SCIENCE SAYS SAFE INJECTION SITE A SUCCESS

Re: "Vancouver's safe injection site contradiction in name and deed: We
should focus on
the problem as a moral issue," by Susan Martinuk
I would like to clarify some misconceptions expressed by Martinuk in last
Friday's
column regarding Vancouver's safe-injection site.

Good public policy should be based on objectively researched evidence,
and not on subjective morality or ideology.

Addiction is a medical problem. Extensive medical research has
established that over the last 20 years. Effective solutions must
therefore be based on good public health principles.

These universally accepted public health principles are: prevention
and epidemiology (research and data), harm reduction, treatment and
rehabilitation. These principles work together to form a
comprehensive, integrated strategy for dealing with public health problems.

Those who exploit the addicted by selling and trafficking in illicit
drugs are criminals and should be targeted with effective criminal and
law enforcement strategies.

Insite, Vancouver's safe injection site, is a harm reduction project.
It is not an original concept. It was patterned on similar, highly
successful, harm reduction programs, (sanctioned by the European
Parliament) in Switzerland, Germany, Belgium, Portugal and Spain, to
name a few, as well as numerous safe injection facilities in Australia.

The project in Vancouver was set up as a clinical trial, to see
whether the European and Australian results could be achieved in a
North American setting.

The research project was conducted by scientists at UBC and the Centre
for Excellence in Clinical Trials for HIV/AIDS.

The protocols followed accepted international scientific standards for
clinical research. The chief researcher is Dr. Julio Montaner, a
respected clinician and current president of the esteemed Council of
the International AIDS Society.

The target population, as in most harm reduction research, was the
small but very high-risk IV drug user cohort in Vancouver, who had
extremely high overdose mortality rates, peaking at over 200 in the
mid-1990s. This group was also at highest risk for HIV and hepatitis C
infection, and for frequent hospitalization. They were also the group
least likely to seek treatment.

Within six months of the establishment of Insite, the overdose deaths
had dropped to zero and remained so among Insite users. Within 18
months, the users of this very resistant group were seeking detox and
treatment. There are now 24 beds in the building that provide
immediate detox treatment facilities.

Moreover, the rates of illness and hospitalization dropped
dramatically, at great savings to the health-care system (Vancouver
Coastal Health Authority), and the spread of HIV and hepatitis C was
contained in this high risk group.

One of the objectives of the project was also to determine whether
public order would be achieved. The Vancouver Police Department's
Commander of the drug unit, at the time, Kash Heed (now chief of
police for West Vancouver), attests that this is so.

The Chinatown Merchants' Association was adversely affected by the
public disorder and were opposed to Insite. Today, they say that
within two years, crime and public disorder has decreased markedly.

As per accepted scientific research principles, the Insite research
and results were analyzed by 22 international research panels from
many countries. They attest to the validity of the research findings:
saving lives, decreasing illness and the spread of disease and
decreasing public disorder. Some of these reports are published in the
May edition of the International Journal of Drug Policy.

Martinuk continues to hold that there are no facts behind Insite's
success. I refer her to the body of supporting, scientific literature.
If she does not trust science, then I refer her to the chief of police
of the District of West Vancouver; to the affected local business
community and the experience of Europe and Australia. Then I ask her
to compare all of this evidence with the one report cited by the
minister of Health (and commissioned by him).

Martinuk holds that this issue should be judged morally and not
scientifically. As a physician whose professional ethic -- do no harm
- -- is based on harm reduction, my view is quite different. I believe
that to deny proven life-saving assistance to those who are
vulnerable, simply because we disapprove of their lifestyles, is
perhaps the greatest immorality of all.

Dr. Hedy Fry is a physician and Liberal MP for Vancouver Centre