ATTENTION OTTAWA: INSITE IS A HEALTH CARE SERVICE

The federal government is once again appealing a court decision in
favour of Insite, Vancouver's internationally recognized supervised
injection site. This time it is appealing all the way to the Supreme
Court of Canada. It is challenging the recent B.C. Court of Appeal
ruling that Insite's supervised injection service is a health care
service which the government of British Columbia had the authority to
implement.

This is consistent with the position of the Dr. Peter AIDS Foundation
when, in 2002 at the Dr. Peter Centre, it integrated supervised
injection service into its range of health care services for people
living with HIV/AIDS.

The centre's approximately 300-day health program participants have a
complexity of illnesses and disabilities in addition to HIV/AIDS,
including serious mental illness and long-standing addiction issues.
About 35 per cent are homeless or have unstable housing. The centre's
health care services range from nursing care to nutritious meals, art,
music and recreation therapies. Counselling includes support for
reducing harm from drug use and assistance with referrals to detox and
other addiction treatment. The Dr. Peter Centre's 24-hour skilled
nursing care residence integrates supervised injection into nursing
practice.

The galvanizing impetus to pursue integration of supervised injection
service was two overdoses -- one in a bathroom, the other in a laundry
room -- fortunately, neither fatal. Aware that there had never been a
death in a supervised injection site anywhere in the world, it seemed
inconsistent with our mission of care for people with HIV/AIDS to
ignore that there was a way to reduce their risk of death by overdose.
We also knew that injecting in clean conditions with sterile equipment
could prevent our severely immuno-compromised clients from having
serious and persistent, often life-threatening, infections.

The foundation consulted the College of Registered Nurses of British
Columbia, the entity authorized and required, under B.C.'s Health
Professions Act, to establish standards for registered nursing
practice. The college's practice standards state it is the
responsibility of an employer to provide a work environment that
supports registered nurses in meeting those standards.

The college confirmed it was within the scope of registered nursing
practice to provide clients with evidence-based information so they
can give themselves intravenous injections more safely. It noted that
teaching and promoting such self-care prevents illness and promotes
health, especially for clients with high-risk behaviour. The College
of Registered Psychiatric Nurses provided the foundation with the same
nursing practice clarification.

When the Dr. Peter Centre integrated supervised service, it did not
request an exemption under Section 56 of the federal Controlled Drugs
and Substances Act because it was undertaking a necessary health
service. The nurses do everything reasonably possible to observe
federal law -- they do not touch, inject or provide the drugs.

The foundation was granted intervener status in Insite's B.C. Court of
Appeal case. In her written summary of judgment, Justice Carol Huddart
stated, "The evidence [provided by the foundation] establishes how and
why the decision in this case will have significant effect on
registered nurses seeking to comply with the professional and ethical
standards to which they are held by their governing body. That concern
is at the root of the division of powers issue and the evidence will
be helpful to a full understanding of that issue."

In an earlier decision, Justice Ian Pitfield found that the
application of federal laws to Insite violated its clients' rights to
life, liberty and security of the person under section 7 of the
Charter. He noted the "incontrovertible conclusion" that "the risk of
morbidity and mortality [death and disease] associated with addiction
and injection can be ameliorated by injection in the presence of
qualified health professionals." This reflects the Dr. Peter Centre
experience.

I hope that the Supreme Court will rule in favour of Insite. The Dr.
Peter Centre experience of integrating supervised injection into a
broader range of health care services offers the possibility of such a
service in any small town or large city in Canada. It does not require
a separate facility and can build upon already existing staff resources.

It is time to make this health care service available to many others
who so desperately need it. It is time to bring individuals in from
the street so they can inject safely and cleanly. It is time to create
therapeutic spaces of acceptance so that greater engagement in health
care is possible for some of our most unwell and disadvantaged citizens.