FEDS WEIGH RISKS OF PULLING THE PLUG ON INSITE

International Opinion, Demand for Research Funding Among Concerns

OTTAWA -- In contemplating the fate of Vancouver's supervised
injection site last year, the federal government concluded that the
risk of offending the international community by keeping Insite open
had more serious consequences than closing it over the objections of
the B.C. government, according to internal documents obtained Friday
by The Vancouver Sun.

One Health Canada document, which describes and evaluates the risks
associated with both options, also warned that refusal to extend
Insite's licence would simply result in the opening of an illegal facility.

With considerable risks inherent in either choice, Prime Minister
Stephen Harper's government -- asked to extend the permit by up to
five years -- found a middle ground last August by extending the
facility's permit only until the end of this year. The government
also refused to renew the $1.5 million in research funding provided
by the former Liberal government when the Downtown Eastside site
opened for a three-year trial in 2003.

In the past, the Harper government has criticized "harm reduction"
measures such as the Insite program, which focuses on reducing the
risk of overdoses and HIV infection rates among hard-core addicts.

The government has said it shouldn't be in the business of
facilitating drug use, and instead should focus on enforcement,
prevention,and rehabilitation.

The facility provides clean needles, a safe place to shoot up, a
referral service for addicts seeking treatment and staff available in
the event of an overdose.

The April 26, 2006 analysis lists seven risks facing the government
should it extends the permit allowing Insite to operate, and six
risks it it were to deny the application.

Each risk is given a "likelihood rating" and a separate "consequence
rating" from one to five. Both numbers are multiplied to indicate the
overall risk rating.

"Negative reaction/criticism from the international community" was
given a likelihood ranking of five, the highest score, and a
consequence rating of three, for a total score of 15 -- the
second-highest of the nine identified risks in extending Insite's permit.

The highest ranking, with a score of 20, related to the expected
demand for renewed research funding for Insite if the permit is
extended, along with additional demands for research funds for other
injection sites that might pop up elsewhere in Canada.

Other risks cited in the report included "negative reaction/criticism
from domestic stakeholders such as the police," which got a total
score of five.

Among the risks associated with killing Insite, Health Canada's
greatest concern was that the government would lose access to
evidence that could be used for "decisions on programs of this nature
in the future." That received the highest possible score of 25.

Next on the list was the risk that an injection site "may continue to
operate illegally without the exemption . . . as one did prior to the
initial exemption." That concern, referring to the Dr. Peter Centre,
was given a likelihood rating of five and a consequence rating of
four, for a total of 20.

"Negative reaction/criticism of the GOC [Government of Canada] from
the B.C. Government and/or the Vancouver Health Authority" had a
likelihood rating of five, but a consequence rating of only two, for
a total of 10.

Another risk was that Health Minister Tony Clement's decision to shut
the site might be challenged in courts, resulting in a likelihood
rating of two but a consequence ranking of four, for a total of eight.

Other risks included "benefits gained to date (increase in public
order) will be lost," which received eight points, and "negative
reaction/criticism from other stakeholders (NGOs, 'like-minded'
countries) about the lack of support from GOC for harm reduction,
which received five points.

Last week, the federal budget committed $64 million over two years to
fund a renewed National Anti-Drug Strategy, which already gets $385
million a year. The new money will be used to combat illicit drug
production, use and dependency, and will not be used for
harm-reduction initiatives.

Researchers with the B.C. Centre for Excellence in HIV/AIDS have
accused the Harper government of taking an "ideological" U.S.-style
war on drugs approach rather than consider evidence that suggests
Insite is effective.

The head of the United Nations' drug control agency, the
International Narcotics Control Board (INCB), criticized the Harper
government earlier this month for "encouraging illicit trafficking"
by allowing Insite to operate legally. The INCB and U.S. President
George W. Bush's administration have led the international battle
against harm-reduction initiatives.

The INCB, however, has come under severe criticism, with the Canadian
HIV/AIDS Legal Network issuing a report this month accusing the UN
agency of being "closed to reason" on the harm reduction issue.

Canadian Stephen Lewis, former UN special envoy for HIV/AIDS in
Africa, accused INCB of aligning itself "with the virus rather than
opposing it determinedly."

A July 24, 2006 Health Canada briefing note on the Insite debate
described supervised injection sites as an important harm reduction
component of the so-called four-pillar approach to drugs that
includes prevention, treatment and enforcement.

"While it is not a complete solution in itself, such sites have shown
some promising results in several European countries and in
Australia," the briefing said.