INJECTION SITE RULING BENEFITS ALL CANADIANS

The recent B.C. Court of Appeal decision that has allowed Insite,
Vancouver's supervised injecting facility for illicit drug users, to
remain open is significant to all Canadians concerned about the harm
drugs cause in our society.

Despite what Herald columnist Susan Martinuk wrote last week, the
benefits that facilities such as Insite provide to inner-city
residents and communities are real and verified. But before
considering the specific rationales for allowing drug addicts to
inject pre-obtained illicit drugs under the supervision of medical
staff, we must assess the proven limitations and unintended
consequences of overreliance on criminal justice approaches to protect
society from illicit drugs.

First, drug prohibition has created a massive global revenue stream
for organized crime, worth an estimated $320 billion US annually. In
some cases, these enormous proceeds threaten the political stability
of entire regions, such as Mexico and Afghanistan. Second, in the
U.S., where the war on drugs has been fought most vigorously, the
incarceration of drug offenders has placed a huge burden on the
taxpayer and contributed to the world's highest incarceration rate.
Primarily as a result of drug-law enforcement and mandatory minimum
sentences, one-in-eight African-American males in the age group 25 to
29 is incarcerated on any given day, despite the fact that ethnic
minorities consume illicit drugs at comparable rates to other
subpopulations in the U.S. Paradoxically, ever-increasing drug
enforcement expenditures and incarceration levels have not prevented
the drug market from becoming more efficient. In fact, all
surveillance systems demonstrate a global pattern of decreasing drug
prices while purity and availability continue to increase.

Third, the association between drug prohibition and increased
inner-city violence is consistent. A recent international example is
the upsurge in severe drug-related violence in Mexico subsequent to
Mexican President Felipe Calderon's escalation in the fight against
Mexican drug traffickers.

Locally, the increasing gun violence in Canadian cities has been
directly linked to clashes between organized crime groups scrambling
over the enormous drug market profits.

Fourth, and most relevant to public health approaches such as
supervised injecting sites, are the epidemics of HIV and overdose
death. Studies have shown these are highest in areas where law
enforcement is prioritized over evidence-based public health
strategies. These harms are significant to all Canadians, given that
HIV is an infectious disease that has spread beyond its traditional
risk groups and is now placing a large burden on the health system.
Each and every case of HIV is estimated to cost $250,000 in medical
expenses. For the above reasons, conservative economists like Nobel
Prize winner Milton Friedman have long argued that the "war on drugs"
does much more harm than good.

In the wake of repeated unsuccessful law enforcement interventions in
Vancouver's poverty-stricken downtown eastside, local policy-makers
looked to models from a growing number of countries in Europe, where
more than 65 supervised injecting programs have been initiated as part
of a pragmatic approach to couple law enforcement efforts with
strategies to improve public disorder. The programs improve public
order by bringing street-based drug addicts indoors where they can be
prevented from sharing needles and overdosing while increasing
enrolment into addiction treatment.

The Vancouver supervised injecting trial has replicated the European
experience. In fact, Insite is undoubtedly the most highly studied
health clinic in Canadian history, with almost three dozen studies now
published describing the program's positive impacts. These are not
simply consultant's reports, but rather rigorous, peer-reviewed
studies published in some of the world's most prestigious medical
periodicals including the New England Journal of Medicine.

Stephen Harper's government has opposed harmreduction programs, but
his position is at odds with the scientific community internationally.
Specifically, due to their effectiveness, harmreduction policies are
now endorsed by all evidence-based scientific consensus bodies,
including the U.S. Institutes of Medicine and the World Health
Organization. This consensus is based on rigorous reviews of the large
volume of international scientific evidence indicating that
harm-reduction programs save tax dollars and improve public health by
reducing HIV rates while increasing uptake of addiction treatment.
This body of evidence is in stark contrast to the documented
deficiencies and unintended consequences of conventional
enforcement-based drug strategies endorsed by the Harper government.

While supervised injecting facilities, like Vancouver's pilot program,
are only relevant to inner-city areas with intractable injection drug
use problems, the B.C. Court of Appeal decision has clear implications
for the role of science in Canada's approach to addiction. To help
address the harms of drugs in our communities, we must move away from
drug-policy approaches that ignore the proven limitations of law
enforcement and toward evidence-based models that couple police
efforts with prevention, treatment and harm reduction strategies.

Evan Wood, MD, is director, Urban Health Program, B.C. Centre for
Excellence in HIV-AIDS and is associate professor, department of
medicine at the University of British Columbia