THE WAR OVER DRUG POLICY

The results on Vancouver's controversial safe-injection site are in,
and they're decisive. Insite, which offers clean needles and
assistance to hard-drug users, is a remarkable success story. It
saves lives, reduces infections and disease, and paves the way to
detox. So why won't Ottawa extend the legal exemption under which it operates?

The answer, of course, is ideology. Stephen Harper's Conservatives
are dead against anything that smacks of being soft on drugs. Some
experts are even accusing them of suppressing research and opinions
they don't like.

That's the official story. The real one is far more complex. In fact,
the lofty claims made for Insite are not borne out by the evidence.
And its most passionate supporters are at least as rigid as those
alleged knuckle-draggers on the other side. Like most of you, I'm a
pragmatist when it comes to drugs. I think it's pointless to
prosecute drug addicts. I think harm reduction is good. Whatever works.

But the war over drug policy is so politicized that "whatever works"
depends on who's doing the talking. Insite - a $3-million-a-year
operation established as a pilot project in 2003 - is the latest
battleground. It pits the harm-reducers - those advocating safe-
injection sites, needle exchanges and general decriminalization -
against the prevention-and-treatment crowd, who want more emphasis on
anti-drug campaigns and a tougher-love approach.

Sadly for the public, neutral research is hard to find. Most of the
many, many studies of Insite have been conducted by the same small
band of true believers. The most fair-minded report I've found comes
from an expert advisory committee assembled by the Health Minister,
Tony Clement. Their job was to examine all the research on Insite and
other nations' safe-injection sites. Their credentials are
irreproachable, and they don't seem to have an axe to grind. Although
Insite's advocates trumpet the report as a victory for their side,
its findings are at best mixed. Among them: The Insite facility
accounts for less than 5 per cent of all injections in the Downtown
Eastside. Just 18 per cent of the 8,000 people who've used the site
account for 86 per cent of the visits. In other words, Insite's
impact on the area is quite limited.

The overdose deaths Insite has prevented probably amount to one a
year - lower than supporters suggest.

Insite has indeed increased access to detox and treatment, although
by how much and with what results isn't known.

It's uncertain to what extent the site has reduced the number of HIV
cases or the incidence of needle sharing. As for hepatitis C (which
is spread by needle-sharing), the report found that 87 per cent of
Insite users are already infected.

Insite hasn't increased public disorder, as some people had feared.
There's no evidence it has reduced public disorder (e.g., local
crime, discarded needles), either.

There aren't enough data to draw reliable conclusions about overall
cost effectiveness/benefit.

Not exactly a ringing endorsement - or a condemnation, either. The
committee noted that the general public has positive views of Insite,
the community supports it and users rate it as highly satisfactory.
Whether there's a better way to spend that $3-million a year is a
question they weren't asked to address.

What you think of Insite probably says more about your world view
than it does about the evidence. Take Vancouver Mayor Sam Sullivan.
Mr. Sullivan, who's a quadriplegic and supporter, says: "I need help
managing my disability, just like they need help managing their disability."

Others don't regard addiction to heroin or crack as a condition to be
managed. They regard it as a curse - one that enslaves people,
sometimes kills them, and preys on society's worst-off. "Rich people
get rehab," says one skeptic. "The poor get safe-injection sites."