For supporters of Insite, Vancouver’s supervised injection site, and those who believe in evidence-based public-health measures more generally, Friday’s ruling from the Supreme Court of Canada was a huge legal victory.
But the celebration should be short-lived. Now that the Champagne has been drained, we are left with a whopping hangover of a realization: Canada’s drug strategy remains deeply flawed.
A comprehensive drug strategy has four pillars: prevention, treatment, harm reduction and enforcement.
The court has shored up one of those pillars, harm reduction. The government has embraced one other, enforcement. The other two key elements, prevention and treatment, have been starved of funds, leaving us with a teetering response to one of society’s biggest public-health challenges – drug misuse and addiction.
Back to the Supreme Court ruling for a moment: In a unanimous 9-0 decision, it upheld the federal government’s right to use criminal law to restrict illicit drug use; at the same time, the court said Insite could stay open, ordering Ottawa to exempt users and staff from prosecution.
Why? Because the scientific evidence demonstrates incontrovertibly that supervised injection sites provide intravenous drug users with clear health benefits, along with advantages for the community. For instance, as a result of Insite, addicts are less likely to share contaminated needles with other drug users. That means there is a lower risk of transmitting diseases such as HIV-AIDS and hepatitis. There are also significantly fewer drug users injecting in alleys and discarding used needles.
“The effect of denying the services of Insite to the population it serves and the correlative increase in the risk of death and disease to injection drug users is grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics,” Chief Justice Beverley McLachlin wrote in a key section of the ruling.
The court’s strong support for harm-reduction measures and its position that law enforcement does not trump public health is a victory of sorts.
But did we really need the top court in the land to tell us that supervised injection sites save lives? The scientific evidence has been clear for years.
The federal government not only chose to ignore the evidence, it mounted a moralistic anti-science campaign against Insite. Former health minister Tony Clement went so far as to say that supervised injection sites offered “no harm reduction” but rather “harm addition.”
The current health minister, Leona Aglukkaq, greeted the Supreme Court’s ruling by saying the government was “disappointed” but would reluctantly comply.
Ottawa is not exactly embracing harm reduction, or evidence for that matter. Further, it seems to have not absorbed one of the most important lessons of the ruling, a reminder that governments are stewards and have a duty to act in ways that enhance the health of individuals and their communities – even when doing so is politically unpalatable.
There is some speculation that the court ruling will pave the way for supervised injection sites to open in other major cities with large populations of injection drug users, such as Montreal, Toronto and Ottawa.
But having the law and science on your side is not near enough. You need money, you need the support of local public-health authorities, you need the backing of the provincial government (meaning a province willing to pick a fight with Ottawa at a time when federal health transfers are being negotiated). And you need to convince a skeptical public that you’re not wasting tax dollars coddling “junkies.”
That’s not going to be easy to do at the best of times, let alone in the current “tough-on-crime,” recessionary atmosphere.
Finally, anyone who wants to open a supervised injection facility still has to apply to Ottawa for an exemption and they are undoubtedly in for a long, expensive legal fight.
In fact, one of the most tragic aspects of the Insite story is how much money was wasted on lawyers and how many opportunities were lost to advance public health while the legal bickering dragged on for years.
Instead of using its energies fighting for the survival of a service with demonstrated benefits (supervised injection), Insite should have been expanding into other areas such as supervised inhalation (sniffing having become a massive problem), and other groups throughout the country should have been expanding their harm-reduction programs such as distribution of safe-crack kits, wet shelters, and finding innovative ways to counter the scourge of methamphetamine addiction.
In pooh-poohing the court ruling, Ms. Aglukkaq said that the federal government prefers to spend on prevention of drug addiction rather than on harm-reduction measures for addicts.
The sad truth is that it has done neither to any appreciable degree.
Instead, the current government treats drug addiction not as a sickness but as a crime. It has chosen to spend dizzying amounts of money building prisons instead of investing in harm reduction, treatment and rehabilitation.
Prisons are not tools of prevention; on the contrary, they are places where addictions and needle-borne infectious diseases flourish.
The other unfortunate aspect of the Insite battle is that it has focused too much attention on harm reduction to the detriment of other important interventions.
Supervised injection targets a small minority, the sickest of the sick. The threat of prosecution is meaningless in this group and, sadly, treatment options are few. So you try to minimize the harm they can do to themselves and others – for compassionate and economic reasons.
But most addicts do not live on the means streets of Vancouver’s Downtown Eastside. They live in mainstream society – struggling at work, in school, at home. Most suffer from another form of mental illness.
The four-pillars approach – prevention, treatment, harm reduction and enforcement – is what they need and what governments should be embracing.
The Supreme Court of Canada has provided a timely reminder that putting all their eggs in the enforcement basket is a legally dubious approach, not to mention poor public-health policy. But it remains up to us – and our leaders – to act.