INJECTION SITE GETS 16-MONTH EXTENSION

As summer ran its course in Vancouver, a 3-year experiment to provide
heroin addicts with a medically supervised injection site neared its
scheduled Sept. 12 expiration. Canada's former Liberal government had
granted the facility, InSite, a permit exempting it from federal drug
laws. To remain open, InSite required a new permit from the
Conservative government -- some of whose members argued it's morally
wrong to aid illegal drug addiction.

InSite is in the Downtown Eastside, Vancouver's impoverished
neighbourhood of concentrated HIV and hepatitis sufferers, drug
addicts and dealers, sex-trade workers and criminals. North America's
first and only such site, it daily serves about 600 addicts who bring
in illegal street drugs and then inject themselves with syringes
dispensed by InSite, under the watch of health professionals. Nurses
and doctors intervene if users overdose and offer general health
care, while counselors are present to offer addiction treatment.

Some 50 similar sites exist worldwide, but InSite remains audacious
given the US "War on Drugs" next door. In British Columbia, however,
it has massive public and political support under a popular "Four
Pillars" drug strategy of prevention, enforcement, harm reduction and
treatment.

During InSite's 3 years, a remarkable consensus that the facility
reduces harm to users and the public developed among scientists,
criminologists and even the Vancouver Police Department. Research,
all positive, was published in 15 peer-reviewed journals, including
the CMAJ (2004;171:731-4), Lancet (2005;366:316-8) and the New
England Journal of Medicine (2006;354:2512-4).

In the spring of 2006, the province wrote to Ottawa formally applying
for a 3.5-year renewal of InSite's permit.

Ottawa's response was a long silence.

Over the summer, InSite became a cause celebre. Activists,
politicians and even scientists lobbied for it, and at the
international AIDS conference in Toronto researchers spoke in support
while AIDS activists demonstrated in the streets. Lawsuits were
threatened. Ethicists joined the fray, including Margaret Somerville
of McGill University's Centre for Medicine, Ethics and Law, who said
given that addicts would continue to be addicts, reduction of serious
harms such as HIV and hepatitis infection is an ethical requirement.
One of the few opponents was the Canadian Police Association, which
in late August demanded that Ottawa close InSite and focus instead on
a national drug strategy.

Less than 2 weeks before InSite's scheduled closure, on Sept. 1,
federal Health Minister Tony Clement announced he was deferring a
decision on InSite pending more research, but it could remain open
until Dec. 31, 2007. Clement's announcement asked: "Do safe injection
sites contribute to lowering drug use and fighting addiction? ...
Right now the only thing the research to date has proven conclusively
is drug addicts need more help to get off drugs."

The Canadian HIV/AIDS Legal Network accused the government of
"playing politics with people's lives."

Dr. Evan Wood, an epidemiologist at the BC Centre for Excellence and
HIV/AIDS and assistant professor of medicine at University of BC who
is, with Dr. Thomas Kerr, principal investigator for evaluation of
InSite, argues that science clearly shows the benefits of InSite, and
seemed nonplussed to find himself one of InSite's most vehement backers.

"I am a scientist, and I hate to be referred to as an advocate," he
said. "But Dr. Kerr and I ... want to see the problem improved as
scientists, because the benefits have been so positive."

Wood added, "I felt like the federal government was politicizing this
because the science is that strong."