Vancouver's safe-injection site was the subject of controversy even before its doors opened three years ago in the city's troubled Downtown Eastside.
Supporters of the site, known as Insite, argue that its presence has significantly reduced the number of users sharing needles and shooting up in public. It provides a safe place for addicts to inject drugs, with clean needles, and provides counselling on-site.
Scientific, peer-reviewed studies of Insite users have found that the rate of addicts seeking to quit their habit has gone up, while there is no evidence that the facility has increased drug use.
But that hasn't stopped the controversy surrounding Insite, where roughly 600 addicts shoot up daily. Those who oppose it argue that the site simply condones drug use without offering any tangible solutions to the city's problems.
Insite faces its largest challenge yet when its exemption from the country's drug laws expires next month.
If the Conservative government does not renew that exemption before Sept. 12, Insite's doors will close. So far, Stephen Harper's government has been non-committal on the issue.
So the question remains, has Insite been a success?
Senator Larry Campbell, the former mayor of Vancouver, and Randy White, the former Reform-Alliance-Conservative MP and founder of the Drug Prevention Network of Canada, were o n-line earlier today to discuss that issue today and took questions from readers of globeandmail.com
The questions and answers are at the bottom of this page.
Senator Campbell was the city's chief coroner before being elected mayor in 2002. He championed the safe-injection site and points to scientific evidence that shows less public disorder, lower HIV infection rates, and more people going into treatment because of the site. He also says that the more than 400 overdoses at the site with no loss of life is further evidence of its success.
Randy White is the founder of the Drug Prevention Network of Canada, which works to advance abstinence-based drug and alcohol treatment and recovery programs. It also opposes the legalization of drugs. Mr. White served as a Reform and Canadian Alliance MP for 12 years before deciding not to run for re-election in 2006. Mr. White was also vice-chairman of the parliamentary committee studying the non-medical use of drugs.
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Jim Sheppard, Executive Editor, globeandmail.com: Welcome, Sen. Campbell, and welcome, Mr. White. Thanks for taking questions today from readers of globeandmail.com on this important questions. May I ask you to start by offering an opening statement or remarks?
Sen. Campbell: The "four pillars" concept is a proven success in addressing the harms of drug addiction. While much of the media attention focuses on the supervised injections site, in fact it is only one component of the strategy. Enforcement, treatment and prevention are all as important as harm reduction.
Randy White: The injection site needs two things to stay open - a certificate from the government and money. In my opinion, the federal government should give neither for the following reasons:
1. The objective must be prevention and treatment. An injection site does neither, as treatment must have the objective of abstinence.
2. Vancouver has become even more problematic with crime and addiction. HIV is not going down and more addicts are gathering in the east side. The injection site has contributed to the problem.
3. Injection sites are the exception, not the rule, in most countries worldwide.
4. The federal government should be the role model for dealing with problems. It has not done well over the last decade as far as drug strategy is concerned. Rehabilitation is inconsistent and prevention is almost non-existent. Before injection sites are explored, the other strategies should be running well.
5. Those who have evaluated the program are normally in favour of legalization and/or harm-reduction. Real evaluation must first take place without bias.
6. One injection site is no answer at all. Those who use it do not use it all the time. To claim the site has saved lives is not based upon any evidence, except to say that some who were overdosing were caught inside at the time.
7. How can a responsible government sanction a person walking through a door with crystal meth to shoot up and assisting in the exercise?
8. Those politicians and many advocates including such organizations as organized addicts groups get the spotlight and public notice. This is not about being a TV star. It is about how best to get people off of drugs.
Sen. Campbell: Mr. White is no longer in government because he was an embarassment to his party and to Canada.
To be blunt, he is a dinosaur and refuses to even consider scientific, peer-reviewed evidence. I suspect that deep in his mind, he believes the earth is flat.
The objective of all addiction services is treatment. However, given the nature of the disease, entry into the treatment process is difficult. Insite offers the entry point for those who traditionally do not use health services.
If Mr. White would simply read the scientifc papers, he would realize that everything he states is false. HIV is going down, there is no increase in addicts in the downtown east side and the site has in fact lowered crime, social disorder and safety.
Mr. White continues to believe that we can jail our way out of a medical problem. He is a firm believer in the U.S. model where prisons are a growth industry, where there are more people in jail than in any other country in the world, and where the population of the prisons is mostly people who are poor, non-white and uneducated.
I have never wished to be a star. Unlike Mr. White, I simply believe in science, good health care and the right of people to live.
One needs to ask: Who is the Christian here?
Further, the support in Vancouver is overwhelming. Four previous mayors including one who is now the premier, the sitting mayor, the chief of police, the health ministry all have written in support of it.
Ranald Walton: Who funds the site? Notwithstanding "scientific" studies suggesting that the site does not increase drug use, I would not want to see the taxes I pay going to subsidize, increase and promote illicit drug use in Canada. Are there federal tax dollars involved?
Randy White: Funding is from various taxed sources. It is accurate to say the taxpayer is funding it all regardless of the governing body. "Scientific studies" is a generality expressed by advocates of this injection site. Even the University of Ottawa study recently said of the crack-user program in Ottawa that it increased the amount of crack smoking. So why would anyone think an injection site is different? The proper use of money budgetted for drug programs should be for treatment [rehabilitation]and prevention [education] That's what any responsible parent would say; certainly not helping my addicted child to shoot up.
Sen. Campbell: Ranald, The medical costs of the site are funded by the health ministry of the provincial government. The scientific investigation is funded by the federal government. The total cost over three years is $7.5 million. Studies have shown that the benefit is $8 million. So not only does it save lives, it saves money.
A.Z., North Vancouver: I work in the area and have seen the positive changes. I no longer see the blood in the needle as a junkie shoots up, I no longer see an addict crouched in a doorway shooting up and I no longer have to bang hard on our back door to warn the users that the door is opening. Not to say out of sight out of mind. But these people are now getting some sort of dignity. I just wonder what kind of proof the government needs [to keep the site open]
Randy White: That is completely incorrect. Either that or you are not looking. This injection site is small. It is one of a kind. It is not eliminating drug activity on the streets and anyone living, working or walking through the area will tell you that.
Sen. Campbell: A.Z. There are in excess of 20 scientific peer-reviewed papers showing the various benefits of Insite.
Michael H., Edmonton: It can be tragic when people become addicted to drugs, legal or illegal. Nonetheless, it happens. One of the most important components of keeping the illicit drug trade booming is the very fact that it is illegal. Critics of this site seem to imply that the site will attract crime. An interesting pilot study performed in the U.K. showed that providing heroin to addicts reduced local crime by over 80% and allowed these addicts to hold regular jobs and pay taxes. If addicts were allowed to be prescribed heroin, wouldn't we have a better chance, in the long run, at eliminating heroin use in society by eliminating the illegal market and in turn eliminating the incentives for importing illegal heroin?
Randy White: It is not just heroin. In fact, in parts of Europe, heroin use is down, not because of an injection site but because cocaine, crystal meth and other products have taken over. Do you suggest legalizing crystal meth as well because it is a problem? A recent study of Swiss Drug Policy [June 12, 2006]indicates "drug consumers switched their preference to cocaine and highly-dosed cannabis rather than heroin." Not a sign of injection-site success. Another study in Vancouver [the treadmill of addiction]clearly indicates crime has not gone down - just unreported and ignored by the courts.
Sen. Campbell: Michael, at the present time, there is a project called the NAOMI trials whereby addicts are divided into two groups. One group is given heroin and one is given methadone. One of the aims of the study is to determine which process works. In Switzerland, I was advised that 10% of the addicts can just say no and 10% require heroin maintenance. The other 80 respond to a continuum of treatment.
James Young, Brantford, Ont.: What is the responsibility of society/government to address problems when citizens get into difficulties when ingesting illegal substances, sort of self-inflicted wounds? Compassion maybe? But to use taxpayers money to condone a crime seems somewhat wrong to my way of thinking. The state offers these people free needles so they won't spread a disease. Similar to paying a potential thief not to rob you, only slightly different context. I don't think anybody would like to see these drugs made legal. It will apparently never be stamped out, people being people, but getting AIDS from partaking is simply collateral damage. Apparently crime is down due to these injectable sites, and is touted as a reason for continuing. This is totally wrong thinking. I don't know if AIDS infection numbers are down. One researcher suggests there would be a saving in emergency hospital visits, so this is given as a reason for funding the SIS. Hardly a valid reason. Drug use and addiction is a blight on society, a sort of cancer, that has to be condemned. It will cost money and time, but the alternatives are too ghastly to contemplate. That is the price we have to pay, sort of like maintaining a peacetime military. The cost of doing business. People are responsible for their own actions. Do what you like but don't expect the taxpayer to pay to get you out of a self-dug hole. Private citizens can help these people if they are so inclined, but it is not a government responsibility. The role of government in this drug business is to insure the Law of the Land is enforced. These needle sites are in violation of existing laws, only suspended if you like, to the best of my knowledge.
Sen. Campbell: James, health care is a govenment responsibility. Addiction is a recognized disease. We assist alcoholics, smokers, people with eating disorders. Because sometime in the distant past, we decided to make certain substances illegal does not mean we should let those people die. I find your reasoning slightly out of touch with reality. If we can lower emergency visits and save money, is that not a valid reason for following this program?
Randy White: Actually, crime is not down because of this injection site nor is the rate of HIV infection or the number of addicts rolling into the area. The advocates say that it saved lives but what they don't say is that the very person that overdosed in the building and was treated doesn't always use the facility and can and will overdose somewhere else.
The role of government is a great question. The Conservative government must make up its mind as to whether it will set the model for Canadians as prevention and treatment being the priorities or accommodating and aiding the drug addicts in their habit. The government needs to show Canadians that it will not circumvent the laws of our nation and will work with United Nations Conventions which reflect a priority on getting people off drugs, not maintaining the habit.
You have a child using drugs and you have two people standing before you. One says "give me your child and I will let them shoot up in my building" and the other says "give me your child and I will get them into rehabilitation." Who would you select? Why should government be any different?
Amir Attaran, Ottawa: Assuming that Ottawa declines Insite's operating permit, are there plans for a legal challenge? As a law professor, I can well imagine ways in which that could happen. (I suppose the converse question exists too: If Ottawa granted Insite's operating permit, are there plans for a legal challenge, but from the other side?).
Sen. Campbell: Amir, quite frankly, I am not sure why a permit is even required. After all, what is Insite doing that is illegal? Providing clean needles, water, a book of matches and a cooker is not illegal. Certainly the police could enter and arrest the addictics for possession but since they are not on the street, this move would seem counter-productive.
Randy White: This is not about giving lawyers a job. This is about right and wrong, the best approach, fixing the problem and getting people off of drugs. But I do wonder why society can't do better than helping people to kill themselves. How can we or the government condone someone bringing crystal meth off the streets [regardless of the quality of drug]and shoot themselves up with it. Irresponsible.
Kelly Conlon, Deep River, Ont.: This question is directed to Randy White: The Insite program has published peer-reviewed clinical results (New England Journal of Medicine) indicating an increased uptake of addicts into detoxification programs and addiction treatment. Do you dispute these results?
Randy White: What I dispute is the number of studies done on this injection site by people with a bias in favour of legalization or continuing one site. The site has had its time. Governments helped fund it. Politicians got their status by promoting it. But the real results are that there are even more addicts, more crime and HIV is not down. There are other studies including one being undertaken right now that will no doubt condemn the program. So who is right? Why not stop this war on drugs between those who want prevention and those who want legalization, and instead develop a national drug strategy that works on the street.
Rose Robin, Victoria: Whether the so-called safe-injection site stays open or not, it appears that Canada, and B.C. in particular, has been woefully inadequate in funding treatment programs for addiction. Couldn't the money spent on the safe-injection site be better spent to fund treatment as a longer-term solution? I speak from painful experience of having had to send an addicted child to the U.S. for treatment and [having]paid for out of our own pockets. Also what message is being sent here about permissiveness and collusion? Drug addiction begins with a choice to use and continues with the choice to use. Why should taxpayers fund the addict's choice to continue to use? I'd much rather pay for helping them get clean.
Sen. Campbell: Rose, I understand your disappointment in the health-care system. As a person who has had an addicted child, you realize that while the addiction is as a result of a bad decision, that person should not have a life sentence of addiction. The supervised injections site is an entry point for an addict to seek help, avoid HIV and Hep and start on a road of recovery. Taxpayers pay the costs of treatment for alcohol and tobacco, which both are way more deadly and expensive than drug addiction.
Aqua Rius, Brandon, Man.: Are illegal drugs illegal everywhere in Canada except for this one little spot in Vancouver? Does this not compromise the police who must enforce the law everywhere else. Seems to me if it is against the law to shoot up and we Canadians consider it to be abhorrent behaviour then it is unconscionable to allow the use of illegal drugs while the police must turn a blind eye. Do the ordinary citizens of Vancouver support the use of this site for this purpose?
Sen. Campbell: Drugs are illegal everywhere in Canada. Not only do the ordinary citizens of Vancouver support the clinic, but the chief of police, four previous mayors including the present premier and the present mayor support it. It has to be stressed that drugs are not handed out at Insite.
Alicia St. Hill, Ottawa: I understand that the clinic is working very well to reduce harm and transmission with the use of clean needles. However, I am wondering how are those who use the clean injection site urged to seek treatment or provided advice to get help with their addiction?
Sen. Campbell: Alicia, people using the site are offered health care, peer counselling and detox at the site. Papers will be presented in the fall that indicate there is a substantial number who go into treatment.
Jordan Hatton: My question is for Randy White. A few years ago, you were a part of a parliamentary delegation that travelled to European countries in order to learn about how different societies deal with the problems associated with drug use. You disagreed with the findings of the delegation, which recommended the implementation of needle-exchange programs and safe-injection sites. However, now that the evidence for InSite is in, showing an increase in the number of addicts who seek treatment, no increase in crime or drug use, and a decrease in HIV and Hep C rates among addicts, how on earth can you still be against this? Is this really about a true belief that such a site "condones" drug use, or is this simply about sticking to a rigid, outdated prohibitionist ideology?
Randy White: Those are general statements that are not quite accurate. You talk about prohibitionist ideology and therefore likely support legalization which is the opposite of what the majority of Canadians, including me, want. The injection site has become a status symbol for Vancouver politicians, a status symbol for people living in the area and an attraction for many others to go and visit. How many injection sites do you want in our country? How much more money are you willing to throw into this one small facility? To what end do you want to take this? Would you not prefer to see television ads directed at our young people to keep them away from drugs?
And, by the way, yes, I was in Europe and only a few of these [injection]places even existed there. In most places, they were not allowed. So don't promote this as common. The other thing I learned there while in meetings with a legalization advocate was "you get to legalize drugs one pilot project at a time" sound familiar?
Al Wonders, Toronto: Hello: I live in an area of Toronto that unfortunately seems to have an overabundance of drug abusers and my concern is that if safe injection sites are sponsored by the government then I am at risk of having one in my neighbourhood. My family and my neighbours are already exposed to violence, prostitution and property crimes as a consequence of this ghettoization (sorry, probably not a word) of drug addicts and a safe injection site will probably just attract more crime to my area and further lower the value of my property. Instead of pandering to the needs of the addicts I would like to see money spent on protecting us law-abiding taxpayers from them. I think that anybody that supports these sites has a total disregard to the consequences that may be felt by those like myself. I also don't see how encouraging drug use can possibly cure it. I think "tough love" is what is needed. Can you give me any reason why a person or family in my circumstances should support a safe injection site plan knowing that we could be the ones suffering the consequences?
Randy White: Actually very few Canadians support an injection site. But a very vocal drug legalization/harm-reduction lobby seems to have invaded the general population with their "pilot projects." The goals in drug addiction must be prevention and treatment and enforcement, which is where the new government is hopefully going. How anyone -- much less a government -- can agree to someone shooting up crystal meth in a government-sponsored building is beyond any reasonable expectation of getting people off of drugs.
Sen. Campbell:Al, I appreciate your comments. But doing nothing is not a solution. Jailing people who are sick is not a solution. When I spoke to the Toronto City Council, I told them to leave a supervised injection site out of the equation at this time. It is only one part of the "four pillars." Again, we have accepted the problems caused by alcohol and tobacco and yet fail to treat the drug-addicted in the same way. The only way to improve your neighbourhood is to engage with those who are causing the problems. Enforcement is one tool but so is harm-reduction, prevention and treatment. Contrary to what Mr. White says, it has made a difference in Vancouver and will continue to do so. The alternative is more of the same.
Charles Darlington, U.S.A.: If anything that breaks the cycle of addiction hurts the illicit hard-drug dealer, why would a government, any government, want to suspend a program that will eventually lead to the reduction in the number of addicted "repeat customers?" It seems both counter-intuitive and counter-productive...not to mention foolishly playing into the hands of the very criminals that drug prohibition, by its very nature, enriches.
Sen. Campbell:Charles. My only comment is that you are absolutely right.
Randy White: Just how does encouraging people to shoot up in a government-sponsored drug center break the cycle of addiction? This is a center that constantly undergoes studies and surveys by people biased in the process itself. There is one center in all of Canada being held up by legalization/harm-reduction lobbyists as the answer to drug problems. It is simply not so.
Victor Wong, Ottawa: Merits of the program aside, how do neighbouring tenants and owners feel about the site? Have concerns been voiced about property values, neighbourhood appearance, etc., based on the site's location?
Randy White: I don't know the answer to this but businessmen have moved out or given up. Some politicians have gotten status from promoting the site which is unfortunate for the addict.
Sen. Campbell: Victor, the majority of tenants and business in the area of the site support it. Property values continue to rise and Strathcona, Chinatown and Gastown continue to prosper. Social disorder is reduced, addiction-related refuse is reduced, crime is reduced.
Jim Sheppard, Executive Editor, globeandmail.com: Sen. Campbell, Mr. White, thanks again for taking questions today from our readers. Any last thoughts?
Randy White: One general comment - 1 site and $3 million. What have we achieved? After the pilot project, do we need 20 more in Vancouver or 10 in each city? What's next? Has it reduced sharing needles? That is what the needle exchange [just one block away]is supposed to do and the past director of that facility was not an advocate of this injection site. The number of addicts flocking to Vancouver is unprecedented. The politicians are always crying about street crime but yet say this injection site must be doing something right.
Advocates talk about "problematic use," thereby normalizing "use."
We need higher standards than an injection site. We need a federal government with a decent plan so we can all work together.
Experience demonstrates that balanced policies, sustained over time, work to control and reduce the drug problem. Harm reduction initiatives that encourage or facilitate drug use will inevitably lead to more drug addiction and more despair for our Canadian citizens.
We need Stephen Harper's government to discontinue the costly [in terms of continuing the drug habit]program and work together on defeating drug addiction.
Sen. Campbell: Do not be frightened by the likes of Mr. White. He is from the "Reefer Madness" crowd that refuses to believe in scientific peer-reviewed evidence. The citizens of Vancouver spoke loudly when they elected Philip Owen, myself and Mayor Sam Sullivan. I would invite all citizens to the Insite web site for more and truthful information. I would like to thank everyone who participated. Knowledge is truth.