supervised injection: common sense finally won

Cheap moral virtues have nothing to do with efficient public health practices, this the vibrant core of the Supreme Court's ruling. In a unanimous decision, the nine appointees to the highest court of Canada have confirmed that drug addiction is a disease, not the result of a soul weakness" wrote Marie-Andrée Chouinard  in "Le Devoir" – October 3rd.

On September 29, 2011, the Supreme Court of Canada ruled unanimously to uphold supervised injection site Insite's legal exemption allowing some injecting drug users (IDUs) in the Downtown Eastside neighborhood of Vancouver to continue to inject their own drugs safely, with sterile equipment, without fearing police intervention.

Scientific evidence

When created, Insite could acquire a special legal exemption from the controlled Drugs and Substances Act which prohibits drug possession and trafficking. This legal exemption was granted under the condition that the facility's impacts be thoroughly evaluated. Consequently, the site has been the focus of more than thirty studies, published in 15 peer-reviewed scientific journals, which have unanimously indicated an array of benefits, including reductions in syringe sharing and public injecting and increases in the use of detoxification and treatment services among patients (1).

Additional cost-benefit analysis of the site, published 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 in the International Journal of Drug Policy in 2010 showed that the facility prevents 35 HIV cases and about 3 deaths every year, indicating an annual societal benefit of about $6 million (2).

Lastly, and to drive the point home, a 2011 study in the world famous Lancet found overdose-related deaths have dropped 35% in the area since Insite opened, much more than 9% drop elsewhere in Vancouver (3).

"A State-sponsored Suicide"

Despite Insite's strong local and national support (4), the site drew persistent criticism since it opened, including criticism from the Bush administration which called Insite "state-sponsored suicide" on its opening. In addition, since it was elected in 2006 the Conservative government has repeatedly voiced fierce opposition to the injection site, Prime Minister Stephen Harper claiming somewhat demagogically: "We as a government will not use taxpayer's money to fund drug use".

In short, there was a serious falling out between the advocates of a pragmatic approach to the follow-up of injecting drug users and the supporters  of a conservative, moralist hard line.

When Federal Health Minister Tony Clement refused to renew the legal exemption granted to the project, Insite decided to turn to the justice, until the country's highest court. On September 29, the Supreme Court of Canada forced Minister Clement to grant Insite necessary legal exemption for adequate operation.  

The conservative government's moralistic approach was undermined by the unanimous decision of the Court's nine justices - although it would have seemed curious to rule otherwise given the amount of scientific evidence in support of the Insite project. Nonetheless, considering the proximity of America's "War on Drugs" policy, such outcome was far from certain. Common sense has finally prevailed and it is a good thing.

Drug users should be helped and assisted rather than punished. When they do not want to stop using drugs,  one should give them the means to do it safely while providing adequate medical and psychological supervision and access to treatment services. Supervised injection sites are only a small part of the prevention and treatment instruments validated by research. And they all have their own purpose and usefulness.

As a conclusion, we hope that the Supreme Court ruling opens the way for additional supervised injection facilities nationwide and elsewhere around the world. Addiction treatment and prevention strategies, as well as the efficient follow-up of drug users demand a variety of instruments and approaches which  go far beyond any "No to drugs" moralistic stance. This requires  will and political courage.

Insite is the only legal supervised injection site in North America, located in the Downtown Eastside neighborhood of Vancouver (British Columbia). The site is dedicated to provide a safe and health-focused location for injection drug use (heroin, cocaine and morphine), although the facility does not supply any drugs. The site's medical staff are present to provide addiction treatment, mental health assistance and first aid in the event of a wound or overdose. In 2009, Insite recorded an average of 702 visits per day, by 5,477 unique users while 484 occurred with no fatalities (source Wikipedia)

Read Dianova's stance about the harm reduction model and supervised injection sites

(1)

• Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users.
• Wood E, Kerr T, Small W, et al. (September 2004). "Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users"
• Wood E, Tyndall MW, Zhang R, Montaner JS, Kerr T (June 2007). "Rate of detoxification service use and its impact among a cohort of supervised injecting facility users". Addiction 102 (6): 916–9.
  

(2)

• Bayoumi AM, Zaric GS (November 2008). "The cost-effectiveness of Vancouver's supervised injection facility". CMAJ 179 (11): 1143–51.
• Andresen MA, Boyd N (January 2010). "A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility". The International Journal on Drug Policy 21 (1): 70 – 6
  

(3)

• Marshall BDL, Milloy M-J, Wood E, Montaner JSG, Kerr T. "Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study". The Lancet
  

(4)

• Read the final report of the Expert Advisory Committee prepared for the Hon. Tony Clement, Minister of Health