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Wednesday, 3 August 2011

Insights into INsite – Canadian drug policy decided by the courts

Canada has two supervised drug injection site.  Both are in Vancouver.
The second  site receives the notoriety and is the focus of this discussion – namely INsite. Opened in 2000.  Its primary purpose was to reduce drug related deaths in Vancouver, concurrently to undertake extensive scientific research on the impacts of such services.  It required an exemption from illicit drug laws to allow for the presence of controlled substances so that users could feel unthreatened from police action while in the site.  
The research is now relatively clear, some 30 odd studies, most showing  benefit or at least no harm.  One poorly done study suggests increased private security requirements.  The latter study is broadly cited as reasons for not supporting the ongoing operation of the centre.  Read the full advisory committee review from 2008 at http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites-lieux/insite/index-eng.php#ex   There are additional supportive studies that have been released since 2008.
The site has been mired in legal issues since 2008 when the conservative government ended the exemption and INsite challenged the decision.  The interpretation being that if the exemption to laws on possession of drugs was not continued the site would close.  Various courts have ruled on the matter as it has worked its way through to the Caandian supreme court.  The BC Appeals court has upheld lower court decisions that take aim at two issues.  The first is the criminalization of possession of drugs.  The second being the apparent ability under the Canadian constitution for provinces to determine what constitutes health care – and in this case the decision allows the province to designate any facility as a health care facility, something that causes grief for the federal government relative to the potential application to other non-hospital health care settings.
The supreme court heard the case in mid-May 2011 and a decision is still pending.  
There are at two issues relevant to Canadians:
1.    The continued resistance of the conservative government to policies that can be perceived politically as supportive of drug use, even though their actions are in reducing drug use and in preserving health.  Combined with the failure of the government to acknowledge the massive weight of evidence demonstrating benefit from INsite.
2.    The ongoing legal circumstances surrounding INsite have effectively barred other large North American cities from establishing supervised drug consumption sites.  Montreal, Toronto, and Ottawa (perhaps under a different mayor) at a minimum are Canadian locations that would move forward once the legal battles are concluded.  In the meantime, hundreds to thousands of users have been denied access to health improving and drug reduction services
You will recall that there are two supervised injection sites in Vancouver, the older one has operated quietly, outside public scrutiny, without fanfare and without legal battles.  The only limitiation is that its clients do not have the benefit of recognition of it being a “legal” safe injection site, however they have not once been hassled by police.
The legal battles of INsite have overshadowed how effective local community action can be in protecting health, and working as a community to address an urgent need. 

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