Safe heroin use site has uncertain fate

Federal ministers unmoved by studies showing the programme has reduced overdose deaths and spread of diseases.

Earl Crowe, a former heroin user who used the Insite safe injection site, stands near a needle disposal unit in Vancouver, British Columbia.

VANCOUVER // In a neighbourhood where rampant heroin use once led to the highest HIV infection rates recorded in a developed country, supporters of a controversial safe injection site are preparing to go to Canada's highest court to stop the federal government from shutting it down. More than 30 studies on the pilot project suggest it saves addicts from dying from overdoses as well as decreasing transmission rates of HIV, which spreads when drug users share needles. But the Conservative federal government is determined to close the safe injection site and it has appealed a court ruling in support of the programme. "I think their opinion is purely ideological," said Thomas Kerr, a research scientist with the British Columbia Centre for Excellence in HIV/Aids. "There's no academic debate. The scientific evidence speaks for itself." Studies showing positive results of the facility, called Insite, have been published in leading medical journals, including The Lancet and the New England Journal of Medicine. Researchers found that Insite cuts down on the spread of blood-borne diseases, while providing addicts with an avenue for treatment. But the growing body of scientific evidence has not stopped federal politicians from arguing that safe injection sites actually do more harm than good. "Allowing and/or encouraging people to inject heroin into their veins is not harm reduction, it is the opposite? We believe it is a form of harm addition," Tony Clement, Canada's former health minister, said at the International Aids Conference in Mexico City in August. His comments were reported to have stunned World Health Organisation officials who were launching a "how-to" guide on fighting the global Aids epidemic at an event where Mr Celement was speaking. The organisation has endorsed safe injection sites. Leona Aglukkaq, Canada's new health minister, shares Mr Clement's views, according to her press secretary, Josée Bellemare. "Our government commissioned a panel of experts to review all Canadian studies on Insite," Ms Bellemare said in an interview. "The expert advisory committee produced a report showing there is no direct evidence the supervised injection site lowers overdose death rates. There is no direct evidence the secure injection site reduces rates of HIV." Mr Kerr said the government hand-picked committee members who produced a report that was never subjected to academic scrutiny. "These people will never show up and debate face to face. They beak off to the media, but we've invited them to public meetings and they never come." Mr Kerr said more research needs to be done, but he insisted there is clear evidence that Insite is working. Shutting it down would be a step back to the late 1990s, when overdose deaths took place on a daily basis in Vancouver's notorious Downtown Eastside and HIV transmission rates were skyrocketing. "It's the highest rate that's ever been observed in the developed world," Mr Kerr said. The crisis prompted authorities to declare a public health emergency in 1998. Inside was conceived as a response and it opened in 2003 when the federal Liberal Party was in power. The Conservatives have threatened to halt the programme since taking over in 2006. Healthcare advocates finally took the government to court, arguing that closing Insite would violate the constitutional right to life and security of those using the facility. A judge agreed, but the government appealed the decision and the case is expected to end up at the Supreme Court of Canada. Some experts have suggested that a Supreme Court ruling in favour of Insite would open the door to creating safe injection sites across the country. Earl Crowe, a former heroin addict who used Insite for two years, said more safe injection sites are necessary. "I know lots of people whose lives have been saved at Insite," said Mr Crowe, who is now prescribed daily dose of methadone, a heroin substitute. In addition to drug counsellors, Insite employs nurses who have responded to hundreds of overdoses, many of which would likely have been fatal if they occurred elsewhere. The facility gets as many as 1,600 visits a day from the Downtown Eastside's approximately 8,000 intravenous drug users. Inside is one of several "harm reduction" initiatives that have sprung up in response to the neighbourhood's drug crisis. Researchers recently completed a controversial year-long study that saw heroin prescribed in gradually smaller doses to chronic users. The results of the North American Opiate Medication Initiative (Naomi), made public on Oct 17, suggest that it helped addicts cut down on drug use, engage in less crime and stay in treatment longer. Critics said Insite and Naomi are dangerous steps towards legalising drugs. But advocates argue that traditional law enforcement methods have not worked and they point to the neighbourhood's long history of drug abuse. [e-mail]