ONE
The battle over Insite’s future
Vancouver Observer- Jenny Uechi
Tomorrow, the Supreme Court will begin hearing the case for continued operation of Insite, Vancouver’s safe injection site. Proponents call it a life-saving health facility, while critics view it as a dangerous facilitator of criminal activity. Whatever the court’s decision, Vancouver will be deeply affected by the decision.
Doctors, nurses and recovering drug addicts gathered at the Insite safe injection site on Wednesday morning to speak in support of the facility.
Vancouver Coastal Health’s chief medical officer, Dr. Patricia Daly, said that studies show supervised injection to be a “legitimate public health project that saves lives”.
Nicola Keate, a recovering addict, said that Insite helped her overcome her long-term drug addiction. “If they hadn’t come down and stepped in to get me up here and get me some help, I’d be dead today,” she said.
Speaking with a slight British accent, Keate reminded people how drug addicts don’t always conform to social stereotypes of poverty and abusive households.
“I’m kind of an oddity because I come from excellent parents and had an extremely good upbringing,” she explained.
Keate said her main problem was shyness, and that being teased as a child for over her accent caused her to become more withdrawn. After being introduced to drugs by a man “twice her age”, she spent a large part of her young adulthood addicted to hard drugs.
Keate is currently receiving treatment at OnSite, the drug recovery centre on the second floor of Insite, and says she has been clean for the last three months.
So far, public health officials and drug users have praised Insite as a life-saving facility that provides a necessary service within the Downtown Eastside, with its estimated population of 5,000 intravenous drug users its high concentration of drug users. A recent UBC study in the peer-reviewed medical journal, The Lancet, reported a 35 per cent drop in overdose deaths in the immediate vicinity of Insite since the facility opened in 2003. As for political support, Mayor Gregor Robertson and previous mayors have called on the federal government to keep Insite open.
Still, Prime Minister Stephen Harper and the Conservative Party have long opposed Insite have asked Canada’s top court to consider giving them power to shut it down. The question is, why?
A health issue, or a criminal activity?
One of the major points of contention over Insite is whether it is a health facility, or a judicial twilight zone where users can freely inject drugs banned by federal law.
For Hugh Lempick, a board member of Vancouver Area Network of Drug Users (VANDU), Insite is clearly the former.
“It’s a health facility,” he said. “If it weren’t a health facility, they wouldn’t have nurses there, it wouldn’t be supervised, it wouldn’t have saved over a thousand lives a year. It saves lives … the federal government, with their law-and-order argument, it’s bullshit.”
Lempick said that many of VANDU’s members rely on Insite, and that he knows “about a dozen” users who have managed to recover from drug use as a result of being introduced to treatment through Insite. Monika Stein, a manager of harm reduction programs at Insite, affirms that drug users at Insite are three times as likely to seek treatment than those who don’t.
In Lempick’s view, drug use is only a visible part of deeper problems. He said many drug addictions are caused by personal traumas such as child abuse and death of family members. Adding that it’s “no excuse” for becoming drug-addicted, Lempick insists that drug users often decide to take steps to break their habit through interaction with Insite’s staff.
Critics, however, are not convinced that Insite helps drug users seek treatment. Simon Fraser University criminology professor Garth Davies expressed doubt over Insite’s effectiveness, writing in a 2007 paper that Insite produced only one referral for every 112 visits.
Al Arsenault, a retired police officer who spent much of his 27-year career in the Downtown Eastside, said some people who use Insite’s services are not interested in stopping their substance abuse.
“Some people are incorrigible,” he said. “They will never, ever quit drugs, as long as we give them a place to shoot up … All they’re doing (at Insite) is facilitating, enabling and condoning destructive, illegal, unhealthy behavior.”
Arsenault, who is director/producer at Odd Squad Productions, a filmmaking company that produces documentaries to prevent youth from criminal activity, has worked on production such asThrough a Blue Lens and Tears for April, which show the devastating effects of drugs on people in the Downtown Eastside.
He argues that Insite “puts the cart before the horse” by helping drug users pursue their habit, and that funding should be directed more toward people seeking treatment. He believes that the $3 million annual budget for Insite should be used for other detox programs, such as Harbour Light, run by the Salvation Army, and the Welcome Home Society in Surrey.
“Support the people who are trying to get off drugs, help them get treatment, then if there’s money left over, deal with the other people who are addicted,” he said.
“At the end of 20 years of treatment, you have a most-likely healthy, productive adult. After 20 years of harm reduction, the person may or may not be alive, almost certainly diseased, and unproductive because they’re putting poison into their bodies. So you wonder where your money should go.”
Gloria Kieler, a pastor from Living Waters Mission, a faith-based outreach program for drug users, agrees that Insite is funded at the expense of detox services in Vancouver.
“People have to wait weeks to get into detox, and by then they’ve changed their mind,” she said. “It’s very difficult — harm reduction is great, but first of all, we should have enough beds for people to go straight into detox. They shouldn’t have to wait weeks. I don’t even feel free to talk to people about going to recovery because they’ll get disappointed trying to get in.”
Referring to documentary Streets of Plenty, Arsenault criticizes nurses at Insite for teaching new users how to shoot illegal drugs like heroin, and believes that the safe injection site does not provide the right setting for people seeking treatment to end their habit.
“You’re sitting with a public health nurse and you’ve got a needle full of drugs in front of you. Is that the best time to ask for treatment? Before you fix? Or, just after you fix, and you’ve added drugs in your brain? It’s nonsense.”
Treatment versus harm reduction
Sammy Mullaly, a nurse who has been working at Insite for three years, explains that staff ‘teach’ users to inject drugs in order to prevent them from injury and overdosing. It’s part of the “harm reduction” model, which is aimed at minimizing adverse consequences of drug use without forcing outright abstinence.
“A lot of people who come in come in with misconceptions, so we teach people how to inject more safely,” she said, noting that nurses help protect users’ health by providing clean needles and managing overdoses, which happen at a frequency of about “five a week”.
While many of the clients at Insite don’t go with the intention of quitting drugs, Mullaly explained that ongoing interaction between staff helps create the conditions for users to seek help.
“A huge part of our job is relationship building,” she said. “We find out all their stories and histories, and we refer them to treatment.”
Daly believes that Insite’s critics and supporters have “common ground” and agree on major points about addiction.
“I support prevention treatment,” she said. “Where the federal government is wrong that harm reduction is another option. You can’t have treatment without harm reduction. Treatment is complex and can take many years and many attempts.”
In Daly’s view, harm reduction and treatment go “hand-in-hand”, and one cannot work effectively without the other.
One issue of contention is that if the Supreme court rules in favour of Insite, there will be more facilities that will be opened in urban centres across Canada.
Dr. Thomas Kerr, director of the urban health research program at the B.C. Centre of Excellence in HIV/AIDS, said that other cities have already been considering opening up a safe injection site, and that Vancouver will be a litmus test of whether they will go through with it.
“There’s been good research undertaken in several cities including Toronto, Montreal and Victoria, showing that these facilities could help reduce public disorder problems related to drug use,” said Dr. Thomas Kerr, director of the urban health research program at the B.C. Centre of Excellence in HIV/AIDS. “But this court case is holding everything up.”
His concern is not that there will be too many safe injection sites in the future, but that there will be too little: when there are long lineups outside Insite, he said, people end up shooting up in alleyways or at home, increasing the risk of overdose and infection.
Colin Ross, a recovering addict who is receiving treatment at Onsite, described the safe injection site as being beneficial both to drug users and the city at large.
“We’re human beings — we deserve it, and you deserve it,” he said, pointing to reporters. “You deserve to have communities cleaner, safer. You deserve to have people being treated, and not leaving needles on your front lawn … The numbers are in, (Insite) works.”
http://www.vancouverobserver.com/
TWO
Listen to Al’s interview with CBC’s Stephen Quinn recorded May 11/11:
http://www.cbc.ca/onthecoast/
THREE
Peer Reviews
Richard Horton, editor of the British medical journal The Lancet, has said that
The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability — not the validity — of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed [skewed], often insulting, usually ignorant, occasionally foolish, and frequently wrong.[27]
Finally, this and other recent public health scares have focused attention on the validity of the precautionary principle. This principle states that, where there are significant risks of damage to the public health, we should be prepared to take action to limit those risks, even when scientific knowledge is not conclusive, if the balance of likely costs and benefits justifies it.
27. Horton, Richard (2000). “Genetically modified food: consternation, confusion, and crack-up”. MJA 172 (4): 148–9. PMID 10772580. http://www.mja.com.au/public/issues/172_04_210200/horton/horton.html.
http://en.wikipedia.org/wiki/Peer_review
