Monday, May 05, 2008

Insite Making Partisan Mountains Out of Political Molehills

Safe injection site poses dilemmas for addiction treatment, federal government

If one were to believe some of the rhetoric being forwarded by supporters of Insite, Vancouver's Safe Injection Site and (predictably) opposition MPs, one would think that the site is under immediate threat of being shut down by federal Health Minister Tony Clement.

"This is going to be catastrophic for people who have substance abuse problems, for society, for taxpayers, for crime," said Liberal MP Dr Keith Martin. Martin was, at the time, referring to then-forthcoming Conservative party drug policies.

Some may recall that the policies covered three different pillars: enforcement, prevention and treatment. In one of the most blatant examples of intellectual dishonesty in recent history, various left-wing ideologues refused to ackowledge the fact that $32 million -- the largest parcel of funds being doled out under the new program -- was directed toward new treatment programs, while another $10 million toward prevention programs. The very same treatment and prevention programs that most of Canada's top drug-policy experts advocate.

One sees a similar rhetorical feat being accomplished in regards to Insite. While those who support the site and those who benefit politically from portraying the government as dangerous and reactionary in regards to it have combined their efforts to perform an act of rhetorical slight-of-hand to try and apply pressure to keep the site open, it turns out that a lot of the hysteria suggesting that the site is in imminent danger of being closed is simply that: hysterics.

But to begin to demonstrate this, one really needs look no further than the most recent news-making item regarding Insite: the release of a recently-completed report about Insite's impact -- or, more notably, lack thereof -- on crime rates in its surrounding community.

"We looked at crime rates in the area surrounding Insite, and we talked to business operators, we talked to service providers, to police, to residents in the surrounding vicinity. We found, overwhelmingly, people had very positive sentiments," said Neil Boyd, a criminologist at Vancouver's Simon Frasier University. "Not only that, crime rates were quite unaffected by the implementation of Insite. ...In fact, we found some improvements in public order with respect to decreased injection debris, decreased injections around the site and those findings simply corroborated other research that had been carried out prior to our study."

Insite operates under an exemption to Section 56 of the Controlled Drugs and Substances Act.

"I don't think there's much doubt anymore," Boyd said. "We have to move to close this chapter and give Insite a long-standing exemption."

There is strong support for Boyd's case. But one also needs to keep in mind that it was Tony Clement, in October of last year, extended Insite's exemption, which was due to expire. This was the second extension that Clement had granted the operation while his Conservative government examined the issue.

Naturally, the extensions themselves were treated derisively by opposition MPs who benefit politically from portraying the Conservative party as being too hard on drugs.

"If Prime Minister [Stephen] Harper really believed that Insite is a useful tool in treating addictions, he would have extended the program for years, not months," said Martin, who insisted that the extension was simply a "stalling tactic" used to leave the issue open so the Conservatives could close the site if they're able to win a majority.

"I am a little cynical about these short-term extensions. It's no way to address a serious health issue," agreed Victoria NDP MP Denise Savoie, who also harped on the Conservative party's alleged "narrow ideological view" on drugs.

This, one remembers, was coming from a party whose press release counter-factually admonished the Conservative party for allegedly not supporting treatment and prevention. Talk about a narrow view.

It would also be indicative of a narrow view to suggest that a fledgling government -- as the Conservatives have been for the past two years -- shouldn't review any active policies of the previous government that may give them cause for concern. And whether the varying supporters of Insite like to admit it or not, Insite does pose a number of practical, moral and ethical dilemmas for the government -- dilemmas that require time to examine.

In particular, Insite does pose a dilemma for politicians who understand that crime often has an interrelated nature. Drug addictions, in particular, have been shown to have an impact on property crime rates. While Insite has been decisively shown to not negatively impact crime rates in its community, the study itself was still important. Property crime in regards to Insite is one dilemma we can now consider effectively solved.

A Health Canada report released last month dealt with this particular dilemma, along with numerous others.

Among those other dilemmas is whether or not Insite provides users with an incentive to seek treatment. Harm reduction strategies clearly do a lot of good. The one particular benefit that offers the greatest public advantage is probably stemming the spread of sexually-transmitted disease.

The recent Health Canada report suggests that the number of referrals from Insite to detoxification and treatment centers has increased the overall use of these facilities -- certainly yet another feather in Insite's cap.

Another dilemma is whether or not the public funding for Insite is a particularly wise investment considering that it essentially supports the use of illicit substances. Clearly, the public benefit of the site would have to exceed its costs. The Health Canada panel conducted a cost-benefit analysis of Insite and found that it accrues $4 worth of public benefit for every single dollar spent. Clearly Insite passes this test as well.

The report also concludes that Insite saves lives by preventing drug overdoses.

"Overall, the report is very positive and confirms our research that the site is doing what it's supposed to do -- provide health benefits without increasing harm," said Sam Kerr, a researcher for Centre for Excellence on HIV/AIDS.

But meanwhile, one also needs to consider the fact that many organizations -- including the CEHA -- were apprehensive about even this study, concerned it would be used as a pretext for closing the site. Clearly, that isn't the case.

With the federal government's investigations into whether or not Insite represents a wise expenditure of Canadian tax dollars bearing obvious fruit in terms of keeping the site open, those who support the site -- and those who seek to benefit politically from it -- have resorted to strenuous data mining on the topic, scouring Tony Clement's comments regarding drug policy in general in order to find some sort of evidence that he intends to close the site.

What has emerged are some rather ludicrous attempts at twisting some otherwise largely-benign comments. In particular, some of these individuals went out of their way to distort some comments made by Clement to the Canadian Medical Association:

"The messages young people have received during the past several years have been confusing and conflicting to say the least," Clement announced. "We are very concerned about the damage and pain that drugs cause families and we intend to reverse the trend toward vague, ambiguous messaging that has characterized Canadian attitudes in the recent past."

"Harm reduction, in a sense, takes many forms," Clement added. "To me, prevention is harm reduction. Treatment is harm reduction. Enforcement is harm reduction."

And, of course, they are. But the simple truth of Clements words didn't stop individuals like Stephen Hwang, a researcher at the University of Toronto's department of medicine, from trying to read intonations of ideological danger into Clement's comments.

"The health of a nation is placed in peril if our leaders ignore crucial research findings simply because they run contrary to a rigid policy agenda driven by ideology or fixed beliefs," said Hwang, in a letter co-signed by 130 like-minded doctors and scientists.

But if Clements agenda was really "driven by ideology or fixed beliefs", one might have expected that he would have avoided visiting the safe injection site, or acknowledging any information that supports it. Instead, he's done the exact opposite.

"I had a good chat with the staff there, understood some of their procedures, asked a lot of questions, got a lot of answers," Clement announced after touring Insite in January 2007. "I think I am continuing to get a deeper understanding and this is all part of being the best health minister I can be for the country."

That was a big part of the short-term rulings made by Clement, while he waited on his own research into Insite, its impact on the surrounding community, and the impact on its users. The fact that the research corroborated previous research is and remains largely immaterial. The simple fact of the matter is that facilities like Insite need to be reevaluated on an annual basis.

Even though Insite is clearly an ideal way to help tackle some of the serious issues that accompany drug use right now, there's no guarantee that the factors that make it so ideal -- a favourable cost-benefit ratio, low impact on crime rates, referral to addiction-treatment services and saved lives -- will endure indefinitely. There may very well come a time in the near future when a new approach becomes necessary, be it due to changing conditions in the surrounding community, or the introduction of newer, more dangerous designer drugs, or any number of other things that are almost certainly going to change in a dynamic society.

Until that time arrives, however, it would clearly benefit Canadian society to allow Insite to continue performing its valuable services. A longer extension to its Drug and Controlled Substances Act clearly needs to be granted, just as Neil Boyd insists.

However, that extension needs to be well short of permanent. At some point over the next two or four years, Insite should be evaluated by Health Canada again, and continually every two or four years after that.

Insite should never be allowed to attain the position of an ideological drug policy orthodoxy that may never be challenged. In fact, it needs to be challenged on an annual basis, and Canadian society needs Insite for as long as it can stand up to scrutiny.

Such reevaluations should be considered minor political maintenance for an operation that, by its very nature, will almost always be contentious.

In the meantime, Canadians should reject the rhetoric of those trying to transform these political molehills into partisan mountains.


  1. It'll be interesting to see, if the conservatives do exactly the opposite of what all of their supporters I've encountered have been saying/blogging to do about insite. For example Hyphenated Canadian (the conservative equivalent of Canadian Cynic) railed against Insite, but now changes his tune?

    I have yet to meet one tory -for- insite. But that could e a generalization.

    And I don't think it's really a stretch, to think conservatives would be opposed to something like insite. Their righteous right supporters would be extremely offended by their support of this.

    But. A breath of fresh air would be to see the nonsense brushed aside on both sides and the issue dealt with with a least some sanity. But given the issue, I doubt that will happen.

  2. Considering that Tony Clement has never said anything about closing Insite, I think a lot of the panic is purely manufactured.

    I'm aware of Clement's opposition to opening safe injection sites in Ontario while he was health minister there, but it's much harder to justify closing down a program after its been shown to be successful than before it even gets started.

    There do remain some dilemmas wit Insite that have yet to be resolved. For example, doctors take a Hippocratic oath that requires that they "do no harm". Certainly, harm reduction, as is the case with Insite, has something to be said for it. Then again, it's hard to argue that consuming a drug like heroin doesn't do harm. The doctor could be considered to be implicit in that self-harm by supervising the injection.

    This, however, is a dilemma that can only be solved by the individual doctor themselves.

    While certainly the ethical guidelines can be taught in the classroom, the ability to make decisions regarding ethics in the course of practice invariably remains in the hands of the practitioner.


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