THE ARGUMENTS FOR AND AGAINST VANCOUVER'S SUPERVISED INJECTION SITE

When the Supreme Court of Canada convenes Thursday to consider
Vancouver's supervised injection site, it will hear detailed
arguments that hinge on the fine print of the Canadian Constitution.

But besides being a landmark showdown between federal and provincial
powers, the hearing also sets the stage for a ruling expected to
affect not only the daily lives of injection drug users on
Vancouver's Downtown Eastside but drug policy across the country and
potentially farther afield.

In cities including Victoria and Montreal, groups that have lobbied
for supervised injection sites along the lines of Vancouver's Insite
facility will be waiting to see whether their proposals could proceed
without breaking the law.

Across the country, researchers and health-care workers are looking
to the Supreme Court decision as a signal that could shape future
health care policy, ranging from needle exchange programs in prisons
to inhalation rooms for crack-cocaine smokers.

Internationally, health researchers will be monitoring the case as a
bare-knuckle brawl between political ideology and evidence-based
research, of which a small mountain has accumulated to back Insite
and which supporters repeatedly cite in their long-running fight to
keep the clinic open.

At home and abroad, policy makers are watching the case in the
context of Prime Minister Stephen Harper's newly-minted majority and
tough-on-crime agenda.

A lightning rod for controversy, Insite attracts support and
detractors along several main lines.

Supporters say:

It saves lives:

There have been no overdose deaths at Insite since it opened in 2003.
On average, nearly 600 injections occur daily at the site and last
year alone there were more than 200 "overdose interventions" by
Insite staff who provide oxygen or drugs to users who are in danger
of overdosing. A paper published in the Lancet in April of this year
found fatal overdoses within 500 metres of Insite decreased by 35 per
cent after the facility opened compared to a decrease of nine per
cent in the rest of Vancouver.

Earlier this month, the B.C. Coroners' Service warned of a spike in
overdose deaths resulting from potent heroin being sold throughout
the province and urged drug users to use community services such as
Insite "where possible." B.C. public-health officials and the British
Columbia Nurses' Union support the facility.

It serves as a bridge to detox and treatment:

Insite was conceived of as part of a four-pillars approach those
being harm reduction, prevention, treatment and
enforcement modelled on similar programs that jurisdictions such as
Switzerland and Germany pursued in the 1990s.

By offering a clean, safe, non-judgmental environment to shoot up,
the reasoning goes, Insite allows drug users to connect with other
services, whether that be treatment for a drug-related abscess or dental care.

Last year, Insite staff made more than 5,000 referrals to other
social and health agencies, including 458 admissions to Onsite, a
neighbouring detox facility that opened in 2007 and recorded a
"program completion rate" of 43 per cent in 2010.

Supporters say supervised injection facilities should be seen as just
one piece of a bigger puzzle in treating drug addiction and its
related toll on society.

It benefits public health and the broader community:

Among the many studies published on Insite are papers that conclude
the clinic has not led to an increase in drug-related crime, is not a
negative influence of those seeking to stop drug use and has resulted
in a drop in public injections in back alleys and doorways.

Studies have also reported declines in dangerous behaviour, such as
sharing needles, and a related decrease in HIV infections. The
Vancouver Police Department supports the facility, which studies have
shown has resulted in fewer discarded needles in neighbourhood streets.

In fighting to keep Insite open, the provincial government argues
that the health benefits of the facility should trump jurisdictional
issues, saying in written submissions to the court that British
Columbians have a "visceral" memory of hundreds of addicts dying
needlessly in flophouses and on the street before Insite was opened.

Those who want to see the site closed maintain:

Insite's operation is an affront to federal control:

When Insite opened, it obtained a three-year exemption from Canada's
Controlled Drugs and Substances Act from Health Canada. That
exemption was extended twice, until June 30, 2008. When the federal
government declined to extend the exemption, Insite supporters
launched a court challenge. The B.C. Supreme Court and the B.C. Court
of Appeal supported B.C.'s right to run the clinic on health grounds.
The federal government appealed.

Federal prosecutors say Ottawa needs to maintain control over drug
policy and that giving B.C. control over Insite would open the door
to a fragmented, patchwork of rules and regulations across the country.

The legal wrangle will zero in on the constitutional conundrum posed
by Insite the federal government has authority over criminal law
and the promotion of health and safety, but provinces decide how
health care can be delivered.

Governments should not facilitate drug use:

Despite the research studies backing Insite and its harm-reduction
approach, there is still profound discomfort for many with any
facility that gives addicts a green light to inject illegal drugs and
flout the law. Governments, they argue, should not be facilitating
illegal, dangerous activities. "The state has no constitutional
obligation to facilitate drug use at a specific location by hardcore
addicts, the mildly addicted, frequent users or occasional users,"
federal prosecutors Robert Frater and W. Paul Riley said in written
submissions to the court.

There have been arguments that money spent on Insite would be better
spent on services such as treatment and that government's support of
supervised injection sites sends a mixed message to young people who
might be considering illicit drug use.

Supervised injection sites do nothing to deter drug use or help drug addicts:

Part of the federal government's argument is that drug laws are not
an unreasonable restriction on individuals' liberty. "Unsafe
injection or, for that matter, consumption by injection at all, is a
choice made by the consumer," the federal prosecutors say in their
brief to the Supreme Court.

There are also arguments that supervised injection sites are a magnet
for drug dealers and predators, and that public safety demands that
illegal drugs be tightly controlled.
ies have shown has resulted in fewer discarded needles in neighbourhood streets.