The Insite Decision

FLAWED DATA

The Supreme Court's Ruling in Favour of Harm Reduction Was Based on
Possibly Faulty Research

In 2003, Insite, the first experimental supervised injection site in
North America, was installed in Vancouver's Downtown Eastside (DTES),
Canada's poster district for entrenched substance abuse and
addiction. At Insite, addicts may legally shoot up illegal drugs in
hygienic, medically protective and non-judgmental circumstances. The
controversial clinic instantly became, and remains, a crucible for
passionate social and legal debate about public policy in dealing
with drug addiction.

Those who argue for Insite believe that its governing philosophy of
"harm reduction" for what they regard as an incurable affliction, is
both ethical and efficacious in reducing disease and deaths. Opposed
to Insite are those who support what one might call the "moral
agency" model. This redemptive perspective, which favours pro-active
strategies of treatment and prevention, has the support of the
federal government, which has tried to close Insite down since 2006.

On Sept. 30, the Supreme Court of Canada ordered the Minister of
Health to permanently exempt Insite from the provisions of the
Controlled Drugs and Substances Act and, by implication, all other
applicants for drug injection sites elsewhere in Canada. In their
ruling, the Supreme Court justices explicitly linked the decision to
their belief that, "Insite saves lives. Its bene-fits have been proven."

How did they come to that understanding? Well, the Insite hearings
were held on May 12. On April 18, a population-based study conducted
by University of British Columbia (UBC) researchers and published in
the leading medical journal The Lancet was conveniently distributed
to the media. The study claims that over the period 20027, drug
overdose deaths within a 500-metre radius around Insite reduced by
35%, while the rest of Vancouver reduced by 9%. Lead researcher Dr.
Thomas Kerr announced that, "the evidence is clear, Insite saves
lives." His words were immediately hailed by Insite's many supporters
in the media as proof of the site's success.

However, an anti-drug watchdog group vigorously contests these
findings. In an analysis of The Lancet study commissioned by the Drug
Prevention Network of Canada and Real Women of Canada, an
international team including three Australian doctors, B.C.
drug-prevention expert Colin Mangham and Dr. Robert Dupont, president
of the U.S. National Institute of Drug Abuse, allege that The Lancet
study's findings of decreased deaths in the Insite area are not
supported by data from the British Columbia Coroner's office, which
indicate that deaths from drug overdoses in the area around Insite
not only did not decrease, they in fact increased between 2002-2007
(see graph to the left).

Amongst other allegations, the watchdog group contends that the
Lancet researchers, some of whom have advocated for Insite since the
1990s, manufactured an appearance of overdose mortality reduction by
including 2001 data in their pre-Insite comparison years, without
stipulating that 2001 was a year of unusual heroin availability. They
were well aware of the anomaly, since it was the subject of two
previous journal articles by three of The Lancet article's
researchers. The analysts further maintain that the UBC researchers
failed to note that 41% of B.C.'s overdose fatalities are not even
injection-related.

More significantly, they affirm, is the UBC researchers' disclaimer
of any knowledge of "confounder" policing changes around Insite
between 2001 and 2005 that might have affected the rates of overdose
deaths. But according to the analysts, the researchers had to have
known that since April 2003, 50-66 police officers were added for
patrol duties, specifically to a 12-block radius of Insite, where the
contested 35% decrease is alleged to have occurred. As evidence, they
point to a 2004 journal article, a "detailed analysis of the effects
of the changed policing," on which three of the UBC researchers
collaborated, which showed a 46% evacuation of drug users from the
area as a consequence of the police crackdown.

The analysts conclude that Insite, hosting about 144,000 opiate
injections annually, saves 1.08 lives per year, a statistically
negligible outcome, but a figure that is proportionally consistent
with a 2008 Canadian Government Expert Advisory Committee's
international review of injecting sites worldwide. In Germany's 25
injecting rooms, hosting 500,000 annual opiate injections, for
example, the cumulative number of lives saved is estimated at about
10 per year.

A complaint about The Lancet study research has been filed with UBC.
The question now arises: If it is found, as their critics charge,
that serious errors undermine the credibility of the research,
invalidating The Lancet study's claims, then the Supreme Court's
justification for their ruling in favour of Insite, that it "saves
the life and health" of addicts, is also void. In that case, unless
the court can point to another source of credible evidence to support
it, it should take the honourable course of action and annul its ruling.