Drugs in Canada

NEEDLE MATCH

Harm Reduction, or Abstinence?

BACK in 2003 many residents of Vancouver reckoned that an answer had
finally been found to the worsening hard-drug problem in the
liberal-minded city's Downtown Eastside district. A reformist city
council, borrowing a European idea, opened the first supervised
heroin-injection clinic in North America. It was set up as a research
experiment, with a three-year remit (since twice extended). The idea
was that giving addicts a safe place to inject themselves would
remove them from crime, disease and other risks, and make them more
amenable to treatment. The Liberals who were then running the federal
government agreed, and blessed Insite, as the project is called, with
C$1.5m (then worth $1.1m) and a vital exemption from drug laws.

Five years on, Insite has proved a disappointment to many in
Vancouver. It has also become the object of partisan conflict. The
Conservative federal government of Stephen Harper dislikes the
project. A committee set up to advise it on the issue found that only
about 500 of Vancouver's 8,000 addicts use Insite each day, and fewer
than 10% of those use it for all their injections. It found no clear
evidence of any increase in treatment, nor of any fall in HIV cases.
It did estimate that the project might have saved one life per year
but found that overdose deaths were still about 50 a year among
addicts. Crime continues unabated as addicts steal to feed their
habits, something which frustrates the local police. The government
therefore proposed to allow Insite's legal exemption to lapse when it
expired in June.

Many health workers thereupon sprang to Insite's defence. They are
convinced that the project's "harm-reduction" approach can work. In
May they gained an order from a justice of British Columbia's Supreme
Court to stop the federal government from closing the clinic. In a
radical ruling Justice Ian Pitfield found the federal law prohibiting
the possession and trafficking of drugs to be unconstitutional and
said that closing Insite would deny addicts access to a "health-care
facility". Allowing the clinic to stay open, he gave the federal
government a year to amend its anti-drug law. The federal government
promptly appealed against the ruling.

Health care in Canada is a provincial matter. Last month Quebec
stepped into the drug debate. Its public-health director announced
that he was considering plans for supervised injection sites in
Montreal and Quebec City. This seems to have made things even
stickier for the federal health minister, Tony Clement.

This week Mr Clement restated his opposition to Insite. "Allowing
and/or encouraging people to inject heroin into their veins is not
harm reduction, it is the opposite," he said while attending an
international conference on AIDS in Mexico City. He wants to focus
instead on treatment and prevention. But he has remained silent as to
whether the government would grant any request from Quebec for
exemption from drug-prohibition laws. Mr Harper's hopes of turning
his government's minority status into a majority at the next election
depend on winning seats in Quebec. So the future of drug policy in
Canada may turn on a political calculation.