Injection site ruling benefits all Canadians
published on January 31, 2010 by Dr. Evan Wood in The Calgary Herald
By Evan Wood
The recent BC Court of Appeal decision that has allowed Insite, Vancouver’s supervised injecting facility for illicit drug users, to remain open is significant to all Canadians concerned about the harm drugs cause in our society.
Despite what Herald columnist Susan Martinuk wrote last week, the benefits that facilities such as Insite provide to inner-city residents and communities are real and verified. But before considering the specific rationales for allowing drug addicts to inject preobtained illicit drugs under the supervision of medical staff, we must assess the proven limitations and unintended consequences of overreliance on criminal justice approaches to protect society from illicit drugs.
First, drug prohibition has created a massive global revenue stream for organized crime, worth an estimated $320 billion US annually. In some cases, these enormous proceeds threaten the political stability of entire regions, such as Mexico and Afghanistan.
Second, in the U.S., where the war on drugs has been fought most vigorously, the incarceration of drug offenders has placed a huge burden on the taxpayer and contributed to the world’s highest incarceration rate. Primarily as a result of drug-law enforcement and mandatory minimum sentences, one-in-eight African- American males in the age group 25 to 29 is incarcerated on any given day, despite the fact that ethnic minorities consume illicit drugs at comparable rates to other subpopulations in the U.S. Paradoxically, ever-increasing drug enforcement expenditures and incarceration levels have not prevented the drug market from becoming more efficient. In fact, all surveillance systems demonstrate a global pattern of decreasing drug prices while purity and availability continue to increase.
Third, the association between drug prohibition and increased inner-city violence is consistent. A recent international example is the upsurge in severe drug-related violence in Mexico subsequent to Mexican President Felipe Calderon’s escalation in the fight against Mexican drug traffickers.
Locally, the increasing gun violence in Canadian cities has been directly linked to clashes between organized crime groups scrambling over the enormous drug market profits.
Fourth, and most relevant to public health approaches such as supervised injecting sites, are the epidemics of HIV and overdose death. Studies have shown these are highest in areas where law enforcement is prioritized over evidence-based public health strategies. These harms are significant to all Canadians, given that HIV is an infectious disease that has spread beyond its traditional risk groups and is now placing a large burden on the health system. Each and every case of HIV is estimated to cost $250,000 in medical expenses. For the above reasons, conservative economists like Nobel Prize winner Milton Friedman have long argued that the “war on drugs” does much more harm than good.
In the wake of repeated unsuccessful law enforcement interventions in Vancouver’s poverty-stricken downtown eastside, local policy-makers looked to models from a growing number of countries in Europe, where more than 65 supervised injecting programs have been initiated as part of a pragmatic approach to couple law enforcement efforts with strategies to improve public disorder. The programs improve public order by bringing street-based drug addicts indoors where they can be prevented from sharing needles and overdosing while increasing enrolment into addiction treatment.
The Vancouver supervised injecting trial has replicated the European experience. In fact, Insite is undoubtedly the most highly studied health clinic in Canadian history, with almost three dozen studies now published describing the program’s positive impacts. These are not simply consultant’s reports, but rather rigorous, peer-reviewed studies published in some of the world’s most prestigious medical periodicals including the New England Journal of Medicine.
Stephen Harper’s government has opposed harm reduction programs, but his position is at odds with the scientific community internationally. Specifically, due to their effectiveness, harm reduction policies are now endorsed by all evidence-based scientific consensus bodies, including the U.S. Institutes of Medicine and the World Health Organization. This consensus is based on rigorous reviews of the large volume of international scientific evidence indicating that harm-reduction programs save tax dollars and improve public health by reducing HIV rates while increasing uptake of addiction treatment. This body of evidence is in stark contrast to the documented deficiencies and unintended consequences of conventional enforcement-based drug strategies endorsed by the Harper government.
While supervised injecting facilities, like Vancouver’s pilot program, are only relevant to inner-city areas with intractable injection drug use problems, the BC Court of Appeal decision has clear implications for the role of science in Canada’s approach to addiction. To help address the harms of drugs in our communities, we must move away from drug-policy approaches that ignore the proven limitations of law enforcement and toward evidence-based models that couple police efforts with prevention, treatment and harm reduction strategies. More >>
Content reproduced with permission of Canwest Licensing.