As summer ran its course in Vancouver, a 3-year experiment to provide heroin addicts with a medically supervised injection site neared its scheduled Sept. 12 expiration. Canada's former Liberal government had granted the facility, InSite, a permit exempting it from federal drug laws. To remain open, InSite required a new permit from the Conservative government — some of whose members argued it's morally wrong to aid illegal drug addiction.
InSite is in the Downtown Eastside, Vancouver's impoverished neighbourhood of concentrated HIV and hepatitis sufferers, drug addicts and dealers, sex-trade workers and criminals. North America's first and only such site, it daily serves about 600 addicts who bring in illegal street drugs and then inject themselves with syringes dispensed by InSite, under the watch of health professionals. Nurses and doctors intervene if users overdose and offer general health care, while counselors are present to offer addiction treatment.
Some 50 similar sites exist worldwide, but InSite remains audacious given the US “War on Drugs” next door. In British Columbia, however, it has massive public and political support under a popular “Four Pillars” drug strategy of prevention, enforcement, harm reduction and treatment.
During InSite's 3 years, a remarkable consensus that the facility reduces harm to users and the public developed among scientists, criminologists and even the Vancouver Police Department. Research, all positive, was published in 15 peer-reviewed journals, including the CMAJ (2004;171:731-4), Lancet (2005;366:316-8) and the New England Journal of Medicine (2006;354:2512-4).
In the spring of 2006, the province wrote to Ottawa formally applying for a 3.5-year renewal of InSite's permit.
Ottawa's response was a long silence.
Over the summer, InSite became a cause célèbre. Activists, politicians and even scientists lobbied for it, and at the international AIDS conference in Toronto researchers spoke in support while AIDS activists demonstrated in the streets. Lawsuits were threatened. Ethicists joined the fray, including Margaret Somerville of McGill University's Centre for Medicine, Ethics and Law, who said given that addicts would continue to be addicts, reduction of serious harms such as HIV and hepatitis infection is an ethical requirement. One of the few opponents was the Canadian Police Association, which in late August demanded that Ottawa close InSite and focus instead on a national drug strategy.
Less than 2 weeks before InSite's scheduled closure, on Sept. 1, federal Health Minister Tony Clement announced he was deferring a decision on InSite pending more research, but it could remain open until Dec. 31, 2007. Clement's announcement asked: “Do safe injection sites contribute to lowering drug use and fighting addiction? ... Right now the only thing the research to date has proven conclusively is drug addicts need more help to get off drugs.”
The Canadian HIV/AIDS Legal Network accused the government of “playing politics with people's lives.”
Dr. Evan Wood, an epidemiologist at the BC Centre for Excellence and HIV/AIDS and assistant professor of medicine at University of BC who is, with Dr. Thomas Kerr, principal investigator for evaluation of InSite, argues that science clearly shows the benefits of InSite, and seemed nonplussed to find himself one of InSite's most vehement backers.
“I am a scientist, and I hate to be referred to as an advocate,” he said. “But Dr. Kerr and I ... want to see the problem improved as scientists, because the benefits have been so positive.”
Wood added, “I felt like the federal government was politicizing this because the science is that strong.” — Deborah Jones, Vancouver
Figure. Activists protested the imminent closure of InSite at the 16th World AIDS Conference held in Toronto this August. Photo by: Canapress, F. Gunn