Vancouver’s Safe Injection Facility, InSite: A Struggle to Survive
January 14 brought good news – at least for now – for residents of the Downtown Eastside in Vancouver, Canada, and more broadly for supporters of harm reduction policies. That’s when the British Columbia Court of Appeal upheld a decision made by the British Columbia Supreme Court back in 2008 which ruled that the closure of InSite would violate the Charter right of the facility’s users to “security of the person”.
Vancouver’s only supervised injection site, InSite has provided intravenous drug users with a safe place to inject drugs and access care services, including addiction counselling and treatment, since 2003. Working under the harm reduction model, InSite’s operations are made possible by a constitutional exemption to Canada’s Controlled Drugs and Substances Act. The initial suit came after Canadian Health Minister Tony Clement announced the federal government’s plan to let the facility’s exemption lapse, citing the need for further research. However, on that same day back in 2006, the Minister also announced that all future research funding would be cut. Oxymoronic, right?
The suit was filed by two intravenous drug using clients of the facility. In response, the British Columbia Supreme Court unanimously agreed that closing the facility would contravene the Canadian Charter of Rights and Freedoms. Despite this, the federal government appealed the decision to the British Columbia Court of Appeal which rendered the same conclusion (2 of the 3 judges upheld the Supreme Court decision). A key difference, however, is that the appeal court effectively concluded that InSite falls under the purview of the provincial government. This is good news with respect to constitutional powers and jurisdictional issues. At this time, the federal government has stated its disappointment with the decision and has made no comment with respect to potentially appealing the decision to the nation’s highest court, the Supreme Court of Canada.
Supporters of the facility can only hope that the Conservative government respects the decision now made by both provincial courts in British Columbia, although this may be asking too much. An ongoing legal battle based on ideology alone is, in my opinion, a waste of taxpayer dollars and serves only to further clog the legal system. Prime Minster Stephen Harper, the gig is up!
Curious to know more about the research supporting Vancouver’s safe injection facility? Check out the Further Reading, below.
A 2005 report commissioned by the Canadian Community Epidemiology Network on Drug Use (CCENDU) estimated there to be some 5,000 intravenous drug users in the Downtown Eastside, nearly a third of the small community’s total population (Buxton, 2005). The disproportionate prevalence of intravenous drug users and often corresponding terminal diseases such as hepatitis B/C and HIV/AIDS concentrated in the community has sharpened policy debates and forced decision makers at all levels to rethink traditional public health principles. At the centre of the debate is whether nation states should be concerned with establishing programs and/or policies for the safer provision of illicit drugs through harm reduction strategies. Approaches within this realm range from medically prescribed drug substitution, needle exchange programmes (NEPs), and the provision of supervised injection or consumption facilities such as InSite located on East Hastings Street in Vancouver – the first legal injection facility in North America (Vancouver Coastal Health, 2007). Despite its establishment in 2003 however, the provision of drugs and related materials are not without a number of challenges and criticisms.
Although several research studies on the topic of safe injection facilities have demonstrated positive effects (e.g. a reduction in needle sharing and reuse of syringes, fewer public injections, an increase in referrals to social services and addiction counselling, a decrease in number of publicly discarded syringes) with no apparent increases in crime or drug use, there still remain several criticisms (Kerr et al., 2005; Stoltz et al., 2007; Wood et al., 2006). While users of the InSite facility in Vancouver obtain illicit drugs prior to direct supervision from staff, much criticism among law enforcement groups, chiefly the RCMP, has attributed such strategies to government condoning drug use. This likely stems from InSite having to operate with an exemption from Canada’s Controlled Drug and Substances Act, enabling users of the facility to consume illicit drugs without arrest (Andresen and Boyd, 2010).
Putting aside the moral and political issues that arise from such facilities, the chief economic criticism among prominent law enforcement groups has been that the resources allocated to the facility could have been more effectively spent elsewhere (Bayoumi and Zaric, 2008). Such criticisms are fair considering global economic uncertainty which has forced national governments to re-evaluate spending. As such, it is important for public decision makers and agencies to pursue fiscally prudent policies (when possible) which strive to maximize the use of scarce public resources while providing the greatest benefit for society. Decisions then concerned with allocating funds should be based on some form of economic efficiency. This is particularly important with respect to public health which operates within the largest and most limited federal and provincial government budgets. If for example there are various policy options which produce comparable health outcomes when responding to illicit drug use, then the programme with the least costs should be chosen.
Although several research studies have been performed to evaluate whether safe injection facilities create a net economic benefit for society, only two have been led by Canadian researchers specific to Vancouver’s InSite facility (Andresen & Boyd, 2010 and Bayoumi & Zaric, 2008). By relying on cost-benefit analysis and cost-effectiveness tools, both researchers concluded that the facility’s prevention of infections and deaths among injecting drug users is of greater economic cost than the resources required in providing InSite services to the community, albeit to differing degrees. It is interesting to note that the Bayoumi and Zaric (2008) report was commissioned by the RCMP, whom is vehemently opposed to the facility’s existence, and found InSite to provide a positive cost-benefit ratio.