THE SCIENCE IS IN: INSITE SAVES LIVES

Drug addiction remains a major public health problem. Unfortunately,
policymakers have been slow to support public-health interventions
that have proven effective in clinical studies. Many of these
interventions are recommended by the World Health Organization (WHO)
and include a range of harm-reduction interventions that remain
controversial in Canada.

One explanation for the slow acceptance of evidence-based
interventions is the aggressive work of lobby groups that prefer the
status quo. The over-reliance on drug law enforcement strategies under
the "war on drugs" has been conclusively proven to be a costly
failure. Law enforcement lobby groups seeking to "make the world
drug-free" have sought to undermine the recommendations of leading
scientific bodies, such as the WHO. These groups include Drug Free
America, Drug Free Australia and the Drug Prevention Network of Canada.

A recent example is Vancouver's supervised injecting facility, known
as Insite, where drug users can inject pre-obtained drugs under the
supervision of medical staff. The B.C. government and Canada's leading
medical and public health bodies, including the Canadian Medical
Association and the Canadian Public Health Association, have endorsed
Insite.

One group that has opposed Insite is REAL Women of Canada. REAL Women
of Canada and the Drug Prevention Network of Canada commissioned Drug
Free Australia to produce a report that called into question a study
published in the prestigious medical journal The Lancet, which
reported a 35% reduction in overdose deaths in a geographical area
around Insite.

Drug Free Australia's critique has never been peer-reviewed or
published in a scientific journal. It contains too many methodological
and factual errors to list here. Most stem from a failure to
appropriately consider the geographic location and causes of deaths.
In fact, the critique simply lists the crude number of drug-related
deaths, including suicides and alcohol poisonings, per year in a
400-block area. This was without any effort to consider how the
population at risk changed over time.

In contrast, the authors of The Lancet study worked with the B.C.
Coroner's Office to accurately determine the location and cause of
each death, and used census data to calculate changes in death rates
in a 40-block area around Insite -- where most Insite users reside.
This approach, which is consistent with standard scientific practice
and was peer-reviewed by experts in the field, demonstrated a 35%
reduction in overdoses in the area around Insite. In contrast, the
authors of the Drug Free Australia report considered a much larger
geographic area, included unrelated deaths, such as suicides, and
failed to make even the most basic adjustments for population growth.
Similar problems pertain to their erroneous claims regarding the
potential impacts of policing and changes in heroin use on overdose
rates, as the timing of these events do not even coincide with the
period studied in The Lancet paper.

Tactics like this are not new. Paid lobby groups produced similar
critiques in an effort to cloud the studies that first suggested that
smoking was harmful. Drug Free Australia mounted a similar campaign
against the supervised injecting program in Australia. This campaign
was dismissed entirely by the Australian Medical Association.
Likewise, one of the authors of the Drug Free Australia report, Colin
Mangham, produced an earlier critique of Insite. However, after it was
revealed that the RCMP funded the report, the RCMP itself admitted
that the report "did not meet conventional academic standards."

Ironically, The Lancet study that REAL Women and others sought to
discredit was published so recently that it was not even included in
the evidence presented in the Supreme Court case focused on Insite.
Rather, the unanimous Supreme Court decision was based on the
substantial evidence demonstrating Insite's benefits that had been
published prior to August 2007. These benefits include increased
uptake into addiction services, reduced HIV risk behaviour and
improved public order.

Dozens of scientists from several Canadian universities -- as well as
scientists from the United States, Britain and Australia -- have
contributed to the evaluation of Insite. This evidence-based research
has demonstrated that Insite saves lives and tax dollars. The recent
Supreme Court decision on Insite recognizes these facts and represents
a triumph of science over ideology. The decision also reinforces that
now is the time to move beyond junk science and baseless attacks, and
allow evidence-based interventions to be the foundation of our
response to health and social harms stemming from drug addiction.