Dr. Perry Kendall is Provincial Health Officer of British Columbia; Dr. Patty Daly is Chief Medical Health Officer for Vancouver Coastal Health; Dr. John Carsley is Medical Health Officer for Vancouver Coastal health.
On Monday, March 23, Bill C2 – the "Act to Amend the Controlled Drugs and Substances Act" – passed in the House of Commons. While Vancouver's supervised Injection site "Insite" was recently granted a one year extension under the existing legislation, should Bill C2 eventually become law then it may well cause the eventual closure of InSite, and will make it almost impossible for any new sites to open in other communities. The Conservative government has labelled this law the "Respect for Communities Act". "Contempt for the Health of Communities" would be more accurate.
The Act lays out the requirements for an application to the federal Health Minister for an exemption to operate a "supervised consumption site" (SCS), like InSite or the injection room at The Dr. Peter Centre, both in Vancouver. The Act is short, as legislation goes. Once you strip away the definitions and explanatory notes, you are left with more than 25 clauses listing the information an applicant must provide. Based on our clinical experience of more than ten years and the results of numerous peer reviewed studies on InSite published in prestigious medical journals, we can say with absolute confidence that virtually all these requirements are unnecessary and excessively onerous. The requirements of the Act are oriented to building a case for denying exemptions rather than approving them.
For example, if there is a demonstrated need for this public health service, would opposition by a single group could prevent the granting of an exemption, or would scientific evidence of clear benefit and lack of societal harm for such services carry greater weight than such opposition.
To give another example, for any staff working in the facility, the applicant must provide police records going back 10 years showing that the potential worker has not had a conviction for a drug offense, conspiracy, money laundering, or terrorism. While most staff will be registered nurses who have already passed police checks just to work as nurses, others may well be recovered addicts who have succeeded in treatment and who the scientific literature shows are among the most successful peer educators. Is it the intent of this bill to bar them from this work?
The Act is also inconsistent with the ruling of the Supreme Court of Canada, which ruled in 2011 that the failure of the minister of health to extend InSite's section 56 exemptions was not in accordance with the principles of fundamental justice, and violated section 7 of the Canadian Charter of Rights and Freedoms. The Court ruled that on future applications for such exemptions, the minister must exercise discretion within the constraints imposed by the Charter, "and aim to strike the appropriate balance between achieving public health and public safety goals." Further, the minister should generally grant an exemption where "the evidence indicates that a supervised injection site will decrease the risks of death and disease, and where there is little or no evidence of a negative impact on public safety."
Our experience in Vancouver shows these sites do not increase crime, do not divert drugs, and do not threaten the safety of neighbourhoods. These are health services. They prevent overdose deaths, open a door to drug detox, keep HIV and hepatitis from spreading and used needles off the streets, treat wounds and infections, and decrease the use of police, ambulance, and emergency medical services.
This law is a thinly veiled attempt to end supervised injection services. Period.
If any legislation at all is required, it needs very few elements: applications endorsed by local and provincial public health authorities, the municipality, local police, and the provincial health and justice ministers. If these approvals are in hand, the federal minister should be required to grant an exemption. It's that simple.
At present, a number of Canadian cities are considering seeking exemptions for supervised consumption sites. The passage of Bill C2 will effectively curtail these needed services. We fear the worst for the health of our cities.
Last October, there was a brief but intense surge in injection overdoses in Vancouver when fentanyl, the powerful prescription narcotic, had been sold as heroin. While deaths occurred in the community, all those who overdosed at InSite were successfully treated and survived. We can only imagine the death toll among some of our most vulnerable citizens if InSite were closed. Do we really want our alleys and hotel rooms to fill up with bodies again?