Insite

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Biography

Insite is the only legal safe injection site|supervised injection site in North America , located at 139 East Hastings Street, in the Downtown Eastside (DTES) neighbourhood of Vancouver , British Columbia . The DTES had 4700 chronic drug users in 2000 and has been considered to be the centre of an "injection drug epidemic". The site provides a safe and health-focused location for injection drug use, primarily heroin , cocaine , and morphine . Official webpage The clinic does not supply any drugs., CBC, 2011-09-30 Medical staff are present to provide addiction treatment, mental health assistance, and first aid in the event of an Drug overdose|overdose or wound. In 2009, the site recorded 276,178 visits (an average of 702 visits per day) by 5,447 unique users; 484 overdoses occurred with no fatalities, due to intervention by medical staff.Staff Writer. "." Vancouver Coastal Health: Insite. Retrieved May 5, 2010. Health Canada has provided Canadian dollar|$ 500,000 per year to operate the site, and the Ministry of Health (British Columbia)|BC Ministry of Health contributed $1,200,000 to renovate the site and cover operating costs.

Operation

Insite is operated in tandem by Vancouver Coastal Health and the Portland Hotel Society . Between September 2003 and July 2008, the site operated under a special exemption of Section 56 of the Controlled Drugs and Substances Act , granted by the 37th Canadian Parliament|Liberal government via Health Canada. The site was slated to close on September 12, 2006, as the exemption was for a three year pilot project. The 39th Canadian Parliament|Conservative minority government granted a temporary extension, then added another six month extension that was to end in mid-2008. A constitutional challenge was heard by the Supreme Court of British Columbia to keep Insite open after Minister of Health (Canada)|Federal Health Minister Tony Clement refused to renew the exemption beyond July 2008. The court ruled that laws prohibiting possession and trafficking of drugs were unconstitutional because they denied drug users access to Insite's health services. Justice Ian Pitfield gave Ottawa until 30 June 2009 to amend the Controlled Drugs and Substances Act and bring it in line with the constitutional principle of fundamental justice (section seven of the Canadian Charter ). The Canadian House of Commons|House of Commons did not amend the law meaning Insite currently operates under a constitutional exception to the Controlled Drugs and Substances Act.

Research

When founded, Insite acquired legal exemption under the condition that its impacts be thoroughly evaluated. Consequently, the site has been the focus of more than thirty studies,Findings from the Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility – Insite, pg 5 published in 15 peer-reviewed journals. The research indicates an array of benefits, including reductions in public injecting and syringe sharing and increases in the use of detoxification services and addiction treatment among patients. In addition, studies assessing the potential harms of the site have not observed any adverse effects.Findings from the Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility – Insite, pg 5 Preliminary observations published in 2004 in the journal Harm Reduction indicate that the site successfully attracted injecting drug users and thus decreased public drug use. However, the researchers cautioned that a full assessment of the site would take several years.

Additional research in the Canadian Medical Association Journal suggests that the site has reduced public injections, neighbourhood litter, and needle sharing. Two studies in the journal Addiction (journal)|Addiction and in the New England Journal of Medicine indicate that patients at the site have increased their use of detoxification services and long-term addiction treatment.Findings from the Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility – Insite, pg 26 Furthermore, research in The Lancet indicates that the site substantially reduces the sharing of syringes.Findings from the Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility – Insite, pg 37 A study in the journal Substance Abuse Treatment, Prevention, and Policy revealed that local police facilitate use of Insite, especially among high-risk users. The researchers concluded that the site "provides an opportunity to... resolve some of the existing tensions between public order and health initiatives."

A 2008 cost-benefit analysis of the site in the Canadian Medical Association Journal observed net-savings of $18 million and an increase of 1175 life-years over ten years. Another cost-benefit analysis published in the International Journal of Drug Policy in 2010 determined that the site prevents 35 cases of HIV and about 3 deaths per year, indicating a yearly net-societal benefit of more than $6 million. A 2011 study in The Lancet found overdose deaths have dropped 35% in the Insite area since it opened, much more than 9% drop elsewhere in Vancouver. An editorial in the Canadian Medical Association Journal noted that after three years of research "a remarkable consensus that the facility reduces harm to users and the public developed among scientists, criminologists, and even the Vancouver Police Department."

In a letter to Lancet, urging retraction of a study claiming 35% decreases in overdose deaths around Insite due to its presence, an international team of medical doctors affiliated with anti-drug organizations claimed that any decreases in overdose mortality can be sufficiently explained by a police crackdown in the area. They said that the crackdown with 48-72 added police, commencing 6 months before Insite opened in the four city blocks around its present location and continuing until this day in an expanded 12 block area around Insite, initially reduced indicators of drug use and users in the targeted area by 46% in 2003. Any reductions in crime, public drug use and litter should therefore be accorded to policing. The authors' reply noted that the police crackdown did in fact end a few weeks after the start of the Insite project and that decreases after that can't be accredited to increased policing.

Reception

Insite enjoys strong local support. While Insite is well liked throughout British Columbia, its popularity is highest inside Vancouver, where some 76% of residents expressed support for the facility. Furthermore, according to a 2007 national survey by Mustel Group, some 63% of Canadians believe the federal government should renew the Insite's mandate while 27% oppose. Support is lowest among Conservatives, only half of whom believe the site should continue operating. Among clients, 95% or greater rated the facility's services as excellent or good, and its staff as reliable, respectful, and trustworthy.

Partners of Insite include the City of Vancouver, the Vancouver Police Department , and the PHS Community Services Society.Staff Writer. "." Vancouver Coastal Health: Insite. Retrieved August 1, 2006. The site has the support of Vancouver's mayor Gregor Robertson (politician)|Gregor Robertson ,Mike Howel Gregor Robertson and Peter Ladner square off in first public debate former mayor Sam Sullivan ,Staff Writer. "." CTV Television Network|CTV / Canadian Press . July 18, 2006. Premier of British Columbia Gordon Campbell (Canadian politician)|Gordon Campbell ,Bailey, Ian. "." The Globe and Mail . October 3, 2007. and former Vancouver mayors Larry Campbell , Mike Harcourt , and Philip Owen .Mickleburgh, Mike. "." The Globe and Mail . August 22, 2006. The International AIDS Society , B.C. Centre for Excellence in HIV-AIDS, and the Canadian Union of Public Employees have also expressed support for Insite.Branswell, Helen. "." Canadian Broadcasting Corporation|CBC / Canadian Press . August 15, 2006.Staff Writer. "." NUPGE.ca. Retrieved August 1, 2006. Though initially opposed to the safe injection site, the Chinatown, Vancouver|Chinatown and Gastown merchants associations now support it. International supporters include the United Kingdom|UK -based think tank Senlis Council,Hainsworth, Jeremy. "." Canadian Broadcasting Corporation|CBC . July 28, 2006. the Australian Parliamentary Group for Drug Law Reform, and the American Drug Policy Alliance .

The site drew criticism from the Presidency of George W. Bush|Bush administration ; the director of the Office of National Drug Control Policy|White House Office of National Drug Control Policy called Insite "state-sponsored suicide" on its opening. In 2006, the Canadian Police Association voted unanimously to encourage the federal government to stop funding Insite and instead invest in a national drug strategy. Moreover, Federal Health Minister Tony Clement branded Insite an "abomination," telling the Vancouver Sun that "allowing and/or encouraging people to inject heroin into their veins is not harm reduction... it is a form of harm addition."

The Royal Canadian Mounted Police (RCMP) has also criticized Insite. This is despite a report commissioned by the RCMP and conducted by two criminologists that concluded in favour of the injection site.Staff Writer. "." Canadian Broadcasting Corporation|CBC . September 1, 2006. The RCMP in British Columbia had agreed to announce their support for Insite in 2009 at a joint news conference with the BC Centre for Excellence in HIV/AIDS; they planned to note "an extensive body of Canadian and international peer-reviewed research reporting the benefits of supervised injection sites and no objective peer-reviewed studies demonstrating harms", and they were to admit that reports commissioned by the RCMP criticizing Insite "did not meet conventional academic standards." However, the RCMP in British Columbia were ordered by headquarters in Ottawa to cancel the news conference days before the event.

The most significant published criticism has been an article by Colin Mangham, the director of research for the Drug Prevention Network of Canada, in the online-only Journal of Global Drug Policy and Practice (JGDPP), which is said to be "posing as open-access, peer-reviewed scientific journal" In the article Mangham claims that “the published evaluations and especially reports in the popular media overstate findings, downplay or ignore negative findings, report meaningless findings and overall, give an impression the facility is successful, when in fact the research clearly shows a lack of program impact and success.” He also claimed that interviews with area treatment centres revealed no referrals from Insite, and that police presence was deliberately bolstered in the area. Based on this article, Tony Clement told an August 2007 meeting of the Canadian Medical Association that his belief that Insite should close had been reaffirmed. Clement stated that "there has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite." The Journal of Global Drug Policy and Practice that Clement was referring to is run by the Drug Free America Foundation , and received much of its initial funding in a $1.5 million grant from a United States Department of Justice|U.S. Department of Justice agency now under investigation for corruption.

Mangham's article has been questioned because it dismisses more than 20 peer-reviewed studies published in reputable medical journals such as The Lancet , the New England Journal of Medicine , and the British Medical Journal , all of which indicate that Insite has a positive effect. The Journal of Global Drug Policy and Practice (JGDPP) article, which was commissioned and financed by the RCMP, drew further criticism in the journal Open Medicine , where a commentary described it as being "fraught with a host of outright factual inaccuracies and unsubstantiated claims."Woods, Evan "" Open Medicine September 7, 2007 More than 130 scientists signed a petition endorsing the commentary, which also criticized the government's evaluation of Insite as distortive and politicized. Another commentary in the International Journal of Drug Policy characterized the government's evaluation as "what may be a serious breach of international scientific standards".

In answer to an op-ed in National Post , the President for Drug Prevention Network of Canada, Gwendolyn Landolt, maintained her organization's view that the research on Insite is flawed. She said that much of the research on Insite was done by scientists who had lobbied for the clinic's establishment and that they consequently lacked objectivity. She further suggested that the these researchers conspire with the editors of academic journals so that their papers are reviewed by referees that supports harm reduction. Gwendolyn Landolt also maintained that data shows that deaths from drug overdoses have actually increased in the vicinity of Insite most years since its inception, contrary to the point made by the allegedly biased Thomas Kerr in his preceding commentary on the misinformation her organization is peddling around.Landolt, Gwendolyn "" National Post June 8, 2011Kerr, Thomas "" National Post May 30, 2011 The next day the Provincial Health Officer of BC, Perry Kendall said that he had never heard of the data Ms. Landolt refers to and confirmed Thomas Kerr's assertion that death from drug overdoses have indeed declined in the preceding years - especially so in the vicinity of Insite.Kendall, Perry "" National Post June 9, 2011

Government and legal controversy

While the Liberal Party of Canada|Liberal government allowed Insite to open, since 2006 its fate has been the responsibility of the Conservative Party of Canada|Conservative government, which has not been as supportive of it. Conservative Prime minister|Prime Minister Stephen Harper has voiced opposition to the injection site in the past, saying that "We as a government will not use taxpayers' money to fund drug use."Staff Writer. "." Canadian Broadcasting Corporation|CBC . August 17, 2006. In mid-July 2006, Conservative Member of Parliament David Fletcher stated that the government would let Insite's special exemption lapse before deciding whether to continue the project.Salinas, Eva. "." The Globe and Mail . July 26, 2006. The following week a spokesman for Tony Clement , the Minister of Health (Canada)|Minister of Health , refuted that, saying that a decision had not been made yet. During the XVI International AIDS Conference, 2006|XVI International AIDS Conference , held in Toronto , two high-ranking Liberal MPs ( Bill Graham (Canadian politician)|Bill Graham and Keith Martin (politician)|Keith Martin ) put their support behind the centre, and criticized the Conservative government for delaying their decision. Insite supporters also demonstrated in Toronto during the conference, prompting the government to further delay any announcement, citing the week's "politicized" nature.

On September 1, 2006, Federal Health Minister Tony Clement deferred the decision of whether to extend the exemption for the site, citing a need for more research. However, on the same day the government cut all funding for future research, amounting to $1.5 million in lost research money.Gohier, Philippe. "." Maclean's|Macleans.ca . December 11, 2006. On August 13, 2007, the Portland Hotel Society and two drug addicts filed suit in the Supreme Court of British Columbia|BC Supreme Court to keep the centre open, arguing that its closure would be a violation of the Canadian Charter of Rights and Freedoms|Charter right of Insite users to "security of the person."Staff Writer. "." Canadian Broadcasting Corporation|CBC . August 17, 2007. On October 4, 2007, during the announcement of its $64-million drug strategy, the Conservative government announced that Insite will be granted another six month extension, allowing it to operate until June 30, 2008. In 2008 Minister Clement explained his position during a House of Commons debate period:

Mr. Clement's stance is based in part upon findings in the Journal of Global Drug Policy and Practice , a fringe science journal. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734229/? tool=pmcentrez

In May 2008, the B.C. Supreme Court struck down sections of the Canadian Criminal Code prohibiting drug trafficking and possession, ruling that they contravened the Canadian Charter of Rights and Freedoms . While this ruling does not take effect until next year, Justice Ian Pitfield also granted Insite an immediate exemption to federal drug laws, giving it legal grounds to continue operating.Staff Writer. . CBC News (The Canadian Press), 27 May 2008. Several days later the 39th Canadian Parliament|federal government announced plans to appeal the decision to the British Columbia Court of Appeal|B.C. Court of Appeal .Staff Writer. . CBC News (The Canadian Press), 29 May 2008. On 15 January 2010, the B.C. Court of Appeal dismissed the federal government's appeal in a 2-1 ruling.Staff Writer.. CBC News (The Canadian Press), 15 January 2010. Three weeks later the federal government announced that it will appeal to the Supreme Court of Canada .Staff Writer. . CBC News (The Canadian Press), 9 February 2010. On February 10th, some 150 people protested the federal government's decision to further appeal. The protesters barred Prime Minister Harper from attending a dress rehearsal for the Vancouver Chinatown Spring Festival Celebration. On February 12, The Canadian Union of Public Employees sent an open letter to Harper, urging him to accept the ruling of the lower courts and allow Insite to remain open..

Of nine Intervention (law)|interveners in the Supreme Court case, one supported the conservative government's case to close the injection site: REAL Women of Canada , a social conservative organization. The other eight, including the Canadian Medical Association argued against the case for closure of the facility. The REAL Woman of Canada group argued that the site would discourage drug users from ceasing their habit, and that they would get "worse and worse until they die" while their families and communities suffered.

In May 2011 a lawyer for the Federal government told the Supreme Court that the government had not decided whether to continue or end support for Insite, contrary to previous statements by Minister of Health Tony Clement; that statement was derided in court as disingenuous by Joseph Arvay , a lawyer for PHS Community Services Society.The Canadian Press, , CBC , 05/2011

On September 29, 2011, the Supreme Court of Canada ruled unanimously to uphold Insite's exemption from the Controlled Drugs and Substances Act , allowing the facility to stay open indefinitely. The ruling states that Clement's decision to apply the CDSA to Insite was "arbitrary, undermining the very purposes of the CDSA, which include public health and safety. It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises." Supreme Court of Canada : September 30, 2011O'Neil, Peter "" The Monreal Gazette September 30, 2011

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