Insite
Encyclopedia
Insite is the only legal supervised injection site
in North America
, located at 139 East Hastings Street, in the Downtown Eastside
(DTES) neighbourhood of Vancouver
, British Columbia
. The DTES had 4700 chronic drug users in 2000 and has been considered to be the centre of an "injection drug epidemic". The site provides a safe and health-focused location for injection drug use, primarily heroin, cocaine
, and morphine
. The clinic does not supply any drugs. Medical staff are present to provide addiction treatment, mental health assistance, and first aid
in the event of an overdose
or wound. In 2009, the site recorded 276,178 visits (an average of 702 visits per day) by 5,447 unique users; 484 overdoses occurred with no fatalities, due to intervention by medical staff. Health Canada
has provided $
500,000 per year to operate the site, and the BC Ministry of Health
contributed $1,200,000 to renovate the site and cover operating costs.
and the Portland Hotel Society. Between September 2003 and July 2008, the site operated under a special exemption of Section 56 of the Controlled Drugs and Substances Act
, granted by the Liberal government
via Health Canada. The site was slated to close on September 12, 2006, as the exemption was for a three year pilot project. The Conservative minority government
granted a temporary extension, then added another six month extension that was to end in mid-2008. A constitutional challenge was heard by the Supreme Court of British Columbia
to keep Insite open after Federal Health Minister
Tony Clement refused to renew the exemption beyond July 2008. The court ruled that laws prohibiting possession and trafficking of drugs were unconstitutional because they denied drug users access to Insite's health services. Justice Ian Pitfield gave Ottawa
until 30 June 2009 to amend the Controlled Drugs and Substances Act and bring it in line with the constitutional principle of fundamental justice (section seven of the Canadian Charter). The House of Commons
did not amend the law meaning Insite currently operates under a constitutional exception to the Controlled Drugs and Substances Act.
Additional research in the Canadian Medical Association Journal
suggests that the site has reduced public injections, neighbourhood litter, and needle sharing. A study in the journal Addiction
indicates that patients at the site have increased their use of detoxification services and long-term addiction treatment. A study in the New England Journal of Medicine
echoed this finding. Furthermore, research in The Lancet
indicates that the site substantially reduces the sharing of syringes. A study in the journal Substance Abuse Treatment, Prevention, and Policy revealed that local police facilitate use of Insite, especially among high-risk users. The researchers concluded that the site "provides an opportunity to... resolve some of the existing tensions between public order and health initiatives."
A 2008 cost-benefit analysis of the site in the Canadian Medical Association Journal observed net-savings of $18 million and an increase of 1175 life-years over ten years. Another cost-benefit analysis published in the International Journal of Drug Policy in 2010 determined that the site prevents 35 cases of HIV and about 3 deaths per year, indicating a yearly net-societal benefit of more than $6 million. A 2011 study in The Lancet found overdose deaths have dropped 35% in the Insite area since it opened, much more than 9% drop elsewhere in Vancouver. An editorial in the Canadian Medical Association Journal noted that after three years of research "a remarkable consensus that the facility reduces harm to users and the public developed among scientists, criminologists and even the Vancouver Police Department."
Insite enjoys strong local support. While Insite is well liked throughout British Columbia, its popularity is highest inside Vancouver, where some 76% of residents expressed support for the facility. Furthermore, according to a 2007 national survey by Mustel Group, some 63% of Canadians believe the federal government should renew the Insite's mandate while 27% oppose. Support is lowest among Conservatives, only half of whom believe the site should continue operating. Among clients, 95% or greater rated the facility's services as excellent or good, and its staff as reliable, respectful, and trustworthy.
Partners of Insite include the City of Vancouver, the Vancouver Police Department
, and the PHS Community Services Society. The site has the support of Vancouver's mayor Gregor Robertson
, former mayor Sam Sullivan
, Premier of British Columbia
Gordon Campbell, and former Vancouver mayors Larry Campbell
, Mike Harcourt
, and Philip Owen
. The International AIDS Society
, B.C. Centre for Excellence in HIV-AIDS, and the Canadian Union of Public Employees
have also expressed support for Insite. Though initially opposed to the safe injection site, the Chinatown and Gastown
merchants associations now support it. International supporters include the UK
-based think tank
Senlis Council, the Australian Parliamentary Group for Drug Law Reform, and the American Drug Policy Alliance
.
The site drew criticism from the Bush administration; the director of the White House Office of National Drug Control Policy
called Insite "state-sponsored suicide" on its opening. In 2006, the Canadian Police Association
voted unanimously to encourage the federal government to stop funding Insite and instead invest in a national drug strategy. Moreover, Federal Health Minister Tony Clement
branded Insite an "abomination," telling the Vancouver Sun that "allowing and/or encouraging people to inject heroin into their veins is not harm reduction... it is a form of harm addition."
The Royal Canadian Mounted Police
(RCMP) has also criticized Insite. This is despite a report commissioned by the RCMP and conducted by two criminologists that concluded in favour of the injection site. The RCMP in British Columbia had agreed to announce their support for Insite in 2009 at a joint news conference with the BC Centre for Excellence in HIV/AIDS; they planned to note "an extensive body of Canadian and international peer-reviewed research reporting the benefits of supervised injection sites and no objective peer-reviewed studies demonstrating harms", and they were to admit that reports commissioned by the RCMP criticizing Insite "did not meet conventional academic standards." However, the RCMP in British Columbia were ordered by headquarters in Ottawa to cancel the news conference days before the event.
The most significant published criticism has been an article by Colin Mangham, the director of research for the Drug Prevention Network of Canada, in the online-only Journal of Global Drug Policy and Practice
(JGDPP), which is said to be "posing as open-access, peer-reviewed scientific journal" In the article Mangham claims that “the published evaluations and especially reports in the popular media overstate findings, downplay or ignore negative findings, report meaningless findings and overall, give an impression the facility is successful, when in fact the research clearly shows a lack of program impact and success.” He also claimed that interviews with area treatment centres revealed no referrals from Insite, and that police presence was deliberately bolstered in the area. Based on this article, Tony Clement told an August 2007 meeting of the Canadian Medical Association
that his belief that Insite should close had been reaffirmed. Clement stated that "there has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite." The Journal of Global Drug Policy and Practice that Clement was referring to is run by the Drug Free America Foundation
, and received much of its initial funding in a $1.5 million grant from a U.S. Department of Justice
agency now under investigation for corruption.
Mangham's article has been questioned because it dismisses more than 20 peer-reviewed studies published in reputable medical journals such as The Lancet
, the New England Journal of Medicine
, and the British Medical Journal
, all of which indicate that Insite has a positive effect. The Journal of Global Drug Policy and Practice
(JGDPP) article, which was commissioned and financed by the RCMP, drew further criticism in the journal Open Medicine
, where a commentary described it as being "fraught with a host of outright factual inaccuracies and unsubstantiated claims." More than 130 scientists signed a petition endorsing the commentary, which also criticized the government's evaluation of Insite as distortive and politicized. Another commentary in the International Journal of Drug Policy characterized the government's evaluation as "what may be a serious breach of international scientific standards".
In answer to an op-ed in National Post
, the President for Drug Prevention Network of Canada, Gwendolyn Landolt, maintained her organization's view that the research on Insite is flawed. She said that much of the research on Insite was done by scientists who had lobbied for the clinic's establishment and that they consequently lacked objectivity. She further suggested that the these researchers conspire with the editors of academic journals so that their papers are reviewed by referees that supports harm reduction. Gwendolyn Landolt also maintained that data shows that deaths from drug overdoses have actually increased in the vicinity of Insite most years since its inception, contrary to the point made by the allegedly biased Thomas Kerr in his preceding commentary on the misinformation her organization is peddling around. The next day the Provincial Health Officer of BC, Perry Kendall said that he had never heard of the data Ms. Landolt refers to and confirmed Thomas Kerr's assertion that death from drug overdoses have indeed declined in the preceding years - especially so in the vicinity of Insite.
government allowed Insite to open, since 2006 its fate has been the responsibility of the Conservative
government, which has not been as supportive of it. Conservative Prime Minister
Stephen Harper
has voiced opposition to the injection site in the past, saying that "We as a government will not use taxpayers' money to fund drug use." In mid-July 2006, Conservative Member of Parliament
David Fletcher stated that the government would let Insite's special exemption lapse before deciding whether to continue the project. The following week a spokesman for Tony Clement
, the Minister of Health
, refuted that, saying that a decision had not been made yet. During the XVI International AIDS Conference
, held in Toronto
, two high-ranking Liberal MPs (Bill Graham
and Keith Martin) put their support behind the centre, and criticized the Conservative government for delaying their decision. Insite supporters also demonstrated in Toronto during the conference, prompting the government to further delay any announcement, citing the week's "politicized" nature.
On September 1, 2006, Federal Health Minister Tony Clement deferred the decision of whether to extend the exemption for the site, citing a need for more research. However, on the same day the government cut all funding for future research, amounting to $1.5 million in lost research money. On August 13, 2007, the Portland Hotel Society and two drug addicts filed suit in the BC Supreme Court
to keep the centre open, arguing that its closure would be a violation of the Charter right
of Insite users to "security of the person." On October 4, 2007, during the announcement of its $64-million drug strategy, the Conservative government announced that Insite will be granted another six month extension, allowing it to operate until June 30, 2008. In 2008 Minister Clement explained his position during a House of Commons debate period:
In May 2008, the B.C. Supreme Court struck down sections of the Canadian Criminal Code prohibiting drug trafficking and possession, ruling that they contravened the Canadian Charter of Rights and Freedoms
. While this ruling does not take effect until next year, Justice Ian Pitfield also granted Insite an immediate exemption to federal drug laws, giving it legal grounds to continue operating. Several days later the federal government
announced plans to appeal the decision to the B.C. Court of Appeal
. On 15 January 2010, the B.C. Court of Appeal dismissed the federal government's appeal in a 2-1 ruling. Three weeks later the federal government announced that it will appeal to the Supreme Court of Canada
. On February 10th, some 150 people protested the federal government's decision to further appeal. The protesters barred Prime Minister Harper from attending a dress rehearsal for the Vancouver Chinatown Spring Festival Celebration. On February 12, The Canadian Union of Public Employees
sent an open letter to Harper, urging him to accept the ruling of the lower courts and allow Insite to remain open..
Of nine interveners in the Supreme Court case, one supported the conservative government's case to close the injection site: REAL Women of Canada
, a social conservative organization. The other eight, including the Canadian Medical Association
argued against the case for closure of the facility. The REAL Woman of Canada group argued that the site would discourage drug users from ceasing their habit, and that they would get "worse and worse until they die" while their families and communities suffered.
In May 2011 a lawyer for the Federal government told the Supreme Court that the government had not decided whether to continue or end support for Insite, contrary to previous statements by Minister of Health Tony Clement; that statement was derided in court as disingenuous by Joseph Arvay
, a lawyer for PHS Community Services Society.
On September 29, 2011, the Supreme Court of Canada ruled unanimously to uphold Insite's exemption from the Controlled Drugs and Substances Act
, allowing the facility to stay open indefinitely. The ruling states that Clement's decision to apply the CDSA to Insite was "arbitrary, undermining the very purposes of the CDSA, which include public health and safety. It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises."
Safe injection site
Supervised injection sites are legally sanctioned and medically supervised facilities designed to reduce nuisance from public drug use and provide a hygienic and stress-free...
in North America
North America
North America is a continent wholly within the Northern Hemisphere and almost wholly within the Western Hemisphere. It is also considered a northern subcontinent of the Americas...
, located at 139 East Hastings Street, in the Downtown Eastside
Downtown Eastside
The Downtown Eastside is one of the oldest neighbourhoods in Vancouver, British Columbia, Canada and is known as "Canada's poorest postal code"....
(DTES) neighbourhood of Vancouver
Vancouver
Vancouver is a coastal seaport city on the mainland of British Columbia, Canada. It is the hub of Greater Vancouver, which, with over 2.3 million residents, is the third most populous metropolitan area in the country,...
, British Columbia
British Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...
. The DTES had 4700 chronic drug users in 2000 and has been considered to be the centre of an "injection drug epidemic". The site provides a safe and health-focused location for injection drug use, primarily heroin, cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, and morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
. The clinic does not supply any drugs. Medical staff are present to provide addiction treatment, mental health assistance, and first aid
First aid
First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...
in the event of an overdose
Drug overdose
The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced...
or wound. In 2009, the site recorded 276,178 visits (an average of 702 visits per day) by 5,447 unique users; 484 overdoses occurred with no fatalities, due to intervention by medical staff. Health Canada
Health Canada
Health Canada is the department of the government of Canada with responsibility for national public health.The current Minister of Health is Leona Aglukkaq, a Conservative Member of Parliament appointed to the position by Prime Minister Stephen Harper.-Branches, regions and agencies:Health Canada...
has provided $
Canadian dollar
The Canadian dollar is the currency of Canada. As of 2007, the Canadian dollar is the 7th most traded currency in the world. It is abbreviated with the dollar sign $, or C$ to distinguish it from other dollar-denominated currencies...
500,000 per year to operate the site, and the BC Ministry of Health
Ministry of Health (British Columbia)
The Ministry of Health is a provincial government department responsible for British Columbia's health system, with a mandate to guide and enhance the province's health services to ensure British Columbians are supported in their efforts to maintain and improve their health.Its annual budget is...
contributed $1,200,000 to renovate the site and cover operating costs.
Operation
Insite is operated in tandem by Vancouver Coastal HealthVancouver Coastal Health
Vancouver Coastal Health is a regional health authority providing direct and contracted health services including primary, secondary, tertiary and quaternary care, home and community care, mental health services, population and preventive health and addictions services in part of Greater Vancouver...
and the Portland Hotel Society. Between September 2003 and July 2008, the site operated under a special exemption of Section 56 of the Controlled Drugs and Substances Act
Controlled Drugs and Substances Act
The Controlled Drugs and Substances Act is Canada's federal drug control statute. Passed in 1996 by the Chrétien government, it repeals the Narcotic Control Act and Parts III and IV of the Food and Drug Act and establishes eight Schedules of controlled substances and two Classes of precursors...
, granted by the Liberal government
37th Canadian Parliament
The 37th Canadian Parliament was in session from January 29, 2001, until May 23, 2004. The membership was set by the 2000 federal election on November 27, 2000, and it changed only somewhat due to resignations and by-elections until it was dissolved prior to the 2004 election.It was controlled by...
via Health Canada. The site was slated to close on September 12, 2006, as the exemption was for a three year pilot project. The Conservative minority government
39th Canadian Parliament
The 39th Canadian Parliament was in session from April 3, 2006 until September 7, 2008. The membership was set by the 2006 federal election on January 23, 2006, and it has changed only somewhat due to resignations and by-elections...
granted a temporary extension, then added another six month extension that was to end in mid-2008. A constitutional challenge was heard by the Supreme Court of British Columbia
Supreme Court of British Columbia
The Supreme Court of British Columbia is the superior trial court for the province of British Columbia. The BCSC hears civil and criminal law cases as well as appeals from the Provincial Court of British Columbia. Including supernumerary judges, there are presently 108 judges...
to keep Insite open after Federal Health Minister
Minister of Health (Canada)
The Minister of Health is the Minister of the Crown in the Canadian Cabinet who is responsible for overseeing the federal government's health department and the enforcing the Public Health Agency of Canada, Canada Health Act, the law governing Medicare...
Tony Clement refused to renew the exemption beyond July 2008. The court ruled that laws prohibiting possession and trafficking of drugs were unconstitutional because they denied drug users access to Insite's health services. Justice Ian Pitfield gave Ottawa
Ottawa
Ottawa is the capital of Canada, the second largest city in the Province of Ontario, and the fourth largest city in the country. The city is located on the south bank of the Ottawa River in the eastern portion of Southern Ontario...
until 30 June 2009 to amend the Controlled Drugs and Substances Act and bring it in line with the constitutional principle of fundamental justice (section seven of the Canadian Charter). The House of Commons
Canadian House of Commons
The House of Commons of Canada is a component of the Parliament of Canada, along with the Sovereign and the Senate. The House of Commons is a democratically elected body, consisting of 308 members known as Members of Parliament...
did not amend the law meaning Insite currently operates under a constitutional exception to the Controlled Drugs and Substances Act.
Research
When founded, Insite acquired legal exemption under the condition that its impacts be thoroughly evaluated. Consequently, the site has been the focus of more than thirty studies, published in 15 peer-reviewed journals. The research indicates an array of benefits, including reductions in public injecting and syringe sharing and increases in the use of detoxification services and addiction treatment among patients. In addition, studies assessing the potential harms of the site have not observed any adverse effects. Preliminary observations published in 2004 in the journal Harm Reduction indicate that the site successfully attracted injecting drug users and thus decreased public drug use. However, the researchers cautioned that a full assessment of the site will take several years.Additional research in the Canadian Medical Association Journal
Canadian Medical Association Journal
The Canadian Medical Association Journal is a general medical journal that is published biweekly by the Canadian Medical Association . It covers research and ideas aimed at improving health for people in Canada and globally. CMAJ publishes original clinical research, analyses and reviews, news,...
suggests that the site has reduced public injections, neighbourhood litter, and needle sharing. A study in the journal Addiction
Addiction (journal)
Addiction is a monthly peer-reviewed scientific journal established in 1884 by the Society for the Study of Addiction to Alcohol and other Drugs...
indicates that patients at the site have increased their use of detoxification services and long-term addiction treatment. A study in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
echoed this finding. Furthermore, research in The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
indicates that the site substantially reduces the sharing of syringes. A study in the journal Substance Abuse Treatment, Prevention, and Policy revealed that local police facilitate use of Insite, especially among high-risk users. The researchers concluded that the site "provides an opportunity to... resolve some of the existing tensions between public order and health initiatives."
A 2008 cost-benefit analysis of the site in the Canadian Medical Association Journal observed net-savings of $18 million and an increase of 1175 life-years over ten years. Another cost-benefit analysis published in the International Journal of Drug Policy in 2010 determined that the site prevents 35 cases of HIV and about 3 deaths per year, indicating a yearly net-societal benefit of more than $6 million. A 2011 study in The Lancet found overdose deaths have dropped 35% in the Insite area since it opened, much more than 9% drop elsewhere in Vancouver. An editorial in the Canadian Medical Association Journal noted that after three years of research "a remarkable consensus that the facility reduces harm to users and the public developed among scientists, criminologists and even the Vancouver Police Department."
Reception
Insite enjoys strong local support. While Insite is well liked throughout British Columbia, its popularity is highest inside Vancouver, where some 76% of residents expressed support for the facility. Furthermore, according to a 2007 national survey by Mustel Group, some 63% of Canadians believe the federal government should renew the Insite's mandate while 27% oppose. Support is lowest among Conservatives, only half of whom believe the site should continue operating. Among clients, 95% or greater rated the facility's services as excellent or good, and its staff as reliable, respectful, and trustworthy.
Partners of Insite include the City of Vancouver, the Vancouver Police Department
Vancouver Police Department
The Vancouver Police Department is the police force for the City of Vancouver in British Columbia, Canada. It is one of several police departments within the Metro Vancouver Area and is the second largest police force in the province after RCMP "E" Division.VPD was the first Canadian police force...
, and the PHS Community Services Society. The site has the support of Vancouver's mayor Gregor Robertson
Gregor Robertson (politician)
Gregor Angus Bethune Robertson is a Canadian politician who has been the 39th Mayor of Vancouver, British Columbia, since 2008. He was elected as part of the Vision Vancouver party slate...
, former mayor Sam Sullivan
Sam Sullivan
Sam Sullivan, CM served as the 38th mayor of Vancouver, British Columbia, Canada and has been invested as a Member of the Order of Canada, the country's highest civilian award...
, Premier of British Columbia
Premier of British Columbia
The Premier of British Columbia is the first minister, head of government, and de facto chief executive for the Canadian province of British Columbia. Until the early 1970s the title Prime Minister of British Columbia was often used...
Gordon Campbell, and former Vancouver mayors Larry Campbell
Larry Campbell
Larry W. Campbell was the 37th Mayor of Vancouver, British Columbia, Canada and is currently a member of the Canadian Senate. Starting in 1969 Campbell worked for the RCMP in Vancouver and then in 1973 as a member of the Drug Squad...
, Mike Harcourt
Mike Harcourt
Michael Franklin Harcourt served as the 30th Premier of the province of British Columbia in Canada from 1991 to 1996, and before that as the 34th mayor of BC's major city, Vancouver from 1980 to 1986....
, and Philip Owen
Philip Owen
Philip Walter Owen was the mayor of Vancouver, British Columbia from 1993 to 2002, making him one of Vancouver's longest serving mayors. His father was Walter S. Owen, who was Lieutenant Governor of British Columbia from 1973 to 1978....
. The International AIDS Society
International AIDS Society
The International AIDS Society is an independent association of HIV professionals, with 14,000 members from 190 countries working at all levels of the global response to AIDS. IAS members include researchers from all disciplines, clinicians, public health and community practitioners on the...
, B.C. Centre for Excellence in HIV-AIDS, and the Canadian Union of Public Employees
Canadian Union of Public Employees
The Canadian Union of Public Employees is a Canadian trade union serving the public sector - although it has in recent years organized workplaces in the non-profit and para-public sector as well...
have also expressed support for Insite. Though initially opposed to the safe injection site, the Chinatown and Gastown
Gastown
Gastown is a national historic site in Vancouver, British Columbia, at the northeast end of Downtown adjacent to the Downtown Eastside. Its historical boundaries were the waterfront , Columbia Street, Hastings Street, and Cambie Street, which were the borders of the 1870 townsite survey, the proper...
merchants associations now support it. International supporters include the UK
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
-based think tank
Think tank
A think tank is an organization that conducts research and engages in advocacy in areas such as social policy, political strategy, economics, military, and technology issues. Most think tanks are non-profit organizations, which some countries such as the United States and Canada provide with tax...
Senlis Council, the Australian Parliamentary Group for Drug Law Reform, and the American Drug Policy Alliance
Drug Policy Alliance
The Drug Policy Alliance is a New York City-based non-profit organization, led by executive director Ethan Nadelmann, with the principal goal of ending the American "War on Drugs"...
.
The site drew criticism from the Bush administration; the director of the White House Office of National Drug Control Policy
Office of National Drug Control Policy
The White House Office of National Drug Control Policy , a former cabinet level component of the Executive Office of the President of the United States, was established in 1989 by the Anti-Drug Abuse Act of 1988...
called Insite "state-sponsored suicide" on its opening. In 2006, the Canadian Police Association
Canadian Police Association
The Canadian Police Association is an organization of Canadian police officers.In 2003, the original "Canadian Police Association" was merged with the National Association of Professional Police to form the Canadian Professional Police Association....
voted unanimously to encourage the federal government to stop funding Insite and instead invest in a national drug strategy. Moreover, Federal Health Minister Tony Clement
Tony Clement
Tony Peter Clement, PC, MP is a Canadian federal politician, President of the Treasury Board, Minister for the Federal Economic Initiative for Northern Ontario and member of the Conservative Party of Canada....
branded Insite an "abomination," telling the Vancouver Sun that "allowing and/or encouraging people to inject heroin into their veins is not harm reduction... it is a form of harm addition."
The Royal Canadian Mounted Police
Royal Canadian Mounted Police
The Royal Canadian Mounted Police , literally ‘Royal Gendarmerie of Canada’; colloquially known as The Mounties, and internally as ‘The Force’) is the national police force of Canada, and one of the most recognized of its kind in the world. It is unique in the world as a national, federal,...
(RCMP) has also criticized Insite. This is despite a report commissioned by the RCMP and conducted by two criminologists that concluded in favour of the injection site. The RCMP in British Columbia had agreed to announce their support for Insite in 2009 at a joint news conference with the BC Centre for Excellence in HIV/AIDS; they planned to note "an extensive body of Canadian and international peer-reviewed research reporting the benefits of supervised injection sites and no objective peer-reviewed studies demonstrating harms", and they were to admit that reports commissioned by the RCMP criticizing Insite "did not meet conventional academic standards." However, the RCMP in British Columbia were ordered by headquarters in Ottawa to cancel the news conference days before the event.
The most significant published criticism has been an article by Colin Mangham, the director of research for the Drug Prevention Network of Canada, in the online-only Journal of Global Drug Policy and Practice
Journal of Global Drug Policy and Practice
The Journal of Global Drug Policy and Practice describes itself as an open access peer-reviewed public health journal. Critics say it is biased, not peer reviewed, and not a legitimate scientific journal...
(JGDPP), which is said to be "posing as open-access, peer-reviewed scientific journal" In the article Mangham claims that “the published evaluations and especially reports in the popular media overstate findings, downplay or ignore negative findings, report meaningless findings and overall, give an impression the facility is successful, when in fact the research clearly shows a lack of program impact and success.” He also claimed that interviews with area treatment centres revealed no referrals from Insite, and that police presence was deliberately bolstered in the area. Based on this article, Tony Clement told an August 2007 meeting of the Canadian Medical Association
Canadian Medical Association
The Canadian Medical Association , with more than 70,000 members, is the largest association of doctors in Canada and works to represent their interests nationally. It formed in 1867, three months after Confederation...
that his belief that Insite should close had been reaffirmed. Clement stated that "there has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite." The Journal of Global Drug Policy and Practice that Clement was referring to is run by the Drug Free America Foundation
Drug Free America Foundation
The Drug Free America Foundation or DFAF is a 501 non-profit organization that currently describes itself as "committed to developing, promoting and sustaining global strategies, policies and laws that will reduce illegal drug use, drug addiction, drug-related injury and death." The organization...
, and received much of its initial funding in a $1.5 million grant from a U.S. Department of Justice
United States Department of Justice
The United States Department of Justice , is the United States federal executive department responsible for the enforcement of the law and administration of justice, equivalent to the justice or interior ministries of other countries.The Department is led by the Attorney General, who is nominated...
agency now under investigation for corruption.
Mangham's article has been questioned because it dismisses more than 20 peer-reviewed studies published in reputable medical journals such as The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
, the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
, and the British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...
, all of which indicate that Insite has a positive effect. The Journal of Global Drug Policy and Practice
Journal of Global Drug Policy and Practice
The Journal of Global Drug Policy and Practice describes itself as an open access peer-reviewed public health journal. Critics say it is biased, not peer reviewed, and not a legitimate scientific journal...
(JGDPP) article, which was commissioned and financed by the RCMP, drew further criticism in the journal Open Medicine
Open Medicine
Open Medicine is a medical journal launched in April 2007. It was established by former editors from the Canadian Medical Association Journal. John Willinsky, international advocate for open-access, is the journal's publisher...
, where a commentary described it as being "fraught with a host of outright factual inaccuracies and unsubstantiated claims." More than 130 scientists signed a petition endorsing the commentary, which also criticized the government's evaluation of Insite as distortive and politicized. Another commentary in the International Journal of Drug Policy characterized the government's evaluation as "what may be a serious breach of international scientific standards".
In answer to an op-ed in National Post
National Post
The National Post is a Canadian English-language national newspaper based in Don Mills, a district of Toronto. The paper is owned by Postmedia Network Inc. and is published Mondays through Saturdays...
, the President for Drug Prevention Network of Canada, Gwendolyn Landolt, maintained her organization's view that the research on Insite is flawed. She said that much of the research on Insite was done by scientists who had lobbied for the clinic's establishment and that they consequently lacked objectivity. She further suggested that the these researchers conspire with the editors of academic journals so that their papers are reviewed by referees that supports harm reduction. Gwendolyn Landolt also maintained that data shows that deaths from drug overdoses have actually increased in the vicinity of Insite most years since its inception, contrary to the point made by the allegedly biased Thomas Kerr in his preceding commentary on the misinformation her organization is peddling around. The next day the Provincial Health Officer of BC, Perry Kendall said that he had never heard of the data Ms. Landolt refers to and confirmed Thomas Kerr's assertion that death from drug overdoses have indeed declined in the preceding years - especially so in the vicinity of Insite.
Government and legal controversy
While the LiberalLiberal Party of Canada
The Liberal Party of Canada , colloquially known as the Grits, is the oldest federally registered party in Canada. In the conventional political spectrum, the party sits between the centre and the centre-left. Historically the Liberal Party has positioned itself to the left of the Conservative...
government allowed Insite to open, since 2006 its fate has been the responsibility of the Conservative
Conservative Party of Canada
The Conservative Party of Canada , is a political party in Canada which was formed by the merger of the Canadian Alliance and the Progressive Conservative Party of Canada in 2003. It is positioned on the right of the Canadian political spectrum...
government, which has not been as supportive of it. Conservative Prime Minister
Prime minister
A prime minister is the most senior minister of cabinet in the executive branch of government in a parliamentary system. In many systems, the prime minister selects and may dismiss other members of the cabinet, and allocates posts to members within the government. In most systems, the prime...
Stephen Harper
Stephen Harper
Stephen Joseph Harper is the 22nd and current Prime Minister of Canada and leader of the Conservative Party. Harper became prime minister when his party formed a minority government after the 2006 federal election...
has voiced opposition to the injection site in the past, saying that "We as a government will not use taxpayers' money to fund drug use." In mid-July 2006, Conservative Member of Parliament
Member of Parliament
A Member of Parliament is a representative of the voters to a :parliament. In many countries with bicameral parliaments, the term applies specifically to members of the lower house, as upper houses often have a different title, such as senate, and thus also have different titles for its members,...
David Fletcher stated that the government would let Insite's special exemption lapse before deciding whether to continue the project. The following week a spokesman for Tony Clement
Tony Clement
Tony Peter Clement, PC, MP is a Canadian federal politician, President of the Treasury Board, Minister for the Federal Economic Initiative for Northern Ontario and member of the Conservative Party of Canada....
, the Minister of Health
Minister of Health (Canada)
The Minister of Health is the Minister of the Crown in the Canadian Cabinet who is responsible for overseeing the federal government's health department and the enforcing the Public Health Agency of Canada, Canada Health Act, the law governing Medicare...
, refuted that, saying that a decision had not been made yet. During the XVI International AIDS Conference
XVI International AIDS Conference, 2006
The XVI International AIDS Conference was held in Toronto, Ontario, during the week of August 13-18 2006. This was the third time that Canada has hosted the International AIDS Conference, after Montreal in 1989 and Vancouver in 1996. The main venue for the conference was the Metro Toronto...
, held in Toronto
Toronto
Toronto is the provincial capital of Ontario and the largest city in Canada. It is located in Southern Ontario on the northwestern shore of Lake Ontario. A relatively modern city, Toronto's history dates back to the late-18th century, when its land was first purchased by the British monarchy from...
, two high-ranking Liberal MPs (Bill Graham
Bill Graham
William Carvel "Bill" Graham, PC QC is a former Canadian politician, who served as Minister of Foreign Affairs, Minister of National Defence, and Leader of the Opposition and interim Leader of the Liberal Party of Canada.-Personal life:...
and Keith Martin) put their support behind the centre, and criticized the Conservative government for delaying their decision. Insite supporters also demonstrated in Toronto during the conference, prompting the government to further delay any announcement, citing the week's "politicized" nature.
On September 1, 2006, Federal Health Minister Tony Clement deferred the decision of whether to extend the exemption for the site, citing a need for more research. However, on the same day the government cut all funding for future research, amounting to $1.5 million in lost research money. On August 13, 2007, the Portland Hotel Society and two drug addicts filed suit in the BC Supreme Court
Supreme Court of British Columbia
The Supreme Court of British Columbia is the superior trial court for the province of British Columbia. The BCSC hears civil and criminal law cases as well as appeals from the Provincial Court of British Columbia. Including supernumerary judges, there are presently 108 judges...
to keep the centre open, arguing that its closure would be a violation of the Charter right
Canadian Charter of Rights and Freedoms
The Canadian Charter of Rights and Freedoms is a bill of rights entrenched in the Constitution of Canada. It forms the first part of the Constitution Act, 1982...
of Insite users to "security of the person." On October 4, 2007, during the announcement of its $64-million drug strategy, the Conservative government announced that Insite will be granted another six month extension, allowing it to operate until June 30, 2008. In 2008 Minister Clement explained his position during a House of Commons debate period:
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- . . . (t)he expert advisory committee was very clear. It found that only 3% of those who attend Insite actually get referred to treatment and that only 10% of those who use Insite use it for all their injections. The expert advisory committee insisted that Insite only saved one life, and that life is important but I want to save more than one life. I want to save hundreds of lives around the downtown eastside, which is why we are focused on treatment and on professionals. Not one life should be lost.
In May 2008, the B.C. Supreme Court struck down sections of the Canadian Criminal Code prohibiting drug trafficking and possession, ruling that they contravened the Canadian Charter of Rights and Freedoms
Canadian Charter of Rights and Freedoms
The Canadian Charter of Rights and Freedoms is a bill of rights entrenched in the Constitution of Canada. It forms the first part of the Constitution Act, 1982...
. While this ruling does not take effect until next year, Justice Ian Pitfield also granted Insite an immediate exemption to federal drug laws, giving it legal grounds to continue operating. Several days later the federal government
39th Canadian Parliament
The 39th Canadian Parliament was in session from April 3, 2006 until September 7, 2008. The membership was set by the 2006 federal election on January 23, 2006, and it has changed only somewhat due to resignations and by-elections...
announced plans to appeal the decision to the B.C. Court of Appeal
British Columbia Court of Appeal
The British Columbia Court of Appeal is the highest appellate court in the province of British Columbia, Canada. The BCCA hears appeals from the Supreme Court of British Columbia and a number of boards and tribunals. The BCCA also hears criminal appeals from the Provincial Court of British...
. On 15 January 2010, the B.C. Court of Appeal dismissed the federal government's appeal in a 2-1 ruling. Three weeks later the federal government announced that it will appeal to the Supreme Court of Canada
Supreme Court of Canada
The Supreme Court of Canada is the highest court of Canada and is the final court of appeals in the Canadian justice system. The court grants permission to between 40 and 75 litigants each year to appeal decisions rendered by provincial, territorial and federal appellate courts, and its decisions...
. On February 10th, some 150 people protested the federal government's decision to further appeal. The protesters barred Prime Minister Harper from attending a dress rehearsal for the Vancouver Chinatown Spring Festival Celebration. On February 12, The Canadian Union of Public Employees
Canadian Union of Public Employees
The Canadian Union of Public Employees is a Canadian trade union serving the public sector - although it has in recent years organized workplaces in the non-profit and para-public sector as well...
sent an open letter to Harper, urging him to accept the ruling of the lower courts and allow Insite to remain open..
Of nine interveners in the Supreme Court case, one supported the conservative government's case to close the injection site: REAL Women of Canada
REAL Women of Canada
REAL Women of Canada is a socially conservative lobby group in Canada. The organization was founded in 1983.REAL stands for "Realistic, Equal, Active, for Life". The group believes that the nuclear family is the most important unit in Canadian society, and that the fragmentation of the Canadian...
, a social conservative organization. The other eight, including the Canadian Medical Association
Canadian Medical Association
The Canadian Medical Association , with more than 70,000 members, is the largest association of doctors in Canada and works to represent their interests nationally. It formed in 1867, three months after Confederation...
argued against the case for closure of the facility. The REAL Woman of Canada group argued that the site would discourage drug users from ceasing their habit, and that they would get "worse and worse until they die" while their families and communities suffered.
In May 2011 a lawyer for the Federal government told the Supreme Court that the government had not decided whether to continue or end support for Insite, contrary to previous statements by Minister of Health Tony Clement; that statement was derided in court as disingenuous by Joseph Arvay
Joseph Arvay
Joseph Arvay, QC is a Canadian lawyer who has argued numerous landmark cases involving civil liberties and constitutional rights. In 2000 he was awarded the Walter S. Tarnopolsky Human Rights Award; described by Madam Justice Michèle Rivet as "one of Canada's most tireless civil rights and human...
, a lawyer for PHS Community Services Society.
On September 29, 2011, the Supreme Court of Canada ruled unanimously to uphold Insite's exemption from the Controlled Drugs and Substances Act
Controlled Drugs and Substances Act
The Controlled Drugs and Substances Act is Canada's federal drug control statute. Passed in 1996 by the Chrétien government, it repeals the Narcotic Control Act and Parts III and IV of the Food and Drug Act and establishes eight Schedules of controlled substances and two Classes of precursors...
, allowing the facility to stay open indefinitely. The ruling states that Clement's decision to apply the CDSA to Insite was "arbitrary, undermining the very purposes of the CDSA, which include public health and safety. It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises."