SUPERVISED INJECTION SITES - A VIEW FROM LAW ENFORCEMENT

People have every reason to be confused about Vancouver's supervised
injection site. It's been up and running since 2003 and has as many
detractors as it has supporters. The only sure thing is the
entrenched debate about what it has accomplished, the alleged bias of
the medical research, and what goes on inside.

As former chief of the Vancouver Police, it fell on me to decide
whether we should support the continued operation of Vancouver's
supervised injection site, Insite. The competing interests were
intense and no matter what one's personal views were, every comment
garnered immediate rebuttal from an expert. The addiction issues,
crime concerns, and moral obligations of those in leadership
positions received continual headlines, so we learned over time to
stick with what we were good at-public safety.

The medical issues were better left to physicians. The Vancouver
Police have tried to do the right thing for all the citizens of this
city within the funding provided by city hall - all under the
umbrella of never-ending suggestions that the police take an even
harder line with the sad reality of what was going on outside the
front door of the site.

Background

The Vancouver Police Department (VPD) supported the opening of the
supervised injection site in 2002 as a research project, not as a
concept, and that support continues to this day. The Vancouver Police
letter of support to the federal health minister has been
inaccurately used by harm reduction proponents as a blanket
endorsement for a wide variety of initiatives and projects
surrounding the supervised injection site (SIS).

One should remember that no matter the direction and views of the
politicians at the time, our position was straightforward - follow
the law. Any injection facility for Vancouver would have to comply
with the law. We didn't hesitate to prosecute offenders and shut down
illegal sites, and there have been some.

Former Mayor Phillip Owen understood the dilemma for the police. He
pursued the exemptions under federal drug legislation to allow the
SIS to open because he knew it could not run without the cooperation
of the police, especially those frontline officers who patrol the
streets and alleys nearby.

Once the exemptions were granted by the federal government, to resist
or block the legal operation of the SIS would put the police in an
untenable situation - should the SIS fail, the police would be blamed
for its demise. So our role became a supportive one, waiting for the
pilot project research results, which we were promised would be
complete in 2 or 3 years.

Health Minister Tony Clement has since advised the Vancouver Coastal
Health Authority, which operates Insite, that their exemption under
Section 56 of the Controlled Drugs and Substances Act has been
extended until 30 June 2008. His comments have been clear: "This
extension will allow research on how supervised injection sites
affect prevention, treatment, and crime to be continued for another 6 months."

Vancouver Coastal Health Authority brought in an independent project
leader to lead the research. There were some logistical and personnel
issues and the person has not been replaced as yet. Everyone is
waiting for the results of the research.

Some say the research is in and clearly shows success while others
say sympathetic evaluators, who support open access to drugs, have
overstated their positive findings of the site, downplayed or ignored
negative findings, or reported meaningless findings in order to give
the overall impression that the facility is successful.

Police in the Middle

There have been many voices of complaint about the value of the SIS
and the peer reviews of certain addiction experts. There have been
magazine articles, medical research, newspaper stories, and letters
to the editor all proclaiming the success of the SIS.

Then there are others who suggest the real purpose of the SIS is to
use it as a foothold for the further expansion of drug use in Canada.
Medical experts (Drs Davies and Mangham) take an educated research
approach contrary to the findings of the SIS proponents.

That is our dilemma. There is a wide variety of medical opinions
about what is right. The problem for the police is that we are not
medical experts and we can only read and try to follow the debate.
The Vancouver Police appointed Inspector Scott Thompson to be the
lead on the debate/discussions, and he values the Carrado/Cohen
review from Simon Fraser University given their qualifications and
relative neutrality.

In the end this will be a decision of government and lawmakers. Our
job will be to enforce what that final decision turns out to be. I
believe we should remain supportive of the research objectives and
the principles behind the original agreements.

Harm Reduction

The supervised injection site is based on the controversial ideology
of harm reduction, which views drug use as inevitable. Thus it is
suggested that the government's role is to reduce the consequences of
that choice, based on the perspective that since individuals are
going to use drugs anyway, why not enable them to do so in a safe
medical environment? It is not clear to me whether harm reduction
supporters want to reduce the incidence and volume of drug use.

I give little credence to active drug users' views on how best to
solve the drug problem, but I do listen to addicts who have gotten
clean. I was told once by Dr Ray Baker that the solution to curing
drug addiction is not complicated. He and his colleagues have done it
for years, and successfully. Support, treatment, abstinence, and
counseling are all part of the solution.

It seems that harm reduction tries to reduce harm to the drug user
while not being judgmental about their actual drug use. This lack of
judgment allows the addict to "freefall through society," as former
VPD Constable Al Arsneault once said, with addicts dropping out of
school, losing jobs, being alienated from their families, committing
or being themselves victims of crime, and making them vulnerable to
disease and death. In fact, the focus of harm reduction is actually
the worst-case scenario for a drug user - total inability to quit and
eventual death.

Recommendations

Abstinence

A lifetime of policing has led me to believe that getting off drugs
should be the first step for addicts, not the last. In locations
where supervised sites have had positive outcomes there has been
accompanying strong support from the police and the courts for those
areas surrounding the site. This means that if an addict chooses to
inject outside the SIS, there are immediate repercussions by the
police and the courts.

This is not the case in Vancouver due to the chronic police shortages
and a liberal attitude toward drug use in general. Police are
naturally suspicious about the positive image of Insite. This image
is undeserved - what goes on in the SIS is abhorrent. My respect goes
to the police officers assigned to the challenging beat of District 2
in which the SIS continues to operate.

Mandatory Treatment

There must be mandatory and compulsory drug treatment for addicts,
especially prison inmates. Treatment must trump individual human
rights when a person's addiction causes problems. Britain and Sweden
are good examples of where tough en-forcement in partnership with the
courts, treatment facilities, and rehabilitation programs really work.

Sweden has among Europe's lowest crime, disease, medical, and social
problems stemming from drug addiction, ac-cording to the United
Nations Office of Drugs and Crime in its 2006 analysis. I would be
interested in the many major European cities on record against
supervised sites. Many facilities have closed, and the reason why
should be part of the research.

Education

If there is to be support of the SIS, there must be the right
accompanying message of the big picture. There must be condemnation
of illegal drug use with no glamorization of the drug culture.
Educational material must be clear, pertinent, and designed to have impact.

The so-called war on drugs commentary may be dated, but the
underlying message is important and valuable. Education is the key.
There must be respect for the rule of law. Use the SIS if you must,
but it is not a free ride; there are certain things you must do and
you must participate in whatever program is available and required.

Has Any Good Come of It?

The casual observer might look at Vancouver's Downtown Eastside
(DTES) and wonder if things are better since the opening of the SIS.
They are better - not a lot, but better than they were 5 years ago.
It is not entirely because of the SIS, but that may have played a
small part. Police crackdown on street level dealers and a focus on
addicts who use or fix in or near parks and schools are prosecuted,
and this has made a huge difference. Enforcement works.

What is lost in many of the discussions about supervised injection
sites are the uniformed officers who patrol the areas around the
sites. I am very proud of their efforts in the DTES and their
continued professionalism in the face of such heated debate and
criticism from both sides. The officers continue to do their job.
There is a huge untold story here.

People have become used to thinking of the DTES as a centre for
public urination and defecation, prostitution, open sex, panhandling,
drug trafficking, assaults, and violent crime. It is not fair. This
is a great neighborhood, a unique community made up of many fine,
law-abiding citizens.

It was never more obvious when 40 additional officers patrolled the
DTES in 2003. People walked the street in safety, baby strollers were
commonplace, and officers were stopped on the street and thanked for
their dedication to make things better.

Jamie Graham was the chief of the Vancouver Police Department from
2002 to 2007. He is currently consulting on security, leadership, and
crisis management issues. He is also a member of the National Speakers Bureau.