When Policy Trumps Science: The Story of Insite

The Harper Government (which is now the legal name for the Government of Canada) is currently continuing its campaign against Vancouver’s safe injections site, Insite.

What is a safe injection site? Simply put, this is a location operating under an exemption from Canada’s drug laws that allow addicts to safely use needle drugs. Addicts can receive free clean needles from Insite for their personal use.  They are also given a safe way to dispose of the needles when they are done. They are allowed to use their drugs at Insite under medical supervision. This medical presence helps with overdoses, counselling, and detoxification.

Front door of Insite

Insite was created in Vancouver in 2003 under a special exemption from Canada’s drug trafficking and possession laws under section 56 of the Controlled Drugs and Substances Act (CDSA) This exemption by the Liberal Government of Canada allowed the Vancouver Coastal Health Authority and the Portland Hotel Society to establish Insite. This was a three year exemption from the laws and in 2006, the Federal Health Minister of the new Conservative Government, extended this by fifteen months.

Fearing that Insite would be closed after that, the Portland Hotel Society and two Insite users, filed a claim with the BC Supreme Court urging them to declare that Insite was the jurisdiction of the province and not the federal government.

This resulted in a lengthy legal battle between supporters of Insite and the Conservative Government. Ultimately, Insite was allowed to continue on the basis that Canada’s drug trafficking laws violated section 7 of the Canadian Charter of Rights and Freedoms. Insite was also ruled to not be the specific domain of British Columbia.

Both sides appealed the decision. The Conservative Government appealed the ruling that the drug laws violated the Charter and the PHS appealed that Insite should be the specific domain of the province. The government lost their appeal and the PHS eventually won their appeal in January of 2010. This led to the current case in court. The Harper Government has appealed to the Supreme Court of Canada that Insite is not exclusively the domain of the province, but the Federal government.

With all this fuss, does Insite actually work?

To answer that question we need to examine the evidence. First, Insite operates on a harm reduction drug policy, which is the idea that society cannot simply declare drugs illegal and expect the problem to go away. Long term goals like total drug abstinence are just that, long term goals. Further, these goals seem unrealistic to most drug users. Instead of criminalizing drug use, harm reduction would take a more humanistic approach of treatment with goals relating to reducing harm to the user and society.

Insite has been positively evaluated in over thirty peer reviewed medical and science journals and papers. One of the most cited reviews appears in the medical journal The Lancet.

The study, Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study by researchers Brandon D L Marshall, M-J Milloy, Evan Wood, Julio S G Montaner, Thomas Kerr, appeared in The Lancet in April 18th 2011 and found a 35% decrease in deaths from drug overdoses in 500 miles of the safe injection site. According to the Vancouver Coastal Health website on Insite, the primary areas where research has been done on Insite relates to

  • Overdoses.
  • Health.
  • Appropriate use of health and social services.
  • Costs for health, social, legal and incarceration associated with injection drug use.

Much of the research has been done by an independent third party, the BC Centre for Excellence in HIV/AIDS. They also published a detailed review of the scientific foundations of Insite, the Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility – Insite.

Aside from lowering the level of overdose related deaths, Insite is making a remarkable dent in the transmission of HIV/AIDS in Vancouver.

“Insite, situated on the worst block of an area once home to the fastest-growing AIDS epidemic in North America, is one reason Vancouver is succeeding in lowering new AIDS infection rates while many other cities are only getting worse.” – New York Times

The simple fact that Insite provides clean needles and disposes of used ones has a profound effect on the control of disease. In the Downtown Eastside of Vancouver, where 5,000 addicts live in a small neighbourhood, needles are frequently reused. Some are shared between users while others are picked up in alleys.

In the 1980′s Vancouver implemented a clean needle program where they gave them away after multiple studies showed cities with such a system saw a decrease in hepatitis and AIDS by 6%.

Getting these off the street is part of Insites important role

In a 2005 study by The Lancet, Insite reduced the amount of syringe sharing in the area among drug users. As needle sharing decreases, the transmission of HIV/AIDS has decreased. This means that the Canadian health care system is less burdened by treating AIDS and has more resources for other issues.

Another major concern about Insite was that since addicts now have a safe place to inject, we would see a large increase in drug use. However this claim was examined scientifically as well. The results, according to the International journal Drug and Alcohol Dependence, Insite increases the chances of addicts to enter into treatment programs and lowers the chances of continual drug use.

One of the common misconceptions is that Insite operates by giving free drugs to addicts in the hope they’ll quit. This is complete untrue. Insite only provides the needles and safe environment. And in that safe environment, addicts find nurses and trained drug treatment personal who can help them not only battle their addictions, but also provide help and support in other areas of their lives. It shouldn’t shock people that when you treat someone with respect and kindness, they respond by viewing themselves with respect and dignity. They start to realize they are worth the effort needed to improve their lives.

If Insite is making such progress combating the spread of HIV/AIDS, reducing deaths from overdoses, lowering the overall costs of healthcare and helping people break their addiction, find homes and improve their lives, why is the Harper Government trying to close it down?

I don’t want to put words in the mouth of the Harper Government, but based on the news reports and the statements made by the government, they don’t want science trumping policy.

The federal government is arguing that Insite violates Canada’s drug laws and shouldn’t be able to continue because of this. They argue this despite the fact that authority of Insite was given to the Province of British Columbia and not the federal government.

A generous interpretation of the situation might be that Harper’s conservatives want drug policy to be decided by the federal government and not the courts. Avoiding the so called “super legislator” of the courts. This might be a reasonable position if the Harper Government had any evidence to back up the notion that Insite wasn’t working.

However, consider this quote taken after significant amounts of positive evidence for Insite was presented to the courts:

“In the end, this program somehow, while not being perfect, works,” interjected Justice Louis LeBel. “Have you evidence that tends to demonstrate that this program doesn’t work?”

The [Federal] lawyer’s stammered response: “I think that’s a fair observation.” – Ottawa Citizen

The problem here is that the Harper Government isn’t simply arguing against the evidence, they’re arguing in spite of the evidence. They have an ideological policy on drug use that isn’t informed by evidence but by their preconceived notions of drugs and drug users.

Most scientifically literate people would agree that science should inform policy, not policy inform science. In skepticism, we often see this when researchers want to prove something, intelligent design, or ESP, for instance. They start with their conclusion first, “ESP exists” or “intelligent design is true” and try to find some kind of evidence that supports this statement. In real science, you start with the evidence, you allow the data to point to a conclusion and thus your results are based on sound method and not cherry picking.

This isn’t the first time a knee jerk reaction to Insite has occurred based on an ideological objection to its scientifically verified operations. In 2008, the RCMP paid for four reports on Insite. The RCMP studies, which were designed to be overly critical of Insite didn’t turn out the way they hoped. The first two actually confirmed the science they were arguing against. The second two were never published and only criticised existing studies and never offered any new data.

One of the reports was written by a harm-reduction critic, which was later used by the Harper Government to insist that the scientific consensus on Insite wasn’t a consensus. When it was revealed that the RCMP had attempted to fudge its reports to make Insite appear unsuccessful, they suddenly had a change of heart and were even going to publically acknowledge Insite’s contribution. That plan never happened.

” It is (1) an exhaustively-documented attempt by elements in Canada’s national police force to create a bogus “academic” argument against Insite. Then (2) an attempt by senior RCMP officers to reverse course and atone for that burst of academic vandalism. And finally, (3) a decision from the RCMP’s highest echelons — or from someone in government outside the RCMP — to stifle the belated atonement, instead letting the sham record stand.” – Macleans Magazine.

What the Harper Government is essentially saying is that they want to set drug policy in Canada, it will be based on what their opinions and ideologies are and not scientific evidence. Further, the courts have no right to dictate what policy should be even when presented with overwhelming scientific data.

Insite is an example of what can happen when good solid peer reviewed science runs into a political unit that is ideologically opposed to its mandate. We are living in an age where science will more and more inform and reinforce policy on all matters of life. Climate change, health policy, drug policy, and these are just the beginning.

13 Responses to “When Policy Trumps Science: The Story of Insite”

  1. Tyro says:

    While I agree with everything you’ve said and I’m an enthusiastic supporter of Insite, I do think that you may be mischaracterizing the government’s position. Are they actually attacking it on the basis that it doesn’t work? I didn’t think so. I thought they opposed it on some flimsy moral grounds – didn’t want to be soft on drugs, don’t want to encourage drug use, blah blah. I don’t think they care whether it helps people and even it’s shown that it definitely saves lives, I’m not sure that’s sufficient to get around the law.

    I don’t have any legal background but I’m thinking of the times when governments have added toxins to drugs with the idea of “deterring” abuse (and to punish users who broke the law) like adding methanol to ethanol to punish drinkers. More recently, the US encouraged drug companies to add acetominophen to opiates by making the combination of drugs easier to prescribe and sell because heavy use would lead to liver failure. There has been attention on this issue and it may be changing but only because the governments have responded to the moral arguments, not because there is anything to prevent laws/regulation from causing harm.

  2. Tyro says:

    Sorry – just to add, I was only disagreeing with the overall thrust. You do make it clear in several places that the government is taking this stance regardless of whether Insite works or not. The health of these marginalized Canadians is irrelevant to them.

  3. Erik Davis says:

    Great discussion Ethan. The only thing I’d say is that a case like this doesn’t need to be framed in this way — the problem is that the Harper government isn’t being honest about its position.

    If they just said outright, “Yes, it’s effective at harm reduction, the science is clear on that. However, we weight consistently applied drug enforcement laws as a more important policy objective than harm reduction…and since we’re the duly elected majority government, we have the mandate to set policy objectives as we see fit,” then I could at least respect the position as honest. I’d still disagree with it, but it wouldn’t be about the rejection of science it would be about policy prioritization.

  4. Travis Erbacher says:

    Great article Ethan. As a former candidate for office, skeptic, and drug policy reform activist, I implore my fellow skeptics to talk about drug issues more often. There are several myths to be exposed here, and our entire policy surrounding drugs really crumbles away to nothing when exposed to evidence and reason.

    Skeptics have much to add to the discussion, as drug prohibition is the most irrational policy ever enacted in this country. Most people don’t realize drugs were criminalized before we really knew anything about them, and that the target of early drug laws were to persecute immigrant communities as opposed to reducing abuse.

    It’s going to be dark days for science under Harper. Here’s hoping they lose this battle.

  5. Composer99 says:

    Great post on the perils of governments making or proposing policy based on stale ideology in lieu of evidence. A flaw that, to be sure, knows no political boundaries (witness the Green party platform health section during the election), but will likely be most on display with the Conservative party now that they have a majority in Parliament.

  6. Bryan says:

    IMO, the problem is much larger than simply opposition to insite. it is clear that drug prohibition does not work – people who want drugs still get them, plus you create an attractive market for criminals. Furthermore, decriminalization of drugs in Portugal had the exact opposite effect of what was expected – overall drug use went down, fewer teens tried drugs, HIV infection went down, and more addicts seeked treatment:

    We should be debating whether our current drug laws are working and whether they’re consistent with our goals. Instead, we’re debating whether or not we should continue a single, small (but proven) program.

  7. Rob Tarzwell says:

    Nice work, Ethan. This is a wonderfully timed tonic to counter conservative sloganeer B. Kay’s piece in Full Comment over at the National Post today. I’d link, but I don’t have an alcohol swab to clean my hands afterward.

    Not only does Insite work, but as Bryan points out above, so did decriminalization in Portugal. So did the less well known but still crucial NAOMI Study (North American Opiate Medication Initiative) which included participation from Vancouver and Montreal. Chronic IV drug users who had failed detoxification and rehabilitation after multiple attempts were enrolled. They were prescribed pharmaceutical grade heroin by study physicians, and guess what? Infectious disease rates went down, as did rates of criminal activity: http://www.naomistudy.ca/

  8. Adrian says:

    Yikes. Tyro, as a conservative government, their announced motivations may not reflect their true motives; judge them by their actions, not their words. I would also advise a quick read of Orwell’s “Politics and the English Language”* to get an idea of how they corrupt the language to fit their needs.

    *May not be actual title (haven’t read it in a while).

  9. Very well done article. I have nothing to add except I had hoped I left this sort of craziness behind to a large extent when I became a Canadian from the USA many years ago. I dread the next 4 years. Hopefully reason will win out in this case in the end.

  10. Jason says:

    As always, enjoyed the article and information. From my humble perspective, drug policy and regulation should not be based upon whether prohibition is effective or not, whether harm reduction is effective or not, or on economic factors, etc. but on the principles which form a free society of personal responsibility and liberty. History clearly demonstrated that prohibition of alcohol was ineffective but if the prohibition of alcohol was demonstrably shown to be effective I would still not agree with the concept. Though I agree with the comments that our silly war on drugs is misguided and often leads to more harm, my core justification for a new approach is based on a slightly different set of principles. Evidence and scientific insight can be useful and a powerful tool when reviewing specific issues at the political level but I wonder if they should be used to cast the deciding ballot on political issues. For example, though smoking is clearly linked to increased health concerns, death, etc. I would never accept government policy based upon the overwhelming evidence to support the prohibition of the product. We may restrict the harm caused to others by the use of the product (banning in public spaces, etc.) but regulating decisions of risk, lifestyle etc. of individual users based on the science negates some of my core principles.

  11. brewjo says:

    Very interesting…. I would like to see this program continue. Does INSITE provide the option for their clients to test the purity and/or quality of the drugs before use?
    Providing such a service could make a big difference. It would disrupt prices and the supply chain in the short term, yet it the long term their may be a significant increase in the quality/purity. Think of it like the way freerange/organic movement has affected change in the big supermarket chains.


  1. [...] I am not talking about legalization of drugs in this post. Instead, I wanted to pass on this link to a SkepticNorth article on Insite. If you aren’t familiar, Insite is a Vancouver project that creates a safe environment for [...]

  2. [...] of you not familiar with Vancouver’s safe injection site should read Ethan Clow’s excellent summary of the issue. I will do my best to summarize. As we learned from the United States in the 1920s (and from our [...]

  • Ethan Clow

    Ethan Clow, born and raised in the Vancouver area, is best known in the skeptical community as Ethan the Freethinking Historian, co-host of Radio Freethinker, a skeptical podcast and radio show on CiTR in Vancouver. And as the former Executive Director of the Centre for Inquiry Vancouver. Ethan graduated with a B.A. in History from UBC in the fall of 2009 and has an active role with skeptical movements in Vancouver and British Columbia. He was an executive member of the UBC Freethinkers, a campus club that promotes skepticism and critical thinking. He still maintains a close relationship with the UBC Freethinkers and helps plan events and organizes skeptical activism as best he can. Currently he works for the Centre for Inquiry as the Executive Director of CFI Vancouver.