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Friday 25 September 2009

Vancouver's 'safe' injection site - A sad and shameful anniversary

This week saw the fifth anniversary of the opening of INSITE, North American’s first and only so-called safe injection site for intravenous drug users, located in downtown Vancouver. It’s nothing short of scandalous that the doors of this shameful monument to the triumph of ideology over common-sense and compassion remain open.

Supporters of INSITE prey on the ignorance of decent folks by reciting such mantras as the “the science is in and it’s conclusive” or “there have been several peer-reviewed studies and they all agree” that INSITE works. It’s what my colleague Margret Kopala calls “the broken-record school of advocacy”: repeat the assertion often enough and people will begin to believe in its truth – including those doing the talking.

The problem is that the assertions aren’t true. To be sure, several studies read glowingly about the merits of INSITE, but the conclusions of some of these studies are contradicted, or at least challenged, by others that expose the inherent unreliability of the data and methodology upon which such conclusions are based.

Take, for instance, the claim that INSITE reduced drug related crime in Vancouver’s downtown eastside. A 2006 report entitled Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime (Wood et al) – one of the many “peer reviewed” studies cited by INSITE supporters –actually warned about the limitations of the research being conducted in this area. “Crime statistics may be confounded by discretionary policing practices and levels of police deployment,” the report reads with extraordinary candour.

The same report dispelled the much publicized myth that drug dealing declined as a result of INSITE’s opening, explaining that a police crackdown against drug dealers just prior to the opening had caused a spike in crime statistics for that specific period that fell off when the crackdown ended. “The small decline in drug trafficking charges in the post-SIF (safe injection site) year is due to this effect,” the report reads.

A thorough and honest examination of all of the available “peer reviewed” studies reveals, contrary to the song being sung by the INSITE choir, that the science is not fully in, and the findings are not conclusive. But quibbling over such things as differing interpretations of data, or the impact of confounding variables, misses the point.

The real problem with INSITE is not its scientific credibility, as dubious as that may be, but its ethical credibility.

Conveniently ignored in this debate is the fact that, as a matter of principle, INSITE provides no treatment whatsoever for the medical condition that draws people to it in the first place – drug addiction. Quite the opposite, its whole purpose is to provide a non-judgmental environment where intravenous drug addicts can inject themselves away from the public eye and without fear of arrest and prosecution.

The suggestion that INSITE is no different than a bar serving alcohol to alcoholics is just plain silly. Bars are for responsible adults who drink responsibly. Bar operators are legally liable for the alcohol-induced behaviour of their patrons, both on the premises and off. Not only is drunkenness not tolerated, but conscientious bartenders will refuse to serve anyone who, in their judgment, is drinking too much.

In contrast to this, INSITE’s “clients” are hardened addicts whose lives have been all but obliterated by their addiction. No recreational drug users here. Unable to hold a job and often homeless, the only thing real for many of these unfortunate souls is the very disease that is the primary cause of their suffering. What they desperately need is intervention to help them break their cycle of dependency; what they get from INSITE instead is a free needle, a wink, and a promise of resuscitation in the all too likely event that they drug themselves to the edge of oblivion – all at taxpayers’ expense.

It’s like Molson executives organizing a BYOB meeting of Alcoholics Anonymous and promising to provide clean glasses for everyone so no-one has to share, then congratulating one another for having thought of and addressed the issue of hygiene.

It’s true that of the hundreds of overdoses that have occurred at INSITE none have resulted in death, something its defenders are quick to point out, but that is mainly due to the little known fact that few drug overdoses result in death anyway. When there is a real danger to the life of an addict who overdoses, staff still have to call for an ambulance, and the patient still has to be transported to, and treated in, a hospital – exactly the same quality of care they would receive if they passed out on the street or in a back alley instead. That’s why the “peer reviewed” studies show that, on average, only one fewer overdose death per year can be attributed to INSITE.

I know a thing or two about this subject beyond the statistics and the abstract question of what is or is not good public policy. Like so many other families, ours has, over the years, had to endure the havoc of having some of its members addicted to alcohol and drugs. Those who have not lived through such an experience can never fully understand the pain of seeing a loved one slowly and ostentatiously disintegrate before your eyes, or the guilt one feels not being able to help them. They cannot understand the chaos that addiction brings to families of addicts, or the willingness to do anything, anything, to restore some semblance of peace and sanity, even facilitating the addict's drug or alcohol abuse if it will buy a moment’s peace. In the world of addiction treatment, this behaviour is called “enabling” and it is by far the worse possible thing one can do for addicts, their families and the community at large.

Addiction is a devastating and chronic affliction that never goes away. There is no known treatment for it – only the possibility that, with much love, patience and, above all, support, it can be successfully managed. The first and most important step in helping addicts achieve this is to not enable their addiction, yet it is precisely this step that those who run INSITE ignore, oblivious to the contribution this makes to the destruction occurring outside its own four walls.

It may be that a handful of lives have been saved by INSITE’s existence, but how many more have been lost? No-one can say, because no-one associated with INSITE cares enough to ask the question, let alone seek the answer. That in itself is perhaps the strongest reason not to trust the so-called “science” behind the experiment.

Each and every time a person injects poison into his or her body at INSITE a crime is committed, but it’s not the addict committing the crime – it’s the organizers and supporters of INSITE who assist in that poisoning who are guilty.

INSITE is now five years old. For the sake of all those who will be hurt by its half-baked practices, let’s make sure that it never reaches the age of six.