No Way Out: The Drug Policy That Failed

WE STILL AWAIT THE SCIENTIFIC PROOF OF HARM REDUCTION'S SUCCESS

Ten months before Vancouver's supervised-injection site opened in
2003, two young researchers gave a stirring presentation. They argued
that such a facility was vital in order to reduce public-health
problems and disorder in the city's notorious drug scene. The
evidence from elsewhere was overwhelming, they insisted, and it was
time to act. "I'm all for it," said Evan Wood, one of the presenters.
"Get one open. Enough's enough already."

Neither Mr. Wood nor his colleague, Thomas Kerr, had a background in
addictions medicine or public policy. Mr. Kerr was a PhD candidate in
educational psychology, and Mr. Wood was a PhD candidate in health
and epidemiology. Yet today, they and a small group of associates
have made their reputation in the world of drug policy as the authors
of nearly two dozen research papers - every one of which reports
remarkably positive results for Insite, the controversial supervised-
injection facility for which they themselves had lobbied hard.

It is this research - all produced under the umbrella of the B.C.
Centre for Excellence in HIV/AIDS - that is repeatedly cited as
scientific proof of Insite's success. It is this research that has
persuaded politicians, policy-makers, editorial writers and much of
the general public that Insite is a compassionate and progressive
tool for harm reduction that saves lives and reduces suffering. After
all, at least 22 peer-reviewed papers say so.

In fact, Mr. Wood, Mr. Kerr and their associates often act more like
advocates than impartial researchers. They aggressively denounce
anyone who even suggests that the value of Insite might still be a
matter for legitimate study or debate. They accuse Insite's critics
of being blinded by ideology and of willfully ignoring mountains of
"peer-reviewed," "evidence-based" studies.

Yet even experts who think Insite is a worthwhile experiment say the
case has not yet been made. Dr. Brian Conway, one of Canada's top
experts on AIDS policy, is one of them. "How much has it done in
terms of reducing the HIV-Hep-C infection rate, the rate of serious
illness that results from drug use, in terms of saving lives? That
hasn't been demonstrated." Nor is quantity the same as quality. The
sheer volume of published research "is more of a tribute to the
efficiency of the people who are writing the papers than anything
else." And in public, the researchers "have tended not to present the
limitations" of their findings.

Some people are not so diplomatic. "You can churn out all the
research you like if you've got a vested interest," says addictions
doctor Milan Khara. The B.C. Centre for Excellence receives millions
of dollars worth of government contracts for research on drug issues.
The tab for the Insite studies is well over $2-million. Yet none of
these studies addresses the central issue in the public mind: Does
Insite reduce overall drug use?

Garth Davies teaches research methodology at Simon Fraser
University's school of criminology. He recently published an
evaluation of all the research literature on safe-injection
facilities, including Insite. He wasn't impressed. "[They] are too
often credited with generating positive effects that are not borne
out by solid empirical evidence," he wrote. "As a result of
methodological and analytical problems ... all claims remain open to question."

Despite this fatal weakness, "there are very few other substantive
areas of research where the debate is this one-sided," Prof. Davies
said in an interview. The same small set of people peer-review each
other's work, and even the drug journals are politicized. "It's very
difficult to get a contrarian opinion published. If you're not on the
side of supervised injection, you get marginalized."

In any event, researchers who want to analyze the data for themselves
are out of luck, because the researchers refuse to share it. Steven
Lehrer, who studies health economics at Queen's University, says it's
frustrating. "They were reporting unbelievably large effects," he
says. And that makes it especially important for independent
researchers to validate the results. "They don't seem interested," he says.

Could it be that the fix is in? When researchers behave like
advocates, it's hard to believe otherwise. "They act as if it's a
done deal," says Prof. Davies. "It has become a professional mission for them."

[sidebar]

FOUR-PART SERIES

LAST SATURDAY Three million needles a year

TODAY Insite: What the science really says

THURSDAY Sweden and Scotland's U-turn on drugs

THIS SATURDAY Next stop: Legalize drugs?