Barbara Kay, National Post · Oct. 5, 2011 | Last Updated: Oct. 5, 2011 3:05 AM ET

In 2003, Insite, the first experimental supervised injection site in North America, was installed in Vancouver’s Downtown Eastside (DTES), Canada’s poster district for entrenched substance abuse and addiction. At Insite, addicts may legally shoot up illegal drugs in hygienic, medically protective and non-judgmental circumstances. The controversial clinic instantly became, and remains, a crucible for passionate social and legal debate about public policy in dealing with drug addiction.

Those who argue for Insite believe that its governing philosophy of “harm reduction” for what they regard as an incurable affliction, is both ethical and efficacious in reducing disease and deaths. Opposed to Insite are those who support what one might call the “moral agency” model. This redemptive perspective, which favours pro-active strategies of treatment and prevention, has the support of the federal government, which has tried to close Insite down since 2006.

On Sept. 30, the Supreme Court of Canada ordered the Minister of Health to permanently exempt Insite from the provisions of the Controlled Drugs and Substances Act and, by implication, all other applicants for drug injection sites elsewhere in Canada. In their ruling, the Supreme Court justices explicitly linked the decision to their belief that, “Insite saves lives. Its bene-fits have been proven.”

How did they come to that understanding? Well, the Insite hearings were held on May 12. On April 18, a population-based study conducted by University of British Columbia (UBC) researchers and published in the leading medical journal The Lancet was conveniently distributed to the media. The study claims that over the period 20027, drug overdose deaths within a 500-metre radius around Insite reduced by 35%, while the rest of Vancouver reduced by 9%. Lead researcher Dr. Thomas Kerr announced that, “the evidence is clear, Insite saves lives.” His words were immediately hailed by Insite’s many supporters in the media as proof of the site’s success.

However, an anti-drug watchdog group vigorously contests these findings. In an analysis of The Lancet study commissioned by the Drug Prevention Network of Canada and Real Women of Canada, an international team including three Australian doctors, B.C. drug-prevention expert Colin Mangham and Dr. Robert Dupont, president of the U.S. National Institute of Drug Abuse, allege that The Lancet study’s findings of decreased deaths in the Insite area are not supported by data from the British Columbia Coroner’s office, which indicate that deaths from drug overdoses in the area around Insite not only did not decrease, they in fact increased between 2002-2007 (see graph to the left).

Amongst other allegations, the watchdog group contends that the Lancet researchers, some of whom have advocated for Insite since the 1990s, manufactured an appearance of overdose mortality reduction by including 2001 data in their pre-Insite comparison years, without stipulating that 2001 was a year of unusual heroin availability. They were well aware of the anomaly, since it was the subject of two previous journal articles by three of The Lancet article’s researchers. The analysts further maintain that the UBC researchers failed to note that 41% of B.C.’s overdose fatalities are not even injection-related.

More significantly, they affirm, is the UBC researchers’ disclaimer of any knowledge of “confounder” policing changes around Insite between 2001 and 2005 that might have affected the rates of overdose deaths. But according to the analysts, the researchers had to have known that since April 2003, 50-66 police officers were added for patrol duties, specifically to a 12-block radius of Insite, where the contested 35% decrease is alleged to have occurred. As evidence, they point to a 2004 journal article, a “detailed analysis of the effects of the changed policing,” on which three of the UBC researchers collaborated, which showed a 46% evacuation of drug users from the area as a consequence of the police crackdown.

The analysts conclude that Insite, hosting about 144,000 opiate injections annually, saves 1.08 lives per year, a statistically negligible outcome, but a figure that is proportionally consistent with a 2008 Canadian Government Expert Advisory Committee’s international review of injecting sites worldwide. In Germany’s 25 injecting rooms, hosting 500,000 annual opiate injections, for example, the cumulative number of lives saved is estimated at about 10 per year.

A complaint about The Lancet study research has been filed with UBC. The question now arises: If it is found, as their critics charge, that serious errors undermine the credibility of the research, invalidating The Lancet study’s claims, then the Supreme Court’s justification for their ruling in favour of Insite, that it “saves the life and health” of addicts, is also void. In that case, unless the court can point to another source of credible evidence to support it, it should take the honourable course of action and annul its ruling.

DRUG OVERDOSE DEATHS

bk**@*******on.ca

The following Media Release was posted today by DPNC President Gwen Landolt.

M E D I A   R E L E A S E

For Immediate Release                                                                      October 3, 2011

A DRUG ADDICT’S DESTINY

Drug addicts are human beings.  They deserve better than being shuffled off to a drug injection site, which will only deepen their addiction and hasten their inevitable and terrifying death.

The Supreme Court of Canada based its decision to legalize the operation of the site on the supposed premise that it “saves lives and health of the addicts”.  This conclusion, however, was based only on the flawed evidence of the activist researchers who had a conflict of interest in that they were also the lobbyists for the establishment of the site a decade ago.

The impartial federal government’s Expert Advisory Committee in its report in March 2008 concluded that the drug injection site, which costs three million dollars annually to operate, only refer 3% of its attendees for treatment, the latter is the only way that an addict can regain his/her health and dignity and return to a normal life.

The happiest people in Canada with this decision will be the drug traffickers whose business will boom by way of the addicts obtaining the drugs from them to bring onto the site to inject themselves.

Conversely, the unhappiest individuals will be the police who will have to deal with the inevitable increase in crime due to the criminal activity caused by addicts who require a minimum of $35,000 annually to feed their addiction.  This is one of the reasons why Vancouver has one of the highest crime rates in North America.

The compassionate and humane solution for drug addicts is to help the addicts, not kill them by allowing them to inject more and more of the drugs into their system facilitated by the drug injection site.

The organization, REAL WOMEN OF CANADA, was one of the official intervenors before the Supreme Court in the matter of the so-called “safe” injection site known ironically as “Insite.”

Here is their response to the Court’s decision.

“Women Building a Better Society”

NGO in SPECIAL consultative status with the Economic and Social Council of the United Nations

M E D I A   R E L E A S E

SUPREME COURT OF CANADA DECIDES

CANADA’S NATIONAL POLICY ON DRUGS

RE: VANCOUVER DRUG INJECTION SITE

The Supreme Court of Canada in its decision handed down today on the legality of the Vancouver drug injection site, has arrogantly decided that it is more capable of determining Canada’s national drug policy than the elected government.

It has ordered the Minister of Health to continue the operation of this controversial drug injection site, even though, under the Controlled Drug and Substances Act (CDSA), this is supposed to be a matter for the Minister’s discretion.

In its judgment, the court talks on both sides of its mouth by claiming it is not interfering with the exercise of ministerial discretion but then goes on to state that the Minister must grant the exemption not only for the Vancouver site, but also generally for all other applicants for drug injection sites in the country, on the grounds, that to do otherwise, would deprive [addicts] of their  “life and security of person” under Section 7 of the Charter.

The practical effect of this decision is that the court has exempted the Vancouver drug injection site from the criminal provisions on illicit drug use and has only graciously allowed the federal government to “regulate” these sites, thus fundamentally changing our national drug policy by widening the use of illegal drugs.

The court has made the decision despite the fact that Canada has been criticized numerous times by the UN’s International Narcotic Drugs Control Board (INCB), for establishing this site, the first in North America, as it contravenes UN drug treaties ratified by Canada.  Apparently, the Supreme Court is of the view that the UN drug treaties ratified by Canada are not binding on us.

The Supreme Court gave as its reasons to exempt the drug injection site from the provisions of the CDSA the fact that it supposedly “saves the lives and health” of drug addicts.

This is highly questionable since this conclusion is based on the flawed research provided by a group of advocates and promoters of the Vancouver drug injection site who have a conflict of interest in this research, since they were also the lobbyist and advocates for the establishment of the drug injection site over a decade ago.

This points out that judges are ill positioned to make national policy decisions.  They have limited access to social data, depend on biased and narrow arguments of the litigants, and also on unreliable information in the media.  They are Isolated from society, and are not exposed to differing perspectives, since there is no public debate, such as occurs in Parliament.

This decision by the Supreme Court on the Vancouver drug injection site stands as a monument to the determination by the Supreme Court to control Canada’s national agenda, not Parliament, presumably on the basis that it believes it knows what is best for the Canadian public.

This decision directly attacks the democratic process and is a flaunting of the power and influence of the courts using the vague words of the Charter to promote their own ideological perspective.

M E D I A   R E L E A S E

For immediate Release                                                                      September 22, 2011

ERRONEOUS STUDY ON VANCOUVER INJECTION SITE EXPOSED

Three Australian doctors, a Canadian Ph.D., and Dr. Robert Dupont, the President of the US National Institute of Drug Abuse (NIDA), are part of an international team, which has exposed major, inexcusable errors in a highly influential 2011 Lancet study on Vancouver’s Insite injecting facility.  The study had claimed that the site has reduced overdose deaths in the immediate surrounding area (Down Town East Side-DTES). This recent analysis nullifies the Lancet study’s claims, which are found to be unsustainable.  According to data from the British Columbia’s Coroner’s office, the number of deaths from drug overdose in the drug injection area has not decreased, but increased each year from 2002 – 2007, despite Insite’s commencement in 2003 (see endnote).

See analysis at www.drugfree.org.au/fileadmin/Media/Global/Lancet_2011_Insite_Analysis.pdf

The erroneous Lancet study was conducted by the same researchers who had previously completed over two dozen other, well publicized, positive, studies on the drug injection site.  These researchers however, have a conflict of interest, in that they were also the lobbyists for the establishment of the drug injection site over a decade ago.

A complaint about this questionable research has now been filed with the University of British Columbia, who employs the Lancet study researchers.

The Lancet article, published on 18 April 2011, may be influential in the Canadian Supreme Court hearings on the drug injection site held on May 12 this year, having been strategically timed to be distributed to the media the week the case was argued before the court. The Court reserved its decision on whether the Canadian government can close the facility, having been hampered from doing so by the court action launched by the operators and supporters of the site.

This exposure of the erroneous study points out that activists cannot be relied on to provide objective science.  The dozens of other studies on Insite provided by these activists are now also under a cloud, as a result of the errors found in 2011 Lancet study.

Contact:

C. Gwendolyn Landolt                                            Chuck Doucette

President                                                                   Vice President

(905) 787-0348                                                         (778) 838-0201

Al Arsenault

Board Member

(604) 788-7051

MR 2011-01

BACKGROUNDER

The Lancet article on Insite by Brandon D L Marshall, M-J Milloy, Evan Wood, Julio S G Montaner and Thomas Kerr  titled “Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study” can be found at http://www.communityinsite.ca/injfacility.pdf.

The Coroner’s data for British Columbia, Vancouver and the Downtown Eastside (where Insite is located) is as follows:

Coroner’s data for BC and Vancouver: http://www.pssg.gov.bc.ca/coroners/publications/docs/stats-illicitdrugdeaths-1997-2007.pdf

DTES data only for each year at Table 45, BC Vital Statistics Agency, Annual Reports: http://www.vs.gov.bc.ca/stats/annual/

Gary Christian, Research Coordinator of Drug Free Australia and Dr. Colin Mangham, Director of Research DPNC, expose the bad science and faulty research methods in the Lancet study of drug overdoses around Insite.

To read the full analysis, please see this document.

We are pleased to tell you that the new DRUG PREVENTION NETWORK OF CANADA BLOG is up and running. You can find it here or under the menu heading LINKS.

In coming days, you will find entries and posts, including photos and videos from our AFFILIATE MEMBER organizations and individuals.

Dear Friends & Colleagues,

We have a new sub-page on our web site menu.

If you click NEWS, you can check the latest news and updates.

But you can also click a new sub-page called AL’S ALERTS.

DPNC Director Al Arsenault is a former Vancouver Police Officer and one of the principals behind Odd Squad Productions, an award-winning film & video house. Al is also a great collector and sharer of news, information and press releases on all things drug-related.

In fact, he sends us so many pieces on such a regular basis, we thought we’d give him his own page.

All that follows on that page flows from the watchful eye of Al Arsenault.

Thank you Ms Landolt for your interview on the radio and your article
in today’s National Post. As a resident of downtown Toronto I have
been involved in arguing against The Toronto Drug Strategy and a safe
use site in Toronto for all of the reasons you mentioned today! Most
people in the general public do not understand that the drugs are
still purchased on the street and that there are no questions asked
when a user presents themselves at a safe use site, consequently these
facilities only enable drug use. The other galling fact is that many
of the people who are there to help in the administering of the drugs
have been or still are users themselves providing a blind leading the
blind scenario. Here in Toronto we have offices set up in the city
which will hand out drug paraphernalia to anyone, no questions asked
under the guise of needle exchange programs. Let me be clear there is
no needle exchange taking place, consequently, these used needles,
crack pipes and condoms find there way into our parks, schoolyards and
back lane ways. As ordinary citizens we have been powerless to get the
city to pick up this mess or to take responsibility for it! You were
also right to point out that most of the studies that have been
released in support of Harm Reduction programs do not follow a true 4
pillar approach nor are Abstinance based organizations involved in the
studies, therefore skewing the results to more harm reduction
programs. Thank you for your work!
Maureen Gilroy

May 30, 2011

Letter to the Editor
The National Post
300 – 1450 Don Mills Road
Don Mills, Ontario M3B 3R5
Fax 416-383-2305

Dear Sir:

Thomas Kerr, author of the article on the Vancouver Drug Injection facility (May 30, 2011) is not an objective observer of the site.

He lobbied for the establishment of the drug injection site a decade ago, and he and his co-researchers have published over two dozen studies on the facility – all positive. It is no coincidence that all these studies have been peer reviewed only by those (as is Mr. Kerr) who support a harm reduction policy i.e. a policy that presupposes that the addict will continue to use drugs and the only solution is to reduce the “harm” to the drug addict. Significantly, Mr. Kerr and his co-researchers have refused to release any data to other researchers so that they can be verified.

Most recently, Mr. Kerr and his co-researchers released a study strategically timed during the week that the Supreme Court of Canada heard arguments on the validity of the site. In this study, it was stated, that the researchers had observed that overdose deaths in the immediate area of the site, had declined by 35% since it opened in 2003. However, the federal government’s Expert Advisory Committee which released a report on the site in March 2008 found that only 5% of the drug addicts in the area used the drug injection site. The claim that Insite resulted in a 35% decrease in overdose deaths, in the area is, therefore, questionable.

In his article. Mr. Kerr attempts to discredit the annual reports of the Government of British Columbia Selected Vital Statistics and Health Status Indicators, which state that the drug induced deaths have increased each year in the site area (with one exception) since the site opened in 2003 by claiming that many of these deaths surrounding Insite were from other causes. This is not so. The B.C. government report definitively states that the deaths are from drug overdose in the area.

Mr. Kerr also attempts in his article to discredit a study by Dr. Colin Mangham who has raised concerns about the methodological deficiencies in Mr. Kerr’s studies.

Mr. Kerr, however, ignores the fact that other researchers have also questioned his studies including Dr. Garth Davies, from Simon Fraser University. Other studies, for example, from the University of Glasgow, have also questioned the validity of drug injection sites. It is with good reason, that two dozen major European cities who have experimented with drug injection sites, signed a declaration in 1994 opposing such sites and want them permanently banned.

2

Well off individuals such are airline pilots, doctors and lawyers, can afford to receive treatment for their addiction. The drug injection site, however, serves to shuffle the poor off to its premises so that they increase the injection of drugs in their bodies which leads only to their inevitable and terrifying deaths. The injection site refers only 3% of its users for treatment.

Treatment is the only solution to drug addiction. Surely, as a civilized society, we can offer this to our suffering drug addicts. They are human beings who deserve better than a drug injection site, supported, not for compassionate reasons, but for reasons of personal, professional or financial bias for its continuation.

Yours truly,

C. Gwendolyn Landolt
President, Drug Prevention Network of Canada

Excellent local CTV video and print story on Insite: http://bit.ly/iUXqLz