Safe Injections Sites Hang in the Balance

The legality of safe-injection sites is currently being considered by Canada’s top court. In a precedent setting decision, the Supreme Court of Canada (SCC) is about to decide if the federal government’s criminal laws against the possession and trafficking of illegal drugs contravene Canada’s Charter of Rights and Freedoms. The section of concern: the Right to Security of the Person which consists of rights to privacy of the body and its health for all Canadians.

In 1999, the Vancouver City Health Authority determined that injection drug use was at the root of a healthcare crisis afflicting Vancouver`s downtown eastside (DTE). The incidence of HIV/AIDS, tuberculosis, Hepatitis C, and drug overdoses had reached epidemic levels.  In order to get control of the situation, an addictions plan was put together which included a proposal for the opening of a supervised injection site.

In 2001, the City of Vancouver approved a plan for addressing drug problems in Vancouver. The plan consists of four branches: prevention, treatment, enforcement, and harm reduction. The plan asked the Government of Canada to initiate research into the feasibility of supervised injection rooms.

In order for a supervised injection site to operate legally in Canada, the federal government has to grant exemptions to sections of the Controlled Drugs and Substances Act (CDSA) dealing with possession and trafficking on the basis that it is necessary and has a scientific purpose.
Cities across Canada and the United States are closely awaiting the Supreme Court decision as they face increasing drug problems and contemplate opening their own safe-injection sites. “European countries have set a good example for Canada and Latin American drug policy is helping set a precedent.” says Donald MacPherson, Drug Policy Co-ordinator for the City of Vancouver, “the momentum is shifting globally towards looking at doing things differently...there is a growing critique of drug prohibition, if you look at how it works you will see that it is not working very well.”

Gwen Landlot, President of the Drug Prevention Network disagrees, “Safe-injection sites are contrary to UN treaties ratified by Canada,” she remarks, “Canada has been criticized for this. We are the only ones in North America to have this site.”
Regardless on their differing position on safe-injection sites, neither can however deny that that the Supreme Court of Canada decision is being closely watched by many and will have a significant impact throughout North America, “If the Supreme court decides in favor of Insite, it opens doors to other cities looking to open similar programs. It also sends a message to the Americans,” explains MacPherson.

Harm Reduction in question

Regardless of the controversy surrounding supervised drug injection rooms, the upcoming Supreme Court decision will make waves. The determination of whether criminal laws in Canada significantly impede the health of Canadians will have significant impact on the future of harm reduction as a part of drug policy reforms in North America.

Such services are provided by Insite, North America and Canada’s first legal supervised injection site that opened in 2003. "Technically, Insite in law is a scientific research project,” explains MacPherson, "the government can choose to extend the exemption of the law or not.”

Exemptions for the site were granted from 2003-2008 by the Government of Canada, however, “when the government changed in 2008, they decided to extend the exemption for the site once, but then not again” explains MacPherson. This decision has resulted in the current court case in front of the SCC.

In 2008, after the Government of Canada decided not to grant the exemption, the Portland Hotel Society, the Vancouver Coastal Health Authority and two long-term addicts and regular users of the services at Insite, Shelly Tomic and Dean Wilson launched a court case.  At trial, the trial ruled that the law violated section 7 of Canada’s Charter of Rights and Freedoms. In his judgment, he writes that addicts are “denied access to a healthcare facility where the risk of morbidity associate with infectious disease is diminished if not eliminated,” ultimately finding against the government of Canada and struck down the provisions, thus allowing Insite to continue operations.

The government of Canada appealed the decision. In a 2-1 split, the British Columbia Court of Appeal determined that healthcare undertakings by a province are potentially immune from criminal law. This decision resulted in another victory for Insite and harm reduction proponents.
Following this result, the government of Canada appealed the ruling for a final time taking the case to the Supreme Court of Canada to make the ultimate decision. Although, there is no set date for the judgment to be released, it is anticipated that the final decision will come out in the fall.

Clean injections versus no injections

According to its website and news release, since opening its doors in 2003, Insite has supervised over 1.8 million injections and despite over 1,500 overdose interventions, there have been no overdose deaths.

The site is monitored by certified nurses and doctors and open to all members of the public over the age of 16. Insite also includes an onsite counselling and rehabilitation service which can be accessed by anyone who comes in to use the facility. Based on a harm reduction model, Insite strives to decrease the adverse health, social and economic consequences of drug use without requiring abstinence from drug use.

But these statistics should be read carefully, cautions Gwen Landlot, “everyone is glowingly positive about SIS but there is more to the story.” She points to the Expert Advisory Committee report prepared for the Canadian government in 2008 which examines the research and data gathered from Insite and an Australian supervised injection site. The report found that only 10% of Insite users use the site for all of their injections and that the injections at Insite account for less than 5% of all injections in the downtown eastside of Vancouver. “[Safe-injection sites are] not curtailing the use of drugs,” remarks Landlot. However, Insite was home to over 220,000 clean injections, which the report deemed as “significant.”

The Supreme Court's decision to come out in the Fall

On May 12, 2011, the court finally heard arguments from both parties and is set to issue a judgment in the upcoming months. MacPherson is optimistic about the outcome. He believes the court will find in favour of the safe-injection site; “I think the Supreme Court will find a way for Insite to remain open. I was impressed with their knowledge of the situation and understanding of the research.”

Landlot is less impressed, she believes that any decision by the SCC which results in keeping the facility open will be an interference with public policy. “If they give licence to the site, they will use the Charter of Rights and Freedoms to further their own agenda. This will decrease credibility of the court and federal government. Judges do not have access to social data...there is no public debate.”

Until then, the debate on harm reduction and safe-injection sites rages on: “What is the hope of harm reduction?” MacPherson muses, “If we legalize drugs, the addiction will still be there. The worst possible case is having addiction and illegal drugs. Drugs are a cash cow for organized crime...chasing addicts is a huge distraction from the real problems...much of the controversy is mis-placed. The topic is drug use, but it should be about the health of the community instead.”

Landlot disagrees, “Safe-injection sites are not a solution or any part of the solution. The only solution is treatment...it is the most effective tool. No solution to allow the addict to deepen the addiction makes sense. We want to help people not kill them; this is what we are doing by giving them more drugs.”