As medical staff of the country's only supervised drug-injection clinic nervously await Friday's decision on its future by the Supreme Court of Canada, one of its leading supporters revealed that he now knows first hand what addiction is all about.
Julio Montaner, renowned around the world for his efforts in combatting AIDS, said he had great difficulty weaning himself from pain-killing narcotics, after breaking a number of ribs this summer when a car collided with his bike.
"I understood everything I was going through, and yet I tell you, it was probably the worst seven to 10 days of my life," said Dr. Montaner, former president of the International AIDS Society and head of the B.C. Centre for Excellence in AIDS/HIV.
"To be honest, I could not wait to take another dose [of drugs]to get rid of all the pain, the insomnia, the anxiety. …Now I have experienced under my own skin what it's like to kick narcotics. It was extremely painful."
Dr. Montaner pointed out that he had been on a form of synthetic morphine for only six weeks before deciding the pain had become bearable enough to stop taking it.
If someone like himself, who understood exactly what he was going through, had trouble ending just a short round of narcotics, imagine the difficulty of long-term heroin addicts kicking their habits, he said.
"People say, 'Oh well, they should just go out and stop.' Well, you have it from me, the horse's mouth, it's easier said than done. The level of sympathy I have for my [addicted]patients today is 100 per cent greater."
Studies have shown that addicts using Vancouver's supervised injection facility, known as Insite, are more likely to access detox to try to get clean from drugs than do other addicts.
Since drug users sharing infected needles is a major cause of HIV transmission, Dr. Montaner said Insite's success, however modest, in curbing addiction is a major reason he supports the clinic.
In its decision, the Supreme Court will either side with a federal attempt to close it down or deliver a slap in the face to the Harper government by allowing the province to override federal anti-drug concerns.
The Insite injection site, where drug users have self-injected drugs under the supervision of health professionals for the past eight years, has strong support across the political and medical spectrum.
Medical staff, addicts and a coalition of groups supporting the clinic have already vowed to bombard the Harper government with demands to let the clinic remain open should the court rule against it.
"Stephen Harper will have an important choice before him," said one of the plaintiffs in the legal action, Shelly Tomic. "He can choose life – or he can choose death for thousands of Canadians suffering while struggling to overcome their addiction."
But there is more at stake than the fate of hundreds of drug addicts. The case constitutes has evolved into a major constitutional brawl between the two levels of government.
Provincial support for Insite has grown apace with federal disenchantment about a facility it views as an officially sanctioned law-breaker.
"It is a classic battle between the federal and provincial governments over the limits of two powers – criminal law and health care – which are mutually exclusive but have obviously conflicted in this case," said Carissima Mathen, a law professor at University of Ottawa.
Prof. Mathen said the federal government may rue the day it waded into the battle. "Its determination to take a hard line with respect to drug use has arguably made it vulnerable to much more serious restrictions on its criminal law power," she said.
For five years, the federal government renewed a special exemption allowing Insite to operate without fear of prosecution under drug laws. In 2008, it balked at renewing the exemption, prompting a coalition of groups and health authorities to ask the courts to clear the way for Insite to continue operating.
With support from the B.C. attorney-general, the coalition persuaded the B.C. Supreme Court and the British Columbia Court of Appeal to find Insite immune from the criminal prosecution under the doctrine of "inter-jurisdictional immunity."
Two key questions face the Supreme Court: Does the withdrawal of Insite's exemption violate the Charter of Rights by exposing users to greater harm by forcing them to purchase street drugs? Is it unjust to prosecute addicts who have no real choice of avoiding criminal behaviour?
The B.C. Health Ministry, which funds the facility, has cited numerous studies that showed Insite's effectiveness in connecting vulnerable, at-risk injection drug users with health services. Vancouver Police also report no risk to the public from the site's operation in the heart of the Downtown Eastside.
Dr. Montaner said that health professional are also able to access hard-to-reach drug users at the facility to enlist them in aggressive anti-HIV treatment. He noted that B.C. is the only province in Canada where the rate of HIV infection is going down.
"So, from our perspective, the benefits of Insite to those infected and to the community at large are irrefutable," he said. "We have every expectation that we will continue this kind of service for the long haul."
The Supreme Court has ruled in previous cases that it violates the Charter to convict someone of a criminal offence if that person did not have a realistic choice to avoid the criminal behaviour, Prof. Mathen said.