Vancouver band Black Mountain could quit their day jobs... but I hope they don't. Very vocal about three members' work at Insite, they're getting word out in a different section of papers the world over: the entertainment section.

Check out the review band interview in the Times of London, the review on the U2 fan 'zine Interference, their homepage, and then check out their new disc, In the Future.

International Carnival of the Positivites 2.7 (Jan '08)

2008-01-29T14:53:00.001-08:00

The International Carnival of Positivites (ICP) most recent edition (2.7) is up over at The Spin Cycle. What is ICP you ask? It is a blog carnival (a.k.a roundup) of blog entries written recently with the theme of HIV. Written from all sorts of points of view: health care folks, positive men and women, councellors, researchers, you name it, someone has written on it.

Mark over at DropDeadHappy nominated "Burnout on the Frontlines" from this very blog for this latest one. Thanks Mark!

Interested in submitting to the next ICP? Follow the link to the official site. It lists the next issue on Feb 10 hosted at Not Perfect At All

How many pillars...

2008-01-26T14:36:00.000-08:00

Here's a good editorial from the Chilliwack Progress. It sucks ya in, thinkin' its gonna say one thing, and then goes for the other...

It does bring home the important point that harm reduction is only one of 4 pillars (along with prevention, treatment, law enforcement).

Harm reduction programs under threat nationwide

2008-01-14T10:28:00.000-08:00

[photo credit]
So the Ontario government has stepped in to save Ottawa's crack pipe program.

The City's mayor & City council had kiboshed the Ottawa Public Health program back in July, a program that created a necessary link for health care workers to a very hard-to reach segment of the community (facilitating entry in to drug treatment) and, oh yeah saves lives and health care dollars. Easy to see why that's gotta go .

Ontario's Ministry of Health & Long Term Care has granted funding to a community clinic to re-instate 2 outreach workers to run the program. Apparently, the mayor is disappointed.

Meanwhile, in related news, the Georgia Straight has a health feature looking at how not only Insite, but Vancouver's other harm reduction programs, including a crack pipe program are at risk thanks to the new federal government's ideology based, "addiction is a crime, not an illness" drug policy, a hard line approach that will recreate all of the US' mistakes.

The Straight article looks closely at that ideology and suggests that Harper & Clement's approach isn't at all answering WWJD.

Interview with Dr. Robert Kerr, BC Centre for Excellence in HIV/AIDS

2008-01-08T11:15:00.000-08:00

Rabble News has an interview with Dr. Robert Kerr, recent recipient of a Canadian Health research award.

There are some really interesting insights (pun not intended) on the interference of politics on evidence based policy making.

Good reading!

Excellent response by Liz Evans to the Kopala column

2007-12-20T09:52:00.000-08:00

Liz Evans' special column in response to M. Kopala's column in the preceeding post.
[all links added]

The dead can't kick drugs

Vancouver's safe injection site isn't the whole solution to the drug problem in the Downtown Eastside -- but it has done a great deal of good

Liz Evans, Citizen Special
Published: Thursday, December 20, 2007

I was saddened by Margret Kopala's recent column, "Revoke this licence to enable" (Dec. 8). Like Ms. Kopala, I remember my first experiences in the Downtown Eastside as shocking, and I too was naive about the problems there when I left the hospital as a nurse to work in the community. It's now been almost 17 years working in the very neighbourhood Ms. Kopala describes. Addiction is clearly dreadful and tragic, but those who offer simplistic solutions offer false hope. Clearly if it were as simple as Ms. Kopala believes, there would be no debate.
Meanwhile, people suffer and die living with addictions.
Ms. Kopala's one sensible point regarding a young girl facing the tragic consequences of addiction is that she could have been her sister. Indeed, those suffering with addiction across Canada, including those helped by InSite, Vancouver's supervised injection site, are someone's sister, or brother, or son, or daughter.
I have called the parents of addicts who had overdosed to tell them their child was dead. I met one mother, at the airport, who had flown across the country to visit her dying son. She arrived too late and fell to the floor screaming in grief when she heard the news.
I was a young, inexperienced nurse. What comfort could I really offer in this tragedy? She wanted her addict son alive, addicted or not. There are things we can do. Harm reduction is one. It can keep people alive, so one day, they can enter treatment.
Harm reduction strategies buy time because not everyone is ready to enter treatment. Clean needles and condom distribution prevent the spread of disease. These are basic health interventions that are accepted across the world, from the United Nations to the medical health officers of every single jurisdiction of this
country.
InSite is neither the problem nor the solution. It is one measure designed to prevent drug overdose deaths, which it has done; reduce public disorder, which it has done; reduce the spread of HIV, which it has done; provide a doorway into the health system and into treatment, which it has also done.
Twenty-five academic papers have now been published in the world's most renowned medical journals including The Lancet, the New England Journal of Medicine, the British Medical Journal, and the Canadian Medical Association Journal. To date there has not been one single independently peer-reviewed article disputing the scientific evidence, which Health Canada paid close to $2 million to compile.
The most recent piece of research indicates that there has been a 30-per-cent increase in the number of people entering detox and methadone therapy as a result of using the injection site -- which strengthens further the argument that harm reduction is a necessary part of the health-care continuum. Making this link from the chaos of the streets to the path of recovery even stronger, OnSite opened above InSite this September, offering 30 beds to addicts wanting to detox, and escape the cycle of addiction.
The public is aware that addiction is a complex issue that requires a comprehensive strategy - one that incorporates improved enforcement, comprehensive prevention programs, and flexible and accessible detox and treatment interventions. But it also needs to include harm reduction - so people don't die unnecessarily, and parents don't continue to lose their children.
Other jurisdictions now also involve harm reduction strategies as part of their overall plans to tackle addiction. Sweden, as was mentioned by Ms. Kopala in her column, has now established needle-exchange programs in order to stop the spread of disease and comply with UN expectations, while conforming to international efforts to limit the global AIDS pandemic. Britain, where a heroin prescription maintenance
program has been in place for many years, has now expanded its addiction treatment program to include stimulant maintenance for cocaine addicts.
In no place where harm reduction approaches have been used have advocates argued they be implemented exclusive of prevention, treatment and enforcement. In every jurisdiction where harm reduction is practised, it is done so in collaboration with local police, business and residents to ensure both the individual users and the broader community equally benefit.
Since InSite opened in 2003, there has been a dramatic decrease in the number of public injections and injection-related litter. As a resident of the neighbourhood, I have witnessed a stark contrast in the livability of the Downtown Eastside since InSite opened its doors. Over the past four years of operation, InSite nurses have now supervised more than one million injections, each of which would have otherwise occurred outside, in the public view, and with a much higher risk of drug overdose death, or spreading HIV and hepatits C.
While I welcome the significant improvement to my neighbourhood for both myself and my children, the primary reason I continue to support InSite is its ongoing life-saving work. More than 900 overdose interventions have happened at InSite - each someone's child who would not be with us today if InSite nurses had not been there to take immediate action.
Like Ms. Kopala, I hope politicians like Stephen Harper [write to him here] and Health Minister Tony Clement [write to him here] think about the children when they consider public health policy relating to drug addiction. I hope desperately that resources are finally put into prevention efforts to stop kids from using drugs in the first place. But I also hope to never again explain to a crying mother why her child died from a drug overdose that could have been prevented, in a civilized country like Canada.
Liz Evans is a nurse and the executive director of the PHS Community Services Society, which operates InSite, Vancouver's supervised injection site.
© The Ottawa Citizen 2007

"The memory of April Reoch deserves better" than this article

2007-12-20T05:39:00.000-08:00

Liz Evans' reaction to this article in the post above...

[Links in this article added by me]

08 Dec 2007
REVOKE THIS LICENCE TO ENABLE

by Margret Kopala, The Ottawa Citizen, Ottawa Citizen

The First Step to Cleaning Up Canada's Worst Neighbourhood Is to Scrap Its Abhorrent Safe Injection Site

Don't call Al Arsenault unless you are prepared to interrupt an awards ceremony. I recently tried but the retired constable was in Victoria receiving two meritorious service awards from British Columbia's lieutenant governor.

The first was awarded to Sgt. Toby Hinton, Sgt. Tim Shields (RCMP) and Arsenault for a short documentary about car theft. The second recognized Arsenault's work as a decoy in capturing thugs beating up the elderly and helpless in Vancouver's Downtown Eastside. Barely a month earlier, their company, Odd Squad Productions, had won the Excellence in Cinema for a Feature Film award at the New York Independent Film and Video Festival, this time for their most recent production, Tears For April: Beyond the Blue Lens.

For Al Arsenault, these awards are the culmination of 26 years being a beat cop in Canada's poorest, most drug-infested neighbourhood.

The 10 most recent years have been focused on making educational films about its squalid underside.

Like other Odd Squad productions, Tears for April is a matter-of-fact yet deeply affecting feature documentary about the lives of several addicts on Vancouver's Skid Row, with April Reoch as its tragic heroine writ large.

The young, part-native addict is already a mother and into drugs when she arrives on the skids at the age of 17. Despite efforts at recovery, she remains there in a downward spiral of prostitution and drug addiction for the rest of her brief life.

Beyond the foul language, weeping sores, broken teeth and needle marked body, the film reveals the addict's few shreds of dignity. April could have been your sister or mine.

The documentary was snubbed by the Vancouver Film Festival because, according to Arsenault, "They prefer ideology over art." New York picked it up but then, unlike Vancouver where decriminalization and harm reduction are the prevailing orthodoxies, New York gets it. According to the National Survey on Drug Use and Health published in September, illicit drug use in the United States among 12- to 17-year- olds has declined.

Notably, use of the initiator drug marijuana by adolescent boys is down by 25 per cent. This is good news for the United States because, as the director of the Office of National Drug Control Policy, John P. Walters reminds us, "We know that if people don't start using drugs during their teen years, they are very unlikely to go on to develop drug problems later in life." America is getting the message and so too is Britain where new laws allowing police to seize drugs and issue warnings have expedited case disposal and, according to BBC News, brought drug use to its "lowest in a decade." Then there's Sweden whose successes toward the goal of a drug-free society have been achieved in part by controversial policies such as compulsory treatment.

In Canada where marijuana use among youth is highest in the industrial world and consumption of other drugs isn't far behind, the Harper government's recently announced National Anti Drug Strategy is a promising start toward getting Canada back on the road to prevention, treatment and enforcement.

If the anti-drug budget is augmented by clearly articulated goals and a strategy for achieving them, results could soon appear.

As these unfold, mandatory minimum sentences and drug courts will affirm that possession and dealing are against the law, something even judges like Justice John Gomery seem to have forgotten.

Canada's National Anti-Drug Strategy makes no concessions to harm reduction or decriminalization measures.

Nonetheless, its biggest problem will be the decriminalizers and harm reduction crowd who have bogged the country down in controversial practices involving needle exchanges, crack pipes and safe injections even though consultation with an experienced organization like Alcoholics Anonymous would have quickly revealed that such practices merely enable the addict.

The epicentre of this approach to drug addiction is Vancouver. Here, opposition to harm reduction practices and safe injection facilities like the Downtown Eastside's Insite is routinely squashed, ignored or lambasted, though an observation that Insite seemed tantamount to "state assisted suicide" did manage to make it into the local press - -- not least because it was made by American broadcaster Dan Rather who was in town scouting out a TV special on the Vancouver Olympics.

The drug-addled stink that will rise from this issue during the 2010 Winter Olympics should alone give pause to reconsider Insite though, to thoroughly mix the metaphor, fur has already flown over its future. Contrary to the findings of
University of British Columbia studies extolling Insite's benefits, a paper published earlier this year by the Journal of Global Drug Policy and Practice challenges the harm reduction approach to drug addiction on both theoretical and practical grounds. "A Critique of Canada's INSITE Injection Site and its Parent Philosophy" by Colin Mangham argues the facility has achieved few or no reductions in the transmission of blood-borne diseases, no impact on overdose deaths, and that the facility is used only sporadically. Any reduction in public disorder, says the 20-year veteran in the drug prevention field, resulted from the injection of 60 police officers into the area when the facility opened, not safe injections at Insite.

Moreover, while the harm reduction lobby takes us on wild goose chases, the really important stuff -- the need to reduce drug use through prevention, help addicts through treatment, and reduce drug availability through law enforcement -- is marginalized even though in the cases of tobacco and alcohol, such approaches have had considerable impact.

Mangham's analysis of the harm reduction phenomenon is particularly important. As manifest in the agencies, bureaucracies and the many politicians that surround all levels of government today, he says it is "a ( libertarian ) ideology viewing drug use not only as inevitable, but as simply a lifestyle option, a pleasure to be pursued, even human right ... ( it believes ) others should only be there to help reduce the consequences of your choice until if or when you choose to choose differently." Or, as Al Arsenault recently told the Province, "... a person can have one foot in the ditch and another in the grave and they go, 'Oh, I don't want to be judgmental, here's your box of needles.'" Yet few seem to have considered that others might have something to say about an ideology that relieves the user of any personal responsibility, destroys families and communities, costs taxpayers money, and is now spilling into other formerly taboo "lifestyle" choices.

Think prostitution, for instance, where the term "sex-trade worker" is a step toward its normalization and ultimate legalization. Similarly, harm reduction is also a first step toward full legalization of drugs.

Even so, Mangham was pilloried in the west coast press though for anyone concerned about this issue, his paper is required reading.

Presumably exhausted by this battle of the experts versus front line workers like Mangham and Arsenault, few now are challenging Simon Fraser's Garth Davies whose paper "A Critical Evaluation of the Effects of Safe Injection Facilities" gathers data about safe injection sites from around the world and concludes "none of the ( positive ) impacts attributed ... can be unambiguously verified." And, certainly, no safe injection facility could have saved April Reoch, whose violent, banal and senseless death arrived not at the end of a needle, nor even at the hand of a john but as a bit of refuse on the garbage heap of humanity's lifestyle choices.

Literally.

Whether it is an academy award for Tears for April or the 2010 Olympics, the world will soon have a wide open window on Vancouver. What will it see? The festering eyesore of degraded humanity ripe for exploitation by the latest serial killer called the Downtown Eastside? Or a city where pushers and users are in treatment or in jail and whose youth are hip to the dangers of drugs?

Insite's licence to enable has been on life support since Canada's minister of health extended it last year but as a first step to cleaning up Al Arsenault's old beat, it's time to pull the plug. It's about the 14- year-olds, Minister Clement. The memory of April Reoch deserves better.

Harm Reduction, a refresher

2007-12-20T05:23:00.000-08:00

Here's a great summary list of the main points of harm reduction from a drug policy perspective (as opposed to incorporating other harm reduction measures like drunk driving prevention programs). Prime Minister Harper obviously hasn't read it, but he should ...

from the site : Drug Policy Alliance

Reducing Harm: Treatment and Beyond
Harm reduction is a public health philosophy that seeks to lessen the dangers that drug abuse and our drug policies cause to society. A harm reduction strategy is a comprehensive approach to drug abuse and drug policy. Harm reduction's complexity lends to its misperception as a drug legalization tool.

Harm reduction rests on several basic assumptions. A basic tenet of harm reduction is that there has never been, is not now, and never will be a drug-free society.
A harm reduction strategy seeks pragmatic solutions to the harms that drugs and drug policies cause. It has been said that harm reduction is not what's nice, it's what works.
A harm reduction approach acknowledges that there is no ultimate solution to the problem of drugs in a free society, and that many different interventions may work. Those interventions should be based on science, compassion, health and human rights.
A harm reduction strategy demands new outcome measurements. Whereas the success of current drug policies is primarily measured by the change in use rates, the success of a harm reduction strategy is measured by the change in rates of death, disease, crime and suffering.
Because incarceration does little to reduce the harms that ever-present drugs cause to our society, a harm reduction approach favors treatment of drug addiction by health care professionals over incarceration in the penal system.
Because some drugs, such as marijuana, have proven medicinal uses, a harm reduction strategy not only seeks to reduce the harm that drugs cause, but also to maximize their
potential benefits.
A harm reduction strategy recognizes that some drugs, such as marijuana, are less harmful than others, such as cocaine and alcohol. Harm reduction mandates that the emphasis on intervention should be based on the relative harmfulness of the drug to society.
A harm reduction approach advocates lessening the harms of drugs through education, prevention, and treatment.
Harm reduction seeks to reduce the harms of drug policies dependent on an over-emphasis on interdiction, such as arrest, incarceration, establishment of a felony record, lack of treatment, lack of adequate information about drugs, the expansion of military source control intervention efforts in other countries, and intrusion on personal freedoms.
Harm reduction also seeks to reduce the harms caused by an over-emphasis on prohibition, such as increased purity, black market adulterants, black market sale to minors, and black market crime.
A harm reduction strategy seeks to protect youth from the dangers of drugs by offering factual, science-based drug education and eliminating youth's black market exposure to drugs.
Finally, harm reduction seeks to restore basic human dignity to dealing with the disease
of addiction.

Burnout on the frontlines

2007-12-16T13:43:00.000-08:00

VANDU is the organization that operated InSite initially before there was a federal loophole.

Fighter for Addicts Ready to Quit
Ann Livingston of VANDU is wearied by death.
By Sarah Ripplinger
Published: December 13, 2007
TheTyee.ca

After spending the past 13 years trying to save Vancouver's poor from the filthy alleys of the Downtown Eastside, Ann Livingston doesn't have a pension plan or any significant savings, but she has decided to quit her job.

Livingston, a star of the widely shown documentary Fix, has spent the last nine years co-ordinating the Vancouver Area Network of Drug Users (VANDU), a non-profit operated by addicts. She's done a lot to help drug users get their voices heard. But she says she is tired of Vancouver's hypocrisy. While the host of the 2010 Olympics is termed the world's "most liveable city" by The Economist magazine, its poorest neighbourhood grapples with an epidemic of HIV/AIDS comparable to Botswana's.
After devoting more than a decade of her life helping people in the Downtown Eastside, Livingston says she hasn't noticed improvements in living conditions or a decrease in the demand for aid. In fact, she says, things just seem to be getting worse.
"Yeah, people did change, but then they died," Livingston remembers thinking to herself last spring. "I started to realize, I do leadership development with people who are very likely to die and there's more dead people now that I've worked with than live people."
She recalls a "critical incident" after watching a former VANDU board member try to kick in the office windows while yelling offences at her.
She found herself breaking down at red lights, rationalizing that, because of
her busy schedule, "now would be a good time to cry."
That was when she decided she had to solve her own problems before taking on everyone else's. She began imagining a new life "because I want to do something more powerful than being the crabby bitch at VANDU who yells at users." She thinks she flies off the handle so much because, for too long, she's put off grieving.
Day starts before dawn Livingston's thick grey hair sits smoothly across her shoulders. She frequently looks into the distance when she speaks. In jeans and a cotton T-shirt, she's outspoken, but her mannerisms are almost shy. She keeps a respectful distance between herself and others.
Most days, she is up checking e-mails by four in the morning. "It's mainly because I have trouble sleeping at night." She works at the computer while balancing on a blue exercise ball to ward off back pain. Then she gets her four-year-old son ready and off to daycare in time to make it to VANDU for a long day of work.
As a single mother on welfare, Livingston moved to the Downtown Eastside with her three boys (four now) in 1993, and was moved to act by the sight of people shooting up and dying on the streets. She enrolled in a four-day course on community organizing. The workshop was run by a group from Nicaragua that shared its experience of starting a literacy campaign and a campaign to collect bottles for making tomato preserves.
She co-founded VANDU in 1998, Pivot Legal Society in 2000, and was a founding member of the Eastside Movement for Business & Economic Renewal Society board in 2001. Livingston also ran for city council three times "to bring the issues of homelessness, ill and criminalized citizens to city hall."
She attends city and police meetings and sits on countless harm reduction, prostitution awareness, economic and community development boards connected with people in the Downtown Eastside.
She does it, she says, because "You never know who you're helping. It could be Christ himself." Livingston, who converted from the Unitarian to Roman Catholic Church, cannot understand how anyone could see people starving, homeless and in need, and do nothing.
Harm reduction baby steps
Livingston believes community involvement is the cure for problems of addiction, homelessness and crime in her neighbourhood. It's an absence of community that has lead to government programs that do little to address the problems of addiction and homelessness in the Downtown Eastside. Programs like the supervised injection site research project, Insite -- that provides clean needles and medical and counselling services to users, overseeing about 600 injections every day -- are really just the tip of the iceberg, she says.
There are approximately 12,000 injection drug users in Vancouver, one third of whom live in the Downtown Eastside.
Despite Vancouver's reputation as a trend setter in harm-reduction policies, Livingston says the city needs more supervised injection sites, safe inhalation sites for crack smokers, and educational programs for users on how to use drugs safely and get clean. Before Insite opened its doors, she used her own money to start her own needle exchange program, doling out thousands of needles to users on the street.
Sitting in her two-bedroom apartment filled with hand-me-down children's toys, VHS boxes and pasted-up slogans -- "Hating someone is like burning down your own house to get rid of rats" -- Livingston tells me she's planning to post her job at VANDU as a job share. Someone will get half her salary to work alongside her for a
while and eventually take over her position.
"I want to job share it first and then just ease out," she said, "because I think job sharing is the most kind thing you could do to another person. And the thing is to find another person who, in a sense, can see the redemptive quality to suffering, because there's a lot of challenges to working at VANDU."
'What do you get out of this?'
But how many people are there who want to work with drug users every day for all the right reasons?
As the only non-drug-user on the VANDU board of directors, Ann says she often feels like an outsider. "People ask: 'What do you get out of this?'"
Livingston says she is tiring of the off-based criticism, and even threats, she attracts. A recent column in The Province newspaper described her as someone who might give needle injection demos to children. She is also an outsider to other organizations that receive government funding. Unlike VANDU, these organizations are restricted from the amount of government lobbying they can do, even to the point of having their hands tied. Whereas, VANDU can lobby all it wants, but on a very tight budget.
Livingston, who is 52, is still energized by opportunities to speak to people around the world about harm reduction and affordable housing. She's still working on setting up provincial, national and international drug user groups. And she says she doesn't have any definitive plans, only a feeling that there must be another way to make a
difference. The moment has arrived, she says, to take a look at "the sort of wasteland of my life."
It's time for Livingston to rescue herself, too.

A breather

2007-12-12T15:26:00.000-08:00

So a brief digression to kick start some creativity instead of continuing to merely regurgitate the news... Here's a walk through my neighbourhood between 4 and 5.30 pm.

Torn over at Sticky Crows has started in on 12 of 12, a photo project by Chad Darnell. The theme this month is "believe". In order to loosely link the whole thing to this blog, here's something I believe in (well, accept the scientific evidence for, but who's gonna quibble semantics):
harm reduction saves lives.
Lives like that of the person pictured here on this banner. Daily. So do lots of other people.

Pictured here: MPs Bill Siksay (Burnaby Douglas) and Libby Davies (Vancouver East) with Nathan Allen of Insite for Community Safety at a rally on Parliament Hill around Nov 12 (in keeping with the theme... this is my bonus pic anyways. Also a comparitor for the amount of snow a month later).

Right, on to the 12 of 12:

Well, it is December, and it always amazes me (in fact, I find it hard to believe) how great the Christmas cactus looks this time of year.

Well, a theme of "believe" lends itself to naturally to considering faith. We have 5 churches in a 3 block radius of our apartment. That's a whole lotta bells.

This is the Canadian Tribute to Human Rights (a.k.a. the human rights monument) by Melvin Charney (1989). Many rallies, protests, protest marches (i.e. public statements of belief) start here at the end of our block. That's city hall in the background (which, if you can believe, also has a belltower that chimes ALOT).

Right, here's something that a prairie girl like me has a hard time believing: look at all that snow! And it's only December!

The main branch of the Ottawa Public Library. Some believe it should be rebuilt, and I'd agree. There's not enough room, plain and simple. However, I hope they keep the cool fanning pages icon.

The famous five who got Canadian law to recognise women as persons. This led to sufferage.

I find it hard to believe however, that Henrietta Muir Edwards drank foamy lattes...

What may be the nicest library around.

It's got a pretty nice view too. That's Ile Victoria Island in the middle of the river.

Holiday lights at the Hill

Looking down Sparks Street through Confederation Square.

My favourite statue in Ottawa outside of the British Embassy. I believe in whimsy. Nature Girls, Laura Ford (1996). Check out these pics to see the best part: their cute lil shoes.

I'm cheating on my first time out... My personal bonus: a message from Leah. I can't believe I'm so lucky...

The power of a hand written letter

2007-12-06T08:37:00.000-08:00

Did you know that no postage is necessary to send mail to your Member of Parliament? Did you know that

Because so few people take the time to write a letter on an issue that concerns them, politicians count each letter as representative of the views of far more citizens. A letter to a federal politician is seen as representing thousands" (Elizabeth May, MP, How to Save the World in Your Spare Time, p.90-91)?

Here's an article (below) from The Toronto Star back in Sept. that illustrates the power of letter writing. Bear in mind that since this article was written, InSite has recieved another extension to the required exemption under Section 56 of the Controlled Drugs and Substances Act. This exemption will expire in June, 2008.

Plenty of time for you to write some letters and get others to as well.

Haven from life in hell

Supervised injection site in Vancouver that has saved dozens of addicts is fighting for its life, too
Sep 15, 2007 04:30 AM
Petti Fong Western Canada Bureau Chief
Vancouver–Earl Crow is alive and surrounded by friends in the Downtown Eastside who've also managed to beat the odds.
Simply being able to survive the alleyways and streets around Main and Hastings is a major accomplishment for Crow.
"I should have been dead long ago and so many people, they're feeling the same thing," says Crow, 46, who has been on and off drugs for almost half of his life.
"This place has connected with people in this community."
What has saved Crow, and others like him, is a supervised injection facility known as Insite, where addicts can receive care from nurses and health professionals.
The injection site, the first and only one of its kind in North America, opened four years ago this month under much fanfare and support from all levels of government.
But while Vancouver and the provincial government still back the project, there are
rising concerns that Ottawa may pull its support.
The previous Liberal government granted an exemption under Section 56 of the Controlled Drugs and Substances Act that allows users to shoot up inside the facility without fear of being arrested.
When the exemption was about to expire last September, federal Health Minister Tony Clement granted a last-minute reprieve. But instead of approving the request for another three-and-a-half years, he gave an extension until only Dec. 31, 2007.
Until a decision is made, additional research is being conducted on the effectiveness of the site, and all available research will be taken into consideration when making a decision as to whether the exemption will be renewed, a spokesperson for Clement said.
Dr. Thomas Kerr, a scientist at the B.C. Centre for Excellence in HIV/AIDS, said there have been more than 25 peer-reviewed research papers published in some of the best medical journals in the world, including The Lancet and New England Journal of Medicine.
"It has shown that there has not been a harmful effect and yet we still have a government that is ideologically opposed," says Kerr.
"Minister Clement can honour the weight of the scientific evidence and recognize that there's been a number of public health and public order benefits, or he can make a decision based on ideology."
In August, a community group in Vancouver launched a volunteer-driven organization to gather signatures and letters from supporters and have been faxing the minister's office in Ottawa daily.
Nathan Allen, a co-ordinator for Insite for Community Safety, says the 4,000 letters will be boxed up and sent to the health minister next month in the hope that the stories will be enough to convince Ottawa to keep the site going.
In one handwritten letter, a user recounted the names of all the people she believes would have been saved had the facility opened earlier.
In another letter addressed to the Prime Minister, someone wrote to say the site has kept the streets cleaner and reduced the number of dropped syringes in the alleyways.
In addition to public pressure, lawsuits have been launched to force the government to keep the site open. The Vancouver Area Network of Drug Users filed an action in B.C. Supreme Court this summer against the federal government seeking a court-ordered exemption to enable Insite to stay open beyond the Dec. 31 extension date.
In another suit, two addicts, Dean Wilson, 51, and Shelley Tomic, 39, who are regular heroin users, claim that if the government doesn't provide the exemption, it will deprive them of their constitutional rights and their pursuit of "life, liberty and security."
Lawyer Monique Pongracic-Speier, who is representing the two claimants, said the suit claims that Wilson and Tomic's constitutional rights will be violated if the federal government shuts down the site. At some point, the lawsuits will probably merge, Pongracic-Speier said.
The government has responded to the lawsuits saying they are without merit.
If the lawsuits and the public pressure fail, a third option has emerged in recent weeks – cutting the federal government out of the facility and running it without support from Ottawa. The federal government funds research for the injection site, but it does not provide direct funding, which comes from the city and province.
Liberal Senator Larry Campbell, the former Vancouver mayor who opened the site in 2003, says he doesn't believe permission is needed from the government.
"I will keep it going and there are lots of people who won't let them shut this health-care facility down," he says.
"This is one of the few peaceful places in the Downtown Eastside and people's lives are being saved in that place. So there's no doubt in my mind that we will keep it open whatever way we can."

Vancouver Mayor to use Olympics lobby for a commitment to InSite

2007-12-05T05:13:00.000-08:00

From canadaeast.com:

Vancouver mayor wants Ottawa to beef up Olympic security budget

Camille Bains, THE CANADIAN PRESS
Published Saturday December 1st, 2007

VANCOUVER - Vancouver Mayor Sam Sullivan is heading to Ottawa to ask for a beefed-up security budget for the 2010 Olympics that would include money for areas outside more high-profile zones.
Sullivan said Saturday that areas called the "Olympic domain", which will include the athletes' village and some sites for medal ceremonies, will be secured by the RCMP, but surrounding areas to be policed by municipal forces also need major protection.
"We do want to stress that security concerns for the Olympics go beyond the Olympic domain,"said Sullivan, who will leave for Ottawa on Sunday to meet with several MPs, including federal Finance Minister Jim Flaherty.
"I'd like to make the case that the municipal police forces should not be unduly taxed to handle what seems to me is clearly Olympic-related security," Sullivan said.
He said he doesn't have a figure in mind when it comes to how much money is needed for more security at the Games.
The RCMP said in an internal report leaked to the media in July that the $175-million security budget the Mounties have for the Olympics is not enough.
Sullivan said his trip to Ottawa will also include applying for $10 million in funding to construct two downtown Vancouver plazas where the public could participate in cultural events and watch various Olympic events on a big screen. He said he was in Torino for that city's 2006 Games, which included such a venue.
"You'd hear the whole crowd gasp (with) oohs and ahs as they would watch the skiing. It was a really great way for the whole community to participate in what was happening."
Sullivan said his trip to Ottawa will also include discussions with Health Minister Tony Clement about the federal anti-drug strategy and innovative treatment options for Vancouver.
He said he will speak to Clement about the need to keep North America's only safe-injection site open for drug addicts.
The facility, called Insite, began operating in 2003 and is funded by the B.C. government.
It allows people to inject their own drugs under medical supervision as a way to reduce harm connected to drug use.
But the federal government hasn't committed to keeping it open permanently, saying more research is needed into how such sites affect prevention, treatment and crime.
Last month, Ottawa gave Insite another six-month reprieve, meaning it can keep its doors open until next June under an exemption from Canada's drug laws.
"We're hoping to get a significant commitment to Vancouver's drug-addiction problems," Sullivan said. [emphasis added]
Sullivan is also to pay a visit to Toronto, where a spokesman for the mayor says he will speak to the Hong Kong-Canada Business Association on using the Olympics as a catalyst for social and economic change.

Huh. "Harm reduction saves lives" Good line. Where'd they get that idea??

2007-12-05T05:05:00.000-08:00

You'd think the Liberals could do a bit better than this... A case of too little too late given their lack of action when actually in power. Hopefully, it is just the beginning of their action on this issue.

From the "24 Hours" free paper, Dec 2nd

Liberals' InSite mail-out panned
By BILL TIELEMAN, 24 HOURS

A federal Liberal Party mailing from leader Stephane Dion into a Vancouver riding about the controversial InSite safe drug injection site is under attack as "fear mongering" by the Conservatives, while the New Democratic Party calls it a "waste."
And the mailing, which misspells the word "minister" in referring to Prime Minister Stephen Harper, is a "rush job" and "confusing," say the two parties.
The November mailing to thousands of households in NDP Member of Parliament Libby Davies' Vancouver East riding accuses the Conservative federal government of "dithering" on renewing InSite's mandate and says "harm reduction saves lives."
But Davies says the Liberals' mailing is ironic.
"I wish they'd done a lot more on harm reduction when they were in government but they don't talk about that," Davies said in an interview, calling it a "waste."
Conservative Party spokesperson Ryan Sparrow said the Liberal mailing strategy is "confusing" and rejected its points.
"We've long been the party that delivers initiatives rather than fear mongering," he said from Ottawa.
But Liberal Party Communications Director Elizabeth Whiting told 24 hours from Ottawa that InSite is a "major issue" worthy of mailing on. Whiting said MPs can mail up to 10 per cent of a non- incumbent riding with their message, paid out of their House of Commons budget, not the party's.
InSite recently got a six-month extension to continue operating until June 2008.

Nov 26 Rally

2007-11-27T16:23:00.001-08:00

Yesterday's leaflet:
.
On the front (in both French and English) :
.
"$ 2 million tax dollars already spent evaluating Vancouver's Supervised Injection Site. Why spend more public money trying to prove the Earth is flat? Keep Insite saving lives."
.
On the back (in both French and English):

"Canadian taxpayers have paid more than $2 Million for an extensive scientific evaluation of Vancouver's Supervised Injection Site.
.
25 research papers published in medical journals have concluded that Insite:
*prevents drug overdose deaths
*reduces the spread of HIV/AIDS and Hepatitis C
*increases access to detox and addiction treatment
.
More than 1, 000, 000 injections have taken place under the supervision of Insite nurses-- that's 1, 000, 000 injections that did not take place in streets or alleys.Why spend more trying to prove the Earth is flat?
.
Tell Stephen Harper to do the right thing--stop wasting tax dollars on more academic studies and base decisions on accepted scientific fact, not ideology.The evidence is in. The world is round and Insite saves lives.www.communityinsite.ca"

The eye-catcher was a big (like 8 feet in diametre) flat earth complete with dinosaurs, dragons and mermaidens. This was made by a local artist who donated his time. The volcano had dry ice that smoldered all afternoon. We also set up the easels and posters that we had to forgo from the other day (due to snow). Still a bit windy, but attention getters just the same.

.

One of our main problems on the day was the proximity of us to daily-protester, "Anti-everything guy" (abortion, same-sex marriage, anything he deems ungodly) with a flat earth was a pretty quick leap for most people who assumed we were together.

MP of the day was Paul Dewar (NDP, Ottawa Centre). Unfortunately, I didn't get a picture, and he didn't get a chance to talk to Nathan from InSite for Community Safety as Nathan was being monopolized (strategically?) by some anti-harm reduction guys.

.

Despite the lack of people (5-6 at any given time), we still drew attention and were able to talk to alot of people. My strategy (to create a buffer between us and anti-everything guy) was to let people get their bearings and then as they headed down the walk let them take in the leaflet and posters then tell them why we were there and did they have any questions.
.
Most disheartening response of the day (and this from a government employee):
Her: We shouldn't have people like that in our society.
Me: What do you propose we do?
Her: I don't care.
Me: Well, that's a pretty unsophisticated response.
Her: (indignant, so she cared that I called her response unsophisticated...): We shouldn't have people like that in our society...
At this point her companion broke in and pointed out that one of our French words was spelt in correctly and we were at the stairs.

.

My most heartening responses of the day (and these out numbered the negative for me, although one volunteer gave up in frustration):
.
"You're preaching to the converted!" and "We're from SanFrancisco, I hope we open one there!"

I hope you do too.

Evidence shows the Earth's not flat! Evidence shows harm reduction works!

2007-11-23T08:42:00.000-08:00

Rally on the Hill to Support InSite, Vancouver's safe injection site

Insite for Community Safety (http://www.communityinsite.ca/)

Monday, November 26, 2007
12:00am - 4:00pm
Parliament Hill, eternal flame fountain
Wellington Street, Ottawa, ON

Rally and information distribution, physical presence on the Hill to show MPs that Canadians support InSite and harm reduction initiatives.

Imagine:

A large sculpture of a flat earth on the main walk of Parliament Hill.

*Let MPs know that evidence shows the Earth's not flat.

**25 peer reviewed journal articles and 2million dollars invested in research show that InSite's harm reduction initiatives work.

Your job: Hand out 2 million dollar bills with Stephen Harper's face on 'em (the amount of research dollars that have been invested in InSite to date) & invite others. That's it.

When: Monday November 26, 2007 8.00 am onwards
**trying to have a mass of people before question period beginning at 2.15 pm**

Nathan Allen, resident of the Downtown Eastside of Vancouver, and the Campaign Coordinator of 'InSite for Community Safety' (www.communityinsite.ca) is in Ottawa this week to raise awareness for Insite, Vancouver's safe injection site. InSite for Community Safety is a broad-based community coalition of individuals and groups from across the political spectrum, working to ensure InSite continues to save lives.

Rally Pics from Nov 19th

2007-11-23T08:26:00.001-08:00

InSite for Community Safety campaign co-ordinator, Nathan Allen is in town this week and has been organizing rallies on Parliament Hill. The first one was held in the morning of Tues, Nov 19th.

About 30 volunteers showed up over the course of the morning and assembled giant photos of current users of the InSite facility at various stages over their lives. Volunteers handed out leaflets of the same photos to MPs and civil servants as they headed to centre block for caucus meetings. Beneath the photos on the leaflets were the taglines: "Insite Saves Them. Insite Saves Lives" and "Before they were 'junkies, they were kids"

Also in attendance were Burnaby Douglas MP Bill Siksay and Vancouver East MP Libby Davies (pictured left with Nathan Allen).

Big Events this week

2007-11-20T18:40:00.000-08:00

Action on Parliament Hill for

InSite, Vancouver's Safe Injection Site
Come and tell the MP's that InSite saves lives.

That addicts don't live "short, miserable lives" (Stephen Harper, Oct 2007)

Where: Parliament Hill

What: Vigil and information distribution, physical presence on the Hill to show MPs that Canadians support InSite and harm reduction initiatives.

Imagine: 20 big banners of faces, faces of InSite clients in various stages of their lives.

Your job: Hand out pamphlets &/or invite others. That's it.

When: Wednesday November 21, 2007 8.00 am onwards **trying to have a mass of people between 8:30am and 10:00am**

Nathan Allen, resident of the Downtown Eastside of Vancouver, and the Campaign Coordinator of 'InSite for Community Safety' (www.communityinsite.ca) is in Ottawa this week to raise awareness for Insite, Vancouver's safe injection site. InSite for Community Safety is a broad-based community coalition of individuals and groups from across the political spectrum, working to ensure InSite continues to save lives.

ALSO:

The Alliance to End Homelessness
2007 Community Forum on Homelessness

LINKING NATIONAL RESEARCH WITH OTTAWA ACTION AND POLICY
IN HONOUR OF NATIONAL HOUSING DAY, THURSDAY, NOVEMBER 22, 2007
Location: University of Ottawa, Tabaret Hall Chapel, 75 Laurier, 1st Floor
Time: 9:00 am–3:30 pm ~ Registration Free ~ Lunch Provided

FEATURING OUR SPECIAL GUESTS
The Research Alliance for Canadian Homelessness, Housing, and Health (REACH 3), a collaborative interdisciplinary network of academic investigators and community partners in Ottawa, Vancouver, Calgary, Toronto, and Montreal.

PRELIMINARY PROGRAM
MORNING PLENARY RESEARCH PANELS
Housing Solutions
MODERATED BY AN OTTAWA REACH3 MEMBER

PANEL MEMBERS

Liz Evans, BScN, Portland Hotel Society, Vancouver
– on innovative housing programs that have been created in Vancouver.

Stephen Hwang, MD, MPH, St.-Michaels Hospital, Toronto
– on policy and program implications of some of their research

Lorraine Bentley, MA, Executive Director, Options Bytown, Ottawa
– reacting with implications for the housing situation in Ottawa.

Resident, Options Bytown, Ottawa
– providing a personal perspective on their housing difficulties in Ottawa

Youth Can Move Forward

MODERATED BY AN OTTAWA REACH3 MEMBER

PANEL MEMBERS
Elise Roy, MD, MSc, Université de Sherbrooke
– Montreal Street Youth

Bruce MacLaurin, MSW, PhD (Cand.), University of Calgary
– Calgary Street Youth

Catherine Worthington, MSc, PhD, University of Calgary
– Calgary Street Youth

Andrea Poncia, Youth Services Bureau of Ottawa
– HIV/AIDS Educator

An Ottawa youth community member
– commenting on the findings and their own experience

INFORMAL LUNCH & NETWORKING CAUCUSES — A 1½ hour opportunity to share ideas from Ottawa and ask more questions of REACH3 members.

Select your lunch then join one of the LUNCH CAUCUSES, focusing on a variety of topics, facilitated by Ottawa’s Alliance to End Homelessness members.

AFTERNOON PLENARY SESSION
The good, bad and ugly – the InSite Experience
The "how" behind linking community agencies and researchers

LED BY SARAH EVANS, LIZ EVANS AND ANITA HUBLEY

A session describing how the community and the academic's worked together on InSite, Vancouver’s legal supervised injection site.

Hear about the good, bad and ugly parts of the experience when the private, public and not-for-profit sectors, come together locally, nationally and internationally.

CLOSING ACTIVITY
WALK FOR HOUSING
Taking the need for a National Housing Program out to the community!

ALL DAY – SPECIAL EXHIBIT
A Sound & Photo Installation
Street Health Stories
How do you take care of your health when you don’t have a home?
8 Street Health Stories in large lightbox prints with headphones
The National Film Board of Canada’s Filmmaker-in-Residence presents the Street Health Stories installation which gives a human face and voice to Street Health’s statistics.
Four photographers who have experienced homelessness ~ Adrienne, Jess, Keneisha, and Meghan document the stories of 28 homeless men and women through audio recordings and portrait-photography. Katerina Cizek, a documentary-maker and the National Film Board of Canada’s Filmmaker-in-Residence at an inner-city hospital, teaming up with partners at the frontlines – doctors, nurses and patients – to create collaborative media.

CNN article that is skinny on the sensationalism...

2007-11-02T11:03:00.000-07:00

...apart from the "watch people shoot up" link that I've left in tact (the tag is sensational, not the link itself which I encourage you to watch).

Big kudos to Lorraine Trepanier for appearing in this news peice.

I've also emphasized an import bit of demographic info that is often missed in news reports about Insite--that not all of the people using the facility are homeless and far from the Prime Minister Harper's assertion that they are living "short, miserable lives". Even this report blurs the mixed demographics by opening with the stereotyped description of tattered clothes, missing teeth, etc. and then burying the observation of older and wealthier people using the facility waaaay down in the story.

Health clinic helps addicts shoot up

By Adam ReissCNN

VANCOUVER, British Columbia (CNN) -- I didn't know quite what to expect when I entered the injection room at Insite, the world's busiest supervised drug clinic.

Similar clinics can be found at 65 locations in eight different countries.

Inside the Vancouver facility, I found more than a dozen people taking illegal drugs, such as heroin and cocaine, under the watchful eye of trained nurses. These drug users were among the more than 700 people who visit the facility every day, bringing their drugs with them.
Insite's goal is to reduce the risk of overdose and limit the spread of diseases like HIV by giving addicts clean needles and a safe place to use them.

"People need to be kept alive long enough in order to get treatment," said Liz Evans, a nurse and founder of Insite.

The clinic, which is sanctioned by Vancouver's health department, opens each day at 10 a.m. and stays open until 4 a.m. the following day. Many of the people in the clinic on the day we visited had tattered clothes, missing teeth and glassy eyes. They swayed as they struggled to keep their balance. Watch people shoot up in the Vancouver clinic »

Outside of the clinic, police patrolled the streets to keep people from buying and selling illegal drugs. Inside, patrons were given access to Insite's clean needles, injection booths and nurses. Similar facilities can be found at 65 locations in eight different countries.

San Francisco health officials recently held a day-long conference on the Vancouver drug clinic, with an eye toward possibly opening a similar one. But San Francisco Mayor Gavin Newsom said the city is unlikely to do so.

"You had a lot of health officials there that did participate in the pros and cons. But my director of the department of public health doesn't feel the city should move forward," Newsom said.
Defenders of the Vancouver clinic say more than two dozen peer-reviewed studies have shown its benefits. One study found a 45 percent reduction in public drug use as a result of the clinic; another showed 33 percent of addicts are more likely to go to detox after using Insite.
Dr. Thomas Kerr, a University of British Columbia research scientist who has studied the program, believes Insite benefits the wider community.

"In the absence of such a facility, not only would [drug users] be high out on the street, but they would be leaving their syringes in school yards, in parks and on city streets," Kerr said.

Dr. David Murray, chief scientist for the White House Office of National Drug Control Policy, opposes opening drug injection clinics in the United States. He believes they do little to help addicts overcome their additions.

"It is a cruel illusion because they are still addicted, trapped, trying to get out and dying by the virtue of the drug itself," he said.

Nurses at the Vancouver clinic say they get all kinds of people using their facility, from an old grandma who comes to inject her pain medication to men in business suits hiding their addictions from their families. [emphasis added]

At the clinic, we met Lorraine Trepanier, 50, a longtime drug user. Trepanier said she used to sell her body for drugs, but now relies on a friend to give her the $20 she uses every day to buy cocaine and heroin.

"I get up in the morning and I make sure I have one down or half a down," she said, referring to her heroin fix. Trepanier believes Insite has helped keep her alive by giving her a supervised setting in which she can take drugs.

Evans and other operators of Insite say that rather than chase addicts from corner to corner and alley to alley, it is more effective to encourage them to use their drugs in a supervised setting.

In the more than four years Insite has been open, there have been roughly 800 overdoses at the facility, but there have not been any deaths. When someone does overdose, nurses try to revive them. If the drug user is in critical condition, they are sent to a hospital.

Trepanier doesn't care what critics have to say about Insite. All she wants is a chance to get her next fix in a clean facility, until the day she finally works up the willpower to kick her addition.

"I don't want to be down here all my life," she said. "I don't want to be chasing this all my life."

Editorial from the McGill Tribune

2007-10-23T21:47:00.000-07:00

http://www.mcgilltribune.com/

EDITORIAL: Needles in a political haystack
Issue date: 10/23/07

Political opposition to drug harm reduction centres is nothing new. Insite-a supervised injection site located in the downtown eastside of Vancouver has encountered nothing but disdain from Stephen Harper's federal government, while the UN's International Narcotics Control Board routinely condemns various harm reduction centres abroad for violating international treaties concerning narcotic drugs.

The U.S. government has also been an outspoken global critic of harm reduction projects that provide legal exemptions for drug use ever since Richard Nixon coined the term "war on drugs." Therefore, it should come as no surprise that early efforts by the San Francisco Department of Public Health to open America's first legal safe-injection site have been met by political
stonewalling and moral indignation.

The scientific evidence supporting supervised injection sites is overwhelmingly positive. Insite, the only facility of its kind in North America, has been the subject of over a dozen studies conducted by the BC Centre for Excellence in HIV/AIDS, none of which have uncovered a single negative effect of the SIS. Furthermore some of the positive effects revealed in their
peer-reviewed research are extremely encouraging: Insite has reduced the overall rate of needle sharing in the area, led to increased enrollment in detox programs and has not led to an increase in drug-related crime or intravenous drug usage.

Nurses at Insite provide care for wounds, supply users with sterile drug paraphernalia and educate users about sanitary practices that cut down on the spread of HIV and Hepatitis C. They are also on-hand for any overdoses-of which there have been over 800 at Insite. Thanks to prompt medical care, not a single overdose at the facility has resulted in a fatality and, not coincidentally, emergency room visits for intravenous drug users are down dramatically.
Unnecessary hospital visits are prevented by simple care at an SIS, saving tax-payers money and cutting waitlists at emergency rooms.

Perhaps most importantly, safe-injection sites put drug users in close contact with social workers. In fact, a recent study showed that intravenous drug users were 20 per cent more likely to enrol in a detox program after using Insite on a regular basis. The power of personal contact, something that is almost impossible to establish when dealing with users in back-alleys, is undeniable.

An SIS in the downtown eastside of Vancouver was an crucial step towards improving the community. It is estimated that the area is home to over 1,500 homeless people, as well as thousands of others living well below the poverty line. The percentage of HIV-positive men and women in the community parallels that of many third-world countries.

San Francisco has similar problems, with estimates of intravenous drug users in the city ranging from 11,000 to 15,000 people. For them, the old methods of enforcement are not working. In fact, a study published in the International Journal of Drug Study concluded that street-level arrests and confiscations only serve to exacerbate drug-related crime and prompt increased
needle sharing.

The Harm Reduction Centre here on campus is based on much of the same ideology. The centre, which became a Students' Society Service in November of last year, aims to educate students on safe alcohol and drug use and bridge the disconnect between the average student and the officials that preach on the evils of drugs. Quebec pharmacy Jean Coutu offers a kit of inexpensive needles and condoms in order to prevent the spread of disease and facilitate safe drug use and sex for low-income individuals.Yet most politicians still believe "The war on drugs" is the answer and refuse to use the formidable powers of government to offer such harm reducing services.

Ideologically it's easy to see why they have a knee-jerk reaction to anything that might seem to make drug use easier, but what they fail to realize is that supervised injection sites don't condone or legitimize drug use at all. The facts show that facilities such as Insite do not increase drug use in the community, nor cause additional relapses. The staff at safe-injection sites work
to save users' lives, while idealistic politicians stick their heads in the sand and pretend drug-busts, harsher jail sentences and preventative campaigns will rid society of the problem. They refuse to see the reality that prohibition and punishment will never completely eradicate drug use from the general population.

This sad state of affairs among our politicians was revealed, yet again, earlier this year, when Harper's government denied Vancouver Coastal Health's request for a three-year extension to Insite's operating exemption. Instead, Insite was granted an additional six months to "gather more proof of its effectiveness." Harper commented that he was "sceptical" about Insite's value,
despite the favourable studies published in over a dozen reputable medical journals such as the Lancet and the New England Journal of Medicine.

Supervised injection sites are not the be-all, end-all solution to the problem of drug usage, but rather, they are an important tool in the battle against intravenous drugs. They cost a measly $2-millon per year to operate, which is pocket-change compared to the millions spent on enforcement and education. Some object to them on moral or philosophical grounds; but the
science behind them is sound, and when morality and pragmatism meet, pragmatism should always triumph.The bottom line is that programs like Insite work.

If Mr. Harper and the politicians in California believe otherwise, then they must be high on something.

Nurses to Supervise Heroin, Cocaine Injections

2007-10-19T23:50:00.000-07:00

Here's an article I got over at nurselink about the proposal to start a safe injection site in San Francisco. My response on the site is also reposted here below the news article. Head on over to nursingling to check out all of the naysayers too.

ASSOCIATED PRESS Oct 19, 2007
City health officials took steps Thursday toward opening the nation’s first legal safe-injection room, where addicts could shoot up heroin, cocaine and other drugs under the supervision of nurses.

Hoping to reduce San Francisco’s high rate of fatal drug overdoses, the public health department co-sponsored a symposium on the only such facility in North America, a four-year-old Vancouver site where an estimated 700 intravenous users a day self-administer narcotics under the supervision of nurses.

“Having the conversation today will help us figure out whether this is a way to reduce the harms and improve the health of our community,” said Grant Colfax, director of HIV prevention for the San Francisco Department of Public Health.

Organizers of the daylong forum, which also included a coalition of nonprofit health and social-service groups, acknowledge that it could take years to get an injection center up and running. Along with legal hurdles at the state and federal level, such an effort would be almost sure to face political opposition.

Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, called San Francisco’s consideration of such a facility “disconcerting” and “poor public policy.”

“The underlying philosophy is, ‘We accept drug addiction, we accept the state of affairs as acceptable,’” Madras said. “This is a form of giving up.”

Sixty-five similar facilities exist in 27 cities in eight countries, but no other U.S. cities have considered creating one, according to Hilary McQuie, Western director for the Harm Reduction Coalition, a nonprofit that promotes alternative drug treatment methods.

“If it happens anywhere in the U.S., it will most likely start in San Francisco,” McQuie said. “It really just depends on if there is a political will here. How long it takes for that political will to develop is the main factor.”

Drug overdoses represented about one of every seven emergency calls handled by city paramedics between July 2006 and July 2007, according to San Francisco Fire Department Capt. Niels Tangherlini. At the same time, the number of deaths linked to overdoses has declined from a high of about 160 in 1995 to 40 in 2004, he said.

Colfax estimated that there are between 11,000 and 15,000 intravenous drug users in San Francisco, most of them homeless men. Like many large U.S. cities, the city operates a clean-needle exchange program to reduce HIV and hepatitis C infections.

Advocates plan to work on building community support for a safe-injection center, including backing from Mayor Gavin Newsom and the Board of Supervisors.

The mayor’s spokesman, Nathan Ballard, said Thursday that although he does not want to discourage debate, he “is not inclined to support this program because, quite frankly, it may create more problems than it supposedly addresses.”

In Switzerland, Spain and other European countries with such programs, the sites have been placed in existing public health clinics and created as stand-alone centers, said Andrew Reynolds, a program coordinator with San Francisco’s city-run sexually transmitted diseases clinic.

Possible locations for opening one in the city include homeless shelters, AIDS clinics or drug treatment centers, he said.

“They aren’t these hedonistic dens of iniquity,” Reynolds said. “There is no buying or selling of drugs on the premises. Staff do not assist in injections.”

While it’s too early to tell what the room in San Francisco would look like, Vancouver’s InSite program is on the upper floor of a low-rise building in a downtown neighborhood where drug users shoot up in the open.

The site, exempt from federal drug laws so users can visit without fear of arrest, has 12 private booths where addicts inject drugs such as heroin, cocaine or crystal. They can use equipment and techniques provided by the staff, and then relax with a cup of coffee or get medical attention in the “chill out” room where they are observed, said program coordinator Sarah
Evans.

“It looks kind of like a hair salon,” Evans said of the bustling space. “If we were a restaurant, we would be making a profit.”

While 800 overdoses have occurred on the premises, none resulted in death because of the medical supervision provided at InSite, said Thomas Kerr, a University of British Columbia researcher who has extensively studied the program. His research also has shown an increase in addicts seeking drug treatment and a decrease in abandoned syringes, needle-sharing, drug-related crime and other problems since the clinic opened, he said.

The results indicate the idea is worth replicating, despite the criticism it may attract, Kerr said. “I prefer the approach of the Vancouver Police Department, which was: ‘We don’t like the idea of this, but let’s look at the evidence and at the end of three years we will tell you either this
is something we can support or it’s something we can’t support,’” he said.

Temple University law professor Scott Burris told the audience at Thursday’s forum that a supervised injection room would seem to run afoul of federal drug possession laws and a state statute that makes it illegal to operate a crack house or any place where drugs are used, but only if the police and federal agents enforce them.

He cited as an example California’s medical marijuana law, which has allowed pot dispensaries to flourish but at the risk of being raided by federal authorities.

“The law isn’t a barrier,” Burris said. “The issue of whether it’s legal doesn’t come up until somebody is arrested.”

My response:
There are so many reasons that this is a good idea: The first point of contact for many street-living addicts is the ER, either for an overdose or an infected abcess. Both of these are costly to the taxpayer/HMO system. If nurses can catch infections early, teach people how to inject safely, spread the word about the necessity of clean needles and clean water AND save the system money AND direct people to resources & services AND direct them to treatment, AND save their lives then the "it's illegal" argument falls a bit flat in the face of that.

It's still illegal outside of the clinic environment. By entering the clinic the user has made an
(either overt or tacit) agreement to use clean gear & stick around afterwards (at least that's the arrangement at the Vancouver InSite). Chronic drug users no longer get high from heroin or
cocaine, they need the drugs simply to remain functional and not go into withdrawl. Users then can get information on treatment programs or be put in contact with other resources while in a frame of mind where they can actually take the information in rather than while they are "jonesing" for a hit.

Just in case anyone envisoning addicts to be "merely" the homeless (although they're the ones to benefit most from this type of frontline care), 13.1% of employed Americans in 1999 were substance abusers and it's suspected that 10% of the nursing population of the US uses drugs and/or alcohol, 6-8% to the point of impairing their clinical judgement (Dunn, Substance Abuse Among Nurses, AORN Journal, Oct 2005)

Apologies, and an update (finally)

2007-10-17T11:58:00.000-07:00

**See my post on letter writing tips in the Feb 2007 archive**

**See my post on who's who in the cabinet from the Aug 2006 archive but be careful, the cabinet has shuffled since then**

**See my fact sheet on Insite in the Aug 2006 archive**

I've been pretty remiss about posting on this blog. My apologies.

You know what finally kicked me back into gear on this issue? The recent trite remarks by the Minister of Health, Tony Clement, that "The party is over" and the simplistic and judgemental remarks of the Prime Minister, Stephen Harper about addict's "...short, miserable lives".

These, combined with a new anti-drug policy that's long on enforcement and fire & brimstone scare tactics, and short on evidence based harms-reduction strategies that actually lead to recovery and treatment for addicts.

I find it hard to believe --despite the significant chunk of the $63.8 million allocated to treatment in the get tough on drug policy announced last week-- that the government hasn't already written off addicts' "short & miserable lives" as dead in the water.

I am deeply disturbed that the Prime Minister can write off the lives of Canadians in this manner.

There is quite an avalanche of new postings here with little or no commentary--basically the opposite of how I originally invisioned this blog.

However, it remains, I think, a good repository of relevant information so that interested people can gather the necessary information to write letters to their MP or to the editors of student, local or national newspapers about Insite in particular and harms reduction in general.

From the sounds of the Speech from the Throne last night and the reactions to it today, it sounds like Canadians will be heading to the polls sooner rather than later.

Don't let harms reduction fall away as an important health care issue.

Don't let the conservatives ignore the harms reduction & treatment pillars of the 4 pillars strategy in overwhelming favour of the enforcement & prevention pillars.

Write to your MP, ask for a balanced approach for Canada: Enforcement and Prevention, yes but in conjunction with --not to the exclusion of-- Treatment and Harms Reduction

**See my post on letter writing tips in the Feb 2007 archive**
**See my post on who's who in the cabinet from the Aug 2006 archive but be careful, the cabinet has shuffled since then**
**See my fact sheet on Insite in the Aug 2006 archive**

In the Ottawa area: Community Forum on Homelessness with Plenary session by Sarah Evans, Liz Evans & Anita Hubley on Insite

2007-10-17T11:52:00.000-07:00

The Alliance to End Homelessness
INVITATION TO REGISTER
2007 Community Forum on Homelessness

download from http://www.endhomelessnessottawa.ca/events/2007CommunityForumonHomelessness.cfm

FEATURING OUR SPECIAL GUESTS
The Research Alliance for Canadian Homelessness, Housing, and Health (REACH 3), a collaborative interdisciplinary network of academic investigators and community partners in Ottawa, Vancouver, Calgary, Toronto, and Montreal.

PRELIMINARY PROGRAM
MORNING PLENARY RESEARCH PANELS
Housing Solutions

MODERATED BY AN OTTAWA REACH3 MEMBER

PANEL MEMBERS
Liz Evans, BScN, Portland Hotel Society, Vancouver
– on innovative housing programs that have been created in Vancouver.
Stephen Hwang, MD, MPH, St.-Michaels Hospital, Toronto
– on policy and program implications of some of their research
Lorraine Bentley, MA, Executive Director, Options Bytown, Ottawa
– reacting with implications for the housing situation in Ottawa.
Resident, Options Bytown, Ottawa
– providing a personal perspective on their housing difficulties in Ottawa
Youth Can Move Forward
MODERATED BY AN OTTAWA REACH3 MEMBER
PANEL MEMBERS
Elise Roy, MD, MSc, Université de Sherbrooke
– Montreal Street Youth
Bruce MacLaurin, MSW, PhD (Cand.), University of Calgary
– Calgary Street Youth
Catherine Worthington, MSc, PhD, University of Calgary
– Calgary Street Youth
Andrea Poncia, Youth Services Bureau of Ottawa
– HIV/AIDS Educator
An Ottawa youth community member
– commenting on the findings and their own experience
INFORMAL LUNCH & NETWORKING CAUCUSES — A 1½ hour opportunity to share ideas from Ottawa and ask more questions of REACH3 members.
Select your lunch then join one of the LUNCH CAUCUSES, focusing on a variety of topics, facilitated by Ottawa’s Alliance to End Homelessness members.
AFTERNOON PLENARY SESSION
The good, bad and ugly – the InSite Experience
The "how" behind linking community agencies and researchers
LED BY SARAH EVANS, LIZ EVANS AND ANITA HUBLEY
A session describing how the community and the academic's worked together on InSite, Vancouver’s legal supervised injection site.
Hear about the good, bad and ugly parts of the experience when the private, public and not-for-profit sectors, come together locally, nationally and internationally.
CLOSING ACTIVITY
WALK FOR HOUSING
Taking the need for a National Housing Program out to the community!
ALL DAY – SPECIAL EXHIBIT
A Sound & Photo Installation
Street Health Stories
How do you take care of your health when you don’t have a home?
8 Street Health Stories in large lightbox prints with headphones
The National Film Board of Canada’s Filmmaker-in-Residence presents the Street Health Stories installation which gives a human face and voice to Street Health’s statistics.
Four photographers who have experienced homelessness ~ Adrienne, Jess, Keneisha, and Meghan document the stories of 28 homeless men and women through audio recordings and portrait-photography. Katerina Cizek, a documentary-maker and the National Film Board of Canada’s Filmmaker-in-Residence at an inner-city hospital, teaming up with partners at the frontlines – doctors, nurses and patients – to create collaborative media.
We gratefully acknowledge support from our Alliance to End Homelessness Members, United Way/Centraide Ottawa, the University of Ottawa & the Homelessness Partnering Strategy, Government of Canada.

The drug problem: Europe tolerance vs. U.S. criminalization

2007-10-17T11:45:00.000-07:00

The drug problem: Europe tolerance vs. U.S. criminalization
RICK STEVES
918 words
16 October 2007
Guelph Mercury
Final
A9
English
Copyright (c) 2007 Guelph Mercury.

Europe has a drug problem, and knows it. But the Europeans' approach to it is quite different from the American "war on drugs." I spend 120 days a year in Europe as a travel writer, so I decided to see for myself how it's working. I talked with locals, researched European drug policies and even visited a smoky marijuana "coffee shop" in Amsterdam. I got a close look at the alternative to a war on drugs.

Europeans are well aware of the U.S. track record against illegal drug use. Since U.S. president Richard Nixon first declared the war on drugs in 1971, the United States has locked up millions of its citizens and spent hundreds of billions of dollars (many claim that if incarceration costs are figured in, a trillion dollars) waging this "war." Despite these efforts, U.S. government figures show the overall rate of illicit drug use has remained about the same.

By contrast, according to the 2007 UN World Drug Report, the percentage of Europeans who use illicit drugs is about half that of Americans. ( Europe also has fewer than half as many deaths from overdoses. ) How have they managed that -- in Europe, no less, which shocks some American sensibilities with its underage drinking, marijuana tolerance and heroin-friendly "needle parks"?

Recently, in Zurich, Switzerland, I walked into a public toilet that had only blue lights. Why? So junkies can't find their veins.

A short walk away, I saw a heroin maintenance clinic that gives junkies counselling, clean needles and a safe alternative to shooting up in the streets. Need a syringe? Cigarette machines have been retooled to sell clean, government-subsidized syringes.

While each European nation has its own drug laws and policies, they seem to share a pragmatic approach. They treat drug abuse not as a crime but as an illness . And they measure the effectiveness of their drug policy not in arrests but in harm reduction .

Generally, Europeans employ a three-pronged strategy of police, educators and doctors. Police zero in on dealers -- not users -- to limit the supply of drugs. Users often get off with a warning and are directed to get treatment. Anti-drug education programs warn people (especially young people) of the dangers of drugs, but they get beyond the "zero tolerance" and "three strikes" rhetoric that may sound good to voters but rings hollow with addicts and at-risk teens. And finally, the medical community steps in to battle health problems associated with drug use (especially HIV and hepatitis C) and help addicts get back their lives.

Contrast this approach with the American war on drugs. As during Prohibition in the 1930s, the United States spends its resources on police and prisons to lock up dealers and users alike. American drug education (such as the now-discredited DARE program) seemed like propaganda, and therefore its messengers lost credibility.

Perhaps the biggest difference between European and American drug policy is how each deals with marijuana. When I visited the Amsterdam coffee shop that openly sells pot, I sat and observed: People we re chatting; a female customer perused a fanciful array of "loaner" bongs. An older couple (who apparently didn't enjoy the edgy ambience) parked their bikes and dropped in for a baggie to go. An underage customer was shooed away. A policeman stepped inside, but only to post a warning about the latest danger from chemical drugs on the streets. In the Netherlands, it's cheaper to get high than drunk, and drug-related crimes are rare.
After 10 years of allowed recreational marijuana use, Dutch anti-drug abuse professionals agree that there has been no significant increase in pot smoking among young people and that overall cannabis use has increased only slightly. Meanwhile, in the United States, it's easier for a 15-year-old to buy marijuana than tobacco or alcohol -- because no one gets carded when buying something on the street.

The Netherlands' policies are the most liberal, but across Europe no one is locked away for discreetly smoking a joint. The priority is on reducing abuse of such hard drugs as heroin and cocaine. The only reference to marijuana I found among the pages of the European Union's drug policy was a reference to counselling for "problem cannabis use."

Meanwhile, according to FBI statistics, in recent years about 40 per cent of the roughly 80,000 annual drug arrests were for marijuana -- the majority (80 per cent) for possession.

In short, Europe is making sure that the cure isn't more costly than the problem.

While the United States spends tax dollars on police, courts and prisons, Europe spends its taxes on doctors, counselors and clinics. EU policymakers estimate that they save 15 euros in police and health costs for each euro invested in drug education and counselling.

European leaders understand that a society has a choice: tolerate alternative lifestyles or build more prisons. They've made their choice.

Rick Steves (ricksteves.com) writes European travel guidebooks and hosts travel shows on public television and radio. This commentary originally appeared in the Los Angeles Times.

From the San Francisco Chronicle

2007-10-17T11:36:00.000-07:00

Drug injection center idea gets an airing in S.F.
C.W. Nevius
902 words
16 October 2007
The San Francisco Chronicle
5star
D.1
English
© 2007 Hearst Communications Inc., Hearst Newspapers Division. Provided by ProQuest Information and Learning. All Rights Reserved.

Two months ago I wrote about an idea for a place in San Francisco where intravenous drug users could shoot up under the supervision of trained personnel. A lot of people thought it sounded crazy.

Well, get ready to hear about it again, because the idea is gaining momentum.

On Thursday, an all-day symposium - co-hosted by the city Department of Public Health - will examine the idea of creating safe injection centers where users could bring their drugs, shoot up and leave, without fear of arrest.

The idea is to decrease overdoses, keep dirty needles off the street, and cut the risk of spreading HIV and hepatitis C. Those are all good things. It is the idea of providing addicts with their own injection clinic that riles people up.

"What's next?" a reader wrote when the first column appeared. "Giving them the drugs, too?"
No. But there's no doubt that if San Francisco ever established such a center, even as a pilot program, there would be an enormous brouhaha.

"It would be huge international news," said Peter Davidson, a researcher at UCSF in the epidemiology and biostatistics department. "It would be the first facility in the United States, and there would probably be a firestorm for a while."

You can count on that. The conservative radio talk show hosts are probably already jump-starting their tonsils. Wacky San Francisco, providing a party room for junkies.

Nor are public officials eager to jump on the bandwagon. Asked for a comment from Mayor Gavin Newsom, spokesman Nathan Ballard said, "The mayor is not inclined to support this approach, which quite frankly may end up creating more problems than it addresses."

Organizers of Thursday's conference are hardly surprised by that reaction.

"Down the road there will be a lot of strong feelings," said Hilary McQuie, Western director of the Harm Reduction Coalition, a national group that combats the adverse effects of drug use. It is organizing the event.

"It's a big topic, and we hope to start a conversation," McQuie said.

Oh, it'll start all right. But Barbara Garcia, the city's deputy public health director, asked where it will go. "We don't want to create a lot of backlash," she said.

San Francisco and the rest of the country may not be quite ready, but injection centers are
getting a lot attention in other parts of the world. Grant Colfax, director of HIV prevention for the city Public Health Department, says there are now 65 centers in eight countries.

In Vancouver, British Columbia, where an injection clinic opened in 2003, "the data ... seem to show that it is actually a benefit to the community," Colfax said.

Opening a shooting gallery benefits the community? How does that work? Well, Dr. Thomas Kerr, the University of British Columbia physician who has been involved with the Vancouver center since its inception, says it is having success treating addicts, even though they are coming to inject themselves.

"We published a paper in the New England Journal of Medicine that showed that we had a 33 percent increase in the use of detox facilities from our population," Kerr said.

But would the addicts actually use the center? McQuie says they have in other cities, and the reason may be something people don't ordinarily associate with drug users - fear.

"I think that a lot of injectors are very afraid of overdosing and dying," McQuie said. Many overdoses happen when users are alone, she said.

Then there is the question of what neighborhood would host an injection center. Davidson says he thinks the Tenderloin would be the logical place, noting that a 2003 survey in which he took part found that more than a third of the city's overdose deaths occurred within 100 yards of the intersection of Turk Street and Golden Gate Avenue.

McQuie says centers attract a certain type of user, probably one whose health is not the best and who is somewhat desperate.

"It's not for everybody," she said. "It's not the most fun place in the world."

Vancouver's center has small booths where users step in, inject and come out. With scrubbed floors and bright overhead lights, it is sterile in every sense of the word.

"They are really for the people (whose lives) are most chaotic," Kerr said. "Homeless people with mental problems who are likely to use public spaces to inject."

Exactly, in other words, those who have the worst effect on the neighborhood and community.
Ask Garcia. Not long ago she opened the front door of her house and found a man passed out on the stoop. She was able to call an ambulance in time, but he nearly died of an overdose.

"So," she says, "I am sympathetic to the dangers."

The rest of San Francisco should be, too. This is a problem that is on everyone's doorstep.

"The mayor is not inclined to support this (which) may end up creating more problems than it addresses." - Nathan Ballard,, spokesman

C.W. Nevius' column appears Tuesday, Thursday and Sunday. His blog, C.W. Nevius.blog, can be found at sfgate.com. E-mail him at cwnevius@sfchronicle.com.

Maybe we can punish the pushers

2007-10-17T11:33:00.000-07:00

Maybe we can punish the pushers
Kelly Roesler
The Ottawa Citizen
901 words
16 October 2007
Ottawa Citizen
Final
A11
English
Copyright © 2007 Ottawa Citizen

'If you are addicted to drugs, we'll help you, and if you sell drugs, we'll punish you," Prime Minister Stephen Harper claimed recently in launching his drug strategy. The statement and the plan were met with a wave of derision from opposition parties, newspaper editorials and columns, and much of the general public, judging from an influx of letters to the editor.

There he goes again, they moaned, lamenting Harper's "ideological" decision to emphasize law enforcement as part of a multi-pronged strategy that includes treatment, education and prevention.

It seems Harper is being demonized for recognizing there are many drug dealers out there who don't suffer the debilitating effects of addiction, who are perpetuating the hugely profitable and pervasive drug market, and that it needs to be addressed.

But where is the rational discourse about law enforcement as a component of a comprehensive drug policy?

Before I am painted as a hard-right, ideological subscriber to the "law and order" philosophy, let me say this: I write as a passionate believer in harm reduction measures; in supervised injection sites, heroin prescriptions, dispensing of alcohol, even free crack kits. All of it.

As a young journalism student I was deeply moved by researching a story on the opening of Vancouver's Insite safe injection site. Simply put, I consider myself "progressive" on drug policy.
But "law" seems to have become a dirty word in our national discussion on drugs, and it shouldn't be. It's a vital piece of a greater plan that encompasses all players in the sad world of the drug trade. This includes addicts -- who need all the support, compassion, health and social supports we can offer -- and dealers, particularly high-level suppliers who drive the market, reap the profits, and especially those who, detached from drug addiction and operating from a business-like perspective, prey on the vulnerabilities of those who are addicted because it's easy.

I have seen this firsthand, in the face of a drug dealer I once met years ago. He was a friend of an acquaintance; a tall, well-built, clean-cut, 20-year-old from a well-to-do Kanata family. He was a reasonably intelligent man who enjoyed sports and music; he was a health nut and young father. He also happened to be a crack dealer.

I spoke to him once, horrified but curious to learn why he would engage in this gruesome trade. He didn't smoke cigarettes or drink alcohol, and he certainly wouldn't consider ingesting the poison he was dispensing to his poor, addicted customers. The conversation painted a chilling portrait of a lack of soul.

He despised the addicts he supplied, speaking of them with utter disgust and disdain. He saw himself as a businessman, making money because it was easy. And it was profitable; he wore top-of-the-line clothing and had money to burn. I never saw or heard of him again, but I'm still haunted by his image.

We can't attribute the entire scope of our drug problem to people like him, but we also can't deny they exist; a group of people who have discovered the warped economic principle of the trade: sell drugs but don't use them. Recognizing these "bad" guys -- in an even-handed, responsible way -- seems to me one part of a policy that is not ideologically based at either end of the spectrum. Isn't that what we're aspiring to?

I'm by no means saying Harper has the right answers -- he has a long way to go, especially when it comes to recognizing harm reduction as not only the logical, but humane policy. But as we work to help addicts, it's just as important to recognize the drug market is currently a criminal enterprise, and take aim at those perpetrating it; those whose addiction to the proceeds of trafficking can't be cured with a harm-reduction strategy. Surely we can distinguish them from the crack-addicted middlemen who deal to support their habits.

Does this mean implementing tougher laws, but working to stipulate they don't have the unintended, sweeping consequence of punishing addicts who need help? Maybe. Does this mean outright legalization of drugs? Maybe. I'm open to all of these ideas. Let's just talk about it.
The most vehement critics appear to condemn any plan or role for law enforcement (or some variation) in drug policy without offering alternatives, or at least acknowledging there are people at the heart of this who need to be dealt with in a different way. Do they think the "bad guys" will magically disappear as we focus solely on helping addicts? It's hard to tell; no one's talking about it.

We need to put aside our instinctual fears about any type of law enforcement propelling us to a U.S.-style war on drugs. There has to be a rational way to approach enforcement, in full conjunction with harm reduction.

We may not like all of what Stephen Harper is offering, but isn't it time to talk about what role
we think the law should play?

Kelly Roesler works on the Citizen's copy desk and as a freelance writer.

FEDERAL DRUG STRATEGY Editorial, Globe and Mail

2007-10-17T11:29:00.001-07:00

FEDERAL DRUG STRATEGY
Editorial
How to address those addictions
424 words
9 October 2007
The Globe and Mail
A20
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

The federal government's new anti-drug strategy is not as simplistic as advance comments by the Conservatives – notably Health Minister Tony Clement's silly “the party's over” declaration – might have led one to believe. It does not merely ape the failed “War on Drugs” strategy employed by the United States. Rather than treat addicts as criminals, it is sympathetic to their plight, devoting two-thirds of the program's $64-million in funding to treatment and prevention. But it would stand a much better chance of success if it were not undermined by a rigid single-mindedness.

From Prime Minister Stephen Harper's perspective, fighting the evils of drug use is entirely about getting Canadians to stop taking drugs. He rejects the ideas behind harm-reduction programs such as the Insite safe injection facility for heroin users in Vancouver.

“I remain a skeptic that you can tell people that we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use but somehow we will keep you addicted but reduce the harm just the same,” he said in announcing the new strategy last week. “If you remain a drug addict, I don't care how much harm you reduce, you are going to have a short and miserable life.”

Nobody will dispute the fact that it is better to avoid drug use entirely than to use drugs more safely. But it's not as easy as it sounds. Some potential drug users might be swayed by prevention campaigns, and some addicts will voluntarily enter rehabilitation. Yet all the available evidence shows that no efforts by governments will get the most hardened addicts to kick their habit. That leaves two options: abandon those people altogether or attempt to limit the health and social costs of their illness.

The harm-reduction programs rejected by Mr. Harper do much in that regard. Insite reduces needle-sharing in the community, limiting the spread of disease. It saves lives by preventing addicts from dying of overdoses. It reduces the number of people injecting drugs in public places and leaving needles behind. Far from endorsing drug abuse, it encourages treatment. According to research, one in five regular visitors enlists in detoxification programs.

Instead of abandoning such efforts, the government should be expanding them. A sensible anti-drug strategy would do so. Unfortunately, Mr. Harper appears under the misguided impression that prevention and harm reduction are mutually exclusive.

FEDERAL DRUG STRATEGY Editorial, Globe and Mail

2007-10-17T11:29:00.000-07:00

Nursing focus in an excellent Globe & Mail article: The inside story of Vancouver's safe injection site

2007-10-17T11:24:00.000-07:00

PUBLIC HEALTH AND DRUG ABUSE
National News

The inside story of Vancouver's safe injection site; Supporters work to convince opponents that Insite saves lives, still fearing for the facility's long-term future

IAN BAILEY
2549 words
6 October 2007
The Globe and Mail
A3
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

VANCOUVER -- Using heroin and cocaine can be a dirty business. That means Bethany Jeal sometimes has a lot to do as a nurse helping addicts at North America's first safe injection site.
The 28-year-old says she isn't shy about strolling off the nursing platform in the injection room of the Insite operation in the city's Downtown Eastside and going up to clients in one of Insite's 12 booths.

Each booth is brightly lit so addicts can find good veins into which to plunge a syringe's needle. But there are also mirrors, which allow nurses from across the room to get an idea of what addicts are doing – whether, for example, they are using alcohol swabs.

“We can see everything that's going on,” said Ms. Jeal, who added “there's a lot of unclean practices with regard to drugs.”

She explained that users do not always wash their hands. The drugs themselves, bought on the street are not sterile. (Insite allows the use of drugs, but does not provide them.) And people do not always use alcohol swabs before plunging needles into their flesh.

“I will definitely walk over to them, and if I don't know them, introduce myself and say, ‘Hey. There's a great way to do this. Why don't you use an alcohol swab first?' ” Ms. Jeal said in an interview.

Ms. Jeal, who has been a nurse for three years, once worked full time at Insite.

Now she pulls the occasional shift in the operation, which opened in 2003 with support from the province, city and Vancouver Police Department, among others, as a means of dealing with disease, overdoses and other problems related to injection drug use, largely in the poverty-stricken Downtown Eastside.

However, many Insite supporters now fear for its future because federal Health Minister Tony Clement this week agreed to only a six-month extension in the Controlled Drugs and Substances Act exemption that allows illegal drugs in the facility without legal sanctions. Insite opened with a three-year exemption granted by the then-Liberal government.

Some say the federal Tories want the issue of Insite's future off the table with the possibility of a fall election, especially since the operation is popular in B.C. – with Premier Gordon Campbell and, according to polls, with the public as well.

B.C. Health Minister George Abbott says Insite represents a practical approach to issues of injection drug use.

“The challenge we have is that for drug-addicted individuals, at least until they resolve to try to move beyond their addictions, they are going to be using. When they use, we want to minimize the public health hazards that are associated with intravenous drug use,” he said.

“No one is saying drug addiction is a good thing. It is clearly a very bad thing. It's how we manage those addictions in a thoughtful and humanitarian way that is the key to understanding Insite.”

INSIDE THE SITE
Insite is open 18 hours a day and, in a rare look at its inner workings, The Globe and Mail had a recent opportunity to visit during working hours.

Despite its unusual business, the injection room was subdued and quiet. The exception was one client, who came in on his bicycle and rode it back and forth, within a range of about a metre. (The man likely kept his bike with him, one observer noted, because it would be stolen if he left it on the street.) There were seven men and one woman, largely focused on taking out their drugs, preparing them and using them under nursing supervision.

A poster on the wall warns: “Take care Of your veins. Avoid abscess, dirty hits, embolism and edema. Avoid injecting particles.”

With its track lighting, black tile and white walls, the injection room has the disconcertingly elegant feel of a furniture showroom in a slick Vancouver shopping district. But as they arrive, clients can pick up clean syringes, little aluminum plates for cooking their drugs, a match or lighter and tourniquet.

“We wanted it to be as calm as it could be, and simple,” said Mark Townsend, manager with the Portland Hotel Society that runs the facility with the Vancouver Coastal Health Authority, explaining the design.

Ms. Jeal was not on duty this day. She spoke about Insite during an interview at a café up the street from the injection site, which is laid out on one floor behind a storefront-style facade on East Hastings, the main street in the Downtown Eastside neighbourhood that is home to about 4,000 injection drug users.

During her shifts, she said, she tries to constantly walk around the injection room, interacting with clients. “That's how we get to know people, get a rapport with people, find out what their thoughts are. Maybe they have an infection going. Or maybe they really want to get into detox.”
The point is to head off unsafe practices that can lead to HIV or hepatitis C, or to direct addicts to detox programs. Sanctioning injection-drug use within Insite also allows for a quick response to overdoses that occur on site as nurses look on, sending them into a scramble of sudden treatment and calls to ambulances. There were no fatalities among 453 overdoses reported between April, 2004, and March, 2006, the last period for which statistics are available.

“You can read through the protocol and study what to expect, but you never really know until you experience it,” Ms. Jeal said on the overdose issue, recalling she was “scared shitless” six weeks into her work at Insite when a man fell off his chair after shooting up. With treatment, he
recovered.

The Burnaby-raised nurse, who never came to the Downtown Eastside in her youth, said Insite is no doubt necessary.

“It's not so much sanctioning drug use. The whole basis of harm reduction is accepting that people use [drugs],” she said. “It's not saying it's a good thing. It's not saying it's a bad thing, or marginalizing people who use drugs. It's saying they do use drugs and taking means to prevent harm that might come from using. It's a moral obligation to do that.”

But the federal government has its doubts. Prime Minister Stephen Harper, announcing a $63.8-million national drug strategy in Winnipeg this week that balances prevention and treatment, said he remains a skeptic about Insite, calling it a “second-best strategy at best.”
The Prime Minister stated, “If you remain a drug addict, I don't care how much harm you reduce, you're going to have a short and miserable life.” He said his government will continue studies on Insite, en route to a conclusion about its value.

The B.C. government provided an initial $1.2-million in capital funding for Insite, plus $2-million for first-year operating costs. Since then, the Vancouver Coastal Health Authority has covered the $2-million annual cost, drawing on its funding from the province. Health Canada provided $1.5-million over Insite's first three years to cover the research aspect. And Ottawa has a key power over its fate because of the controlled-substances exemption.

“I would have preferred a longer extension but I will tell you this. It certainly is better than not having any extension,” Mr. Campbell said.

“I think it's important that the extension has been made and what we will do now is continue to work with, not just the city, but with the federal government to ensure an even further extension.”

Mr. Campbell, a former Vancouver mayor, acknowledged that people will have questions about whether Insite is working. “We believe it is making a difference. We think it is effective. So our job is to continue to work on behalf of the province, the health-care system and patients in this regard.”

The current mayor, Sam Sullivan, said that city council would like the exemption extended for at least 3½ years, and that he plans to continue to make the case for Insite with federal officials. “It's a great achievement to have an exemption,” he said. “I look forward to getting a further exemption.”

POLITICAL BATTLE
Insite has its critics. The Canadian Police Association and the RCMP have criticized the operation for, among other things, creating an enabling environment.

Although there have been a number of studies endorsing Insite for steering addicts into detox and addiction programs and encouraging safe injection practices, other studies have not been so enthusiastic. One, by the Drug Prevention Network of Canada that was released in the Journal of Global Drug Policy last May, said positive findings about Insite had been overstated while negative findings were not given prominence.

In an interview, Mr. Clement said he is awaiting more research on how supervised injection sites affect prevention, treatment and crime before a decision would be made on Insite's fate. Six contracts have been put to tender. Successful bids have been accepted for three.

Mr. Clement, who opposed safe injection sites when he was an Ontario health minister years ago, insisted that his government has yet to make a final decision on Insite's fate, and dismissed the allegations of critics that the six-month extension was intended to put Insite beyond debate in an election.

“When we have decided something, we will certainly let everybody know, but we have not made that decision,” he said when asked about the required federal exemption.

Mr. Clement, who toured Insite last year, said it isn't yet clear how the facility fits into the tough drug strategy announced in Winnipeg. The government's posture this week is all about research, he said.

“The researchers said, ‘We need more time in order to do proper research for you and for Canadians,' and we gave them more time. There's nothing more sinister than that,” Mr. Clement said.

Mr. Abbott, B.C.'s Health Minister, said Ottawa deserves some credit for continuing with exemptions for Insite that were launched by a previous Liberal government. But he said Insite is a key to B.C.'s goals on injection drug use.

“I have always made it clear to Tony that I am supportive of this facility, that we believe it is a valuable part of the continuum of care for the drug addicted, and have always made clear to him we're prepared to assist in providing whatever information they believe they need to support the extension of their support for this facility.”

Mr. Abbott would not speculate on what Victoria will do if Mr. Clement eventually rules out an extended exemption for Insite, saying he was reluctant to consider hypothetical questions.
“We'll cross that bridge if and when we get to it. I would like to think that over the next six months, we will be able to provide them with the evidence that would support what they need
to get their support for this,” he said.

But Insite's operators are thinking about a Tory-engineered demise for Insite, and Mr. Townsend of the Portland Hotel Society says the situation looks bleak. “I believe if the PM does the wrong thing, we will have no choice but to keep the site open,” he said. “We would try our best to carry on as we could.”

But, he said, it wouldn't be easy. “It's hard to run a medical facility, a hospital or a supervised injection site with volunteers. You can't run these things with bake sales.”

Letters have been written to the Prime Minister's Office, and there is a talk of a protest visit to Parliament Hill. Mr. Townsend's society and a pair of drug addicts even filed a statement of claim in B.C. Supreme Court arguing the closing of Insite would violate their Charter rights to “security of the person.”

A PERSONAL STORY
One of those addicts, Shelly Tomic, warmly recalls the support she has received from Insite since its first day as she grappled with a hunger for heroin, cocaine, speed and meth. She is now in recovery, but visits Insite when she feels the need to inject heroin.

Ms. Tomic, who has tested positive for hepatitis C and is disabled and unemployed, said she once had a heart attack at Insite – nurses called 911 when they noticed she was in distress. She said the site is better than the alleys and bar bathrooms she once used to shoot up.

“In Insite, you've always got clean rigs every single time, and even if you could get clean needles before Insite, you didn't necessarily have a sterile place to do it,” said Ms. Tomic, 39.

“You have got clean rigs. You don't have to rush to get it into you for fear of being arrested, or somebody taking [your drugs] from you or [being] mugged for it. And if you overdose at Insite, you have got medical staff right there to help you.”

She added: “[Insite] is sort of like the show Cheers, for Norm,” she says. “That's how I feel about Insite. I go in. Everybody knows me.”

Milestones in Insite's history
*******
November, 2002
Larry Campbell, Vancouver's newly elected mayor, promises to move quickly on the creation of a safe injection site, acting on debate over the issue that has been under way for years.

September, 2003
Insite opens as North America's first safe injection site, bolstered by $1.2-million in capital funding from the B.C. government, plus $2-million for first-year operating costs. (Since then, the Vancouver Coastal Health Authority has covered the $2-million annual cost of the operation, drawing on its funding from the province.) Health Canada allots $1.5-million over three years to cover research costs.

September, 2006
Federal Health Minister Tony Clement approves a 16-month extension in an exemption to Section 56 of the Controlled Drugs and Substances Act that allows Insite to operate. He rules out considering applications from other municipalities for such sites until the review is completed. Vancouver police salutes the minister's decision, noting the department “congratulates the federal government for making a very difficult decision on a complex issue.”

Oct. 2, 2007
Mr. Clement announces a six-month extension of the exemption to June 30, 2008, to allow for more research on issues around supervised injection sites.
Ian Bailey

Insite client data collected from April, 2004, to March, 2006 (the most recent statistics available):
CLIENT GENDER Female: 30% Male: 70%

CLIENT INJECTIONS, BY DRUG
Other: 20% Morphine: 12% Cocaine: 27% Heroin: 41%

CLIENT NUMBERS
There were 453 overdoses and no fatalities.
4,084 referrals were made with 40% to addictions counselling.
The busiest day was May 25, 2005, with 933 visits in 18 hours.
There were 6,227 nursing care interventions with 2,055 for abscess care.

SOURCE: VANCOUVER COASTAL HEALTH AUTHORITY, INSITE, B.C. CENTRE FOR EXCELLENCE IN HIV/AIDS

'Serious time for serious crime'; Opposition pans Harper's $63.8M national anti-drug strategy as U.S.-style war on drugs

2007-10-17T11:23:00.000-07:00

'Serious time for serious crime'; Opposition pans Harper's $63.8M national anti-drug strategy as U.S.-style war on drugs
Meagan Fitzpatrick
CanWest News Service
849 words
5 October 2007
Edmonton Journal
Final
A3
English
Copyright © 2007 Edmonton Journal

The federal government will introduce legislation this fall that would require mandatory minimum jail sentences for people convicted of "serious" drug crimes, Prime Minister Stephen Harper said Thursday.

"Currently there are no minimum prison sentences for producing and trafficking dangerous drugs like methamphetamines and cocaine," Harper told a news conference. "But these are serious crimes; those who commit them should do serious time."

But in launching the government's long-awaited, $63.8-million national anti-drug strategy in Winnipeg, Harper also promised to be compassionate toward people hooked on illegal drugs. In particular, the prime minister said he is concerned about rising drug use among youth. He also noted that drug use takes an expensive toll on the health-care system and fuels crime.

"Narcotics destroy lives. They rob young people of their futures, they tear families apart, they make our streets less safe and they lay waste to our communities."

Harper said the government's response will be two-pronged, focusing on drug addicts on one hand and on drug producers and dealers on the other.

"Drugs are dangerous and destructive. If drugs do get hold of you, there will be help to get you off them," Harper promised. "But if you sell or produce drugs, you will pay with prison time."

"Our two-track approach will be tough on the dealers and producers of drugs and compassionate for their victims."

He underlined that tough new anti-drug laws will be a major component of the government's plan, but confirmed that two-thirds of the funding will go toward the prevention and treatment of illicit drug use. The plan also includes a major national public awareness campaign aimed at youth and their parents.

"Interdiction by itself is not going to be enough," said Harper, flanked by Public Safety Minister Stockwell Day and Health Minister Tony Clement. "Our government recognizes that we also have to find new ways to prevent people from becoming enslaved to drugs and we need new laws to free them from drugs when they get hooked."

Other details unveiled by Harper about the plan included funding for the provinces and territories for drug abuse programs, modernizing treatment services and making them more widely available, financial support for youth intervention programs, more money for police agencies to investigate and prosecute drug crimes, ramping up the RCMP's drug unit programs, and increased funding for the Canada Border Services Agency.

Some details of the plan were in the last federal budget, including a breakdown of the overall funding to distribute about $10 million to prevention initiatives, $32 million for treatment for drug addicts, and $22 million to crack down on production and dealers.

"Solving Canada's drug problem will require a huge effort. We won't get clean overnight but we will put our country on the road to recovery," said Harper.

Even before it was made public, the government's plan drew darts and laurels from all sides of the drug debate. Liberal and New Democratic Party critics said the government is embracing a U.S.-style "war on drugs" that treats drug abuse as more of a criminal matter than a health issue. Liberal MP Keith Martin, a physician, and NDP MP Libby Davies both said in interviews earlier this week that the government should focus more on harm-reduction programs, such as
safe injection sites and needle exchanges.

The Vancouver safe injection site, Insite, was in danger of closing after its exemption from federal drug laws was scheduled to end at the end of this year. This week, however, the government gave the facility a six-month reprieve, extending its exemption to June 30, 2008.
Prime Minister Harper admitted on Thursday that he remains skeptical about the program and said that even if it's effective, it's a "second-best strategy at best."

"If you remain a drug addict, I don't care how much harm you reduce, you're going to have a short and miserable life," said Harper. He pledged to continue to study the program and gather the facts on it, but noted that his government's "tentative conclusion" is that safe injection sites, if allowed to operate, should operate in concert with other programs that aim to treat addicts.
Critics of the government said the reprieve for the Vancouver site was just designed to get the controversy over harm-reduction policy off the table in time for Harper's drug strategy announcement.

The Canadian Police Association, meanwhile, has expressed support for the government's get-tough approach to drugs. The organization has called for stronger legislation and a new system of graduated consequences to prevent and deter drug use. The group's president, Tony Cannavino, has called the government's promise to crack down on illegal drug use and dealers "a cornerstone, because a lot of violence is related to drugs."

A $64-MILLION STRATEGY

2007-10-17T11:20:00.000-07:00

A $64-MILLION STRATEGY
National News
Harper takes aim at drug culture
GLORIA GALLOWAY
623 words
5 October 2007
The Globe and Mail
A4
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

Canada has become too drug-friendly and it's time for a culture change, Prime Minister Stephen Harper said yesterday as he laid out his government's get-tough strategy for reducing the use of illegal substances.

Police and others fighting the battle against drug abuse are up against a culture that “since the 1960s” has done little to discourage drug abuse and “often romanticized it – romanticized it or made it cool, made it acceptable,” Mr. Harper said.

“As a father I don't say all these things blamelessly. My son is listening to my Beatles records and asking me what all these lyrics mean. It's just there, it's out there. I love these records and I'm not putting them away. But, that said, there has been a culture that has not fought drug use and that's what we're all up against.”

Mr. Harper, flanked by Health Minister Tony Clement and Public Safety Minister Stockwell Day, announced his new two-year, $64-million anti-drug strategy at a Salvation Army building in Winnipeg.

Two-thirds of that money will go to prevention and treatment programs and the rest will be used to beef up enforcement, including the introduction of new mandatory minimum sentences for an unspecified slate of drug crimes.

The Conservatives say they will create an awareness campaign targeted at young people and their parents, fund new treatment services and launch a national youth intervention program to divert young drug users into assessment and treatment programs instead of detention.
On the enforcement side, they plan to direct resources at identifying and closing down grow-ops, pay for more enforcement measures at the border and ramp up the RCMP's Proceeds of Crime Program.

Gone are any musings, such as those of the previous Liberal government, about decriminalization of so-called softer drugs such as marijuana.

Critics have ripped apart the government's strategy on many fronts, especially Mr. Harper's unwillingness to embrace harm-reduction measures such as those offered at Insite, Vancouver's safe-injection site. It allows addicts to safely inject illegal dugs and connect with health professionals who can direct them toward treatment.

The government this week extended funding to that program but only for six months so it can be further studied.

“I remain a skeptic that you can tell people that we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use but somehow we will keep you addicted but reduce the harm just the same,” Mr. Harper said of the Insite program. “If you remain a drug addict, I don't care how much harm you reduce, you are going to have a short and miserable life.”

But Thomas Kerr, a professor in the University of British Columbia's Department of Medicine who has studied Insite and its effect on the prevention of the spread of HIV-AIDS, said Mr. Harper is ignoring the facts.

“The government continues to misrepresent the science around harm reduction. In the case of Insite we have shown that there has been a 33-per-cent increase in the rate of entry into detox programs,” Dr. Kerr said. “In no way is the facility perpetuating addiction. In fact, it's helping people quit drug use.”

Leon Mar of the Canadian HIV/AIDS Legal Network said education programs, such as the one proposed by the government, have previously proved ineffective. Health Canada's own review of the Drug Abuse Resistance Education program implemented widely across Canada, he said, has shown that the program does not prevent or delay drug use.

Vancouver safe-injection site can operate until June under six-month extension

2007-10-17T11:17:00.000-07:00

Vancouver safe-injection site can operate until June under six-month extension
BY STEPHANIE LEVITZ
CP
1116 words
2 October 2007
19:56
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.

VANCOUVER _ Ottawa's six-month reprieve for Vancouver's safe injection site simply allows the government to shelve the issue until after a possible fall election, leaving a suffering community in limbo, supporters of the site said Tuesday.

Though they applauded the announcement from the federal government that Insite can remain open until next June, doctors, community activists and opposition politicians said they are frustrated that a health issue has become a political football.

Health Canada announced Tuesday it would extend the exemption from Canada's drug laws that allows Insite to operate. The exemption was set to run out at the end of the year.

``I think what this is an indication of is that the government is currently really trying to sit out the issue of Insite rather than making a decision one way or another that inevitably would offend a lot of people on one side or another,'' said Benedikt Fischer, director of the Illicit Drugs, Public Health and Policy Unit at the Centre for Addictions Research of B.C.

``That problem is postponed but not resolved.''

The former storefront provides a place for addicts to safely inject themselves with their own heroin under the supervision of medical staff.

A spokeswoman for Health Canada said the exemption will allow further research.

``It's for the purposes of research into the impact of such sites on prevention, treatment and
crime,'' said Jirina Vlk, acting head of communications for the department.

Reams of research have been done on Insite since it opened in Vancouver's beleaguered Downtown Eastside in 2003.

The studies examining the centre have included results showing drug addicts who used the program were more likely to enrol in detox programs, more likely to start methadone replacement programs and reduce their number of monthly visits to shoot up.

In August, a group of 130 prominent doctors, scientists and public health professionals endorsed a commentary published in the journal Open Medicine that said the injection site was being judged by a different standard than other health measures.

``Harm reduction has now been shown to be effective _ Insite in particular _ on a variety of fronts and I think that the real issue is when are we going to finally agree to expand the role of Insite both in terms of the hours of operation and the number of people we can serve,'' Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS in Vancouver, said Tuesday.
The centre has led many studies into the centre's work.

``The federal government at this time has taken the strategy, if you want, of giving us a piecemeal licence to operate and the latest effort, let's be clear, sounds a lot like a political effort to get this issue off the table in case an election be called. We cannot accept this kind of behaviour.''

When the site was approved in 2003, Vancouver officials applied for an exemption from the Controlled Drugs and Substances Act, which makes the use of heroin illegal.

The site was granted a three-year exemption for the purposes of a pilot study on the site's impact.

Federal Health Minister Tony Clement had announced in September 2006 the exemption would be extended until December of this year to allow for further study.

The Vancouver Coastal Health Authority had requested an extension for three and a half years.
Former Vancouver mayor Larry Campbell, now a Liberal senator, said he doesn't even believe the exemption is needed because he said it's unclear how the law would be enforced without the exemption.

``I realize that the Conservative government has a difficult time because they can't seem to find any substantiated evidence that would back their Neanderthal response,'' he said.

``The fact is that this is a health-care facility and it should be left open and expanded in many places across Canada.''

Clement also said in 2006 that a new National Drug Strategy would need to be in place before the government considered allowing any other supervised rejection sites to open in Canada.
The minister said in an interview with The Canadian Press last week that strategy is expected this week.

Mark Townsend, of the Portland Hotel Society which runs Insite, called Tuesday's announcement depressing and a distraction from the real problems facing addicts on the Downtown Eastside.

``We've got people that are sick, people that are dying, mentally ill people living in crummy hotels,'' said Townsend.

``There's loads to do and the supervised injection site is important but really they just need to accept that the evidence is in and they do the right thing.''

Back in April, Health Canada put out a request for proposals for further study connected with Insite, asking for input on health issues, public order and safety issues and similarities and differences between Vancouver and other Canadian cities.

Townsend said several noted researchers in the field declined to apply for the grants because of a gag order that would prohibit them from talking about their findings unless given approval from the government.

``The prime minister is out there trying to find a researcher that will tell him the world is flat, so he's got an excuse to cut it,'' Townsend said.

A Simon Fraser University criminologist who was told last week that he won one of the grants said his work will examine the impact of the site on crime in the Downtown Eastside.

``We're going to be doing interviews, detailed interviews, with a sample of police, residents, business owners in the vicinity and social service agencies,'' Prof. Neil Boyd said.

``We're also hoping to use police data, calls for service and arrest data, to determine whether there have been changes in activity over time at the site.''

His research will be submitted to the government in February.

Vancouver Mayor Sam Sullivan welcomed the government's announcement, which came on the same day that the city was considering a report on substitution treatment for people with drug addictions in the city.

The 34-page report looks at the use of opiate replacement drugs, like methadone, and also a North American study being carried out in part in Vancouver that prescribes legal opium to addicts.

The report also outlines five clinical trials the city would like to run in conjunction with the Inner Change Society and Chronic Addiction Substitution Treatment program announced earlier this year.

The report was approved by city council and the mayor plans to ask the federal government to fund the studies under the new National Drug Strategy

Fate of safe-injection site remains up in the air

2007-10-17T11:16:00.000-07:00

SIX-MONTH REPRIEVE
National News
Fate of safe-injection site remains up in the air
IAN BAILEY
490 words
3 October 2007
The Globe and Mail
A4
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

VANCOUVER -- The federal Health Minister has cleared Vancouver's safe-injection site to operate for another six months, but critics say the decision announced yesterday does nothing to clear up uncertainty about the fate of the controversial operation that provides a safe place for drug addicts to use heroin or cocaine.

In a terse statement, Tony Clement said he would allow Insite a continued exemption under Section 56 of the Controlled Drugs and Substances Act that allows the use of otherwise illegal drugs by clients at the facility in the poverty-stricken Downtown Eastside.

The extension runs until June 30, 2008. “[It] will allow research on how supervised injection sites affect prevention, treatment and crime to be continued for another six months,” the statement said.

The minister was not available for comment. His press secretary, Laryssa Waler, would only refer to the statement's point about additional research when asked for further comment.
Perry Kendall, B.C.'s provincial health officer, said he thought enough research had already been done on Insite, which opened in 2003.

Insite has been credited with helping to reduce overdoses and drug-related disease. Clients bring their own drugs to the site with a freedom allowed by the exemption Mr. Clement has renewed for the second time. The B.C. government finances the program.

In comments that reflect a broad consensus of support, Premier Gordon Campbell earlier this week urged the Tories to maintain Insite, calling it “part of the solution” to issues of drug addiction.

Mark Townsend, a community worker for the Portland Hotel Society, which operates Insite in partnership with the Vancouver Coastal Health Authority, said the uncertainty is a stress for clients, staff and medical officials working with the operation.

“It's like constantly debating the same tiny speck of dust,” Mr. Townsend said. “It's stressful on the ground for the human beings, the doctors and nurses involved with it. It's stressful for the people who work in the bureaucracy and care about people on the ground and are trying to put together programs that help people.

“The clients do get stressed about it as well. It's like you're constantly about to be fired from your job.”

Mr. Townsend echoed the view of many observers, including NDP and Liberal MPs in Vancouver, that the Tories are reluctant to shut down Insite while an election is possible, so they have put the issue on ice for now.

Libby Davies, NDP MP for Vancouver East, said the Tories are “playing politics” with an important community asset, central to helping protect drug users from disease, overdoses and other harm. Insite is located in Ms. Davies's riding.

She predicted a community fight to save the facility. “People know they will have to gear up for another campaign to keep Insite going,” she said.

DRUG POLICY Editorial The wrong way to go

2007-10-17T11:15:00.000-07:00

DRUG POLICY
Editorial
The wrong way to go
413 words
3 October 2007
The Globe and Mail
A20
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

‘The party's over,” federal Health Minister Tony Clement intoned this past weekend. Mr. Clement was talking about drug users, but it wasn't entirely clear which ones. It might have been otherwise law-abiding citizens who occasionally smoke marijuana. Or perhaps it was all those partiers suffering from debilitating addictions to hard drugs such as heroin and crack cocaine. Either way, Mr. Clement appears to have borrowed his rhetoric from the 1980s. To go with it, he appears set to borrow the disastrous “War on Drugs” strategy from south of the border.

This week, the federal government is set to unveil a new $64-million anti-drug strategy. Some of its anticipated components, including more money for treatment programs and a crackdown on drug smuggling at the border, are worthwhile. But the government is also reportedly set to shift away from harm-reduction programs. In their place, it is expected to launch both an anti-drug messaging campaign targeting teenagers and a crackdown on illegal drug use – presumably meaning more criminal charges against both hard- and soft-drug users.

All the available evidence suggests that this will be a waste of time and money. Worse, it could cost some lives and ruin others. The overwhelming body of research shows that harm-reduction strategies such as Insite, the Vancouver safe-injection site for heroin users, succeeds in limiting the health and social costs of addiction, preventing deaths from overdose and disease and directing addicts toward treatment. Yet rather than expand such programs, the government is reluctant even to keep Insite going; it announced yesterday that the site will be allowed to operate through June of next year, but refused to confirm its long-term future. As much of the rest of the world recognizes addiction for the disease it is, the Conservatives appear poised to revert to treating it like a crime. Meanwhile, rather than continue with the previous government's plan to decriminalize possession of small amounts of marijuana for personal use, they will ensure that more Canadians are saddled with criminal records for indulging in a substance no more harmful than alcohol or tobacco.

This new strategy may play well with some members of the Conservatives' base. But as evidenced by what has transpired in the United States, it will do absolutely nothing to reduce drug use. Its only effect will be to make the effects of substance abuse all the more painful.

Ottawa adopting failed U.S.-style "war on drugs"

2007-10-17T11:13:00.000-07:00

Ottawa adopting failed U.S.-style "war on drugs"
533 words
1 October 2007
09:30
Canada NewsWire
English
Copyright © 2007 Canada NewsWire Ltd. All rights reserved.

TORONTO, Oct. 1 /CNW/ -- New National Anti-Drug Strategy plays politics with people's lives

TORONTO, Oct. 1 /CNW/ - The new National Anti-Drug Strategy to be officially unveiled this week by federal Health Minister Tony Clement is a huge step backward for Canada's response to HIV/AIDS, said the Canadian HIV/AIDS Legal Network today.

The new strategy funds law enforcement, prevention and treatment programs - three of the four so-called "pillars" common in many drug strategies. But the fourth pillar, harm reduction - which includes needle exchanges, methadone clinics and safe-injection facilities - has been eliminated.

"The federal government is ignoring widely published scientific evidence on the value of investing in harm reduction programs," said Richard Elliott, Executive Director. "It seems clear that the new drug strategy is based on ideology instead of evidence, and from every angle - human rights, public health, or use of taxpayers' dollars - that's irresponsible and unacceptable."
Even worse, Minister Clement is sowing confusion by claiming that other measures, such as law enforcement, constitute harm reduction in their own right.

"This is just smoke and mirrors," said Elliott. "The reality is that some people can't or won't stop using drugs. Harm reduction pragmatically and realistically acknowledges this fact by providing evidence-based programs and services to lessen the harms associated with drug use. Arresting and imprisoning people can't be considered harm reduction."

The new drug strategy apes the failed U.S. approach of treating drug addiction primarily as a criminal matter, rather than a matter of public health. But despite spending billions of dollars on its "war on drugs," not a dent has been made in reducing either drug supply or drug consumption in the United States. Rather, the establishment of "get-tough" criminal approaches to drug addiction has filled U.S. prisons with non-violent, often small-scale offenders.

Relying on criminal law inevitably also leads to increased fear, stigma and discrimination. As a result, many people hide their drug use, which usually means avoiding the public health and harm reduction programs that could help treat them. Insite, Vancouver's safe injection facility, is one such program.

"The facts speak for themselves: Insite has lowered the rates of syringe-sharing and deaths from overdoses, reduced the risk of HIV and hepatitis C transmission, and increased the chances of directing drug users to addiction treatment services," said Elliott. "Instead of mounting a public misinformation campaign, Minister Clement and his government should be sharing these facts with Canadians to explain why funding harm reduction programs like Insite is a responsible investment in public health."

About the Canadian HIV/AIDS Legal Network
The Canadian HIV/AIDS Legal Network ( www.aidslaw.ca ) promotes the human rights of people living with and vulnerable to HIV/AIDS, in Canada and internationally, through research, legal and policy analysis, education, and community mobilization. The Legal Network is Canada's leading advocacy organization working on the legal and human rights issues raised by HIV/AIDS.

OTTAWA'S NEW SUBSTANCE-ABUSE STRATEGY

2007-10-17T11:11:00.000-07:00

OTTAWA'S NEW SUBSTANCE-ABUSE STRATEGY
National News
Get-tough plan on drugs doomed, experts say; Liberal MP calls Tories' policy a triumph of ‘ideology over science,' urges medical, not moral, approach to issue
ANNE McILROY
SCIENCE REPORTER
647 words
1 October 2007
The Globe and Mail
A4
English
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

Canada's war on drugs is about to escalate. But as the federal Conservative governments prepares to unveil a new strategy that cracks down on illicit drug users, critics say they are ignoring a mountain of research that shows the get-tough approach doesn't work.

“This is a failed approach. The experiment is done. The science is in,” says Thomas Kerr, a researcher at the University of British Columbia and member of the university's faculty of medicine.

The $64-million anti-drug strategy, to be announced in the next few days, is expected to include stiffer penalties for drug offenders and more money to stop drugs getting across the border. There will also be a massive campaign to warn young people not to use drugs.

It is not expected, says Liberal MP Keith Martin, to include money for what experts call “harm reduction.” These are programs such as Vancouver's controversial safe injection site, where heroin addicts can shoot up in a sterilized, supervised setting.

The idea behind harm reduction is to reduce the health effects of drug use without requiring people to beat their addiction. Experts compare it with smokers using a nicotine patch; people still get their fix, but it is vastly preferable to smoking a pack a day.

A study published by Dr. Kerr and his colleagues last year found that the Vancouver supervised injection site, known as Insite, reduced the risk of overdoses and encouraged more users to seek treatment. It did not increase crime in the neighbourhood, nor lead to increased drug use.

But Prime Minister Stephen Harper has said he does not think the site should receive federal health money, and Health Canada must make a decision about the future of Insite by the end of the year.

Dr. Martin, a physician from British Columbia, says the Conservatives' approach is a triumph of “ideology over science.” While he supports more money for police to go after drug dealers or
organized crime, Dr. Martin says substance abuse needs to be treated as a medical problem, not a moral one.

That's the approach taken in many European countries that have much lower rates of illicit drug use than Canada, he said.

Erik Waddell, a spokesman for Health Minister Tony Clement, said yesterday that the minister was travelling and would not be available for an interview.

Mr. Waddell said he couldn't discuss the details of the new strategy either. But earlier this year, he told The Globe and Mail that the Conservatives disagreed with the Liberals' approach. “In every poll, when Canadians are asked whether they want more law enforcement or less, they want more. So the bottom line is that Canada's new government will be taking a different approach.”

The Liberals had put forward a bill to decriminalize the possession of small amounts of marijuana, but the Conservatives did not reintroduce it after taking office in early 2006.
But the Liberals were also harshly criticized – by academics, doctors and the federal auditor-general – for focusing too much on enforcement.

The current drug strategy, which was renewed in 2003, devotes almost three- quarters of its resources to enforcement. Only 3 per cent of the annual $245-million goes to prevention, and another 3 per cent to harm reduction.

Barney Savage, director of public policy at the Centre for Addiction and Mental Health in Toronto, says law enforcement is extremely important, but so is prevention, treatment and harm reduction. “You have to balance the law enforcement perspective with the health perspective.”

The Canadian Association of Chiefs of Police also advocates a balanced approach in dealing with drug abuse and addiction issues.

Harper government to unveil get-tough national drug strategy CP

2007-10-17T11:09:00.000-07:00

Harper government to unveil get-tough national drug strategy
BY TERRY PEDWELL
CP
822 words
29 September 2007
15:35
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.

OTTAWA _ Health Minister Tony Clement will announce it's anti-drug strategy this week with a stark warning: ``the party's over'' for illicit drug users.

``In the next few days, we're going to be back in the business of an anti-drug strategy,'' Clement told The Canadian Press.

``In that sense, the party's over.''

Shortly after taking office early last year, the Conservatives decided not to go ahead with a Liberal bill to decriminalize small amounts of marijuana.

Since then, the number of people arrested for smoking pot has jumped dramatically in several Canadian cities, in some cases jumping by more than one third.

Toronto, Vancouver, Ottawa and Halifax all reported increases of between 20 and 50 per cent in 2006 of arrests for possession of cannabis, compared with the previous year.

As a result thousands of people were charged with a criminal offence that, under the previous Liberal government, was on the verge of being classified as a misdemeanour.

Police forces said many young people were under the impression that the decriminalization bill had already passed and were smoking up more boldly than they've ever done before.

Clement says his government wants to clear up the uncertainty

``There's been a lot of mixed messages going out about illicit drugs,'' Clement said in an interview Saturday after a symposium designed to bring together Canada's arts and health communities to combat mental health issues.

There's also a health-care cost element to suggesting to young people that using illicit drugs is OK, the minister said.

``The fact of the matter is they're unhealthy,'' Clement said.

``They create poor health outcomes.''

For too long, Clement argues, governments in Canada have been sending the wrong message about drug use. It's time, he says, to take a tougher approach to dealing with the problem.

``There hasn't been a meaningful retooling of our strategy to tackle illicit drugs in over 20 years in this country,'' Clement said.

``We're going to be into a different world and take tackling these issues very seriously because (of) the impact on the health and safety of our kids.''

The Conservatives' wide-ranging $64 million anti-drug strategy is expected to combine treatment and prevention programs with stiffer penalties for illicit drug use, and a crackdown at the border against drug smuggling.

Justice Minister Rob Nicholson and Public Safety Minister Stockwell Day will join Clement in announcing the plan as part of a range of initiatives to be unveiled by the Tories surrounding next month's throne speech.

Clement said treatment and prevention programs were his key priorities for the health element of the drug strategy.

``Yes, there's a justice issue to that,'' he said.

``But there's also a treatment issue, there's also a prevention issue.''

Clement has suggested in the past that he opposes so-called harm reduction strategies for combating illegal drug use, including safe-injection sites where nurses provide addicts with clean needles and a safe place to use drugs.

At a Canadian Medical Association meeting last month, he was quoted saying ``harm reduction, in a sense, takes many forms. To me, prevention is harm reduction. Treatment is harm reduction. Enforcement is harm reduction.''

The following day, a petition signed by over 130 physicians and scientists was released, condemning the Conservative government's ``potentially deadly'' misrepresentation of the positive evidence for harm reduction programs.

Vancouver's Insite safe injection clinic is facing a December 31 deadline for the renewal of a federal exemption that allows it to operate.

Critics of the Conservative government's approach to illicit drug use say the federal government would be making a serious mistake by failing to renew the exemption.

``I think there's very little chance that Mr. Clement will extend the safe injection site's permit to continue,'' says Dr. Keith Martin, a British Columbia Liberal MP and former substance-abuse physician.

``But in doing that they will be essentially committing murder.''

Advocates say safe-injection sites help to prevent the spread of serious diseases, including AIDS and Hepatitis by preventing users from sharing needles while opponents say the sites simply promote illegal drug use.

Martin says he's all for increasing penalties for people who sell illegal drugs, including gangsters, but wonders why the Tories would want to target users when he says similar strategies in other countries haven't worked.

``I can't understand why the Conservatives are embracing a war-on-drugs approach that has proven to fail,'' he said.

``By all means, go after the pushers. By all means, absolutely go after the organized crime gangs that are the real parasites in this situation,'' he added.

``But for heaven's sake, treat the user as a medical problem and adopt the solutions that have proven to work in other countries.''

The other point of view: Canada's Shooting Gallery

2007-10-17T11:00:00.000-07:00

Some journalism biased in the other direction...

Canada's Shooting Gallery
By Mary Anastasia O'Grady
1165 words
27 August 2007
The Wall Street Journal
A10
English
(Copyright (c) 2007, Dow Jones & Company, Inc.)

Vancouver, British Columbia -- Early on a cool, rainy morning here last week, I decided to walk from my hotel in the most fashionable quarter of this fashionable West Coast metropolis to the "Downtown East Side." I was going to see an old friend, who in his retirement years has joined a Catholic ministry dedicated to outreach among the prostitutes in this notoriously seedy area. I wanted to visit the neighborhood where he works, in part, because it also happens to be where provincial authorities have set up a "safe injection site" for drug addicts. Many of the young women on the streets are hooked on opiates.

When I asked for directions from the hotel concierge, her eyebrows went up and she asked me what time of day I would be going. "As long as it's early and you stick to Pender Street, you should be OK," she said, tracing a path for me on a map.

Her advice, I later realized, was another way of saying, "stay off East Hastings Street," the epicenter of life for drug users here and the location of "InSite," North America's only legal, government-sponsored, injection clinic. Later that morning, as my friend showed me around the neighborhood in his car, I saw why. The sidewalks in front of the clinic were lined with addicts, and for blocks in both directions, all humanity looked sick, drawn, impoverished and defeated. In the gloom of a drizzly, cloud-covered Sunday morning, I felt I had entered one of Dante's inner circles of suffering.

Like most wealthy societies, Canada struggles with the problem of drug addiction. Prohibition was supposed to limit the supply of evil weeds, and thus the temptation to experiment with addictive chemicals. Yet decades of drug laws have had little effect, if any, on the availability of mind-altering substances and their corrosive effects on some part of the population.

While the benefits of prohibition are hard to discern, the cost of the war on drugs is quite clear. Inside the borders of rich countries, the large profits make vigorously pushing illegal substances worth the risk. Children, even in rural areas, are an especially attractive target under the black-market pricing structure. Addicts have to pay dearly; yet, like all intelligent vendors, dealers offer "introductory prices" for beginners. For criminals, prohibition profits make weapons, information technology and bribery of law-enforcement officials easily affordable.

These days Canadians are all too familiar with the price of the drug war outside their borders. Their military is now engaged in some of the heaviest fighting in Afghanistan, where reports from the field suggest that what is making the mission so difficult, at least in part, is the fact that the bad guys have enlisted support from the poppy growers who serve the heroin trade.
Organized crime is also flourishing in the Western Hemisphere. Colombian society has been shredded by drug cartels and, more recently, by narcotrafficking left-wing guerrillas and right-wing paramilitaries. The U.S. effort to block Caribbean transit routes sent the traffickers into Central America and Mexico. Since taking office in July 2006, Mexican President Felipe Calderon has made defeating the drug lords a priority. The Calderon crackdown has produced a spike in violence in the past year, claimed the lives of numerous Mexican law-enforcement officials and, if reports from the border are true, is now having a spillover effect in the Southwestern U.S. Yet the drugs keep coming, answering the demand.

This record suggests that attacking supply as a way to reduce demand is fighting a losing battle. Sophisticated economists -- most notably the late Milton Friedman -- have argued that the power of the market is just too great and that the unintended consequences are bound to cause both more bloodshed and more corruption.

Yet even though the war on drugs has been an obvious failure, Canada's experimental approach is hardly a promising alternative. Vancouver's InSite is simply horrifying in different ways. I didn't venture inside the clinic itself, but someone who has describes "bright white lights and a cold clinical setting," with the obligatory "absolutely no smoking" sign hanging at the entry. The idea is that junkies are going to use anyway so the state should help lower the risk, being careful, of course, not to pass judgment. The drugs are illegal, but in the interest of "harm reduction," the state will provide sanitary injection services. "Come right in, get your fix. There, you feel better, don't you?"

This is like something out of Aldous Huxley's novel, "Brave New World." Utilitarian big government discovers a low-cost, efficient method of getting the dregs of society out of everybody's hair. All it takes are sterile needles and mind-numbing drugs supplied by the addicts themselves. Leaving aside the quaint notion that putting oneself in a perpetually medicated state may not be the best way to reach one's human potential, the clinic's approach is hugely problematic. Even the most pro-legalization libertarians would have to agree that a government that engages in drugging the citizenry is pretty far removed from the classic definition of the modern liberal state.

Canada is now debating this issue. A group of 130 Canadian scientists and doctors recently published a statement arguing that InSite has been successful because there has been "reduced needle sharing, decreased public drug use, fewer publicly discarded syringes, and more rapid entry into detoxification services by persons using the facility." But last week Health Minister Tony Clement suggested that other studies have drawn far less happy conclusions. Critics of "harm reduction" programs say that despite free needles, junkies tend to share anyway and that addicts continue to sell sex and spread disease. They also note that signing up for "detoxification" is a far cry from rehab and it's not the least bit clear that needle clinics are paths to treatment.

There is another problem as well with the nanny province getting into the drug injection business: It adds to what one British Columbian described to me as "the growth of the poverty industry" in Vancouver. The bureaucracy that exists to "serve" the drug-dependent community has little interest in seeing the problem go away and, with it, their jobs. Here, as in many other arenas, there is a normal bureaucratic impulse to expand, broadening the state's subsidization of dependency. Viewed in this light, a state-sponsored shooting gallery is good for business.
Something is also very wrong when society officially winks at its own prohibition laws. Indeed, InSite demonstrates that encouraging drug use through the welfare state while at the same time attempting prohibition is not just illogical. It also produces the worst of all worlds.

(See related letters: "Letters to the Editor: Down in the Trenches in a War That Can't Be Won" -- WSJ Aug. 30, 2007)

Safe-injection site adding detox beds and housing

2007-10-17T10:59:00.000-07:00

Safe-injection site adding detox beds and housing
Canadian Press
152 words
27 August 2007
Guelph Mercury
Final
A5
English
Copyright (c) 2007 Guelph Mercury.
VANCOUVER

Addicts who shoot up their own drugs at the city's safe-injection site will soon have a place to start getting clean as the facility expands to include detox beds and short-term housing.

As of mid-September, IV drug users at the supervised injecting facility called Insite won't have to wait for detox beds elsewhere, but can instead go directly into detox on the second floor of the same building where they've been getting their fix.

The detox floor will include 12 rooms, each with its own bathroom, a common area, kitchen and exam room, where professionals will assess users and provide counselling.

Those who are homeless or don't want to go back to living in an unsafe place where people are using can then move up to the third floor for temporary shelter.

Editorial, Globe and Mail, SAFE INJECTION SITES

2007-10-17T10:58:00.000-07:00

SAFE INJECTION SITES
Editorial
Renew Insite's licence
626 words
27 August 2007
The Globe and Mail
A14
English
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.

Illegal drug study says number of deaths high in Downtown Eastside

2007-10-17T10:57:00.000-07:00

Illegal drug study says number of deaths high in Downtown Eastside
CP
723 words
23 August 2007
16:42
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.
VANCOUVER (CP) _ Residents of the poverty-riddled Downtown Eastside have seven times the provincial rate of drug-induced deaths, says a report on drug use in Vancouver.
The report from the Canadian Community Epidemiology Network on Drug Use says deaths from illicit drug use were down in Vancouver and the rest of British Columbia for 2006.
Downtown Eastside residents have a 33 per cent higher death rate than the rest of the province.
The report released Thursday says Vancouver's rate of newly diagnosed hepatitis C cases declined from 2006 and new cases of HIV were down from 2005 in connection to intravenous drug use.
The report also says the volume of ecstasy seized by police in 2005 was more than 40 times that seized in 2002.
``This document provides a unique snapshot of the state of drug use in the city,'' Dr. Jane Buxton, Vancouver site co-ordinator, said in a news release.
``Our hope is that we can empower people with a basic understanding of some of the issues involved so that they can begin to do something about it.''
The group says the study was done to provide policy makers and community leaders with better information to help develop harm reduction and prevention techniques to reduce drug use.
The report found the life expectancy for men in the Downtown Eastside, ``the centre of the injection drug use epidemic in Vancouver,'' is nine years less than for Vancouver overall and three years less for women.
In 2006, there were 131 illicit drug deaths in British Columbia, 42 of them in Vancouver, compared with 146 deaths in B.C. and 46 deaths in Vancouver the previous year.
``There has been a dramatic decline in the number of illicit drug deaths in both Vancouver and B.C. since 1998,'' the report said.
Since 2003, the number and proportion of First Nations people to die from illicit drug use has increased to an average of 17 a year or 10 per cent of deaths.
In the 2001 census, 4.4 per cent of B.C. residents identified themselves as aboriginal.
The Downtown Eastside has a higher rate of tuberculosis than Vancouver or British Columbia.
``Challenges to TB control include unstable housing, mobile populations (including populations moving back and forth between the Downtown Eastside and their rural or reserve home communities), and addictions, co-morbidities and non-compliance to TB treatment.''
Studies in top international journals, including the Lancet and British Medical Journal, suggest Vancouver's safe-injection site, where users are given clean needles to inject their drugs, reduces the chance of people passing along infections such as HIV.
But in order to allow the safe-injection site to operate the federal government must grant an exemption from the Controlled Drugs and Substances Act.
The clinic's current exemption lasts until the end of the year and Health Minister Tony Clement has said he wants comprehensive research on the clinic before giving the further operating approval.
The report says between December 2003 and March 2005 4,764 people used the safe injection site.
Insite ordered 1.2 million sterile needles between April 1, 2006, and Feb. 15, 2007.
``It is important that harm reduction programs attract high-risk users, as the contact presents an opportunity to inform users about safer drug use practices and connect them to health services and drug treatment,'' the report says.
Between March 2004 and August 2005 the drugs most often used at Insite were heroin (40 per cent) and cocaine (28 per cent), as well as morphine, dilaudid, oxycodone, crushed crack cocaine, crystal methamphetamine and Talwin-Ritalin.
A study done before and after the site opened found ``significant reductions in the mean number of injection drug users injecting in public and publicly discarded syringes.''
Vancouver police department statistics indicated there was no increase in drug trafficking, assaults or robberies.
The report said said crack cocaine is one of the commonly used drugs in Vancouver's Downtown Eastside.
``While people of all socio-economic backgrounds use crack people who are homeless, street involved or otherwise living in poverty have high rates of use and experience profound negative health consequences.
``There have been few harm reduction initiatives in Vancouver that specifically target the harms associated with crack use.''

130 scientists urge Ottawa to base Insite decision on science, not ideology

2007-10-17T10:49:00.000-07:00

130 scientists urge Ottawa to base Insite decision on science, not ideology
CP
228 words
21 August 2007
10:58
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.

TORONTO (CP) _ A group of 130 prominent doctors, scientists and public health professionals is calling on the federal government to use scientific evidence, not political ideology, when deciding whether to extend the life of Vancouver's safe injection site.

The group has endorsed a strongly worded commentary on the issue published by Open Medicine, an online medical journal.

In the commentary, Dr. Stephen Hwang says that if government refuses to accept the scientific evidence backing the Insite program it should be transparent about the basis for its objections.
Hwang says the health of the nation is placed in peril if leaders ignore crucial research findings simply because they run counter to a policy agenda driven by ideology or fixed beliefs.

Hwang, a researcher in the Centre for Research on Inner City Health at Toronto's St. Michael's Hospital, says the federal government seems to be judging the safe injection site program by an entirely different standard than it would other health measures.

An exemption that allows the safe injection site to operate expires at the end of this year.
Signatories to the commentary include Dr. Robert Brunham, head of the British Columbia Centre for Disease Control; Dr. Richard Lessard, Montreal's director of public health; and leading HIV-AIDS researcher Dr. Mark Wainberg

The question of charter rights

2007-10-17T10:44:00.000-07:00

Does anyone know the outcome of this court action? It presents an interesting question

Addicts, operator of BC safe-injection site go to court to keep facility open
BY BY CAMILLE BAINS
CP
918 words
17 August 2007
13:30
The Canadian Press
English
(c) 2007 The Canadian Press. All rights reserved.

VANCOUVER (CP) _ Two drug addicts and a group that runs Canada's only safe-injection site have launched court action, saying any effort by the federal government to close the place would violate addicts' Charter rights.

Shelly Tomic and Dean Wilson, along with the Portland Hotel Society which helps operate the facility, filed a statement of claim in B.C. Supreme Court on Friday.

They want the court to declare the operation of Insite, as the facility is known, the exclusive jurisdication of the province and that the federal government shouldn't play any role in its future.

Closing it would be a violation of Tomic's and Wilson's right to ``security of the person,'' the court documents say.

Insite opened four years ago as a pilot project in the Downtown Eastside for IV drug users to inject their own heroin and cocaine with clean needles under the supervision of a nurse.
Addicts who get their fix at the site -- instead of in back alleys and the area's single-room hotels -- can also access referrals to detox and rehabilitation services.

But the future of Insite is currently in Ottawa's hands because in order for the facility to operate, it needs the federal government to grant it an exemption from the Controlled Drugs and Substances Act.

The exemption is set to expire Dec. 31 and federal Health Minister Tony Clement has been noncommital about whether it will be renewed.

``Should Insite close due to the revocation of the exemption. . . Wilson, Tomic and other users will face risk of death or serious harm to their physical and mental health,'' the court documents say.

``In particular, Wilson and Tomic will face increased risks of overdose, infection, decline in their mental and psychological well-being and other health-related complications from drug use.''
The documents go on to say the services provided at Insite are health-care matters and are therefore ``within the exclusive jurisdiction of the province of British Columbia.''

Mark Townsend, director of the Portland Hotel Society, said the ongoing uncertainty is no way to operate a health service for vulnerable people.

``It's not even funded by the federal government, it's 100-per-cent funded by the province, yet they get to give us an extension here and there to create this endless kind of worry,'' Townsend said.

``We'd rather not be in court on this issue but what we really need is just to get the clarification that, really, this is about health care,'' he said.

The site, known as Insite, is the only facility of its kind in North America.

Tomic, a 39-year-old addict with a long history of addiction issues, said she got involved in the legal action because she's seen its positive effects first-hand

``A lot of people will end up dying if they shut it down because with the fear of the police picking them up, they start (injecting) too much just to get it in them before they're caught,'' said Tomic, who was one of the first to use the facility.

Tomic said she's been taking methadone for about 10 months as part of her treatment to withdraw from heroin. And despite staying clean so far, she said she still visits Insite to talk to the staff on days when she feels like relapsing.

Dean Wilson, the other addict named in the statement of claim, credited Insite for keeping him and his two sons alive.

``This is gold-standard medicine,'' Wilson said. ``Addiction is a health issue.

``This is a life-saving measure down here. It may not be a life-saving measure in (Toronto's) Rosedale or Mount Royal in Montreal but in the Downtown Eastside, it is a life-saving measure.''
The court documents note Wilson has been addicted to herion for about 38 years, contracted hepatitis C in 1969 and has had several close calls with overdoses.

The suit says before Tomic and Wilson began getting treatment for their addictions, they stopped in at Insite to inject about six times a day for Tomic and 15 times a day for Wilson.
Dr. Evan Wood, an epidemiologist at the B.C. Centre for Excellence in HIV/AIDS, said 24 studies have pointed to Insite's benefits.

Since 2003, research published in top journals has stated the site reduces public injections, overdose fatalities and the transmission of blood-borne infections like HIV and hepatitis C, Wood said, adding crime hasn't increased in the area despite initial fears by some in the community.

``From a scientific perspective, I believe this is a health issue,'' Wood said, adding he agrees with the court action.

``(Prime Minister) Stephen Harper has failed to show any leadership on this issue and the fact that it's going to the courts now is not surprising,'' he said.

``If the facility closes and somebody contracts HIV or dies of an overdose and has a compelling argument that this wouldn't have happened to them had the federal government not removed this service, then I think that raises legal issues as well.''

Monique Pongracic-Speier, one of three lawyers working on the case for free, said her clients are merely asserting their constitutional rights regarding the use of a facility that's helped them stay alive.

``After all, Insite is about saving lives. That's the bottom line.''

Kerr, Tyndall, Ahang, Lai et al, American Journal of Public Health

2007-10-17T10:31:00.000-07:00

Circumstances of First Injection Among Illicit Drug Users Accessing a Medically Supervised Safer Injection Facility
Kerr, Thomas; Tyndall, Mark W; Zhang, Ruth; Lai, Calvin; Et al
2867 words
1 July 2007
American Journal of Public Health
1228
Volume 97; Issue 7; ISSN: 00900036
English
© 2007 American Journal of Public Health. Provided by ProQuest Information and Learning. All Rights Reserved.

There have been concerns that safer injecting facilities may promote initiation into injection drug use. We examined length of injecting career and circumstances surrounding initiation into injection drug use among 1065 users of North America's first safer injecting facility and found that the median years of injection drug use were 15.9 years, and that only 1 individual reported performing a first injection at the safer injecting facility. These findings indicate that the safer injecting facility's benefits have not been offset by a rise in initiation into injection drug use. (Am J Public Health. 2007;97:1228-1230. doi:10.2105/AJPH.2006.086256)

Medically supervised safer injection facilities, where injection drug users can inject preobtained illicit drugs, have been implemented in various cities to reduce the public health effects of illicit drug use.1 Although evidence suggests that safer injecting facilities reduce overdose deaths,2 HIV risk behavior,3 and public disorder,4 this intervention remains highly controversial,5-7 largely because of concerns that the provision of a legal place to inject drugs may encourage initiation into injection drug use.8,9 Preventing initiation into injection drug use is a key public health priority,10 and it is noteworthy that fears regarding potential increased rates of injection drug use were among the reasons for the US federal ban on funding for needle exchange programs.9

In the light of concerns regarding the potential of safer injecting facilities to promote initiation into injection drug use,11 we examined length of injecting career and circumstances surrounding initiation into injection drug use among a cohort of users of a safer injecting facility in Vancouver, British Columbia. The Vancouver safer injecting facility-known as Insite-opened in September 2003 as part of a 3-year pilot study.

The Scientific Evaluation of Supervised Injecting (SEOSI) cohort has been described previously.12 In brief, the SEOSI participants were a representative sample of users of the Insite safer injecting facility derived through random recruitment at the Insite facility. During study visits, blood samples for HIV and hepatitis C virus testing were drawn and a questionnaire was administered to elicit demographic and other information, including drug use and HIV risk-associated behavior.

METHODS
First, we examined length of injecting career. To avoid the potential bias resulting from participants' potential unwillingness to report that their first injection was within the safer injecting facility, we calculated duration of injection drug use by subtracting each participant's age at first injection from the participant's current age rather than asking this question directly. Later in the interview, we assessed the circumstances surrounding initiation into injection drug use among SEOSI participants. Variables of interest included injection by someone else during first injection, injection with a used syringe during first injection, and location of first injection (including within the safer injecting facility). As a subanalysis, we compared the overall rate of initiation into injection drug use among SEOSI participants since the safer injecting facility had opened with the expected rate of initiation among local street youths during a similar follow-up period.

RESULTS
Overall, 1065 participants completed surveys from December 1, 2003, to October 21, 2005 (Table 1). The median age of the participants was 39 years (range= 19-64 years); 312 (29%) participants were women. The median number of years of injection drug use was 15.9 (interquartile range=8.6-25.9). High levels of HIV risk-associated behavior at the time of initiation into injection drug use were reported: 213 (20%) participants reported that their first injection was performed with a used syringe, and 796 (75%) participants reported that they were injected by someone else during their first injection. One man reported performing his first injection within the safer injecting facility. On die basis of the difference between age at first injection and current age, we calculated that an additional 14 individuals had initiated injection drug use since the opening of Insite, all of whom did not report performing their first injection within the facility. When these data were extrapolated to the entire population of safer injecting facility's users (i.e., approximately 5000 individuals),13 the estimated number of injection drug users who may have initiated injection drug use inside and outside the safer injecting facility were 5 (95% confidence interval [CI] =2, 12) and 70 (95% CI= 55, 80), respectively.

For comparison purposes, we estimated the rate of initiation into injection drug use that might be expected among the estimated 1250 Vancouver street youths during a single year.14,15 On the basis of published estimates of the annual incidence of first injection among Canadian street youths (8 per 100 person-years),16 one can estimate that approximately 100 (95% CI=81, 122) Vancouver street youths initiate injection drug use each year. This rate is higher than the rate observed among users of safer injecting facilities overall, and street youths represent only a small fraction of the local population that is at risk for initiating injection drug use on an annual basis. The 14 individuals who initiated injection drug use outside of the safer injecting facility likely did so completely independently of the existence of the safer injecting facility. Thus, the values that are most relevant for comparison are likely the estimated rate of initiation among street youths (100; 95% CI=81, 122) and the estimated rate of initiation within the safer injecting facility (5; 95% CI=2, 12).

DISCUSSION
Our findings indicated that most users of the safer injecting facility were long-time injection drug users, and we found no evidence to suggest that the safer injecting facility prompted elevated rates of initiation into injection drug use in the community. In fact, the median years of injection drug use among users of safer injecting facilities were greater tìian the median years of injection drug use (10; interquartile range=4-20) among participants in another cohort study of local injection drug users (the Vancouver Injection Drug Users Study).17 Although 1 individual reported performing his first injection at the safer injecting facility, even when we included individuals who initiated injection drug use outside the safer injecting facility, the overall rate of recent initiation into injection drug use among users of the safer injecting facility was markedly lower than the estimated background community-level rate of injection initiation.16,18
The negligible number of new injectors observed in the Vancouver safer injecting facility compares favorably with the proportions observed in European safer injecting facilities.11 Our findings also may reflect rules that prevent first-time injectors from using the safer injecting facility. More specifically, the staff members at the safer injecting facility ask all new visitors to the facility to sign a waiver indicating that they have injected previously, and it is known in the community that first-time injectors are prohibited from using the facility.

The findings pertaining to risky behavior during first injections were consistent with those of previous studies19 and indicated the need for interventions to prevent initiation into injection drug use and programs that promote safer injecting practices among new injectors. Given the high rates of syringe borrowing and assisted injection during the first injections reported among participants in this study, rules preventing first-time injectors from using the safer injecting facility should potentially be reevaluated. For example, perhaps first-time injectors could inject at the safer injecting facility if, after a careful assessment, an addiction counselor determined that the individual was unlikely to act on referrals to abstinence-based treatments and remained highly likely to initiate injection drug use.

This study relied on self-reports that may have been susceptible to socially desirable reporting. Although studies indicate that injection drug users may underreport undesirable behaviors, participants were blinded to this eventual use of the data, and therefore, we have no reason to believe that our estimates were biased. This assumption was further supported by the fact that our primary outcome was calculated by subtracting the age at first injection from the participant's current age rather than asking directly about years of injecting. However, we recognize tìiat socially desirable responding may have biased our estimates of the number of first injections performed at the safer injecting facility among the 14 individuals who initiated injection drug use after the safer injecting facility opened. Regardless, even if we assume that all of these individuals initiated injection drug use at the safer injecting facility, the rate of initiation into injection drug use among users of safer injecting facilities still would be lower than the rates that have been reported among similar at-risk populations.

Also, even though we generalized the rates observed in the SEOSI cohort to the overall cohort of users of the safer injecting facility, we thought that this was justifiable because SEOSI was based on a random sample and because previous comparisons between the SEOSI cohort and the overall cohort of users of the safer injecting facility have shown the 2 populations to be statistically similar.12 A further potential limitation of our study pertains to our comparison of rates of initiation into injection drug use from other settings and from previous years. We recognize that contextual and temporal differences may have limited the appropriateness of these comparisons, but local estimates were unavailable.

We found that the Vancouver safer injecting facility is used by individuals with long injecting careers and that users of the safer injecting facility were almost universally long-term injectors. Together, these findings indicate that the reported benefits of the safer injecting facility on HIV risk-associated behavior and public disorder were unlikely to have been offset by negative effects of increased rates of initiation into injection drug use.

References
1. Kimber J, Dolan K, van Beek I, Hedrich D, Zurhold H. Drug consumption facilities: an update since 2000. Drug Alcohol Rev. 2003;22:227-233.
2. Poschade S, Hoger R, Schnitzler J. Evaluation of the Work of the Drug Consumption Rooms in the Federal Republic of Germany [in German]. Final Report on Behalf of the Federal Ministry for Health. Baden-Baden, Germany: Nomos; 2003.
3. Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005;366:316-318.
4. Wood E, Kerr T, Small W, et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ. 2004;171:731-734.
5. Strang J, Fortson R. Supervised fixing rooms, supervised injectable maintenance clinics- understanding the difference. BMJ. 2004;328:102-103.
6. Wright NM, Tompkins CN. Supervised injecting centres. BMJ. 2004;328:100-102.
7. Capozza KL. U.S., Canada spar over anti-drug policies. United Press International. September 16, 2003.
8. Vancouver's heroin users get safe-injection site. Canadian Broadcasting Corporation September 15, 2003.
9. Vlahov D, Des Jarlais DC, Goosby E, et al. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. Am J Epidemiol. 2001;154(12 suppl):S70-S77.
10. Vlahov D, Fuller CM, Ompad DC, Galea S, Des Jaríais DC. Updating the infection risk reduction hierarchy: preventing transition into injection. J Urban Health. 2004;81:14-19.
11. Hedrich D. European Report on Drug Consumption Rooms. Lisbon, Portugal: European Monitoring Centre for Drugs and Drug Addiction; 2004.
12. Wood E, Kerr T, Lloyd-Smith E, et al. Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users. Harm Reduct J. 2004;1:9.
13. Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. Attendance, drug use patterns, and referrals made from North America's first supervised injection facility. Drug Alcohol Depend. 2006;83:193-198.
14. Poulin C, Fralick P, Whynot EM, et al. The epidemiology of cocaine and opiate abuse in urban Canada Can J Public Health 1998;89:234-238.
15. Wood E, Stolte J, Montaner J, Kerr T. Evaluating metharnphetamine use and risks of injection initiation among street youth: the ARYS study. Harm Redud J. 2006;3:18.
16. Roy E, Haley N, Ledere P, Cedras L, Biais L, Boivin JE Drug injection among street youths in Montreal: predictors of initiation. J Urban Health. 2003;80:92-105.
17. Kerr T, Marsh D, Li K, Montaner J, Wood E. Factors associated with methadone maintenance therapy use among a cohort of polysubstance using injection drug users in Vancouver. Drug Alcohol Depend 2005;80:329-335.
18. van Ameijden EJ, van den Hoek JA, Hartgers C, Coutinho RA. Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users. Am J Epidemiol. 1994;139:1153-1163.
19. Fuller CM, Vlahov D, Latkin CA, Ompad DC, Celentano DD, Strathdee SA Social circumstances of initiation of injection drug use and early shooting gallery attendance: implications for HIV intervention among adolescent and young adult injection drug users. J Acquir Immune Defic Syndr. 2003;32:86-93.

Abstract
Medically supervised safer injection facilities, where injection drug users can inject preobtained illicit drugs, have been implemented in various cities to reduce the public health effects of illicit drug use.1 Although evidence suggests that safer injecting facilities reduce overdose deaths,2 HIV risk behavior,3 and public disorder,4 this intervention remains highly controversial,5-7 largely because of concerns that the provision of a legal place to inject drugs may encourage initiation into injection drug use.8,9 Preventing initiation into injection drug use is a key public health priority,10 and it is noteworthy that fears regarding potential increased rates of injection drug use were among the reasons for the US federal ban on funding for needle exchange programs.9 In the light of concerns regarding the potential of safer injecting facilities to promote initiation into injection drug use,11 we examined length of injecting career and circumstances surrounding initiation into injection drug use among a cohort of users of a safer injecting facility in Vancouver, British Columbia. In fact, the median years of injection drug use among users of safer injecting facilities were greater tìian the median years of injection drug use (10; interquartile range=4-20) among participants in another cohort study of local injection drug users (the Vancouver Injection Drug Users Study).17 Although 1 individual reported performing his first injection at the safer injecting facility, even when we included individuals who initiated injection drug use outside the safer injecting facility, the overall rate of recent initiation into injection drug use among users of the safer injecting facility was markedly lower than the estimated background community-level rate of injection initiation.16,18 The negligible number of new injectors observed in the Vancouver safer injecting facility compares favorably with the proportions observed in European safer injecting facilities.11 Our findings also may reflect rules that prevent first-time injectors from using the safer injecting facility.

Copyright American Public Health Association Jul 2007 Thomas Kerr, PhD, Mark W. Tyndall, MD, ScD, Ruth Zhang, MSc, Calvin Lai, MMath, Julio S.G. Montaner, MD, and Evan Wood, PhD About the Authors All authors are with the British Columbia Centre for Excellence in HIV/AIDS, Vancouver. Thomas Kerr, Mark W. Tyndall, fulio S. G. Montaner, and Evan Wood are also with the Faculty of Medicine, University of British Columbia, Vancouver. Requests for reprints should be sent to Thomas Kerr, PhD, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 (e-mail; tkerr@cfenet.ubc.ca). This brief was accepted August 16, 2006. Contributors T. Kerr and E. Wood originated and designed the study, supervised all aspects of study implementation, drafted the article, and incorporated reviewer suggestions. T. Kerr, R. Zhang, and C. Lai conducted the statistical analyses. M. W. Tyndall and J. S. G. Montaner made significant contributions to the formulation and design of the analyses, interpretation of the data, and drafting of the article. All authors helped to interpret findings and review drafts of the article. Acknowledgments The safer injecting facilities evaluation has been made possible through a financial contribution from Health Canada, the Michael Smith Foundation for Health Research, and the Canadian Institutes for Health Research. We wish to thank the staff of the Insite Safer Injecting Facility, the Portland Hotel Society, and Vancouver Coastal Health (Chris Büchner, David Marsh, Heather Hay). We also thank Aaron Eddie, Suzy Coulter, Megan Oleson, Peter Vann, Soni Thindal, Dave lsham, Daniel Miles Kane, Steve Gaspar, Cristy Power, Carl Bognar, Jo-Anne Stolte, and Deborah Graham for their research and administrative assistance. Note. The views expressed in this article are those of the authors and do not represent the offical policies of the study's sponsor. Human Participant Protection The evaluation received ethical approval from the University of British Columbia/Providence Health Care Clinical Research Ethics Board and from Health Canada

Nursing Leader, Liz Evans (Letter to the editor, June 7 National Post)

2007-10-17T10:16:00.000-07:00

Counterpoint
Editorials
(Retrieved from Factiva)

The evidence is clear: Harm reduction works
Liz Evans
National Post
587 words
7 June 2007
National Post
National
A24
English
(c) 2007 National Post . All Rights Reserved.

When the National Post comments on harm reduction so glibly (" 'Harm reduction' doesn't work," editorial, May 29), and without any research to back up those comments, it does itself, and its readers, a great disservice.

Addiction is a complex issue, and anyone who thinks a simple solution exists hasn't worked in Vancouver's Downtown Eastside. I am the executive director of the non-profit organization that, together with Vancouver Coastal Health, runs Vancouver's Supervised Injection Site. I am a nurse by training, and a public health advocate by design -- because all of my training as a nurse wasn't enough to make a substantial difference in people's lives.

Just like the author of the Post's editorial, I thought helping those with addiction was simple. We just need to offer treatment. But if it were that easy, the problem would have been solved long ago. I wouldn't have had to call the parents of addicts who had overdosed and tell them their child was dead. I met one mother, at the airport, who had flown across the country to visit her dying son. She arrived too late and fell to the floor screaming in grief when she heard the news. She wanted her addict son alive, addicted or not. Which is what harm reduction does -- it keeps people alive, so that one day, they can enter treatment.

Harm reduction strategies buy time because not everyone is ready to enter treatment. Clean needles and condom distribution prevent the spread of disease. These are basic health interventions that are accepted across the world, from the United Nations to the medical health officers in every jurisdiction of this country.

Vancouver's Supervised Injection Site -- the only one in North America is -- neither the problem nor the solution. It is one measure designed to reduce public disorder, which it has done; reduce the spread of HIV, which it has done; provide a doorway into the health system and into treatment, which it has also done. The Supervised Injection Site receives no federal government money to operate. In the past, the federal government did pay for a group of highly qualified research scientists to conduct a thorough evaluation of Insite and its outcomes, and has proved its success.

I agree that any nation-wide drug strategy desperately needs to incorporate improved enforcement, comprehensive prevention programs and flexible and accessible detox and treatment interventions. But it also needs to include harm reduction -- so people don't die unnecessarily and parents don't continue to lose their children. The most recent piece of research indicates that there has been a 30% increase in the number of people entering detox and methadone therapy as a result of using the injection site -- which strengthens further the argument that harm reduction is a necessary part of the health care continuum.

As Stephen Harper prepares to unveil his new drug strategy, we welcome the much-needed resources to expand addiction treatment. We want Canada to have a drug strategy that Canadians can be proud of. A drug strategy that acknowledges the suffering of our citizens, one that allows access to desperately needed treatment and support and doesn't send addicts back to die alone in Canada's back alleyways.

-Liz Evans is executive director of the PHS Community Services Society, which operates InSite, Vancouver's Supervised Injection Site

UN is Closed to Reason, gives govt ammunition

2007-03-10T16:09:00.000-08:00

**"Closed to Reason" document link is in the sidebar**

Narcotics board looks to be 'closed to reason'

WAR ON DRUGS. International panel is dead set against supervised injection sites, even if it can't cogently argue why

Peter McKnight, Vancouver Sun
Published: Saturday, March 10, 2007

Given how the federal Conservatives feel about harm reduction measures, they didn't really need an excuse to shut down Insite, Vancouver's supervised injection facility. But the International Narcotics Control Board recently provided them with one nonetheless.

In its annual report, released last week, the United Nations panel stated that Insite facilitates "the illicit use of internationally controlled substances and violate[s] the provisions of international drug control treaties." Consequently, the board plans to advise Health Minister Tony Clement to shut down the site, possibly at the board's annual meeting next week.

This is certainly not the first time the board has spoken out about supervised injection sites -- SIFs. As the Canadian HIV/AIDS Legal Network and the Open Society Institute document in an excellent expose of the board titled Closed to Reason, the sites, which now exist in Switzerland, Germany, the Netherlands, Australia, Spain, Norway, Luxembourg and Canada, have received significant attention from the board's annual reports for at least six years.

Each year the board has condemned countries that operate SIFs, concluding, without argument, that the sites amount to a violation of international law. A typical example comes from the board's 2002 report, where it said:

"By permitting injection rooms, a government could be considered to be in contravention of the international drug control treaties by facilitating, aiding and/or abetting the commission of crimes involving illegal drug possession and use, as well as other criminal offences, including drug trafficking."

As Closed to Reason documents, board members have been even less accommodating in public speeches. In a 2000 address to the UN, former board president Lourenco Martins described SIFs as "shooting galleries," and said they are places where "drug abusers are allowed to abuse illicit drugs obtained from the illicit market under supervision and under, supposedly, hygienic conditions."

This skepticism about the hygiene of SIFs seems a recurring motif, as the board said last week that it opposed "poorly supervised" injection rooms, which would seem to suggest that hygienic, well supervised rooms are A-OK.

But apparently not, since current president Philip Emafo maintained recently that SIFs violate "the most fundamental principal" of drug control treaties. Exactly how Emafo and the board came to this conclusion is a mystery since the annual report provides no explanation of why SIFs contravene the treaties.

Nevertheless, despite -- or perhaps because of -- the board's apparent inability to construct an argument to support its conclusions, it has engaged in attempts to silence anyone who speaks in favour of SIFs.

Stephen Lewis, former UN Special Envoy for HIV/AIDS in Africa, visited Insite in 2006, spoke about how it could help reduce the transmission of blood-borne diseases, and advised other Canadian cities to consider following Vancouver's lead.

For his trouble, Lewis received a call from board secretary Koli Kouame, who equated SIFs with "opium dens," and threatened to inform then-UN secretary-general Kofi Annan of Lewis's heresy. Kouame made good on his threat, with Emafo demanding in the letter to Annan that Lewis retract his statements. To his credit, Lewis refused to do so.

After all, there is good reason to believe the board is simply wrong in holding that SIFs violate drug control treaties. According to Article 4 of the 1961 UN Single Convention on Narcotic Drugs, parties must "limit exclusively to medical and scientific purposes the ... distribution of, trade in, use and possession of drugs."

The board concluded that Insite violates this article since, in the board's erroneous view, Insite's purpose is to get "public nuisances off the streets." Yet while studies suggest Insite has helped to improve public order, this was never the purpose of the site.

On the contrary, Insite was opened to test the efficacy of such medical interventions in improving the health of addicts and their communities, which suggests that it has both scientific and medical purposes. It's hard to imagine any intervention that would be more in keeping with Article 4.

But don't take my word for it. Lawyers advising Health Canada came to a similar conclusion about the legal status of Insite before its opening, and lawyers in Germany, the Netherlands, Slovenia and Switzerland have all concluded that SIFs don't violate drug control treaties.
But you don't have to take their word for it either, since the UN itself has concluded that SIFs comply with the treaties. In 2002, the board, which apparently doesn't take anyone's word for it, asked lawyers with the UN International Drug Control Program for advice on the legality of SIFs.

Contrary to statements made by board members before -- and since -- 2002, the lawyers said:
"It would be difficult to assert that, in establishing drug-injection rooms, it is the intent of parties to actually incite or induce the illicit use of drugs, or even more so, to associate with, aid, abet or facilitate the possession of drugs." Obviously it's not difficult for board members to make those assertions, but notice how this quote seems a direct rejoinder to the comments board members continue to make.

The lawyers' report continued: "It seems clear that in such cases the intention of governments is to provide healthier conditions for IV drug abusers, thereby reducing their risk of infection with grave transmittable diseases and, at least in some cases, reaching out to them with counselling and other therapeutic options."

The report concludes by saying that permitting SIFs falls "far from the intent of committing an offence" under the treaties. Nevertheless, shortly after receiving the lawyers' report, Emafo said SIFs incite people to use drugs. And every year since receiving the lawyers' advice, the board has maintained that SIFs violate the treaties. All of which makes one wonder why the board asked for the advice in the first place.

Perhaps the board thought the lawyers' report would be more to its liking, more in keeping with its ideology. And make no mistake about it, the board has proven time and again that its positions are the products of its ideology rather than of legal or scientific arguments.

The ideology is, simply put, one of drug prohibitionism, of maintaining the war on drugs at any cost and responding with hostility to any suggestion that harm reduction might play a role in reducing the health and societal costs of drug addiction.

For example, Closed to Reason notes that the board has repeatedly praised countries that have engaged in draconian drug crackdowns, including Bulgaria, Russia, China and Thailand, which recently addressed its drug problems by arresting thousands of people and murdering many others.

In contrast, while the board claims to support harm reduction measures such as opiate substitution treatment and needle exchanges, members have attempted to discredit such interventions, with the board president, as recently as 2002, wrongly claiming that needle exhanges contravene drug treaties.

The board is, of course, free to continue promoting the failed war on drugs, however counterproductive it may be, provided it makes its agenda explicit.

But as a body charged with monitoring countries' compliance with drug control treaties, it should not be free to tell falsehoods about the legal status of harm reduction measures to advance its agenda. And it should certainly not be free to use those falsehoods to try to pressure governments into complying with that agenda.

pmcknight@png.canwest.com

Why start now?

2007-02-22T14:50:00.000-08:00

Insite's current exemption is up in Dec. 2007. It's time to start writing letters.

"What?!" I hear you say, "But Jen, that's months away!"

However, read the post below. It looks like things are starting to move on Canada's Drug Policy. It was last updated in 2003 (For a good background on current drug policy go to the Community Insite link and click on "Further reading". Entry #8 refers to the 2003 Federal drug policy update).

Since the current government has a track record of wanting to increase the criminality of everything (particular forms of marriage, age of consent, reducing the age young offenders can be tried as adults-- just 3 quick examples), any new policy is likely to be quite punitive and heavy-handed.

Write to the Prime Minister, your MP, Minister of Health (Tony Clement), the Ministers of Indian & Northern Affairs, Status of Women, Vancouver Olympics, Minister of Human Resources and Social Development and many others. See my post on Aug 31 for reasons to choose one minister or another.

**but fair warning: there has been a cabinet shuffle: check who is the current minister.

Write about Insite specifically or about Canada's Drug Policy in general but write now!

**Nursing students: depending on your community or clinical placements, you could have some unique and worthwhile anecdotes that could really personalize this issue. See the Tips on Letter writing post -- not the next one, but the one after that.

Rumblings in Ottawa

2007-02-22T14:36:00.000-08:00

It's time to get active about Insite again.

Here's why: Perhaps in preparation for the Dec '07 deadline on the legislative extension allowing Insite to function, or perhaps in response to the eternal threat of an election (and possible Conservative majority) it looks like action on drug policy is happening here in Ottawa.

At a luncheon here today US "Drug Czar" John Walters was invited by the Canadian Centre on Substance Abuse (a curious move given that the CCSA is a supposedly independant, non-partisan but federally funded agency). Here's the content of an email I recieved at the end of last week from a contact and InSite for Community Safety:

"U.S. Drug Czar John Walters has been invited by the Canadian Center on Substance Abuse to try and rationalize U.S. drug policy to a Canadian audience. Mr. Walters is a reputed zealot, known for an eagerness to drug test every student in America. He is also an infamous purveyor of anti-cannabis propaganda. As Eugene Oscapella from the Canadian Foundation for Drug Policy said: "We in Canada have agreed to take John Walters off your [US] hands for a few hours on February 22. I am more than a little perplexed as to why the Canadian Centre on Substance Abuse, a supposedly independent drug policy agency, is inviting him to speak without using a panel format that would allow his statements to be challenged. There will be a question and answer session after his speech, but that will hardly offer the opportunity for a balanced debate. I wonder if these were the only terms on which he would speak here."

Drug Policy in the United States: A Presentation by John P. Walters Director, White House Office of National Drug Control Policy You are cordially invited to a luncheon event with featured speaker John P. Walters, Director of the White House Office of National Drug Control Policy. Mr. Walters will provide an overview of the U.S. National Drug Control Strategy, its progress and challenges. Opening remarks will be delivered by Michel Perron, Chief Executive Officer, Canadian Centre on Substance Abuse (CCSA), Canada's national addictions organization. An informal question and answer period will follow the presentation.

Date: February 22, 2007 Time: 11:45 am - 1:15 pm (lunch is included)
Location: Fairmont Chateau Laurier, Tudor Room (1 Rideau Street, Ottawa, ON K1N 8S7) Registration: Seating is limited and RSVPs are required.

Since I wasn't the one cordially invited I had no luck finagling my way into the lunch (although it was looking good there for a while...) despite RSVP'ing and talking to the communications person a couple of times.

Here's the official response the press release about the press conference that happened up in Centre Block of the Hill today:

MEDIA ADVISORY: CHALLENGE TO US DRUG CZAR CRITICISMS OF CANADIAN DRUG POLICY

Who: Senator Larry Campbell, Ethan Nadelmann, Line Beauchance, Eugene Oscapella
Where: Charles Lynch Press Theatre, Parliament Hill, Ottawa
When: Thursday, February 22, 2007 at 1:30 p.m.

OTTAWA AND NEW YORK, February 21, 2007: The Canadian Foundation for Drug
Policy (Ottawa) and the Drug Policy Alliance (New York) will be holding a press conference in the Charles Lynch Room, Centre Block, Parliament Hill, Ottawa, at 1:30 pm, Thursday, February 22, 2007. The press conference is being held on the occasion of the visit to Ottawa by the head of the US Office of National Drug Control Policy (the US "drug czar") John Walters. Speakers at the press conference will challenge the continuing criticism of Canada's drug control efforts by Mr. Walters, and discuss pressure by the US Administration on the Government of Canada to follow the American model of drug control, which is based heavily the use of the criminal law, policing and incarceration ("criminal prohibition). Speakers at the press conference will also address the failure of US drug control policies in the United States, the misleading rhetoric by the US Administration about Canada's contribution to US drug problems, and the damaging effects of US drug control policies on Canada, including the risks US poppy eradication policies pose for Canadian soldiers in Afghanistan.
Speaking at the press conference will be:
The Honourable Larry W. Campbell, Senator, former Mayor of Vancouver, former RCMP Drug Squad member, and former Chief Coroner of British Columbia.
Ethan Nadelmann, founder and executive director of the Drug Policy Alliance, New York, the leading organization in the United States promoting alternatives to the war on drugs. Mr. Nadelmann is a former Princeton University professor and author of several books and articles on policing, crime control and drug policy.
Professor Line Beauchesne, Department of Criminology, University of Ottawa,
the author of several books on drug policy, and co-founder, Canadian Foundation for Drug Policy.
Eugene Oscapella, Ottawa lawyer, co-founder, Canadian Foundation for Drug
Policy, and lecturer on drug policy in the Department of Criminology, University of Ottawa.

Canadian Foundation for Drug Policy: http://www.cfdp.ca/
Drug Policy Alliance: www.drugpolicy.org
Time to get the letter-writing started.

Tips on successful letter writing [redux]

2007-02-22T14:14:00.000-08:00

According to Elizabeth May, formerly Executive Director of the Sierra Club of Canada, now leader of the Green Party of Canada, in her book "How to save the world in your spare time" (2006), letters to politicians are more effective than emails, post cards or petitions.

"Because so few people take the time to write a letter on an issue that concerns them, politicians count each letter as representative of the views of far more citizens. A letter to a federal politician is seen as representing thousands" (p.90-91).

A handwritten letter is the best, typed is okay, but an email is often only glanced at or automatically discarded by employees.

When the time line on writing to the Health minister and/or the PM in support of Insite is short (as with the exemption last fall) a fax of the letter with the original following in the mail will be the most effective means of contacting a minister and/or your MP regarding Insite.

If you choose to write to one of the other ministers I have listed back in Aug, an email to their office may have some effect as they are likely recieving less/no mail on this issue. If you only have time to send emails, send several and make them unique. Here are some tips gathered from various sources:

Maximize efforts by identifying key players. In this case, Tony Clement, Minster of Health, Prime Minister Harper.

No stamp necessary if you write to their House of Commons address (although some websites say that Constituency offices are more effective, this is only the case if your return address is in that riding).

For MPs: Provide a return address and let them know that you live in their riding. This will provide you with much greater credibility in their eyes.

**Student Nurses: Our voices are super-powerful: We are only writing (on this or any subject) because we have an interest and emotion behind writing. Unlike others who may write, we have no vested interest other than we recognise what is the right thing to do and feel strongly about it.**

It is worth writing to your MP even if s/he or their official party line supports your view. If the issue ever came up for debate or vote in the House your letter would count as the voice and opinion of constituents.

Keep the letter relatively brief—no more than 1 ½ pages – typed or hand written.

Tell them why this issue is important to you, what you think should be done, back it up with facts and/or references and ask for a reply.

Illustrate the key messages by telling your story in your own words—this will have a much greater impact than any pre-written communication they received in the office.

With that in mind, back in August I included other Ministers in the cabinet to whom you may want to write and let them know why this issue matters to you, how you think it relates to their office and that you want to know where they stand on the issue. The cabinet has since been shuffled so you will have to look up who's who in the new zoo. However, Clement and Harper remain the key ones to focus on. The others are just icing.

Be respectful and give the MP the benefit of the doubt. Whatever information you have about an MP's position, it may not be accurate and they may be open to changing their mind. They will respond better to a calm, polite letter — remember passion can be expressed with reason. In this case it can also be supported with peer-reviewed evidence as well.

Don't put down those who oppose extending the exemption. You could be insulting someone close to that person — not an endearing tactic. You'll also just lose credibility.

Ask for their support and request a reply — you can provide them with your phone number and/or email address to make it simple for them to get back to you (See my response from Mr. Clement last fall). When you do hear back, please share the response in the comments section here—we want to know what’s happening.

Feel free to let them know that you were compelled to write based on an email from a concerned indivual and with information from this blog. A grassroots effort by individuals with no vested interests in Insite other than a recognition of Insite's value to the community that it serves, and with compassion for those individuals, could be a powerful message.

Copying a form letter is less powerful. Personalizing it can make it work though.

Clement makes surprise visit to INsite

2007-01-09T19:22:00.000-08:00

Ian Bailey, CanWest News ServicePublished: Thursday, January 04, 2007

Font:

VANCOUVER - Canada's health minister made his first-ever visit to a safe-injection site, touring the Insite facility in Vancouver's Downtown Eastside Wednesday.

Tony Clement, accused by critics of having a hidden agenda against such operations, spent about 30 minutes in Insite during his surprise tour.

Clement strolled through the waiting room, injection room and lounge of the operation during his tour, chatting with users and staff while reporters waited outside.

Clement was a tough critic of safe-injection sites as health minister under former Ontario premier Mike Harris about three years ago, vowing to keep them out of that province because he preferred anti-drug education, awareness, treatment and rehab for addicts.

Since entering federal politics, he has been accused of being equally skeptical.

''I had a good chat with the staff there, understood some of their procedures, asked a lot of questions, got a lot of answers,''Clement said after his tour.
But he declined to say whether his views had changed.

''I think I am continuing to get a deeper understanding and this is all part of being the best health minister I can be for the country,''he said.

Insite, which opened in 2003, faced the prospect of closure last fall as Clement tried to decide whether to renew an exemption that allows the use of illegal drugs inside the facility.

He eventually decided to allow Insite to operate through the end of 2007, awaiting studies on supervised injection sites that will help him decide on its long-term fate.

He defended the fact that he did not visit before making that ruling.
''It's important for me to accentuate that I am here now,''he said.

Clement, on the second day of a visit to Vancouver, was previously non-committal about a visit to the operation, which has been praised by B.C. Premier Gordon Campbell and Vancouver Mayor Sam Sullivan as a means of controlling the health risks associated with injection drug use.
But he said the timing was right Wednesday because he was also visiting a nearby Salvation Army detox centre and homeless shelter.

Clement began his tour about 30 minutes after Insite opened for the day so clients entered and left as he was inside.

''A couple of the clients recognized him,''said Chris Buchner, HIV/AIDS and harm-reduction manager with Vancouver Coastal Health.

''(They) were very interested in telling him how important this place was to them,''said Buchner.
Buchner said people were shooting up as Clement had his tour.

''(Clement) was very interested, very attentive,''he said.

Dean Wilson, a board member with the Vancouver Area Network of Drug Users, said he was stunned to see Clement through Insite's front window while passing by.
Wilson said the sight of Clement initially drew his attention because the minister was well dressed, standing out among the regular clients.

''I wanted to see who it was, and then I saw it was honorable member Clement so I went right after him,''said Wilson.

The pair chatted for several minutes.
''I just wanted to tell him that we never promised that this would stop crime,''Wilson said, referring to Insite.
ibailey@png.canwest.com
Vancouver Province

NPR & Insite

2006-11-11T14:54:00.000-08:00

Thanks to fellow nurse, Matt for this NPR link to radio commentary on Insite from a couple of years ago.

NPR InSite