Tag Archives: Insite

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

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

insiteLate 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

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

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).

Insite – Incremental Death?

Yesterday the federal government announced it would extend the legal exemption that allows Insite, Vancouver’s supervised injection site, to stay open until June 2008. (to understand why the Injection site is important click here, here and/or here)

So the good news is brief and temporary: Insite, gets to stay open an additional 6 months.

And here’s the bad news. Tom Flanagan, Harper’s chief strategist has recently published his tell all book: Harper’s Team: Behind the Scenes in the Conservative Rise to Power. One of the books key messages? Conservatives must adopt an “incrementalist” strategy. In other words, they must slowly when advancing the conservative agenda – move too quickly and the electorate will turn against them.Insite Logo

This begs the question. Is the reprieve for Insite genuinely designed to give the Federal Government more time to assess whether it is having a sufficiently positive impact? This is very much my hope. Those in the know tell me that the Federal Government only got around to appointing the team to assess Insite a few weeks ago. Given that this team’s report was never going to be ready in time for Christmas deadline another temporary extension was widely expected.

Part of me desperately wants to believe in the Harper as “policy wonk” narrative. If this is the case, then the overwhelming evidence in favour of Insite may be persuasive to a person focused on outcomes. On the evidence it would be hard to justify pulling the plug on Insite.

Flanagan’s incrementalism thesis however, plays on Insite supporters’ worst fears. If Flanagan is to be believed (and there are good reasons to believe him) then the reprieve is simply a way to hold off a decision until after an election (and a hoped for majority government) at which point it will be politically “safe” to kill Insite. As I mentioned in an earlier post, it is very hard to imagine the Conservatives picking up a seat in Vancouver if they kill Insite. If however, they appear to be moderate and are considering saving it, they boost their chances of capture a seat like Vancouver-Quadra. This is certainly the fear of Keith Martin and other local federal Liberals.

So am I excited that Insite got a 6 month extension? Not really. Insite works. Moreover it is operating at capacity. We shouldn’t be debating whether or not it stays open. This is akin to arguing if we should keep open a single public hospital in a country where there is no public healthcare insurance. It’s the wrong debate. The question should be – how do we scale this policy up nationally?

But that’s not the debate we are having, and likely won’t be having for a few years. So in the interim let’s save Insite.

As far as I can tell our fate in this capacity rests on whether Harper is an incrementalist, or a policy wonk.

Our New/Old Drug Policy: Welcome to the 1980s

The Tories are beginning to lay down the ground work for a new (or should we say old) drug strategy.

The ‘new’ strategy? A TV campaign informing kids that drugs are bad, an increased presence at the border and a slight increase in funding for drug rehabilitation. If it sounds like the 1980s all over again, it is.

Ironically, it is being billed under the new tagline: “Enforcement is harm reduction.”

This is bad news for all of us. The tentative progress of the last decade is about to be lost in one fall swoop, including of course, Vancouver’s Insite injection site.

Let’s be clear, enforcement is not harm reduction.

There is no evidence to suggest that an increased police presence will have any impact on the drug problem in Vancouver, or anywhere else in the country for that matter. Indeed, American’s 36 year old war on drugs demonstrates otherwise. My question to Tony Clement is: what are doing that Nixon (who coined the term “war on drugs“), Carter, Reagan, Bush Sr., Clinton, Bush Jr., and previous Canadian governments, didn’t try? With only a fraction of the resources America dedicated to similar campaigns, explain to us why this policy will be success?

In short, Clement’s strategy is analogous to yelling at a non-english speaker when they don’t understand you. It’s a strategy – and for some people it feels good – but it accomplishes nothing. This is because the problem isn’t that they can’t hear you – it’s that they don’t understand you. Similarly, it’s not that many drug users don’t know drugs are bad – or haven’t seen warning messages – it is that they have come to a place where they are truly dependent. Screaming at them, arresting them, and legally marginalizing them isn’t going bring them into the fold and increase the likelihood they’ll seek treatment – if anything it will accomplish the opposite. I would love to see Clement in the downtown eastside, yelling at users to seek treatment. It would be about as alienating and as effective as it sounds. Contrast that to the injection site’s strategy of developing a relationship with users over time, and keeping the door open for when they are ready. Is it ideal? No, nothing about the world of drugs is ideal. But at least it works.

The simple fact is, Clement wants to overturn a program that enjoys the support and cooperation of the Vancouver Police Department, local community leaders, local business leaders, and Vancouver Costal Health. Still more problematically, Clement wants to replace a program supported by evidence and science with one based on ideology and fear.

The benefits of the injection site and harm reduction strategies are clear. They include:

  • Saving lives by:
    • Reducing overdose fatalities
    • Reducing injection-related infections such as HIV and Hepatitis C
    • Increasing access to addiction treatment programs
  • Improving public order by:
    • Reducing public injections
    • Reducing drug-use related public disorder
    • Reducing drug related waste (such as needles) in public spaces
  • Reducing healthcare and policing costs associated with drug-use by:
    • Reducing emergency room visits
    • Reducing use of ambulatory and emergency response services
    • Reducing police resources dedicated to drug-use related public disorder

If the Conservatives aren’t interested good public policy, policy that saves lives, improves public order and reduces healthcare costs… so be it. But I am certain they are interested in electoral outcomes. Given the injection site’s support in Vancouver (the last polls show it receives a 70% support rate) it will be difficult to secure a seat in the city if the Insite injection site is perceived to be on the chopping block. With Emerson stepping down, the Conservatives won’t have a single MP from one of the country’s three largest cities. If evidence and science can’t persuade them, maybe, just maybe, electoral math can.

For myself, the Insite injection site is what re-invigorated my interest in municipal politics. I hope it survives the December 31st exemption renewal deadline. Otherwise, I’d hate to be the politician who saw Insite go down on their watch – I know I’ll be volunteering for who evers campaign is opposing theirs.