IT WORKS

In 1992 a famous Canadian scientist, Gordon Guyatt, coined the term
"evidencebased medicine." Today, leading medical and public health
bodies around the world embrace his notion that health policy and
clinical practice must be based on the best available scientific
evidence. While much has been gained by this approach, some still
don't recognize the primary role science should play in determining
public-health policy. Instead, they rely on substandard, bogus
research to support positions that are driven more by ideology than
logic.

Nowhere is this problem more apparent than in recent debate concerning
Insite, Vancouver's Downtown Eastside supervised injection site, and
the related subject of harm reduction (Insite Clinic Enables Drug
Users and Helps Spread Human Misery, Barbara Kay, May 18). There is
now a large body of science showing that harm reduction programs such
as needle distribution efforts are effective in reducing drug-related
harms, including HIV infection, and do not enable or increase drug
use. The evidence is so strong that the World Health Organization and
the United Nations have issued technical guidelines recommending that
countries implement a set of harm reduction programs in response to
drug use and HIV/AIDS.

Likewise, a large body of scientific evidence shows that Insite is
meeting its basic objectives. These studies -by recognized research
organizations such as the University of Toronto, Simon Fraser
University, the University of British Columbia and the B.C. Centre for
Excellence in HIV/ AIDS (where I work) -emphatically prove that Insite
does not cause harm by increasing crime or perpetuating active drug
use. The program now has the support of leading national health
organizations such as the B.C. Council of Medical Health Officers, the
Canadian Medical Association, the Canadian Association of Nurses and
the Canadian Public Health Association.

However, some commentators cannot bring themselves to accept the
scientific results of more than 40 peer-reviewed studies that show
clearly that Insite saves lives and health-care dollars, reduces
disease transmission and promotes entry into addiction treatment.
Faced with overwhelming evidence, some have set out on a relentless
search to create and disseminate any shred of evidence suggesting that
Insite does not work.

So what do you do when you simply can't accept that Insite works? You
turn to the work of Colin Mangham of the Drug Prevention Network of
Canada. This work, originally paid for by the RCMP and posted on a
website operated by the Drug Free America Foundation, was commissioned
after the RCMP had already paid for two consultant reports on Insite.
Interestingly, while the two earlier reports validated the
peer-reviewed research showing that Insite and other supervised
injection sites were working, the Mangham paper offers a number of
factually incorrect criticisms and concludes that Insite is causing
significant harm.

Sadly, a few people have overlooked the fact that virtually no one is
taking the Mangham paper seriously anymore. In fact, even though the
RCMP paid for the research, they have since admitted that the report
was commissioned to "provide an alternative analysis" to existing
research and that the Mangham paper "did not meet conventional
academic standards."

Tony Clement, when he was the federal health minister, frequently
cited the Mangham report. However, on May 12, 2011, during the Supreme
Court of Canada hearing, the lawyers representing the federal
government admitted that they did not have any research indicating
that Insite is not working.

Despite the failure of the Mangham report, the Drug Prevention Network
of Canada has not let up in its opposition to Insite. A lawyer
affiliated with the abstinence advocacy organization recently declared
that drug overdose deaths in Vancouver's Downtown Eastside had
increased in virtually every year since the facility opened. This
claim stands in stark contrast to a recent study published in the
prestigious medical journal, The Lancet, which showed that overdose
deaths around Insite had declined by 35%.

How could such a discrepancy exist? The maxim that "a little knowledge
is a dangerous thing" may apply in this instance. In citing data from
the B.C. Vital Statistics agency, the Drug Prevention Network of
Canada representative lumped all drug-related deaths together,
including many causes of death that bear no relevance to Insite,
including suicides and alcohol-related deaths. Conversely, The Lancet
study systematically reviewed each recorded death and excluded those
that did not apply.

Drug use and the associated health-related harms, such as the spread
of HIV/AIDS and death by overdose, remain major challenges throughout
the world. As a society we have an ethical duty to uphold the
Canadian-pioneered tradition of evidence-based medicine and base our
policies on the best available evidence. If we stick to the evidence,
harm reduction programs such as Insite will remain important
components of our response to fight drug use and disease transmission,
and promote individual and community health. If we don't, the human
and fiscal toll of illicit drug use will continue to spiral out of
control for generations to come.