Category Archives: Insite

Conservative Senator Talks Harm Reduction

Why Insite Matters

For those who have not seen it there is a stunning piece on the 5th Estate about Insite – the Supervised Injection Site in the Downtown Eastside of Vancouver – where TV cameras are allowed inside the facility for the first time.

I wish I could embed the video in this blog post and walk you through it, but sadly the CBC doesn’t allow me to do this. To view the piece you have to go to the 5th Estate’s website.

The piece is long, so below I recommend some specifics point that touched me. You can scroll directly to them:

02:20 – A basic video walk through of Insite that explains, plainly how it works.

04:15 – Interview with Darwin Fisher – the Insite intake manager – who shares with us the logic of Insite. In short, the facility connects some of the most marginalized citizens with society, giving us an opportunity to provide them with services, develop relationships, and keep the door open to the possibility of getting into detox programs.

09:58 – An interview with a user – David Brodrick – who talks about why he uses Insite and his desire to respect his community. Insite’s critics sometimes want us to forget these people are humans – living in our own backyard – this clip makes that impossible to do.

25:09 – A discussion about how the Federal Government is trying to shut Insite down and how four successive Vancouver Mayors – from across the political spectrum – are supportive, along with the community, local business and the BC Government (who funds it).

31:00 – It is hard not to be blunt here. But for those who don’t support Insite, are you prepared to tell this person, their friends, and their family, that you believe their addiction comes from a moral failing and that they should either go into detox right now, or die on the streets of Vancouver? Without Insite, this is essentially the choice we are putting before people like David. Insite is not the solution, but it is a step in the process that helps us address the problem.

My only critique of the piece is that it opens by stating Insite is experimental and controversial. This language that perpetuates a false story. Insite is no longer experimental. It is a piece of the healthcare system in Vancouver that is proven – in peer reviewed medical journals – to be an effective way to save lives. Moreover, it is proven, by a federal government report, to save taxpayers’ money. Finally, in Vancouver, Insite is not controversial. It enjoys overwhelming support, among business leaders, community groups, within conservative and liberal political parties and among the public at large. Insite – and harm reduction strategies – are about as controversial in the lower mainland as public transit. The debate isn’t about whether it should exist, but how we can do more of it.

If you are intersted in supporting Insite – consider visiting this website.

Shootings in Vancouver – how our definition of success leads us to failure

After a rash of shootings in Vancouver last week (which continues) I was completely astounded to read this quote by the RCMP in the Globe and Mai:

Violence between competing Mexican cartels is squeezing the flow of drugs from source countries such as Mexico and Colombia through cities such as Los Angeles, one of the major sources for Vancouver-based groups that buy and sell illegal drugs, says Pat Fogarty, RCMP superintendent with the combined forces special enforcement unit. Gangs in the Lower Mainland are now fighting over the dwindling supply.

“The distribution lines have been disrupted,” Supt. Fogarty said yesterday in an interview. “It’s like in any marketplace – the demand stays high, but there’s not as many distributors out there because the little guys get knocked off.”

“The bigger ones survive, the other ones don’t. And these guys don’t resolve things through a court process. It’s ‘I want my piece of the pie’ – well, there’s none left for you.”

Essentially, the RCMP is admitting that the more successful it becomes – the more capable it gets at limiting the flow of drugs – the more violence we can expect from drug dealers on our streets.

Why? Because when demand remains constant and fewer drugs are available, their value will increase making it more tempting to use violence to hold on to, or increase, your share of the marketplace. In essence, the RCMP is admitting that attacking the supply side of the drug trade is an ineffective approach. (The irony of course, is that the reduction has nothing to do with RCMP strategy or tactics but, as the Center for Strategic International Studies notes, everything to do with the geopolitics of the drug trade).

So, the RCMP has inadvertently admitted that the key to managing the War on Drugs is not to reduce supply, but to reduce demand.

This is precisely what makes projects like the NAOMI trial and the Insite injection site so important – they help to both reduce demand for drugs and, in the case of NAOMI, eliminate the demand from illegal sources altogether. This is what makes the RCMP’s opposition to Insite and NAOMI even more puzzling. If – by their own admission – reducing demand is the only way to effectively reduce the crime associated with the drug trade, why are they trying to shut down our most effective tools?

Wente’s disgraceful piece on Insite and harm reduction

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Last Saturday Margaret Wente wrote this disgraceful piece on harm reduction in Vancouver.

In short, what is written is a compilation of anecdotal statements that ignore the actual research and science that has measured Insite’s positive impact. A quote from a sergeant who may or may not have an axe to grind is apparently worth more than the numerous peer reviewed articles in publications like the New England Journal of Medicine or The Lancet. This is of course Wente’s MO – she doesn’t need science or research, like Colbert her gut is her guide – something we learned long ago from her coverage of global warming.

This sadly, is not the worst of it. Wente goes on to misrepresent both the goals of Insite and the position of its advocates.

No one – least of all Insite’s advocates – believes Insite is the entirety of the solution. The goal is, and always has been to have a complete response (hence the four pillars). Insite seeks to reduce harm but it can’t ‘solve’ the drug problem alone, no one claimed it would and judging it by such a bar is misleading.

Is rehabilitation and treatment essential? Absolutely – something Insite supporters also believe. This is why OnSite (a temporary treatment facility pointedly not included in Wente’s article) was placed atop Insite so that users would have somewhere to stay while a permanent facility was found for them. Insite was never designed to replace treatment, but to reduce harm for those who refused or could not get it as well as provide a vehicle to help users seek help and get on treatment.

There are plenty of commentators I disagree with but enjoy reading because they challenge my assumptions and provoke interesting or thoughtful insights. Sadly, most of the time I read Wente I’m reminded why she’s not one of them.

Two additional points. The first is how the injection site has become an East vs. West phenomenon. Here in Vancouver the debate is over. Insite has public support, on the street, in the newspapers and in the halls of power. Even the comments in the Globe reflect a bias in favour from those commenting from Vancouver especially but BC in general.

Second, I initially wrote this in the comment section on the globe website (where one is exposed to some truly horrifying thinking) and thought nothing more of it until Andrew F. emailed me a supportive note. And I thought comments on newspaper articles were simply a cathartic exercise!

Tory logic: Injection sites in Quebec = good, in BC = bad

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So Yaffe’s Wednesday column (which I talked about yesterday) about how Insite would not be challenged by the conservative government if it were in Quebec has turned out to be sadly prescient.

Today, the Globe is reporting that Federal Conservative Health Minister Tony Clement is willing to consider Quebec’s request for an injeciton site even as he works to shut down the site in Vancouver. For a party that was supposed to let the west in, this is a complete outrage.

Health Minister Tony Clement says his government will not necessarily oppose safe-injection sites for illegal drugs in Quebec even though it will appeal a court decision allowing a similar facility in British Columbia…

…”I am obligated to consider each situation as a unique situation. That’s my obligation as the Minister of Health.”

Appalling. Apparently the local consensus reached in Vancouver about this approach means nothing to this government. Nor apparently, do the votes in Vancouverites. With this move it is hard to imagine the Conservatives winning any seats in Vancouver.

For those interested in a sensible drug policy… sign here.

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Here is an opportunity to sign the resolution coming out of the Community Forum on the National Anti-Drug Strategy held in Toronto on March 26th.

Signatures generated at the Forum and from the on-line version total over 1600, from people across Canada. We will be presenting the resolution to Parliament soon, so please add your signature asap, if you haven’t already. Please also forward this message to any interested contacts or networks. And while you are at it, consider signing the Insite injection site petition as well.

As many of you know I believe a drug policy built on scientific research and evidence – not fear – is one that will most likely generate results.

That said, I know this won’t change the world, but it might help a little.

Expert Advisory Committee report: Insite works

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Late Friday afternoon (PST) Health Canada tried to quietly release the Final report of the Expert Advisory Committee on Supervised Injection Site Research. (Since government reports are public domain I’ve created a downloadable, easier to read, PDF version that can be found here).

Why quietly release such an upbeat report? Because the Health Minister is ideologically committed to closing Insite. Unfortunately for him, the report confirms what researchers and scientists have been telling us all along: that Insite works.

Consequently, for what must be the first time in Health Canada’s history the department is trying to bury a study that highlights how one of its programs improves healthcare outcomes to Canada’s most marginalized citizens.

Ah, the irony.

Well, one can’t blame him. The Minister simple doesn’t want anyone to know that his own hand picked experts have robbed him of any scientific basis for ending the program.

Below are some of the report’s highlights about how INSITE benefits the public:

INSITE encourages users to seek counseling, detoxification and treatment. Such activities have contributed to an increased use of detoxification services and increased engagement in treatment. Translation: INSITE helps drug users get off drugs.
Observations taken 6 weeks before and 12 weeks after the opening of INSITE indicated a reduction in the number of people injecting in public. Translation: INSITE gets drug users off the streets, making the safer and more community friendly.
There was no evidence of increases in drug-related loitering, drug dealing or petty crime in areas around INSITE. Translation: INSITE doesn’t increase crime.
A private security company contracted by the Chinese Business Association reported reductions in crime in the Chinese business district in a surrounding area outside the DTE. Analysis of police data for the DTE and surrounding areas showed no changes in rates of crime recorded by police. Translation: INSITE definitely doesn’t increase crime.
There is no evidence that INSITE influence rates of drug use in the community or increase relapse rates among injection drug users. Translation: INSITE doesn’t encourage drug use.
Every dollar spent on INSITE saved 0.97 to 2.90 in government spending on other services. Translation: INSITE saves taxpayers dollars – especially in heathcare costs.

These benefits are significant. However, the Conservatives spin machine is already hard at work. Specifically, it is trying to use this line – out of context – to support its claim that INSITE is ineffective:

“The injections at INSITE account for less than 5% of injections in the Downtown Eastside. This limits the likelihood of significant direct impact from INSITE in the Downtown Eastside.”

However, since the report also points out (contrary to what James Moore has misleadingly telling his constituents) that:

“An average of more than 600 visits a day shows that INSITE operates near capacity.”

The report isn’t arguing that INSITE is ineffective, it’s simply pointing out that it isn’t large enough to meet the demand. This is akin to claiming that a hospital should be declared “ineffective” and shut down because the people it didn’t have the capacity to serve were still dying of heart attacks.

The Conservatives now have two months before the June deadline they created to decide: are they going to shut down a program that reduces drug addiction and saves the public money?

Afghanistan and Vancouver's Downtown Eastside

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Taylor and I published this op-ed in today’s Toronto Star. It is not often that one can show a direct link between our soldiers in Afghanistan and Canadians in downtown Vancouver.

We originally entitled the piece: From Kandahar to Carnegie – dealing with the opium trade at home and abroad a title I think sounds better. I suspect however that the Star justly felt the reference to the Carnegie Centre – the community centre that serves Vancouver’s downtown eastside – may have been to obscure, especially for Toronto readers.

Failed strategy connects Afghan fields, city streets

Dec 07, 2007 04:30 AM

David Eaves
Taylor Owen

In the coming months, under the leadership of the former U.S. ambassador to Colombia, U.S. private contractors will likely attempt to fumigate poppies in Afghanistan. Around the same time, the Canadian government will decide whether to shut down the Insite supervised injection site in Vancouver’s Downtown Eastside.

The two policies are inextricably linked and unambiguously bad.

In April, the United States appointed William Wood, nicknamed “Chemical Bill,” its new ambassador to Afghanistan. In his previous post, Wood championed and oversaw the fumigation of large swaths of the Colombian countryside. The result? For every 67 acres sprayed, only one acre of coca was eradicated. Moreover, production increased by 36 per cent. In addition, the spraying negatively impacted legitimate crops, contaminated water supplies and increased respiratory infections among the exposed populations.

Wood is in Kabul for a single reason – to execute a similar plan in Afghanistan. Poppy production, once held in check by the Taliban government, is exploding – up 60 per cent in 2006. Poppies yield 10 times the value of wheat, so it is unsurprising that about 10 per cent of an otherwise impoverished Afghan population partakes in the illicit poppy harvest. It earns them upwards of $3 billion (U.S.) a year, or roughly 65 per cent of Afghan GDP.

The short-term economic costs and long-term development and health impacts of fumigation will be borne by those whose livelihoods are both directly and indirectly connected to poppy cultivation. Spraying could easily cause public opinion to turn against the Karzai administration and NATO forces, further compromising the mission and increasing the danger to Canadian soldiers.

Given the increased risks this policy poses to both our soldiers and the overall mission, the government’s silence is unconscionable. Others have not been so quiet. British Prime Minister Gordon Brown recently observed that there is little international support for fumigation. He announced an alternative policy to wean farmers off of opium, one that includes an ambitious plan to top up payments for legal crops, such as wheat.

Such policies, however, are only part of a long-term project. Success will require a holistic view, one that understands the connections between the consumption of illicit drugs in places like Vancouver and their cultivation in Afghanistan. Specifically, this means tackling the demand for opiates. Although 90 per cent of world heroin comes from Afghanistan, the vast majority is consumed in western countries. Blaming Afghan farmers for the problem is as hypocritical as it is ineffective.

Reducing the cultivation of poppies in Afghanistan begins not on the streets of Kandahar, but on the streets of Vancouver’s Downtown Eastside.

Fortunately, such policies exist. Insite, Vancouver’s supervised injection site, offers a real first step toward reducing poppy cultivation. This small storefront provides drug users with a sanitary and safe place to inject in the presence of registered nurses. The result: 21 peer-reviewed studies document how Insite diminishes public drug use, reduces the spread of HIV and increases the number of users who enter detox programs.

But Insite does more than get drug use off the street. It is a portal into the health-care system for addicts who are too often shut out. Drug users who visit Insite are an astounding 33 per cent more likely to enlist in a detoxification program. Indeed, Insite has added a second facility, called Onsite, that capitalizes on this success by allowing drug users to immediately access detox and drug treatment services on demand.

Sadly, the Harper government remains ideologically opposed to Insite. It is unclear if the federal government possesses the legal authority to close the site but there is significant concern it will attempt to do so within six months.

The Conservatives should be looking to scale Insite nationally, not contemplating its closing. A national network of injection sites could dramatically reduce heroin use in Canada by channelling more drug users into drug treatment programs. Diminishing the demand for heroin would in turn devalue the poppies from which it is derived. Changing this economic equation is both safer and more effective than fumigation if the goal is shifting Afghan production from poppies to legal crops. Admittedly, Canada’s share of the global consumption of heroin is relatively small, but our success could provide a powerful and effective example to the international community.

To many Canadians, Afghanistan is a world away. But the lives of drug users outside Vancouver’s Carnegie Centre and those of our soldiers in Kandahar are bound together – linked by the international opium trade. What we do in Afghanistan shapes events in Vancouver’s Downtown Eastside, and vice versa. Canada’s soldiers, drug users and ordinary citizens deserve a government that recognizes this reality.

David Eaves is a frequent commentator on public policy. Taylor Owen is a doctoral student and Trudeau Scholar at the University of Oxford.

CNN's converage of Insite

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The Insite supervised injection site is starting to attract more and more attention. Last week CNN broadcast this 3 minute bit about the site.

What’s fascinating is how a simple parsing of the language in the video reveals the depth of the differing perspectives.

Listen carefully and you’ll notice how those opposed to the injection site deal in abstract terms whereas those who support it talk in tangible outcomes.

For example, in the clip, Dr. Thomas Kerr and Insite workers/supporters cite tangible benefits: a 45% reduction in public drug use in the area, users being 33% more likely to enter detox, the reduction of discarded used needles in parks and schools. This are measurable, tangible benefits and outcomes.

Contrast that to the quote from an unnamed US official: “It that is a cruel illusion. Because they’re still addicted, trapped trying to get help and dying by virtue of the drug itself.”

Here is a vague comment designed to appeal to your emotions. More importantly, it is devoid of fact, research, or for that matter, logic. Being addicted, trapped, and dying from drug use is a reality for users whether the injection site exists or not. The injection site at leasts gets users in regular contact with social workers – which is why users who use the site are 33% more likely to enter detox – those relationships build trust, which enables users to seek help.

But the worse quote is from Dr. Colin Mangham, director of the Drug Prevention network. His “research” shows that 800 people overdosed at Insite in 4 years.

First off, this isn’t research, this is publicly available information. Second, Mangham’s statement presumes that those 800 overdoses would not have occurred if Insite did not exist. This is pure fantasy. Indeed one of the main purposes behind creating Insite was to ensure overdoses would occur within the site as opposed to on the street. Those who overdose at Insite receive medical attention quickly and cheaply (a nurse is on hand who provides the necessary treatment). It is worth noting that despite these 800 overdoses, they has not been one death at Insite.

In contrast, when drug use occurs on the street, deadly overdoses are both commonplace and expensive. Victims invariably require paramedics, who in turn may require a police presence. In addition, overdose victims may get taken to an emergency room – the most expensive point of contant in the medical system.

I expect with the Olympics coming there is going to be more coverage of this type. One things the Federal Government will have to consider is that, if they shut Insite down, an army of international reporters swarming the downtown east side are going to want to know: what more effective policy did you replace it with? (Hint: there isn’t one).

eaves.ca

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