EN GARDE! HEALTH MINISTERS DUEL OVER FATE OF SUPERVISED INJECTIONS

VANCOUVER -- It's the big, ugly weed in the otherwise rosy garden of
relations between Ottawa and Victoria these days. Premier Gordon
Campbell has often spoken of his devotion to civil, constructive
relations with Ottawa, regardless of whether Conservatives or
Liberals are running the place. But there is one point of sharp
dispute these days.

Federal Health Minister Tony Clement and B.C. Health Minister George
Abbott are at odds over the value and propriety of Insite, North
America's only sanctioned safe-injection operation.

And this dispute is headed back to court.

Mr. Clement has announced a federal appeal of a recent B.C. Supreme
Court ruling that Insite, where addicts shoot up under medical
supervision, can operate indefinitely because it provides a valuable
health service. In Victoria, Mr. Abbott says B.C. may intervene in
the appeal to protect its right to run its health system as it sees fit.

Political scientist Allan Tupper of the University of British
Columbia plays down the rift, suggesting the language between the
parties has not yet turned inflammatory. "This is just an ongoing
question of managing a complex country through a federal system of
government," he said. "You have these disputes."

But Mr. Abbott has an exasperated tone as he talks about some of the
things Mr. Clement has been saying about Insite these days.

In late May, Mr. Clement told the House of Commons health committee
that "supervised injection is not medicine; it does not heal the
person addicted to drugs.

"The evidence is that Insite's injection program saves, at best, one
life a year. A precious life, yes. I believe we can do better and we must."

Mr. Abbott offers a perspective different from that of Mr. Clement,
who was critical of safe-injection sites when he was Ontario's health minister.

"It gives us an opportunity to meet with people who, otherwise, would
be injecting in back alleys beside dumpsters sometimes with needles
that had been used by other users, consequently spreading HIV/AIDS
and other intravenous drug-use diseases," Mr. Abbott said this week.

He said he was talking to Mr. Clement before the federal minister
made his remarks, but that he was nonetheless blindsided by them.

"In the past, his arguments had been that he was unpersuaded, but was
looking at the evidence," said the B.C. minister.

He noted he is "sometimes disappointed by my federal colleague's
comments that somehow Insite should be a magic bullet or else it's
not valuable."

Mr. Abbott does not rule out future chats with Mr. Clement on the
issue, but said, "I don't believe I [am] particularly optimistic
about changing his mind.

"At this point, I am still very pleased to discuss the matter with
him, but I sense from his comments that he and others may have
reached some conclusions which put us at odds on this question."

Mr. Clement said the Insite situation will not curb his ability to
work with Mr. Abbott on issues of mutual interest.

"I get along very well with Minister Abbott. We are able to disagree
without being disagreeable," he said in a statement to The Globe and
Mail, referring to recent joint work on funding for programs in the
Downtown Eastside, including treatment beds for sex-trade workers and
street treatment teams.

"We will continue to work for the benefit of all Canadians even
though we may sometimes disagree."

Mr. Abbott said he is talking to his cabinet colleague Wally Oppal,
the Attorney-General, about B.C. seeking intervenor status in the
federal appeal.

The point, Mr. Abbot said, would be to fight for the province's
ability to provide health care as it sees fit, germane to the
operation of Insite.

"We want to emerge from this with at least the same opportunity to
deliver health care, unfettered by federal jurisdiction, as we have
going into it.

"We believe that Insite is a part of the continuum of treatment that
we can provide to that very vulnerable group of British Columbians
that are substance addicted."

As part of his May 27 ruling, Mr. Justice Ian Pitfield of the B.C.
Supreme Court rejected legal arguments that Insite had immunity from
federal drug laws. The site has been allowed to operate because of an
exemption from laws that make drugs used there illegal. The exemption
was first extended by the former Liberal federal government.

"This is an area where we're obviously happy to continue discussions
with the federal government, but in the final analysis, the direction
of the courts may be supreme in this matter," Mr. Abbott said.

Judge Pitfield's ruling clears Insite to operate indefinitely.

Meanwhile, there is talk of cabinet shuffles in both Victoria and
Ottawa. However, it is unlikely that views on Insite will change even
if the ministers in charge of health in either capital do.

That is because the leaders shuffling the ministers are firm in their
own Insite-related positions.

Mr. Harper, possibly speaking to a political base critical of the
idea of state-sponsored havens for drug use, has described Insite as
a "second-best strategy" for dealing with addiction.

However, Premier Gordon Campbell has said Insite is "making a
difference. We think it is effective."

Through a spokeswoman, Mr. Campbell declined comment on the evolution
of his views on harm reduction, but his perspective may reflect the
view on addiction that he gained as Vancouver mayor from 1986 to 1993.

Mr. Abbott said he came to appreciate Insite when, as community
services minister, he had discussions with public-health officials
about the model. "The most persuasive arguments, from my perspective,
are not that this is some kind of magic bullet or magic pill to
eliminate the ills of drug abuse, because it's not."

[sidebar]

WHAT THE JUDGE SAID

The following are excerpts on federal-provincial jurisdiction issues
as they apply to the case of Insite, Vancouver's safe-injection
facility, from the ruling by Mr. Justice Ian Pitfield of the British
Columbia Supreme Court:

"[The PHS Community Services Society] argues that Insite is a
carefully considered and developed health care facility initiated by
the Health Authority, in its capacity as a delegate of the provincial
legislature, and in furtherance of the provincial power to govern
matters of health in the Province. It says that Insite is the product
of a detailed assessment of the personal and health consequences of
injection drug use in the [Downtown East Side], and the best health
care delivery technique to address those issues. As such, it is part
of the core areas of health care over which the Province has
exclusive jurisdiction and which the federal Parliament cannot impair. ...

"... In response, Canada says that Parliament has a compelling state
interest in prohibiting the injection of controlled substances, in
part because of their adverse effects on individual and community
health. Canada says that the reach of the [Controlled Drugs and
Substances Act], which had the effect of criminalizing injection, has
but an incidental effect on the provincial domain of health care.
Permitting Insite to continue its operations will create a safe haven
from the criminal law and undermine its national objective and importance.

"The difficulty in this case results from the fact that the CDSA
prohibition against possession indirectly controls injection, which
is not proscribed by the criminal law, and in doing so, has an
incidental effect upon a vital part of a provincial health-care
undertaking. As a result, the federal power to legislate in relation
to criminal law, and the power of a provincial delegate to provide
health care services meet in head-to-head conflict. This is a classic
case of 'double-aspect.' That being the case, the doctrine of
interjurisdictional immunity cannot be applied."