INSITE CHEZ NOUS?

The chances of a supervised injection site opening in Quebec aren't
high, but the province is at least thinking about it

Now that heroin addicts in Vancouver can breathe a little easier,
thanks to the British Columbia Supreme Court's decision late last
month to extend supervised injection facility Insite's exemption from
federal drug laws for at least a year, there are murmurs that Quebec
is mulling a similar project. Earlier this month, provincial Health
Minister Philippe Couillard said the government was "looking into this
very seriously," sending shivers of excitement through the addiction
treatment world.

Of course, it's premature, and the province is backpedalling from any
firm commitment. Marie-Eve Bedard, a spokesperson for the minister,
tells the Mirror the province still has a long way to go before it
gives any kind of project similar to Insite the go-ahead. "We are
studying the results from Vancouver and from facilities overseas," she
says. "But there are no concrete projects yet." Insite workers will be
coming to Quebec next month to meet with Couillard to present their
findings in the hope that he will push for the creation of a
made-in-Quebec version. But it won't be easy, and it won't be quick.

"We also have to consider the ethics of such a project," says Bedard.
"Is our society ready to accept this? Where would it go? How would
residents there react? What would the negative impacts be?"

Politics at play

At Cactus, a Centre-Sud needle exchange facility, no one is holding
their breath. Jean-Francois Mary, a community organizer there, says
they will continue doing what they're doing, and focus on how to
improve it. From now until 2013, he says, Cactus will concentrate on
issues like "public drug consumption, reaching the people in need and
halting the spread of disease" like HIV and hepatitis C, he says.
Before anything like Insite arrives in Quebec, says Mary, "There needs
to be a feasibility study.. We'd have to look at things like how to
make it work, whether it would be decentralized or one big centre, and
what is the need?" He believes supervised injection sites work, based
on the evidence from Vancouver and similar locations in Europe, but,
in Quebec, "I don't think, at the political level, they are ready. And
the federal government has never taken a position on this except to
appeal the B.C. decision."

Late last month, after the Insite decision was handed down, Health
Minister Tony Clement told the federal Health Committee that the
science surrounding the findings, following five years of research,
"can only be described as 'mixed,'" and that the many studies based on
Insite are written by "the same authors who plough their ground with
regularity and righteousness." He disputes the assertion that Insite
has led to a decrease in the spread of HIV or hepatitis C, "or whether
Insite's benefits are greater than its $3-million annual cost."
Furthermore, since Insite opened in 2003, there have been 50 overdose
deaths in Vancouver's Downtown Eastside (DTES). Insite, he says,
"saves about one life per year."

Less death, more treatment

Nathan Allen, an Insite organizer and DTES resident, is obviously
disappointed with Clement's attitude, and says the facility saves
many, many more people than just one. In the five years Insite has
been operating, he says, "There have been 868 overdose interventions,
and each required either oxygen or a defibrillator. Ambulances were
called. In each of those cases, the likelihood of death, if not
imminent, was certainly there and prevented. Even if you lowball that
number and just look at respiratory failure, or even if it is just one
life, that's something."

Allen says Insite has supervised over one million injections since it
opened, and, without quoting numbers, has had a marked change on life
and death on the streets. "In the '90s, there was literally a death
every day. And the DTES is a relatively small neighbourhood. The
experience of someone you know dying every week. that's just not
happening now." He says many Insite users go on to seek additional
detox programs.

In Montreal and Vancouver, meanwhile, the North American Opiate
Medication Initiative (NAOMI), a scientific study that provides
addicts with heroin to consume on site to monitor how subjects would
interact with society if they needn't resort to crime to pay for it,
is set to expire at the end of this month. Initial results show,
according to researchers, that the treatment has been positive: a
retention rate of 85 per cent, with many subjects entering further
addiction treatment, and showing the responsibility to hold down jobs
and apartments.

But NAOMI is not a policy, but a project, and Allen is pinning some
hope on Quebec. "Quebec has a strong voice in Canada as to how to look
at health care," he says.