Staying Alive, The Fifth Estate

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.....

... 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...

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

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

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.

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

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

[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.

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

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)

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.

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"

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”

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:

1. At press conference endorse the program/document/agency up for discussion so as to look like the good guy for the cameras.
2. At the actual conference deride the program/document/agency up for discussion.
3. 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.

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

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

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

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

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

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

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

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

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

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."