Safe Injection Sites - British Columbia


By Perry Bulwer, B.A., LL.B. 

December 2001

From 1999 to 2002 I was a law student at the University of British Columbia in Vancouver, Canada. I was also involved with various community-based advocacy groups supporting the rights of drug addicts and sex-trade workers. The following paper that appears after this intro and news updates, was written in December, 2001 for one of my law courses. It was a response to government inaction in the face of a publicly declared health crisis. It was subsequently published on the website of Pivot Legal, which at the time was a new legal advocacy organization serving Vancouver's most marginalized citizens. Pivot and its lawyers have since received several awards for outstanding community service. This paper, its companion piece on international law issues, as well as similar research were used by Pivot and other activists in the fight to force the government to act. In September 2003 North America's first legal supervised injection site, INSITE, began operating in Vancouver, Canada as a scientific pilot research project. The scientific evidence to date shows that such a facility saves lives by preventing overdose deaths and the spread of communicable diseases. However, the Conservative government under Stephen Harper has questioned the effectiveness of the service and has threatened to withdraw funding. In April 2008, the operaters of INSITE launched a constitutional case to test the federal government's power to close the facility. In May 2008, a letter leaked to the CBC revealed that doctors at the University of British Columbia's Department of Medicine last year unanimously urged Prime Minister Stephen Harper to keep INSITE open. On May 27, 2008 the B.C. Supreme Court struck down as unconstitutional sections of the Controlled Drugs and Substances Act. It gave Ottawa until June 30, 2009 to fix the law and bring it inline with the constitutional principle of fundamental justice. The court also granted INSITE an immediate exemption, allowing it to remain open. Ottawa must now update its laws to ensure provinces are free to provide health care services to addicts. Government opposition to effective harm reduction measures is nothing new, as this article explores. On October 8, 2008 Pivot filed a complaint with the federal auditor general alleging that the RCMP secretly commissioned research in hopes of discrediting INSITE. Consequently, the RCMP announced it would conduct an internal review regarding Pivot's allegations. This article, Vancouver's Radical Approach to Drugs, provides an updated overview of Vancouver's harm reduction approach to illicit drug use. And here is a transcript of a radio interview with Dr. Gabor Maté, a physician at INSITE, on the biological and socio-economic roots of addiction.

See related legal arguments in the following two articles on this blog:

The Constitutional Obligation of the City of Vancouver to Support Safe Injection Facilities 





By Perry Bulwer, B.A., LL.B. 

December 2001


The purpose of this paper is to explore the possibility of compelling the British Columbia provincial government, through legal action, to establish and fund Safe Injection Facilities (SIFs) as part of a program of health services for injection drug users (IDUs). Before examining the legal issues I will provide a brief background to the problem of infectious diseases and fatal drug overdoses. I will then consider the government policy response to the existing health crisis. Following that is a description of the function of SIFs and their effectiveness in other jurisdictions. I will then discuss the current legal framework and the impediments to establishing SIFs. Next, I consider whether there is a cause of action under human rights legislation. Finally, I turn to constitutional issues, namely sections 7 and 15 of the Canadian Charter of Rights and Freedoms. I conclude that there is evidence and the legal basis, under human rights legislation and the Constitution, to support an action against the government compelling it to establish SIFs.


In 1997, the National Task Force on HIV, AIDS and Injection Drug Use declared that “Canada is in the midst of a public health crisis concerning HIV, AIDS and injection drug use…. The number of new HIV infections among injection drug users is increasing rapidly, with Vancouver now having the highest reported rate in North America”.1 In that same year the Vancouver/Richmond Health Board declared a public health emergency in response to the emergence of an HIV/AIDS epidemic, as well as the high rate of fatal overdoses among IDUs, centred primarily, but not exclusively, in the Downtown Eastside.2

Recent estimates put the HIV prevalence rate among IDUs in Vancouver between 23 and 28 percent, and IDUs account for 38 percent of new HIV infections.3 Another serious communicable disease transmitted easily from one needle-sharing IDU to another is Hepatitis C. It is estimated that 85 percent of IDUs in Vancouver are infected with that disease.4 Tuberculosis, Hepatitis A & B, and syphilis also occur at epidemic rates among Vancouver IDUs. Tuberculosis, for example, had a 38 percent prevalence rate among Vancouver IDUs in 1998.5 Included in this epidemic of diseases among IDUs is an epidemic of fatal drug overdoses. From 1996 to 2000, there was an annual average of 312 overdose deaths in the Vancouver region.6

These various statistics are alarming, and even more so in light of the fact that the provincial government has apparently done little to stem this rising tide of disease and death. The problems associated with illicit drug use, while magnified, are not unique to Vancouver. However, in several European cities governments long ago proactively developed comprehensive harm reduction programs to deal with the public health issues associated with injection drug use. As part of a continuum of health care and associated services for drug addicts, SIFs were opened in several cities. Evidence indicates that these facilities are associated with an array of positive health and social outcomes, including reducing disease transmission and fatal overdoses. Considering the serious problem in Vancouver, the provincial government should establish and fund SIFs.


Under the previous provincial government, responsibility for addiction and other drug-related services fell to the Ministry for Children and Families. According to a 1998 review of alcohol and drug services in Vancouver by that Ministry there were major problems with existing service delivery, particularly in terms of accessibility, scope and the number of services available.7 That report stated:
The impact of the lack of adequate resources cannot be overstated. The simple fact is: there is not enough of anything, there are waiting lists for everything and we are chronically under-serving many. There is not only a need for more of the same, but new and innovative approaches need to be developed to attend to emerging trends and issues.8

The problem is especially acute for the most vulnerable populations such as IDUs who have difficulty accessing health care. A 1999 study suggested that “…access to drug and alcohol treatment, methadone maintenance and counseling services has been woefully inadequate in the downtown eastside and had diminished even further since 1995”.9

The new provincial government transferred responsibility for addiction services to the Ministry of Health Services, however, the range and level of services has not increased in response to the ongoing crisis. According to the previous Ministry’s“strategic purposes”, the priorities for addiction services include supporting “…education and harm reduction strategies to prevent the spread of HIV and other related infectious diseases”.10 Perusal of the current Ministry’s website indicates that of the addiction services carried over from the previous government, very few are based on harm reduction, but are instead abstinence-based programs.11 This means that not only is the range and level of addiction services “woefully inadequate”, but those most in need, and most likely to perpetuate the cycle of disease, will not access what services are available due to the requirement of abstinence. Apparently, the recommendation that “new and innovative approaches need to be developed” 12 has not been carried out.

A recent comparative study observed that in Europe during the 1990s, following the implementation of broad harm reduction prevention measures, including SIFs, there was a steady decrease in IDU-related harm. During that same period, the opposite trend occurred in Canada, including Vancouver. There was very limited harm reduction programming, consisting mostly of limited needle exchange and methadone programs, while IDU-related harm continued to increase at alarming rates.13 Perhaps, then, a brief look at the European experience will help determine the appropriateness of SIFs for dealing with the health crisis here.


There are presently over 40 SIFs operating in various European countries, including Germany, Switzerland and the Netherlands. Other countries planning or in the process of setting up SIFs include Spain and Australia.14 There are three primary goals of SIFs: to prevent the spread of drug-related disease by providing sanitary conditions and clean equipment for injection drug use; to prevent overdose deaths by providing supervision of drug injections by medically trained staff who can immediately intervene when problems occur; and the reintegration of drug users within mainstream society by providing a gateway through which injection drug users can access the health care system.15

Evidence suggests that those goals are being met in places where SIFs are operating. In Germany and Switzerland, large reductions in overdose deaths were reported in areas served by SIFs. As well, HIV/AIDS prevalence rates in drug users showed significant declines where SIFs were part of a comprehensive harm reduction strategy. Furthermore, various research data indicate that SIFs are an effective way of contacting the most marginalized drug users and connecting them to a wide array of health services they wouldn’t otherwise access.16 A comprehensive review of the literature reveals that SIFs are significantly reducing disease, hospitalization and death in those cities that have them. Moreover, they “have contributed to a stabilization of or improvement in general health and social functioning of clients” as a result of, among other things, the improved access to health services for addicts.17

I have presented here only a cursory view of the evidence as to the efficacy of SIFs. In any legal action brought against the government in an effort to compel it to establish SIFs, a great deal more evidence would be introduced on both sides of the issue. I am confident, however, based on the research, surveys and studies to date that there is evidence sufficient to establish that SIFs can effectively reduce death and disease transmission among IDUs. Therefore, the provincial government has at least a moral obligation to put people’s lives ahead of politics and establish SIFs. Whether or not it has a legal obligation remains to be seen, but first I will examine the current legal framework and the possible impediments to establishing SIFs.


Under existing Canadian laws many of the activities associated with SIFs are illegal. The Controlled Drugs and Substances Act (CDSA) is the federal law that criminalizes certain conduct related to numerous prohibited substances listed in several schedules attached to the Act. Included in the list is heroin and cocaine, the two drugs most likely to be consumed in SIFs. While drug use by itself is not illegal, it is illegal to possess (s.4), traffic (s.5(1)), possess for the purpose of trafficking (s.5(2)), import and export (s.6), and produce a prohibited substance (s.7). Section 2(2)(b)(ii) of the CDSA specifies that

(b) a reference to a controlled substance includes a reference to

(ii) anything that contains or has on it a controlled substance and that is used or intended or designed for use

(A) in producing the substance, or

(B) in introducing the substance into a human body

Of concern to employees of SIFs would be the offences related to possession and trafficking. For the purposes of the CDSA, the definition of ‘possession’ is that found in section 4(3) of the Criminal Code:

(a) a person has anything in “possession” when he has it in his personal possession or knowingly

(i) has it in the actual possession or custody of another person, or

(ii) has it in any place, whether or not that place belongs to or is occupied by him, for the use or benefit of himself or of another person; and

(b) where one of two or more persons, with the knowledge and consent of the rest, has anything in his custody or possession, it shall be deemed to be in the custody and possession of each and all of them.

Subsection (a)(i) & (ii) describes what is referred to as ‘constructive’ possession and subsection (b) refers to ‘joint’ possession. Although it is extremely unlikely staff of SIFs would be guilty of personal possession, given the broad definition of possession it appears they could still be held criminally liable for possession of prohibited substances. However, a conviction for constructive or joint possession would depend on proof that the staff had a measure of control over the drugs. As long as clients of SIFs were responsible for obtaining, holding and administering their drugs without staff involvement then it is unlikely that staff would be found to have the necessary control. Although staff could also technically be charged with possession of certain drug paraphernalia such as syringes, this is extremely unlikely. Needle exchange programs across Canada are operating with impunity and there is no reason to believe SIFs would be any different in that regard.

Staff of SIFs might also be exposed to a charge of trafficking. Trafficking is defined in section 2(1) of the CDSA as selling, administering, giving, transferring, transporting, sending or delivering a prohibited substance. It also includes offering to do any of those things. Because staff would be providing equipment such as syringes they could be considered as administering the substance. However, as above, this would contradict the current enforcement standard regarding syringes. As long as strict guidelines are adhered to by staff, and they are merely observers, intervening only in emergencies, then trafficking charges should not arise.

In some situations staff of SIFs might also be open to charges of criminal negligence causing bodily harm or death. These offences are set out in sections 219-221 in the Criminal Code. In order to establish this offence the crown must prove the accused did or failed to do something they had a legal duty to do. It also must be shown that the accused showed “wanton or reckless disregard for the lives or safety of other persons”. However, case law suggests that for criminal negligence to apply the accused’s conduct must demonstrate a marked departure from the standard of behaviour expected of a reasonably prudent person in the circumstances.18 Standards of practice for SIFs are well established in all the European facilities. Though no SIF yet exists in Canada, standards of practice established in various health care services would be comparable to those required in a SIF. Some examples include needle exchange programs, the Street Nurse program in Vancouver, and hospital emergency rooms. Together, these various standards would define the standard of behaviour of a reasonably prudent person in the context of providing health services to IDUs.

A SIF or employee might also be vulnerable to civil action. If the facility allows the possession and use of illegal drugs and a patient suffers some harm, for example by overdosing, the facility might be liable for negligent care of the patient. The same would hold true if a patient harmed another patient using those drugs. However, to avoid both criminal and civil liability a facility or individual could claim the defence of necessity of treatment. The claim would be “…that allowing the use of illegal drugs was a necessity for the treatment of the patient and/or that, in the circumstances, it would be negligent to prohibit possession of a controlled substance by a patient, as this might interfere with essential medical treatment”.19 Supporting this defence is all the compelling evidence showing the benefits and reductions in harm associated with SIFs. Such evidence suggests that IDUs are at much greater risk of harm when injecting outside of SIFs as compared to inside them.

Furthermore, with regard to criminal liability, the Crown has the discretion whether or not to lay a charge. Current enforcement standards involving health care services operating in a “gray” area of the law, such as needle exchanges,20 suggest the same standard would apply to SIFs. Public funding of SIFs and the lack of moral blameworthiness on the part of staff working to reduce harm to IDUs are two other reasons why the Crown is unlikely to lay criminal charges. The exception might be in those rare situations where an employee caused harm by failing to meet the required standard of behaviour of the reasonable person in similar circumstances.


Section 55(1)(a) of the CDSA permits the Governor in Council to make regulations respecting the circumstances in which controlled substances may be imported, exported, produced, packaged, sent, transported, delivered, sold provided, administered, possessed, obtained or otherwise dealt in. Section 55(1)(b) allows the identification of persons or classes of persons who may be authorized to conduct these activities. Section 56 of the CDSA allows the Minister of Health to
…exempt any person or class of persons or any controlled substance or precursor or any class thereof from the application of all or any of the provisions of this Act or the regulations if, in the opinion of the Minister, the exemption is necessary for a medical or scientific purpose or is otherwise in the public interest.

The Minister’s power to exempt is extremely broad. It is almost unfettered discretion to make such an exemption based merely on his or her opinion. Even if the Minister does not accept that SIFs constitute a medical purpose, SIFs could still be exempted as serving the public interest. These two provisions could be applied to SIFs, their staff and clients thereby protecting them from criminal charges.


In considering whether there is a foundation for taking legal action against the provincial government for failing to establish SIFs, I start with a look at human rights legislation. The B.C. Human Rights Code21 provides that

8(1) A person must not, without a bona fide and reasonable justification

(a) deny to a person or class of persons any accommodation, service or facility customarily available to the public, or

(b) discriminate against a person or class of persons any accommodation, service or facility customarily available to the public

because of the race, colour, ancestry, place of origin, religion, marital status, family status, physical or mental disability, sex or sexual orientation of that person or class of persons.

The Canadian Human Rights Act,22 in section 3, also includes disability as a prohibited ground of discrimination. Section 25 of that Act defines ‘disability’ as including a “previous or existing dependence on alcohol or a drug”. Canadian courts have also, on several occasions, characterized drug dependency as a disability.23 For example, in R. v. Nguyen, Ryan J.A. quoted with approval a description of the “…sub-class of people who, by falling prey to heroin addiction, become effectively disabled from functioning as useful, self-supporting, productive members of society”.24

In saying that drug addicts, as disabled persons, are being discriminated against because SIFs are not available, the argument is that they are being denied reasonable access to quality health care services, something customarily available to the public. Due to the nature of their disability, drug addicts, as documented above, have difficulty accessing health care services. However, SIFs in other jurisdictions have proven highly effective in connecting drug addicts to essential health services that meet their particular needs and successfully reduce the rates of disease transmission and death by overdose. Does this mean, then, that the provincial government has a duty to accommodate the medical needs of IDUs by providing SIFs?

The B.C. Medicare Protection Act25 echoes the Canada Health Act26 by stating in the preamble an intention to “confirm and entrench universality, comprehensiveness, accessibility, portability and public administration as the guiding principles of the health care system”. Section 3 of that Act ensures “reasonable access…to quality medical care, health care and diagnostic services” to everyone in B.C., with no financial or other barriers. B.C.’s Health Act27 goes further and imposes a duty on the Minister of Health to do the following:

7(1)(a) take account of the interests of health and life among the people of B.C.,

(b) especially study the vital statistics of B.C.,

(c) endeavour to make an intelligent and profitable use of the collected records of death and sickness among the people,

(d) make sanitary investigations and inquiries about the cause of disease, and especially of an epidemic,

(e) inquire into the causes of varying rates of mortality and the effect of locality, employment and other circumstances on health,

(f) make suggestions as to the prevention and interception of contagious and infectious diseases the minister believes most effective and proper, and as will tend to prevent and limit as far as possible the rise and spread of disease…

There is a positive duty on the Minister beyond merely suggesting an opinion as to what the “most effective and proper” interventions are. The Minister is required to make studies, investigations and inquiries into the causes of epidemics such as are occurring in the Vancouver region. The Minister must also “endeavour [that is, make an earnest attempt] to make an intelligent and profitable use of” those investigations, inquiries and studies. The evidence to date overwhelmingly points to the fact that SIFs, especially as part of a comprehensive harm reduction program “will tend to prevent and limit as far as possible the rise and spread of disease”. There is strong support, therefore, for the proposition that the government must accommodate the special health needs of drug addicts, as disabled persons, not only to ensure their access to required health services, but also to prevent and control contagious diseases.

Accommodation means changing a rule or a practice, making adjustments or making alternative arrangements to remove the discriminatory effects on an individual or a group. SIFs would be an alternative arrangement allowing IDUs to access essential health services that, because of their disability, they have been unable to access. Of course, the government could defend against a claim of discrimination, but it would have to demonstrate that a complainant or a group of complainants could not be accommodated without undue hardship.

In a recent decision, British Columbia (Public Service Employees Relations Comm.)v. B.C.G.E.U.,28 also known as Meiorin, the Supreme Court of Canada clarified the law regarding the duty to accommodate. The result of that decision was to make the distinction between direct discrimination and adverse effect discrimination irrelevant, and to make the duty to accommodate to the point of undue hardship a key element of any defence to a claim of discrimination. Shortly after the Meiorin decision the same court, in British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights),29 also known as Grismer, reaffirmed its new test in Meiorin and applied it to the provision of services. In the new three-part test…the defendant must prove that:

(1) it adopted the standard for a purpose or goal
that is rationally connected to the function
being performed;

(2) it adopted the standard in good faith, in the
belief that it is necessary for the
fulfillment of the purpose or goal; and

(3) the standard is reasonably necessary to
accomplish its purpose or goal in the sense
that the defendant cannot accommodate persons
with the characteristics of the claimant
without incurring undue hardship.30

In Grismer the Court held that the Superintendent of Motor Vehicles discriminated against Mr. Grismer by refusing licenses to all people with his particular optical disorder. The Superintendent was under a duty to accommodate Mr. Grismer by allowing him to be tested individually. Another example of accommodating disabled persons with regard to the provision of a service is in Chipperfield v. British Columbia (Ministry of Social Services).31 In that case the Ministry of Social Services had a duty to provide a transportation subsidy to persons receiving social assistance who have disabilities which prevent them from using public transit. The subsidy must be equivalent to the transportation subsidy provided to those who can use public transit.

There is a limit to the obligation to accommodate, that is, if it creates undue hardship on the service provider. This implies that some hardship is acceptable, but what constitutes undue hardship is a question of fact and will vary with the circumstances. There is no exhaustive list of factors, but in the context of SIFs two factors that a government resisting the establishment of SIFs might raise, other than the legal objections answered above, are safety and cost. However, it is difficult to imagine convincing arguments that SIFs would pose a safety risk to either employees or clients, or that the cost of funding SIFs would impose undue hardship on the government.

First of all, the very nature of SIFs is to promote safety, for both IDUs and the general public. The staff in SIFs would be at no greater risk than those in similar medical clinics and services. The evidence supports the contention that SIFs dramatically reduce harm. To oppose SIFs is, in essence, to prefer the current unsafe practices of injection drug use and all the serious, negative consequences that fall from that. Secondly, regarding costs, the government will actually save money in the long run by establishing SIFs. The Rand Institute in the U.S.A. has conducted numerous studies for several years on drug control policy. “A 1994 study commissioned by the U.S. office of National Drug Control Policy found that treatment is 10 times more cost effective than interdiction in reducing the use of cocaine in the United States. The same study found that every additional dollar invested in substance abuse treatment saves taxpayers $7.46 in societal costs and that additional domestic law enforcement efforts cost 15 times as much as treatment to achieve the same reduction in societal costs”.32 There is no reason to believe those figures would be substantially different in Canada. From a fiscal, as well as a public health policy point of view, it makes perfect sense for the B.C. government to fulfill its obligation to accommodate IDUs by establishing SIFs.



Any legal action taken to compel the government to establish SIFs should include constitutional arguments based on the right to security of the person and equality found in sections 7 and 15 respectively of the Canadian Charter of Rights and Freedoms. Section 7 provides that
Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

It may be that the provincial government is depriving IDUs of their constitutional rights by not establishing health care facilities, such as SIFs, that provide medically necessary services vital to the security of their person. In arguing this position the challenge would not be to any statute, but to government inaction in the face of a legislated duty to act. It is unlikely a challenge to the laws themselves, that is, those laws that stand in the way of establishing SIFs, would be successful. For one thing, there are valid defences to those laws. There is also the exemption in section 56 of the CDSA, even though that exemption is rarely given. By not exempting SIFs from application of the law the government is effectively denying IDUs their right to security of the person in the form of necessary medical services.

There have been successful section 7 challenges to government decisions to deny services. In New Brunswick (Minister of Health & Community Services) v. G.J.,33 the Supreme Court of Canada found that the provincial government had deprived the appellant of her right to security of the person by denying her legal aid in a complex child custody case. Lamer C.J. for the majority said:
the subject matter of s.7 is the state’s conduct in the course of enforcing and securing compliance with the law, where the state’s conduct deprives an individual of his or her right to life, liberty or security of the person. I hasten to add, however, that s.7 is not limited solely to purely criminal or penal matters.34

In R. v. Morgentaler, Beetz J. stated:

“Security of the person” must include a right of access to medical treatment for a condition representing a danger to life or health without fear of criminal sanction.35

In Rodriguez v. British Columbia (A.G.), Sopinka J., speaking for the majority said

There is no question, then, that personal autonomy, at least with respect to the right to make choices concerning one’s own body, control over one’s physical and psychological integrity, and basic human dignity are encompassed within security of the person, at least to the extent of freedom from criminal prohibitions which interfere with these.36

In R. v. Parker, a case involving the use of a prohibited substance, marijuana, for medical purposes, Rosenburg J.A., relying on the decisions in Morgentaler and Rodriguez, concluded

that deprivation by means of a criminal sanction of access to medication reasonably required for the treatment of a medical condition that threatens life or health constitutes a deprivation of the security of the person…. Depriving a patient of medication in such circumstances, through a criminal sanction, also constitutes a serious interference with both physical and psychological integrity.37

The criminal sanctions that prevent the establishment of SIFs deprive IDUs, whose medical condition represents a danger to their life or health, access to appropriate medical services. The sanctions also interfere with their psychological integrity and basic human dignity by denying them a clean, safe environment staffed with medically trained personnel in which they can self-administer treatment for their illness of addiction.38 Therefore, IDUs are being deprived of their right to security of the person by not having available medical services, in the form of SIFs, that are reasonably required for their medical condition. However, the criminal sanctions standing in the way of SIFs can easily be avoided if the Minister of Health simply exempts them from application of the law as being “necessary for a medical purpose or…in the public interest” under section 56 of the CDSA. If the government chooses not to establish SIFs then its action, or lack thereof, can be said to deprive IDUs of their right to security of the person.

If a court finds that the section 7 right to security of the person is violated it is unlikely the government’s position can by saved by section 1 of the Charter. It is rare that a violation of the principles of fundamental justice will be upheld as a “reasonable limit prescribed by law as can be demonstrably justified in a free and democratic society”. The government could argue that its decision not to set-up SIFs was prescribed by law, that the objective of the policy was pressing and substantial (for example, budgetary concerns), that the decision was rationally connected to the objectives and that it constituted a minimal impairment of section 7. However, despite, these arguments, it is likely a court would find that the deleterious effects of the decision, namely denying necessary medical treatment to control epidemics of disease and overdoses, far out-weigh any salutary effects such as potential budgetary savings. While a section 7 challenge is certainly possible, an even stronger challenge with more likelihood of success is a section 15 argument that IDUs are denied their equality rights.


Section 15(1) of the Charter provides that
Every individual is equal before and under the law the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

Government failure to make reasonable accommodation for disabled persons amounts to discrimination against them. Sopinka J. for the Supreme Court of Canada, in Eaton v. County Board of Education, stated
…discrimination does not lie on the attribution of untrue characteristics to the disabled individual. … Rather, it is the failure to make reasonable accommodation, to fine-tune society so that its structures and assumptions do not result in the relegation and banishment of disabled persons from participation which results in discrimination against them.39

I have already established above that drug addiction amounts to a disability in Canadian law, so failure to accommodate IDUs special health care needs by providing SIFs is arguably discrimination.

In Law v. Canada (Minister of Employment and Immigration), Iacobucci J. articulated what was, in his view, the proper approach to analyzing a claim of discrimination under section 15:

First, does the impugned law (a) draw a formal distinction between the claimant and others on the basis of one or more personal characteristics, or (b) fail to take into account the claimant’s already disadvantaged position within Canadian society resulting in substantively different treatment between the claimant and others on the basis of one or more personal characteristics? If so, there is differential treatment for the purpose of s.15(1). Second, was the claimant subject to differential treatment on the basis of one or more of the enumerated or analogous grounds? And third, does the differential treatment discriminate in a substantive sense, bringing into play the purpose of s.15(1) of the Charter in remedying such ills as prejudice, stereotyping and historical disadvantage? The second and third inquiries are concerned with whether the differential treatment constitutes discrimination in the substantive sense intended by s.15(1).

The Supreme Court of Canada applied that approach in a subsequent case involving a claim of discrimination based on temporary disability.40 In Granovsky v. Canada (Minister of Employment and Immigration, Binnie J. stated:
The true focus of the s.15(1) disability analysis is not on the impairment as such, nor even any associated functional limitations, but is on the problematic response of the state to either or both of these circumstances. It is the state action that stigmatizes the impairment, or which attributes false or exaggerated importance to the functional limitations (if any), or which fails to take into account the “large remedial component” (Andrews v.Law Society of B.C. , [1989] 1 S.C.R. 143, at p.171) or “ameliorative purpose” of s.15(1) (Eaton v. County Board of Education, [1997] 1 S.C.R. 241, at para 66; Law v. Canada, [1999] 1 S.C.R. 497, at para 72; Eldridge v. British Columbia (A.G.), [1997] 3 S.C.R. 624, at para 65) that creates the legally relevant human rights dimension to what might otherwise be a straightforward biomedical condition.41

Binnie J., at paragraph 80, reiterates the emphasis on the state’s response to the disability:
The “purposive” interpretation of s.15 puts the focus squarely on the third aspect of disabilities, namely on the state’s response to an individual’s physical or mental impairment. If the state’s response were, intentionally or through effects produced by oversight, to stigmatize the underlying physical or mental impairment, or to attribute functional limitations to the appellant that his underlying physical or mental impairment did not warrant, or to fail to recognize the added burdens which persons with temporary disabilities may encounter in achieving self-fulfillment, or otherwise to misuse the impairment or its consequences in a discriminatory fashion that engages the purpose of s.15, an infringement of equality rights would be established. (emphasis added)

In the case of SIFs the government, by “oversight”, has failed to adequately respond to the health crisis affecting IDUs. This lack of response further stigmatizes IDUs, who are already one of the most marginalized groups in society, and who are, in essence, criminalized as a result of their disease. This failure to respond to the crisis by establishing SIFs is also a failure “to recognize the added burdens” IDUs face in accessing the health care system. The failure to accommodate the health care needs of IDUs perpetuates the view that they are somehow less worthy of health care services than other Canadians. SIFs are one of the only approaches to the epidemics facing IDUs that have shown to effectively provide them access to the health care system. They are an alternative arrangement that would effectively accommodate the health care needs of IDUs as disabled persons.

Case law suggests that where discrimination based on an enumerated ground in s.15(1) is made out, government can be required to take positive action to remedy the problem. In Eaton, Sopinka J. stated that
…the purpose of s.15(1) of the Charter is not only to prevent discrimination by the attribution of stereotypical characteristics to individuals, but also to ameliorate the position of groups within Canadian society who have suffered disadvantage by exclusion from mainstream society as has been the case with disabled persons.42

In Eldridge v. British Columbia43 the Supreme Court of Canada held that the failure of provincial health authorities to provide funding for sign language interpreters for the deaf violated s.15(1). In that case the appellants sought and won equal access to health care services that are available to everyone. The government was required to provide interpreters for that purpose. A case involving IDUs would also claim the right to equal and effective access to health care services, but that purpose would be achieved through SIFs as opposed to interpreters.

Another helpful case is Auton (Guardian ad litem of) v. British Columbia (A.G.). Alan J. applied Eldridge and found that

[t]he petitioners are the victims of the government’s failure to accommodate them by failing to provide treatment to ameliorate their mental disability. That failure constitutes direct discrimination. Further, the petitioner’s disadvantaged position stems from the government’s failure to provide effective health treatment to them, not from the fact that their autistic condition is characterized, in part, by an inability to communicate effectively or at all.44

The petitioner’s in that case forced the government to provide funding for effective early treatment of autistic children. This decision goes further than Eldridge in the sense that the government was forced to fund an entirely different system of treatment as opposed to merely providing access to an existing system.

Accommodating IDUs by establishing SIFs would go a long way to ameliorating the dreadful conditions they face. SIFs would drastically reduce the prevalence and transmission rates of communicable diseases among IDUs. They would also greatly reduce the unconscionably high fatal overdose rates. SIFs would not only save lives and improve the physical health of IDUs, but they would also contribute to their mental health and social well-being by connecting them to an array of social services.

As for a section 1 analysis if it is found that a failure to accommodate IDUs with SIFs is an infringement of their section 15 right, it appears from Eldridge that such an analysis may not be necessary. In that case La Forest J. did not go through the steps of the Oakes45 test. Instead, he found that the decision not to fund medical interpretation services for the deaf did not constitute a minimum impairment of their section 15(1) right. Having decided that, it wasn’t necessary to go through the elements of the Oakes test. At paragraph 94 he stated:
…I am of the view that the failure to fund sign language interpretation is not a "minimal impairment" of the s. 15(1) rights of deaf persons to equal benefit of the law without discrimination on the basis of their physical disability. The evidence clearly demonstrates that, as a class, deaf persons receive medical services that are inferior to those received by the hearing population. Given the central place of good health in the quality of life of all persons in our society, the provision of substandard medical services to the deaf necessarily diminishes the overall quality of their lives. The government has simply not demonstrated that this unpropitious state of affairs must be tolerated in order to achieve the objective of limiting health care expenditures. Stated differently, the government has not made a "reasonable accommodation" of the appellants' disability. In the language of this Courts' human rights jurisprudence, it has not accommodated the appellants' needs to the point of "undue hardship”….

If a court finds that by not establishing SIFs the government is failing to reasonably accommodate disabled persons under s.15(1) then such discrimination could not meet the minimal impairment test and thus could not be saved by section 1.


There is no doubt that a health crisis of epidemic proportions has existed for several years among injection drug users in the Vancouver region. The provincial government has not taken effective measures to control the spread of disease or reduce the death rate associated with injection drug use. Evidence demonstrates that SIFs are effective at doing both. The government is discriminating against IDUs by not providing them with effective access to essential health care in the form of SIFs.

The litigative strategy most likely to succeed in compelling the government to establish SIFs would proceed on two fronts: under human rights legislation and by constitutional challenge under sections 7 and 15 of the Canadian Charter of Rights and Freedoms. Under human rights legislation the basic argument is that the government has a duty to accommodate IDUs as disabled persons by establishing SIFs and thereby removing the discriminatory effect of lack of access to necessary medical services. A section 7 challenge will argue that IDUs are deprived of their right to security of the person by not having access to necessary medical services in the form of SIFs. The section 15 argument is essentially the same as the human rights argument. The government failure to make reasonable accommodations for IDUs, as disabled persons, amounts to discrimination and is a violation of their Charter rights. The evidence and arguments set forth in this paper demonstrate that there is a strong case for compelling the government to establish and fund SIFs.


1 Canadian National Task Force on HIV, AIDS and Injection Drug Use, “HIV/AIDS and Injection Drug Use: A National Action Plan (1997)”, at 3-4, online:

2 Penny Parry, “Something to Eat, A Place to Sleep and Someone Who Gives a Damn”, HIV/AIDS and Injection Drug Use in the DTES, Final project report to the DTES Community, Minister of Health and V/RHB, 1997.

3 Supra note 1, at 5; Fischer, B., Rehn, J., Blitz-Miller, T., (2000), “Injection Drug Use and Preventive Measures: A Comparison of Canadian and Western European Jurisdictions Over Time”, Canadian Medical Association Journal, 162(12), 1709-1713.

4 Canada Communicable Disease Report, “Hepatitis C – Prevention and Control: A Public Health Consensus”, Vol. 2552 (Supplement, June 1999; online:

5 Thomas Kerr, Safe Injection Facilities: Proposal for a Vancouver Pilot Project (Vancouver: Harm Reduction Action Society, 2000) at 3 [citing the Vancouver Injection Drug Users Study (VIDUS), 1998 report]

6 Selected Vital Statistics and Health Status Indicators, 1996-2000: Drug induced deaths by age and gender. Victoria: British Columbia Vital Statistics Agency.

7 Supra note 5, at 23.

8 Ministry for Children and Families. (1998) Report on the Status of the Implementation of the Recommendations of: The Review of Alcohol and Drug Services in Vancouver.

9 Martin Schechter, et al, “Do Needle Exchange Programmes Increase the Spread of HIV Among Injection Drug Users?: An investigation of the Vancouver Outbreak”. AIDS, 1999, 13:F45-F51, at F50.

10 Ministry for Children and Families. Addiction Services: Our Mission and Mandate. (Victoria: Ministry of Children and Families, September 2000) at 1.

11 Last revised September 20, 2001.

12 Supra note 8.

13 Supra note 3, Fischer et al.

14 Kate Nolan et al., “Drug Consumption Facilities in Europe and the Establishment of Supervised Injecting Centres in Australia”, (2000) 19 Drug and Alcohol Review, 337 at 338-340.

15 For a description of SIF models see Kerr, supra note 5, at 29-30 and Appendix 1.

16 Kerr, supra note 5, at 32-35; Lindesmith Centre, Research Summary: Safe Injection Rooms, (1999) online: ; Lindemsith Centre, Research Brief: Safer Injection Rooms, (1999) online:

17 Supra note 14, at 340-341.

18 R. v. Anderson (1990), 53 CCC (3d) 481 (SCC); R. v. Waite (1989), 69 CR (3d) 323 (SCC); R. v. Tutton (1989), 69 CR (3d) 289 (SCC); R. v. Barron (1985), 23 CCC (3d) 544 (Ont. CA); R. v. Nelson (1990), 54 CCC (3d) 285 (Ont. CA); R. v. Gingrich (1991), 65 CCC (3d) 188 (Ont. CA); R. v. Ubhi (1994), 27 CR (4th) 332 (BCCA).

19 Ralph Jurgens & Richard Elliot, eds., Injection Drug Use and HIV/AIDS: Legal and Ethical Issues (Montreal: Canadian HIV/AIDS Legal Network, 1999).

20 The B.C. Compassion Club Society and its 1700 members are also technically violating the law, but the Vancouver Police Department and the Crown have exercised their discretion by not arresting members or laying charges.

21 Human Rights Code, R.S.B.C. 1996, C.210 proclaimed in force 1997.

22 Canadian Human Rights Act, R.S.C. 1985, C. H-6.

23 Entrop v. Imperial Oil Ltd., [2000] O.J. 2689 (Ont. CA), 50 O.R. (3d) 18, at para 89; Toronto Dominion Bank v. Human Rights Commission (1998), 163 D.D.R. (4th) 193 (FCA) at paras 1,15,16 of majority decision.

24 R. v. Nguyen (1995), 56 B.C.A.C. 290, at para 13, citing Oliver J. in R. v. Ping Li (unreported, November 19, 1993) Vancouver Registry No. CC930521.

25 Medicare Protection Act, R.S.B.C. 1996 c.286.

26 Canada Health Act, R.S.C. 1985, c. C-6.

27 Health Act, R.S.B.C. 1996 C.179.

28 British Columbia (Public Service Employees Relations Comm.)v. B.C.G.E.U. (1999), 35 C.H.R.R. D/257.

29 British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights) (1999), 36 C.H.R.R. D/129.

30 Ibid. at D/136, para 20.

31 Chipperfield v. British Columbia (Ministry of Social Services) (No.3) (1998), 33 C.H.R.R. D/340 (B.C.H.R.T.).

32 The Lindesmith Centre-Drug Policy Foundation, online:, cited December 10, 2001.

33 New Brunswick (Minister of Health & Community Services) v. G.J., [1999] 3 S.C.R. 46.

34 Ibid. at para 65.

35 R. v. Morgentaler,[1988] 1 S.C.R. 30, at para 90.

36 Rodriguez v. British Columbia (A.G.), [1993] 3 S.C.R. 519, at 587-88.

37 R. v. Parker, [2000] O.J. No. 2787 (Ont. CA), at para 97.

38 It could be argued that feeding an addiction is not the same as treating it. Nevertheless, it is a form of treatment since addicts become violently ill if they do not receive the drug, and the only way to receive the drug is to administer it themselves. Obviously, one goal of a SIF is to ultimately wean an addict from his dependency, but whether or not that goal is achieved the SIF still provides a medically necessary service.

39 Eaton v. County Board of Education, [1997] 1 S.C.R. 241, at para 67.

40 Whether drug addiction is characterized as a temporary or immutable disability the same analysis would apply.

41 Granovsky v. Canada (Minister of Employment and Immigration), [2000] 1 S.C.R. 703, at para 26.

42 Supra note 51, at para 66.

43 Eldridge v. British Columbia, [1997] 3 S.C.R. 624.

44 Auton (Guardian ad litem of) v. British Columbia (A.G.) (2000), 78 B.C.L.R. (3d) 55 (Auton #2).

45 R. v. Oakes, [1986] 1 S.C.R. 103.



Canada Health Act, R.S.C. 1985, c. C-6.

Canadian Charter of Rights and Freedoms, Constitution Act, 1982.

Canadian Human Rights Act, R.S.C. 1985, C. H-6.

Controlled Drugs and Substances Act, R.S.C. 1996, c.19.

Criminal Code, R.S.C. 1985, c.46.

Health Act, R.S.B.C. 1996, c.179.

Human Rights Code, R.S.B.C. 1996, C.210.

Medicare Protection Act, R.S.B.C. 1996, c.286.


Auton (Guardian ad litem of) v. British Columbia (A.G.) (2000), 78 B.C.L.R. (3d) 55 (Auton #2).

British Columbia (Public Service Employees Relations Comm.)v. B.C.G.E.U. (1999), 35 C.H.R.R. D/257.

British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights) (1999), 36 C.H.R.R. D/129.

Chipperfield v. British Columbia (Ministry of Social Services) (No.3) (1998), 33 C.H.R.R. D/340 (B.C.H.R.T.).

Eaton v. County Board of Education, [1997] 1 S.C.R. 241.

Eldridge v. British Columbia, [1997] 3 S.C.R. 624.

Entrop v. Imperial Oil Ltd., [2000] O.J. 2689 (Ont. CA), 50 O.R. (3d) 18.

Granovsky v. Canada (Minister of Employment and Immigration), [2000] 1 S.C.R. 703.

New Brunswick (Minister of Health & Community Services) v. G.J., [1999] 3 S.C.R. 46.

Rodriguez v. British Columbia (A.G.), [1993] 3 S.C.R. 519.

R. v. Anderson (1990), 53 CCC (3d) 481 (SCC).

R. v. Barron (1985), 23 CCC (3d) 544 (Ont. CA).

R. v. Gingrich (1991), 65 CCC (3d) 188 (Ont. CA).

R. v. Morgentaler,[1988] 1 S.C.R. 30.

R. v. Nelson (1990), 54 CCC (3d) 285 (Ont. CA).

R. v. Oakes, [1986] 1 S.C.R. 103.

R. v. Parker, [2000] O.J. No. 2787 (Ont. CA).

R. v. Tutton (1989), 69 CR (3d) 289 (SCC).

R. v. Ubhi (1994), 27 CR (4th) 332 (BCCA).

R. v. Waite (1989), 69 CR (3d) 323 (SCC).

R. v. Nguyen (1995), 56 B.C.A.C. 290, at para 13, citing Oliver J. in R. v. Ping Li (unreported, November 19, 1993) Vancouver Registry No. CC930521.

Toronto Dominion Bank v. Human Rights Commission (1998), 163 D.D.R. (4th) 193 (FCA).


Canada Communicable Disease Report, “Hepatitis C – Prevention and Control: A Public Health Consensus”, Vol. 2552 (Supplement, June 1999; online:

Canadian National Task Force on HIV, AIDS and Injection Drug Use, “HIV/AIDS and Injection Drug Use: A National Action Plan (1997)”, at 3-4, online:

Fischer, B., Rehn, J., Blitz-Miller, T., (2000), “Injection Drug Use and Preventive Measures: A Comparison of Canadian and Western European Jurisdictions Over Time”, Canadian Medical Association Journal, 162(12), 1709-1713.

Jurgens, R. & Elliot, R. eds., Injection Drug Use and HIV/AIDS: Legal and Ethical Issues (Montreal: Canadian HIV/AIDS Legal Network, 1999).

Kate Nolan et al., “Drug Consumption Facilities in Europe and the Establishment of Supervised Injecting Centres in Australia”, (2000) 19 Drug and Alcohol Review, 337.

Kerr, Thomas, Safe Injection Facilities: Proposal for a Vancouver Pilot Project (Vancouver: Harm Reduction Action Society, 2000)

Lindesmith Centre, Research Summary: Safe Injection Rooms, (1999) online:

Lindemsith Centre, Research Brief: Safer Injection Rooms, (1999) online:

Lindesmith Centre-Drug Policy Foundation, online:, cited December 10, 2001.

Martin Schechter, et al, “Do Needle Exchange Programmes Increase the Spread of HIV Among Injection Drug Users?: An investigation of the Vancouver Outbreak”. AIDS, 1999, 13:F45-F51.

Ministry for Children and Families. (1998) Report on the Status of the Implementation of the Recommendations of: The Review of Alcohol and Drug Services in Vancouver.

Ministry for Children and Families. Addiction Services: Our Mission and Mandate. (Victoria: Ministry of Children and Families, September 2000) at 1. Last revised September 20, 2001.

Parry, Penny “Something to Eat, A Place to Sleep and Someone Who Gives a Damn”, HIV/AIDS and Injection Drug Use in the DTES, Final project report to the DTES Community, Minister of Health and V/RHB, 1997.

Selected Vital Statistics and Health Status Indicators, 1996-2000: Drug induced deaths by age and gender. Victoria: British Columbia Vital Statistics Agency.


  1. UPDATE OCTOBER 19, 2009:

    CBC News reports on a new study that suggests that crack cocaine users are at increased risk of being infected with HIV and that safe smoking rooms could reduce that risk. Read the study at:

    Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs

    For a commentary on the study, which was published in the Canadian Medical Association Journal, see:

    The changing landscape of crack cocaine use and HIV infection

  2. UPDATE JANUARY 15, 2010:

    CBC NEWS - B.C. court affirms injection site's right to exist

    The B.C. Court of Appeal has dismissed an attempt by the federal government to shut down Vancouver's supervised injection site on the city's troubled Downtown Eastside.

    The federal government appealed a previous B.C. Supreme Court ruling in favour of Insite, and on Friday morning in Vancouver, the B.C. Appeal Court confirmed the injection site's constitutional right to exist.

    Read more at:

  3. UPDATE FEBRUARY 9, 2010

    CBC News - Ottawa to appeal injection site ruling

    The federal government is asking the Supreme Court of Canada for leave to appeal a lower court ruling that sanctioned Vancouver's supervised drug injection site.

    The case has raised important questions about the division of powers among federal and provincial governments that need answers, said Justice Minister Rob Nicholson on Parliament Hill Tuesday.

    Read more at:

  4. UPDATE JUNE 7, 2010

    A new study published in the Lancet medical journal on May 29, 2010 has come to the following conclusion:

    "Treatment with supervised injectable heroin leads to significantly lower use of street heroin than does supervised injectable methadone or optimised oral methadone. UK Government proposals should be rolled out to support the positive response that can be achieved with heroin maintenance treatment for previously unresponsive chronic heroin addicts."

    A pdf of the study is available at: Two news reports on the study are here and here.

  5. UPDATE JUNE 24, 2010

    CBC News - Supreme Court to hear injection site appeal

    Canada's top court has announced it will hear the federal government's appeal in relation to Vancouver's supervised drug-injection site.

    UPDATE AUGUST 30, 2010

    CBC News - CMA Journal article backs drug injection site

    An article in the Canadian Medical Association Journal slams the federal government for its efforts to shut down Insite in downtown Vancouver, Canada's only safe injection site for drug addicts.

    A co-author of the paper has told CBC News he believes the federal government should stand aside, allow the centre to operate, and abandon an appeal to the Supreme Court

    "We've concluded after reviewing the evidence that Insite is doing what it's supposed to be doing, and furthermore that we're very concerned that the federal government has misled on the science," said Dr. Michael Rachlis, a professor of health policy at the University of Toronto.

    Read more at:

  6. UPDATE APRIL 17, 2011

    CBC News - Vancouver injection clinic cuts overdose deaths: journal

    Overdose deaths in Vancouver's troubled Downtown Eastside have dropped by more than a third since the creation of Insite, the neighbourhood's supervised injection clinic, according to a study in the British medical journal The Lancet.
    see summary at:

    The Lancet commentary accompanying the new study notes the issue is "politically fraught," adding supervised injection facilities "should be expanded to other affected sites in Canada, based on the life-saving impacts identified in Vancouver."
    read more at:

    UPDATE MAY 10, 2011

    The Tyee - Band of mayors petition feds on fate of Insite

    Vancouver mayor Gregor Robertson and five of his predecessors called on the federal government today to reconsider its opposition to the Insite safe injection facility.

    Eleven other groups that filed for intervener status will also make arguments tomorrow. The BC Nurses Union is among them. The union issued a press release Monday declaring its support.

    "It is simply disgraceful that the federal government continues to try and outlaw this legitimate healthcare service and in the process attempt to make criminals out of nurses who are saving lives and providing quality care to this vulnerable population," said union vice president Janice Buchanan.

    Other intervening parties that support Insite include the BC Civil Liberties Association, the Canadian Medical Association and the Dr. Peter AIDS Foundation

    UPDATE JULY 31, 2011

    CBC News - Free crack pipes to be handed out in Vancouver

    Health officials in Vancouver say they will launch a pilot project later this year to distribute clean, unused crack pipes to drug users. ... It's part of the city's harm-reduction strategy that seeks to reduce the transmission of disease while ensuring health-care and social workers are able to interact with hard-to-reach drug addicts. ... The calls for free crack pipes comes as advocates in Vancouver also push for a safe-inhalation site, where crack users could smoke the drug in the presence of health-care workers, who would respond to overdoses. Any decision on such a site will likely have to wait until the Supreme Court of Canada rules on the future of the city's safe-injection site, known as Insite.

    CBC News - UPDATE September 30, 2011

    Vancouver's Insite drug injection clinic will stay open.
    Top court rules on clinic's exemption from federal drug laws.

    Vancouver's controversial Insite clinic can stay open, the Supreme Court said Friday in a landmark ruling. In a unanimous decision, the court ruled that not allowing the clinic to operate under an exemption from drug laws would be a violation of the Charter of Rights and Freedoms.

    The court ordered the federal minister of health to grant an immediate exemption to allow Insite to operate.

    "Insite saves lives. Its benefits have been proven. There has been no discernible negative impact on the public safety and health objectives of Canada during its eight years of operation," the ruling said, written by Chief Justice Beverley McLachlin.


    Canada (Attorney General) v. PHS Community Services Society, 2011 SCC 44

  7. June 24, 2013

    War on Drugs failing to limit drug use in Vancouver

    A comprehensive report on the drug situation in Vancouver shows health-focused policies have been more effective than federal law enforcement measures at reducing illicit drug use and improving public health and safety.

    Researchers at the Urban Health Research Initiative (UHRI) at the BC Centre for Excellence in HIV/AIDS compiled 15 years of data in response to the ongoing public and individual health-related harms resulting from illicit drug use, including HIV and hepatitis C transmission.

    “Drug trends in Vancouver are shifting, with fewer people injecting drugs and more people ceasing their use, a result of the innovative harm reduction and addiction treatment programs implemented,” said Dr. Thomas Kerr, report co-author and UHRI co-director. “It’s important policymakers at all levels of government take note of this evidence and focus efforts on approaches proven to be more effective. Continuing to invest in failed policies like the war on drugs does little to reduce health and social harms.”

    The Drug Situation in Vancouver report includes detailed information on drug use trends, drug availability, HIV rates, and behaviors among some of the city’s most vulnerable people who use illicit drugs. The analysis found:

    Fewer people using injection drugs
    Significant decrease in syringe sharing and related HIV and hepatitis C transmissions
    Increase in drug cessation and access to addiction treatment
    Unchanged ease of access to and affordability of illicit drugs

    Among people who use drugs in Vancouver, methadone maintenance treatment increased from 11.7 per cent in 1996 to 54.5 per cent in 2008, remaining stable since. In addition, reports of difficulty accessing addiction treatment dropped from 19.9 per cent in 1996 to as low as 3.2 per cent in 2006, and has remained below 1996 levels. There was a corresponding upward trend of injection drug use cessation during a similar period, with a rate of just 0.4 per cent in 1996 compared to 46.6 per cent in 2011. Conversely, researchers found between 2000 and 2011 illicit drugs remained easily accessible and prices were stable.

    “The availability of drugs in Vancouver is troubling, however, consistent with international trends highlighting the overall success of market factors in making drugs freely and easily available,” said Dr. Evan Wood, report co-author and Canada Research Chair in Inner City Medicine at UBC. “While there have been public health benefits of the harm reduction strategies, the best strategy is to expand evidence-based addiction treatments to reduce demand for drugs and reduce the size of the drug market.”

    continued below

  8. While there has been an overall decline in illicit drug use since 2007, there has been an increase in the use of some drugs. Among street-involved youth, for instance, there is a high rate of crystal methamphetamine use, with rates of injection having doubled since 2010.

    “Needle exchanges and the supervised injection facility have proven to save lives, but drug use trends are changing and policies and programs should reflect these changes,” said Lorna Bird, a drug user and member of the Western Aboriginal Harm Reduction Society. “We need more harm reduction interventions, like safer crack smoking kits, supervised consumption facilities for people who smoke illicit drugs, and programs focused on at-risk youth.”

    Among the key ongoing factors contributing to high-risk behaviours associated with illicit drug use is the prevalence of unstable housing among people who use drugs, which continues to be between 50 and 70 per cent. Unstable housing includes homelessness, shelters, and Single Room Occupancy hotels.

    “Homelessness and unstable housing amplify harms experienced by drug users,” said Dave Hamm, board member of the Vancouver Area Network of Drug Users (VANDU). “Quality affordable housing is critical to reducing the harms associated with using currently illicit drugs and connecting drug users to supports and programs that will help them live healthy, productive lives.”

    Drug Situation in Vancouver report:

  9. UPDATE: SEPTEMBER 30, 2013

    Today marks the two-year anniversary of the decision by the Supreme Court of Canada in support of Insite, Vancouver’s supervised injection service, to continue to save lives and promote public health. The Canadian Drug Policy Coalition, in conjunction with PIVOT Legal Society and the Canadian HIV/AIDS Legal Network, sent a letter to federal Health Minister Rona Ambrose expressing deep misgivings about attempts by Ambrose’s government to hold back the implementation of new safer consumption services in Canada. You can view a copy of the letter here:

  10. Drug users sue Abbotsford over anti harm reduction bylaw

    CBC News May 21, 2013

    Advocates for needle exchanges are suing the City of Abbotsford, saying the city's bylaw which bans harm reduction centres violates basic human rights.

    The city, located in the Fraser Valley east of Vancouver, has a 2005 zoning bylaw that prevents methadone treatment clinics, needle exchanges and supervised injection sites from setting up.

    "It's become difficult for people to have clean needles," said Scott Bernstein, a lawyer with Pivot Legal Society, who is launching a lawsuit and a human rights complaint on behalf of three illicit drug users.

    "People who use drugs are actually entitled to the same level of health care as everybody else."

    The Fraser Health Authority asked the city to lift the ban in 2010, but the motion failed to pass. A public consultation was held earlier this year, but no decision has been announced.

    Berstein says he hopes the lawsuit will prompt action for some 500 injection drug users in Abbotsford, whose lives are at risk because the bylaw has prevented clean needle distribution and other live-saving public health programs in the city.

    Abbotsford Mayor Bruce Banman declined to comment.

    Abbotsford reconsiders ban on harm reduction facilities

    CBC News January 22, 2013

    The City of Abbotsford is holding a public consultation tonight as it reconsiders its eight-year old ban on harm reduction centres, including medical marijuana dispensaries and needle exchanges.

    The city, which is located in the Fraser Valley east of Vancouver, has a zoning bylaw that prevents methadone treatment clinics, needle exchanges and supervised injection sites from setting up.

    Mayor Bruce Banman says the ban on pot dispensaries is unlikely to be changed, but he can see the benefit of allowing other harm reduction facilities.

    "I've said publicly all we have to do is reduce one case of AIDS and a couple cases of hepatitis C and this program pays for itself."

    Banman adds that the real harm reduction has to happen at the detox level, and that's the Fraser Health Authority's responsibility.

    The forum takes place tonight at 7 p.m. PT at the Matsqui Centennial Auditorium.

    The city considered lifting the ban in 2010 but the motion failed to pass. see:

  11. Vancouvers Harm Reduction Approach Is Working

    A 15-year study shows that fewer people use and inject drugs since the city adopted a public health approach and opened a safe injection site.

    By McCarton Ackerman, The Fix June 25, 2013

    A newly published 15-year study indicates that Vancouver's progressive efforts in harm reduction have effectively reduced illegal drug use and improved public safety.

    see: Urban Health Research Initiative

    The report by the BC Centre for Excellence in HIV/AIDS examined drug use from 1996-2011 in the city's impoverished Downtown Eastside, once known as "Ground Zero" for HIV and overdoses. The city then adopted a harm reduction approach that included opening Insite, Canada's first legal supervised injection site, in 2003. Dr. Thomas Kerr, co-author of the report and co-director of the center's Urban Health Research Initiative, says fewer people in the area are using drugs—and out of those who still do, fewer are injecting. Almost 40% of users reported sharing needles in 1996; that number dropped to 1.7% in 2011. The percentage of users who accessed methadone treatment jumped from 12% to 54% during that time period. The study also found fewer new HIV and Hepatitis C infections related to sharing needles. "A public health emergency was declared here because we saw the highest rates of HIV infection ever seen outside of sub-Saharan Africa—in this community," says Kerr. "At the same time, the community was being leveled by an overdose epidemic."

    However, Canada's Conservative government still opposes Vancouver's programs. It introduced the Respect for Communities Act earlier this month, which will require applicants to consult with community, provincial and municipal authorities and law enforcement officials before setting up new supervised injection facilities. "We have a federal government that ignores science in favour of ideology, and people are sick and dying as a result," says Kerr. "When we're dealing with matters such as life and death, I think we're obligated to base our decisions on the best available scientific evidence. I think it's unethical to do otherwise." Canada's Supreme Court decided in 2011 that Insite could continue to operate, but the new federal legislation will make it much harder for similar sites to open. There are no legal safe injection sites in the US.

  12. War on Drugs failing to limit drug use in Vancouver

    New report finds declines in drug use associated with harm reduction services, not law enforcement efforts.

    British Columbia Centre for Excellence in HIV/AIDS June 24, 2013

    Vancouver, B.C. (June 24, 2013)A comprehensive report on the drug situation in Vancouver shows health-focused policies have been more effective than federal law enforcement measures at reducing illicit drug use and improving public health and safety.

    Researchers at the Urban Health Research Initiative (UHRI) at the BC Centre for Excellence in HIV/AIDS compiled 15 years of data in response to the ongoing public and individual health-related harms resulting from illicit drug use, including HIV and hepatitis C transmission.

    “Drug trends in Vancouver are shifting, with fewer people injecting drugs and more people ceasing their use, a result of the innovative harm reduction and addiction treatment programs implemented,” said Dr. Thomas Kerr, report co-author and UHRI co-director. “It’s important policymakers at all levels of government take note of this evidence and focus efforts on approaches proven to be more effective. Continuing to invest in failed policies like the war on drugs does little to reduce health and social harms.”

    The Drug Situation in Vancouver report includes detailed information on drug use trends, drug availability, HIV rates, and behaviors among some of the city’s most vulnerable people who use illicit drugs. The analysis found:

    --Fewer people using injection drugs

    --Significant decrease in syringe sharing and related HIV and hepatitis C transmissions

    --Increase in drug cessation and access to addiction treatment

    --Unchanged ease of access to and affordability of illicit drugs

    Among people who use drugs in Vancouver, methadone maintenance treatment increased from 11.7 per cent in 1996 to 54.5 per cent in 2008, remaining stable since. In addition, reports of difficulty accessing addiction treatment dropped from 19.9 per cent in 1996 to as low as 3.2 per cent in 2006, and has remained below 1996 levels.

    continued in next comment...

  13. There was a corresponding upward trend of injection drug use cessation during a similar period, with a rate of just 0.4 per cent in 1996 compared to 46.6 per cent in 2011. Conversely, researchers found between 2000 and 2011 illicit drugs remained easily accessible and prices were stable.

    “The availability of drugs in Vancouver is troubling, however, consistent with international trends highlighting the overall success of market factors in making drugs freely and easily available,” said Dr. Evan Wood, report co-author and Canada Research Chair in Inner City Medicine at UBC. “While there have been public health benefits of the harm reduction strategies, the best strategy is to expand evidence-based addiction treatments to reduce demand for drugs and reduce the size of the drug market.”

    While there has been an overall decline in illicit drug use since 2007, there has been an increase in the use of some drugs. Among street-involved youth, for instance, there is a high rate of crystal methamphetamine use, with rates of injection having doubled since 2010.

    “Needle exchanges and the supervised injection facility have proven to save lives, but drug use trends are changing and policies and programs should reflect these changes,” said Lorna Bird, a drug user and member of the Western Aboriginal Harm Reduction Society. “We need more harm reduction interventions, like safer crack smoking kits, supervised consumption facilities for people who smoke illicit drugs, and programs focused on at-risk youth.”

    Among the key ongoing factors contributing to high-risk behaviours associated with illicit drug use is the prevalence of unstable housing among people who use drugs, which continues to be between 50 and 70 per cent. Unstable housing includes homelessness, shelters, and Single Room Occupancy hotels.

    “Homelessness and unstable housing amplify harms experienced by drug users,” said Dave Hamm, board member of the Vancouver Area Network of Drug Users (VANDU). “Quality affordable housing is critical to reducing the harms associated with using currently illicit drugs and connecting drug users to supports and programs that will help them live healthy, productive lives.”

    The 56-page Drug Situation in Vancouver report was released at Carnegie Community Centre in Vancouver and is available online at:

  14. Best evidence says supervised injection sites are ‘best care’

    by THOMAS MAN, The Globe and Mail July 05, 2013

    Supervised injection sites are places where people can safely inject drugs under medical supervision. Understandably, there are many questions and concerns regarding the existence and creation of more such sites in Canada. As a taxpayer, health-system user and family physician, I share many of these concerns. But first, I’d like you to meet John.

    Every three months, John walks into my office and refills his medications. He is a middle-class working citizen with three children. He has high blood pressure and high cholesterol, is 15 pounds overweight and was recently diagnosed with prediabetes. At each visit, we discuss the need for 30 minutes of daily exercise and better eating habits.

    John and I both realize that his health, finances, family, quality of life and mortality are all at stake. But changing behaviour can be difficult. There are numerous hurdles to overcome, including current and past circumstances, genetics and his individual choice, all of which contribute to his state of health.

    As John tackles these hurdles, I write his prescriptions and work with him to find ways to reduce the risks. After all, they will affect his life, his family and, probably, other Canadians. The national cost of heart disease and stroke is upward of $20-billion a year.

    So how does his situation relate to injection drug use? Much like John’s lifestyle, injection drug use has been repeatedly shown to be a product of current and past circumstances, genetics and individual choice. Injection drug use affects the individual, families and other Canadians.

    I’m concerned about the harms associated with users injecting in public spaces, stray needles, crime rates, health complications, health-care spending and the morality of funding supervised drug use. But I’m also relieved by what I have learned.

    The majority of studies published in medical journals have shown that government-established supervised injection sites and needle exchanges do not increase drug use or drug users. They do not increase drug-related criminal activity, according to Vancouver Police Department statistics. Rather, multiple studies have shown that there is less injection drug use in public spaces, fewer stray needles and a corresponding increase in the number of needles discarded in neighbourhood safe disposal boxes.

    In regards to health concerns, supervised injection sites have been associated with safer injection practices. By accessing the appropriate addiction, social, and preventative health services through these sites, there is less need for delayed, complicated and significantly more expensive medical treatments. While the yearly operating cost of Canada’s first supervised injection site is about $3-million, the prevention of the spread of HIV alone is estimated to save Canadians more than $5-million a year in health-care costs.

    Finally, is it moral to fund a site for the supervision of drug use? Each of us will have to find his or her own answer. Speaking for myself, I refuse to pick and choose which patients deserve compassionate care and which deserve righteous judgment.

    At the end of the day, I will advocate for supervised injection sites the same way that I advocate for John and all my patients’ health: using the best available evidence to provide the best available care, regardless of my biases toward each patient’s current or past experiences, genetics or decisions.

    It’s our health. They’re our taxes. Let’s take care of them together.

    Dr. Thomas Man is a family physician in Toronto.

  15. Abbotsford drug bylaw goes to human rights tribunal

    City passed bylaw in 2005 to block access to supervised injection sites

    CBC News July 18, 2013

    The City of Abbotsford will have to answer to the B.C. Human Rights Tribunal after allegations its anti-harm reduction bylaw discriminates against drug users.

    Abbotsford amended its zoning in 2005 to block access to facilities such as sterile needle exchanges and supervised injection sites.

    Barry Shantz with the B.C.-Yukon Association of Drug War Survivors, the group behind the human rights complaint, says the city acted outside its jurisdiction and violated the Charter rights of drug users.

    “Drug users are consistently facing stigma and discrimination in Abbotsford,” he said.

    “The tribunal’s acceptance of our complaint and Drug War Survivors as representatives for the marginalized and vulnerable is a good first step in giving us some dignity back.”

    Shantz argues drug addiction should be treated as a medical issue, not a criminal one.

    “This is a confidence-builder,” he said.

    “All of the scientific evidence supports harm reduction. The most studied medical facility on the planet is InSite [Vancouver’s supervised injection site]. Double thumbs up from any research and study that ever happens here. So we are cranking up the heat.”

    The Fraser Health Authority has a harm reduction plan for Abbotsford, but has been unwilling to implement it while the city's bylaw stands.

    The B.C. Human Rights Tribunal is expected to hear the complaint early next year.

  16. Insite helped me battle drug addiction and win

    by Guy Felicella, Vancouver Observer August 4th, 2013

    I have used drugs since 1991, and started injecting them in 1997.

    I used in back alleys, all day and every day. I became consumed by heroin and truly believed that there was no hope for me.

    Heroin was my friend. It never judged me; it was always warm and made me feel like I could do anything. The Downtown Eastside is a tough place for anyone, but it is one place where everyone who doesn’t fit in is accepted, and I fit right in.

    I’m one of the lucky ones who escaped without catching HIV even after using in the dirtiest of places, but when you’re addicted, you don’t care about health. Most people would use others needles, share hits of drugs but I always thought it wasn’t worth it so I used my own stuff, never sharing.

    In the late 1990s to early 2000s, things became so bad in the DTES that overdoses and HIV were spreading at a rapid pace. There were handfuls of people handing out clean needles, but most people would just share and it began to look pretty terrible for all addicts downtown.

    In 2003 Insite came into the picture and I was one of the first people to sign up. They preached of a safe environment and a place where you can use in safety. In 2009, 484 overdoses occurred there with no fatalities.

    I learned so much from the staff there. I finally felt like someone cared, and you could really feel the love. In a place where it seemed impossible to get clean, people now had the choice to change their lives.

    If you ever wanted help, it was right upstairs. I have been a part of the recovery program at Onsite on more than one occasion, and every time I started using again, they never judged me. They would always say: “Next time, you’ll do it.”

    In fact, Insite saved my life on three occasions, twice in one day. I did a lethal dose of heroin and was dead for six minutes and 53 seconds. The nurse Sara brought me back and I remember waking up and crying, telling her I didn’t want to use anymore.

    So back upstairs to Onsite treatment I went. What people often don’t understand is how hard recovery can be, and I left once again. The staff at Onsite still supported me; they never gave up on me even when I gave up on myself.

    In December 2012, I became suicidal and lost my desire to live. A nurse at Insite named Cookie took the time out of her day to calm me down and it was her kind words that inspired me to give it another try.

    So the journey began again and I stopped using on March 18, 2013. I’m currently in a treatment center and this is the most work I have ever done on myself.

    It is because of God and Insite/Onsite that I am where I am today. If they didn’t exist in my life, I wouldn’t be here, and neither would many others.

    The people who work there care so much about human life, from the front desk all the way down to the chill room. They give hope to people who live and struggle with addiction.

    They care if you use, they care if you want to get clean, they care about you, period.

    They give you options and choices and it is up to you, but at least the choice is there. Before Insite and Onsite, there was no choice but to use or die. Society puts so much emphasis on the fact that drug users are bad, but we are human beings.

    Doesn’t everyone deserve the right to get clean or to use in a safe environment with the support of kind staff who will break their backs to help you? You see, compassion is the answer. Never give up on someone because you never know when your kind gesture might inspire them to get clean.

    I know it worked for me, and it can work for countless others. I think Onsite is the best thing that has ever happened to Vancouver and I would go to any length to support them. They inspired me to get my life back.

  17. Vancouvers Insite celebrates 10 years as threat of Conservatives Bill C-65 looms


    It's ironic, and typical, that as Insite celebrates its 10th anniversary of successful operation in Vancouver's Downtown Eastside, the Conservative government in Ottawa is still railing against Safe Injection Sites and no doubt has Bill C-65 ready to go when Parliament returns October 16.

    Bill C-65, An Act to amend the Controlled Drugs and Substances Act, was the last bill to be introduced before parliament recessed in June. It's a nasty bill, couched in anti-harm reduction rhetoric, full of misconceptions, and designed to shut down any attempt to open a safe injection site in Canada.

    The bill is a shining example of Conservative ideology trumping evidence-based health and science.

    But try as hard as they can -- Insite just won't go away and nor will public support for it. After numerous court rulings, including the Supreme Court of Canada, enormous public scrutiny, more than 24 peer reviewed scientific studies, Insite will continue no matter what legislation the Conservative government throws at it.

    September 2003 marks the opening of Insite, but the struggle to get there began many years before that.

    The original application to Health Canada was subject to a run of hurdles that would have challenged an Olympic athlete. The then Liberal government was wary and skeptical of approving the original Section 56 exemption under the Controlled Drug and Substances Act that was needed for Insite to operate. Mounting public pressure, particularly from Vancouver, forced the government into giving the exemption and Insite launched its critically needed services.

    Insite opened as part of a public health plan after a 12-fold increase in overdose deaths in Vancouver between 1987 and 1993. At the time, the Vancouver area was also seeing drastic increases in communicable diseases amongst injection drug users, including Hepatitis A, B, and C and HIV/AIDS.

    What has been remarkable about Insite is its ability to overcome political challenges and retain strong community support.

    I remember vividly, participating in a community action named "1000 Crosses" in Oppenheimer Park. The crosses represented the people who had died needlessly from drug overdoses. I vowed to take the message for action to Ottawa, as a newly elected Member of Parliament.

    continued below

  18. I recall how opposed the local business community was at first when Insite was first raised as a needed health intervention and to save the lives of injection drug users. I remember meeting with Allan Rock, then Minister of Health in in Ottawa in 1997, and later, with Bud Osborn, who came to a second meeting to convince the Minister that Insite could turn the tide of preventable drug overdoses. Bud presented Allan Rock with a book of his powerful poetry that spoke the truth about the situation in the Downtown Eastside. Poetry that became a rallying call for action, and this excerpt from Bud's poem stays with me:

    "...but with these thousand crosses
    planted in oppenheimer park today
    who really see them
    feel sorrow
    feel loss
    feel rage
    our hearts shed bitter tears
    these thousand crosses are symbols
    of the social apartheid in our culture
    the segregation of those who deserve to live and those who are abandoned to die these thousand crosses represent the deaths of drug addicts these thousand crosses silently announce a social curse on the lives of the poorest of the poor in the downtown eastside....".

    Even in opposition the Conservatives wouldn't consider a shred of mounting evidence that Insite was part of the solution, not the problem. Prior to the 2006 election we invited Stephen Harper to visit the facility on East Hastings Street, to see for himself what important work was underway. Of course he refused.

    Conservatives don't like reality to confuse their "truth."

    Insite had to fight tooth and nail to get its permits to operate extended, while in Ottawa in 2007 the Conservative government eliminated "Harm Reduction" from Canada's Drug Strategy. But still Insite continued to garner positive international reviews and continued to save lives.

    Ten years marks a sustained commitment by the Vancouver Network of Drug Users (VANDU), and the Portland Hotel Society and many others who never shied away from the belief that drug users have human rights, dignity and a right to access health care.

    For my part, I'm proud to have been part of this struggle for INSITE and what it stands for. I remain determined to defeat not only Bill C-65, but also the architects of the absurd stance that public policy can ignore scientific evidence.

    Libby Davies is the Member of Parliament for Vancouver East.

  19. Fentanyl overdoses Why a safe injection site is an election issue

    Overdose deaths cast light on Insite's decade-long battle with Conservatives

    By Jason Proctor, CBC News August 11, 2015

    From his vantage point on the sidewalk next to Vancouver's supervised injection site, Jace Korpan watched a suspected fentanyl crisis unfold on Sunday.

    Korpan, a regular presence in the Downtown Eastside, says he is not a drug user but is familiar with the Insite facility.

    There was a lineup outside the door, and as word of overdoses on the street spread, workers ran back and forth to administer an antidote. The price of failure: death.

    "Because of them, people are here still," said Korpan. "That's the honest truth. That's the bottom line."

    An election issue?

    You won't get much of an argument on that point from the addicts, business people and residents nearby.

    Nor from the province, medical authorities or the Vancouver police, who put out a warning about a deadly batch of pink heroin, potentially tainted with fentanyl, in the hours after 16 people overdosed last weekend.

    But more than a decade after opening its doors and getting support all the way to the Supreme Court of Canada, North America's first legal supervised injection site is still fighting Ottawa for survival.

    Advocates say that battle may add a political edge to the current fentanyl crisis.

    "I would be happy if this was an election issue," said Dr. Patricia Daly, chief medical health officer with Vancouver Coastal Health.

    Most of the recent headlines around fentanyl have come from the shocking deaths of recreational users: a popular Burnaby teen; and the young North Vancouver parents of a two-year-old, now orphaned.

    But there's another side to the problem; fentanyl has also cut a swath through the Lower Mainland's sizable population of habitual and injection drug users, where the synthetic opioid is passed off as OxyContin or cut into heroin.

    "The value of a place like Insite — and we've seen this through a number of studies — is that overdoses do occur there, but there's immediate medical resources available, so that there have been no deaths from overdoses," said Daly.

    "Even people who have had suspected fentanyl overdoses."

    In fact, it was following a rash of fentanyl-related overdoses at Insite last October that police began an investigation, which they claim led them to a major distributor of the drug.

    continued below

  20. Respect for communities

    Insite opened in 2003, partly in response to an earlier heroin crisis that saw as many as 200 people dying annually in the Downtown Eastside by the mid-1990s.

    But the Conservative government has opposed the facility from the start, arguing communities should focus on prevention and enforcement, as opposed to helping addicts essentially poison themselves.

    The fight ultimately wound up at the Supreme Court of Canada, whichfound Insite "saves lives" and ruled unanimously that the facility should be allowed to operate under an exemption from drug laws.

    In response to the ruling, the Conservatives introduced Bill C-2, the Respect for Communities Act, which passed into law this June.

    At the time, Health Minister Rona Ambrose said the legislation established "rigorous criteria" for the type of exemption a supervised drug injection site would need to operate.

    "This law requires that the voices of law enforcement and parents be heard before drug injection sites can be considered to open in local neighbourhoods," she said.

    But advocates claim the rules instead set a bar no facility will be able to clear. Pivot Legal Services Society lawyer Adrienne Smith argued against Bill C-2 in front of a parliamentary committee.

    "With this law in force, even if there were a Liberal or NDP health minister who wanted to grant an exemption, the wording of the legislation makes it nearly impossible," Smith said.

    "So this Conservative government on its way out the door has effectively barred access to supervised injection services that could save lives across the country in the midst of a fentanyl crisis."

    At present, Insite has to apply for its exemption every year.

    No 'magic treatment'

    Obviously, the government doesn't see things that way.

    Daly said she doesn't want to see young people taking drugs either, and she'd also like to help addicts stop using.

    "I'm in agreement with the government on that," she said.

    "But where we disagree on that is we both have those goals, but how do we get there? I don't have a vaccine that can prevent addiction, and I don't have a magic treatment for addiction."

    As with everything in Vancouver's drug wars, there appears to be a gulf between ideology and on-the-ground reality; politics fill the gap.

    On the sidewalk near Insite, a dozy man sitting near Korpan speaks up: "I challenge you to find me some real heroin right now."

    As Korpan nods, the man says the street is flooded with synthetic drugs. A lot of it is fentanyl.

    That's reality. So is addiction. And regardless of the risk, desperate people are going to inject.

    Which means overdoses are going to happen.

  21. With Drug Policy in Election Spotlight, Insite Earns International Praise

    With the election heating up, drugs and addiction are becoming a divisive issue in federal party platforms. The Liberals and NDP promise to legalize or decriminalize marijuana while the Conservatives continue to promise tougher legislation.

    Canadian drug policies are once again earning international attention: British journalist Johann Hari spent four years studying Insite and other international treatment programs for his book Chasing the Scream: The First and Last Days of the War on Drugs. He recently sat down with TVO's The Agenda to talk about his findings.

    Addiction, he says, is neither caused by drugs nor the people who use them, but rather by unstable and unsupportive environments. When people feel isolated and disconnected from society, that is when addiction happens.

    He points to projects like Insite in Vancouver's Downtown Eastside, Portugal's decision to decriminalize all drugs, and Switzerland's prescription heroin program as successes in reintegrating addicts into society and reducing their reliance on chemicals.

  22. Safe Injection Facilities

    Out of Harm's Way

    By Keri Blakinger, The Fix October 7, 2015

    No one has ever died shooting heroin in an injection center anywhere around the world. So, why are they still illegal in the US?

    Damien Trimingham was a bright kid. He was well-liked and a successful athlete. He came from a good family. He did not seem destined for a life of addiction— and indeed he wasn’t.

    At just 22, Damien died of a heroin overdose.

    The police did not notify his worried family for three days.

    That was in February of 1997, and now almost two decades later, his father Tony, a psychotherapist, has become a leading voice in harm reduction.

    On Sept. 30, he recounted his son’s story to a crowd of more than 200 at “Out of Harm’s Way,” a panel discussion in Manhattan.

    “It was, of course, a shock even though we knew that death was a possibility with heroin use,” he said. At the time of his death, Damien was trying to stay clean. His father said, “That’s one of the ironies of heroin use, that the people who die are often the ones trying to give it up.”

    He continued, “I was to find out later that no one has ever died in an injection center anywhere around the world, even though there are many overdoses.”

    That’s when Tony latched onto the idea of safe injection facilities (SIFs). Although they aren’t legal in the United States (yet), there are around 100 SIFs operating around the world, in places like Canada, Spain, Germany, Holland, and Norway.

    The idea is that SIFs provide a safer environment for injection drug users. Staff are available to teach safe injection practices and clean syringes are free for the taking. Crucially, there’s also naloxone available to treat overdoses immediately, without any fatalities.

    Predictably, SIFs tend to face some initial resistance, but in Australia, Tony was instrumental in turning the tide of public opinion.

    The year that Damien died, the Australian government proposed a heroin prescription program, but ultimately the prime minister vetoed it. But the time seemed ripe for harm reduction and so Tony took action. He wrote a letter to the local paper, describing his son’s death and explaining how unnecessary it was. The paper published his piece on the front page, and it sparked debate.

    After four years of lobbying and advocating, Tony said, “We got our injection facility, thank goodness.” He added, “It was a hard road because there were opponents.”

    Overall, though, he said it’s often apathy and not opposition that is the toughest obstacle. “Most of the general public don’t really care,” he said. “They’re not pro, they’re not against. It doesn’t affect them.”

    Like Australia, Germany has safe injection sites, and another of the panelists—former Frankfurt drug czar Werner Schneider—documented the history of his city’s harm reduction efforts. Frankfurt began exploring harm reduction in earnest in the 1990s in response to a significant uptick in heroin use. That exploratory work quickly led to the creation of a safe injection facility.

    Schneider said, “The most important result of this program was a tremendous reduction of drug-use related death cases.” Simultaneously, the city witnessed a decrease in criminality and also a decrease in public concern about drug use as a major citywide problem.

    Like Frankfurt, Vancouver experienced a ballooning heroin problem in the '90s. Canadian Senator Larry Campbell—a former law enforcement officer who was also the mayor of Vancouver—told the crowd that as overdose deaths skyrocketed, so did HIV and incarceration rates.

    continued below

  23. After a decade as a cop and two as a coroner, Campbell got tired of watching the bodies pile up, and so in 2002 he ran for mayor.

    “I ran on the platform that I would open a supervised injection site in Vancouver,” he said.

    He did that, but keeping open North America’s only safe injection facility, Insite for Community Safety, was a struggle. Although the federal government initially offered the program a three-year legal exemption, once that initial approval expired, Insite had to sue to keep its doors open.

    Campbell said that SIFs are a crucial part of the shift from punishing addicts to treating addiction as a medical problem.

    “Addiction is a medical disease. Addiction is not a criminal offense. No one starts out life saying, ‘You know what, I think I’ll be an addict,’” he said.

    “You can address this as a humanitarian gesture, a humanitarian idea, that we’re all people … but I recognize that there are those who don’t move from a humanitarian end but from an economic end.” That works, too, though, because Campbell explained that safe injection facilities can save on welfare, police and prison costs.

    “So whether you believe in humanitarianism or economy,” he concluded, “this is an idea that works. It’s good, and it’s time.”

    Liz Evans, a nurse who works with Insite, concurred. She said that Insite is estimated to have saved $14 million in 10 years. “Over 2 million injections have taken place and not one has resulted in death,” she said.

    Over time, the community has come to accept the program. Evans said that the last poll taken showed that 76% of Vancouver residents supported the safe injection site.

    By bringing users off the streets, it has created a better environment with less public injection around the facility but also, she said, the presence of a safe injection facility seems to encourage people to get help. “If you’ve just come to Insite once, you’re 33% more likely to come to detox or treatment,” she said.

    Evans pleaded for “peace” in the War on Drugs and said, “The controversy today should not be around where … a safe injection facility makes sense. The controversy today should be over how we have allowed the status quo to persist for such a long time.”

    She added, “In Vancouver, drug users will tell you that Insite is a symbol of care. This is a humane space where we are able to reverse a pattern of exclusion.”

    The panelists—and moderator Amy Goodman of Democracy Now!—drew an enthusiastic crowd, and the evening was punctuated regularly by bursts of applause. (One comment that drew particularly raucous support was a question Tony posed to the crowd: “Who in here supports safe injection facilities?”)

    Although many audience members came from in and around New York City, some traveled much farther, with four- and five-hour drives from Binghamton and points north.

    One of those longer commuters was John Barry, the executive director of an upstate New York syringe exchange called the Southern Tier Aids Program (STAP).

    “We need one of these,” he said.

    He acknowledged that growing political will and legal support for SIFs could be difficult, but he didn’t see it as impossible: “I think the dominoes have to fall in the right order.”

  24. Opening five safe injection sites makes financial sense for Ontario: study

    The Canadian Press December 1st, 2015

    VANCOUVER — Opening five safe-injection sites in Ontario makes financial sense, says a medical researcher who based his study on a Vancouver clinic where drug users shoot up under supervision.

    Dr. Ahmed Bayoumi of St. Michael's Hospital in Toronto said establishing facilities such as Insite in that city and in Ottawa would save money and reduce the incidence of diseases such as HIV and hepatitis C.

    "Three facilities for Toronto and two for Ottawa represent a good investment compared to other things that we ordinarily invest in in health care," he said in an interview Monday.

    Insite is North America's only supervised-injection site, where addicts shoot up their own drugs under the watchful eyes of a nurse to prevent overdoses.

    The site provided a baseline for estimating the approximate cost of operating a safe-injection site as well its effectiveness at improving users' health, Bayoumi said.

    Victoria and other cities across Canada have considered establishing similar facilities.

    Montreal announced its intention to open a safe-injection site after a 2011 Supreme Court of Canada decision ruled against the former Conservative government's attempts to shut down Insite for violating federal drug laws.

    Unlike in Vancouver's Downtown Eastside, Bayoumi said multiple facilities would be more appropriate in Ontario, where populations of drug users are more spread out.

    He said the study's economic estimates are conservative because they're based on Insite being a freestanding clinic, compared to an approach that would incorporate safe-injection facilities into existing health centres.

    While the study focused on needs in Toronto and Ottawa, Bayoumi said other Ontario cities could also benefit from such facilities.

    "The next step is mostly a political decision rather than a research decision, as in, 'Is there an interest and a will to actually establish some facilities?'"

    Ontario's health minister said a national strategy to deal with intravenous drug users, rather than a piecemeal approach, would be most beneficial.

    "I think that more than anything, this is an opportunity to bring together all jurisdictions and look at this in a uniform way," Eric Hoskins said.

    "We, up until recently, had a federal government that made it clear they didn't support such sites. We now have a government that understands the science and is willing and prepared and wants to make decisions based on evidence."

    The minister said any request for a safe-injection site would have to come from municipal governments.

    Insite opened in 2003 as part of a harm-reduction plan to tackle an epidemic of HIV-AIDS and drug overdose deaths in the Downtown Eastside.

    The facility provides clean needles to addicts to stop the spread of infectious diseases before they inject drugs at one of 12 booths.

    Studies in major medical journals have hailed the success of Insite, suggesting it has helped reduce overdose deaths, infectious diseases and crime in the 10-block area that draws addicts.

    The former federal government was criticized for wanting Insite to be shut down over concerns it promotes drug use, but lost a series of legal battles that kept the clinic open.

    Geordon Omand, The Canadian Press

  25. Vancouver drug overdose death toll rises to 4 within last 24 hours

    Drug overdose death toll rises as police update numbers with a 4th death Wednesday afternoon

    CBC News December 23, 2015

    The death toll from a rash of overdoses within the last 24 hours has risen to four, Vancouver police said Wednesday just hours after issuing a public warning.

    Police had initially reported three deaths but Wednesday afternoon were called to the scene of another overdose — this time, a man in his 50s.

    Police say there have also been 17 non-fatal overdoses in the city — most of them on the Downtown Eastside.

    Their warning comes in the wake of recent concerns over stolen fentanyl patches and counterfeit percocets.

    "Various drugs from the scenes of the overdose deaths have been seized and forwarded to Health Canada for analysis, but investigators expect to find fentanyl in many of those samples," said a statement from Const. Brian Montague.

    Fentanyl is a synthetic narcotic that is 50 to 100 times more toxic than other opioids, the statement said.

    Among the three dead, a 24-year-old man in Downtown Vancouver, a 35-year-old man in East Vancouver and a woman believed to be in her mid-20s on the city's Downtown Eastside.

    Police say the public warning applies to both "seasoned" and recreational drug users.

  26. Greater Victoria sees 8 suspected drug overdose deaths in a week

    Morphine, heroin, fentanyl and methamphetamine found in one confirmed overdose case

    The Canadian Press December 27, 2015

    The B.C. Coroners Service says drugs are likely the cause of eight deaths in Greater Victoria over the past week.

    "That's quite a bit higher than we would expect in a one week period," said coroner Barb McLintock.

    She says five men and three women have died of suspected overdoses in several communities, including Saanich, Langford and Sooke, between December 20 and 26.

    The only confirmed overdose is a man who died in a downtown Victoria parkade last Saturday, and was found to have a mixed cocktail of drugs in his system, including morphine, heroin, fentanyl and methamphetamine.

    The coroner is still waiting on toxicology reports for the other seven deaths.

    "It would appear most of them, if not all, of these unfortunate people who died were regular experienced drug users," said McLintock.

    Other agencies such as police have also reported seeing a number of overdoses where people survived.

  27. Victoria overdose deaths renew call for supervised injection site

    'It's time that we start actually providing comprehensive harm reduction,' says social worker

    CBC News December 28, 2015

    A recent spate of deaths likely caused by drug overdoses in Victoria have advocates calling for a supervised injection site and better health care for drug users in the city.

    "We supply people with safe, clean supplies and nowhere to use them. And then we wonder why people die," said Bruce Wallace, assistant professor at the University of Victoria's School of Social Work.

    "It's time that we start actually providing comprehensive harm reduction and we start addressing why we're stigmatizing and criminalizing people."

    Fentanyl warnings

    The BC Coroners Service said drugs are likely the cause of eight deaths in Greater Victoria over the past week.

    Health officials in Victoria and Vancouver have been warning drug users about fentanyl, a highly potent and dangerous opioid increasingly being mixed with illegal narcotics across the country.

    The coroner is still waiting on toxicology reports in seven of the deaths, but in one case, a drug overdose has been confirmed.

    The man, who died in a downtown Victoria parkade last Saturday, was found to have a mixed cocktail of drugs, including fentanyl, in his system.

    Frequent drug users at risk

    Of the 30 overdoses in the past few weeks in the Greater Victoria Area, five of them have been tied to a homeless camp near the city's courthouse, say officials.

    Residents of the camp say a man who lived there, Brad Paul, was found dead in his tent and have erected a small memorial in his name.

    But, they say, they're concerned about more than just those who live at the camp.

    "So many have died outside of just this camp, and they just get forgotten," said camp resident Sean Manley.

    Many in the tent city carry an emergency kit that contains Naloxone, an opioid blocker that can quickly reverse the effects of an overdose.

    It's a kit that some advocates say can play a big part in helping to prevent overdose deaths.

    "These things save lives, everyone should have the training and a Naloxone kit on them," said safe injection site advocate Darrin Murphy.

    The kits have only been available to the general public for the past year.

  28. Safe injection sites have potential to save lives says Jane Philpott

    Federal health minister says the more people know about them, the greater their support

    By Susan Lunn, Peter Zimonjic, CBC News March 14, 2016

    Toronto's medical officer of health is calling on Canada's largest city to move one step closer to opening three safe drug-injection sites.

    In the report, Dr. David McKeown calls for three sites to be located at The Works Needle Exchange Program, the Queen West Community Health Centre and the South Riverdale Community Health Centre.

    Federal Health Minister Jane Philpott told the CBC last week that supervised injection sites are among a number of strategies the government has put forward to cope with drug abuse and overdose deaths.

    "From a public health point of view it makes a tremendous amount of sense," she said. "Sites like Insite in Vancouver and others like them have the possibility to save countless lives."

    There are only two in the country right now, and both are in Vancouver. Insite has existed for years. The other just received approval from Health Canada.

    Overdoses on the rise

    In 2013, there were 206 overdose related deaths in Toronto, a problem that has been on a steady rise for years. In the last decade alone, the number of reported overdose deaths in the city has risen by 41 per cent.

    Toronto Coun. Joe Cressy, chair of the city's drug strategy panel, says the increase in overdoses has been accompanied by rises in the number of drug-related diseases such as HIV and hepatitis C.

    Drug use has caused a number of other issues across the city that safe injection sites may be able to address, Cressy said.

    "We're hearing frequently from our residents that they have an issue of needles being found in the local coffee shop bathrooms, in the local park, in the local school yard," Cressy said.

    Contentious issue

    Next week McKeown will recommend Toronto hold public consultations about potentially opening the three supervised drug injection sites.

    continued below

  29. The issue is a contentious one. The union representing Toronto police officers has already come out against the idea.

    Toronto Mayor John Tory admits getting unanimous consensus isn't easy.

    "These are difficult issues," he said. "They have some emotional aspects to them, they have some substantive aspects to them, some on which even reasonable people can disagree."

    There is interest in safe drug injection programs in other cities as well, including Ottawa, Victoria and Montreal. The federal government has to approve their plans, but the new Liberal government is much more open to the concept than its predecessor.

    The previous Conservative government fought to close Insite all the way to the Supreme Court of Canada, losing that battle in 2011. Its subsequent legislation laid out several conditions that had to be met before a site could open.

    The former health minister, now the interim Conservative leader, Rona Ambrose, says she'll be watching to make sure those rules are respected.

    "I would expect that the government would follow the law and make sure that there is wide support in the neighbourhood, and that this is something the people in the neighbourhood support and that there [are] public consultations," she said.

    Philpott says for now she will try to work within the Conservative's legislation, pointing out it requires consultation, not consensus.

    "One-hundred per cent consensus in many situations is difficult to achieve," Philpott said. "Having said that we are always in favour of consultation … and I think it's the kind of thing that the more people understand about what it actually offers the more people are in favour of it."

    Philpott said that officials at the Public Health Agency of Canada who "hadn't had the opportunity to visit" Insite in the past are going there to study it.

    If Toronto city council gives the green light to hold public consultations it will still take until the fall at the earliest before the city could formally apply to the government to open three drug-injection sites in the city.

  30. Seattle considers supervised injection site says King County sheriff

    'I've got to wrap my mind around a place where you go to shoot up and you're not going to get arrested'

    By Wanyee Li, CBC News March 15, 2016

    The sheriff in Seattle is looking to Vancouver for answers as the American city considers opening a supervised injection site.

    It would be a first in the United States.

    Canada has two legal supervised injection sites, both of which are in Vancouver. Advocates for supervised injection sites, who were instrumental in setting up Insite in Vancouver's Downtown Eastside, are heading to Seattle this month to share ideas.

    King County's sheriff says he is cautiously open to the idea.

    "I've got to wrap my mind around a place where you go to shoot up and you're not going to get arrested. And it's maybe promoted with tax dollars," said John Urquhart, sheriff of King County.

    "It's going to be a tough sell."

    He says law enforcement in the region has not accepted the idea.

    "One thing that I found about police chiefs and sheriffs is they cry and moan and say what we're doing isn't working … and then they turn around and advocate for the status quo," he said.

    "And I'm not willing to do that."

    City officials are also considering setting up a supervised injection site in Victoria and Toronto, where the police union has already voiced its opposition.

    Heroin addiction an 'epidemic'

    Urquhart calls heroin addiction an "epidemic" in the United States and says desperate times have pushed him to consider radical solutions.

    "The reason it's on our radar is because it's not just in back alleys anymore. It's not just junkies like we used to say," he said.

    Urquhart worked as a narcotics detective for 25 years before becoming sheriff.

    "I arrested people and I took them to jail … and guess what? It didn't make a difference. The war on drugs hasn't worked."

    Urquhart says in an ideal world, he would like to see more treatment centres in Washington — enough so that all addicts would have access to one.

    "But society, especially in this country, is not able to provide that."

    Since politicians are not willing to take that step, according to Urquhart, he is looking forward to hearing from Vancouver officials on how supervised injection sites could make for a temporary solution.

    "That's the issue — how do we keep these people alive?"

    With files from CBC Radio's The Early Edition

    To listen to the full interview, click the link labelled: Seattle considers supervised injection site.

  31. Canadian official causes stir with progressive speech at UN narcotics conference

    by Tom Blackwell | National Post March 16, 2016

    The Liberal government used its first foray into the global anti-narcotics arena this week to signal a clear shift away from the war-on-drugs philosophy, promising more safe-injection sites, promoting “harm reduction” and touting its plan to legalize marijuana.

    The speech by Hilary Geller, an assistant deputy minister of health, caused a stir at the generally staid Commission on Narcotic Drugs conference in Vienna, observers said.

    The audience of government and non-governmental organization officials from around the world “erupted in applause” mid-way through the address and gave a prolonged ovation at the end, said Jason Nickerson, an Ottawa-based researcher who is attending the meeting.

    The talk not only contrasted with the Harper government’s international stance on drugs, but stood out from the cautious pronouncements most other nations made, said the Bruyère Research Institute scientist, who favours more liberal policies.

    “There are some countries here that are coming out and saying important, progressive things,” he said. “But it’s certainly not as explicit as what Canada is saying.”

    A Conservative opposition critic had a different reaction, sounding the alarm about Geller’s prediction of more government-sanctioned injection sites – where opioid users can use illicit intravenous drugs under a nurse’s supervision.

    While the Supreme Court of Canada ruled such sites legal, the Conservatives passed legislation requiring extensive public consultations and other measures before they could be set up, said Rob Nicholson, the party’s justice critic.

    “Drugs that are used at these injection sites, mostly heroin, are dangerous and addictive and they kill Canadians,” said the former justice minister. “I disagree with the idea they are safe. There’s nothing safe about taking heroin.”

    Nicholson also stressed that the Conservatives invested hundreds of millions of dollars in drug-abuse treatment and prevention.

    Still, the Harper government was generally tough on the issue, implementing mandatory-minimum jail sentences for some trafficking offences and beefing up police narcotics enforcement.

    continued below

  32. On the world stage it opposed having international conventions embrace harm reduction, programs that focus on preventing the side effects of illegal drug use — like HIV infection — rather than prosecution.

    That put the Conservative government in league with some of the world’s most authoritarian states, said Richard Elliott, head of the Canadian HIV/AIDS Legal Network.

    Under Harper, Canada also failed to condemn the death penalty for drug offences, enforced regularly by nations like Iran and Indonesia, he said.

    Geller stressed this week her government opposes capital punishment “in all cases.”

    Her stance generally marked a “180-degree” shift, said Donald MacPherson, executive director of the Canadian Drug Policy Coalition.

    “It was very moving for the Canadians in the room, people who have been working on this issue for 10 years in a context where Canada has been more aligned with China and Russia and Pakistan.”

    The Vienna conference is a precursor to the UN General Assembly’s special session on drugs this year, which will consider a possible overhaul of international narcotics treaties and their law and order approach.

    Geller said Canada remains committed to combating illicit drug activities, but believes a comprehensive public-health approach is needed, including prevention and treatment.

    Harm reduction is “critical,” she said, referring to needle-exchange programs and safe injection sites, as in Vancouver and as requested by advocates in Toronto, Ottawa and Montreal.

    “With one long-standing supervised injection site already operating in Canada, we have recently approved a second, and anticipate that there will be others in future,” said Geller.

    She also defended the government’s plan to “legalize, strictly regulate and restrict access to” marijuana. The current approach is not working, with high rates of pot use among young people, thousands of Canadians earning criminal records for non-violent offences and organized crime reaping huge profits, said Geller.

    A day earlier, another UN body had chided Canada for its cannabis intentions, which it said violated the international Convention on Narcotic Drugs.

    Read the Notes for Hilary Geller's Address at:

  33. Vancouvers safe injection site the first in North America opened 13 years ago. What’s changed?


    VANCOUVER — On a recent afternoon, a woman sat on the sidewalk, steps from this city’s supervised drug-injection facility, Insite, pant leg rolled up, needle in hand. A young man walked by and casually offered a reporter a ball of speed. A short time later, three police cars swooped in to arrest a hoodied man for allegedly wielding a hammer in a nearby alley during a suspected drug-induced frenzy.

    Thirteen years after this facility, North America’s first, opened in the Downtown Eastside with an emphasis on harm reduction over treatment — a model now being contemplated in several Canadian cities — one might be tempted to wonder: what’s changed?

    A lot, insist Insite staff, academics, and area residents, who point to a reduction in overdose deaths and the spread of disease in the neighbourhood.

    “Go back to the 30-plus peer-reviewed journals and look at what the evidence seems to be suggesting,” said Andrew Day, operations director at Vancouver Coastal Health, which runs the facility.

    “If we weren’t here, it would be even worse.”

    Still, skepticism persists.

    Toronto’s medical officer of health, Dr. David McKeown, recently called for three supervised-injection sites in the city amid growing overdose rates.

    In response, federal Conservative health critic Dr. Kellie Leitch warned that “drugs like heroin are dangerous and addictive which is why we believe that every effort should be made to help people get off drugs.”

    The Toronto Police Association’s president is worried such facilities will attract crime and loitering and swallow up police resources. The city would be better off directing money at treatment, Mike McCormack said.

    “Insite is not a model we want to see replicated.”

    Nestled in the shadow of the dilapidated Balmoral Hotel, Insite sees 600 to 900 visitors daily. Clients register using whatever name they want and tell staff what drug they’ve brought with them — typically heroin, cocaine or meth.

    They pick up whatever supplies they need from a counter — syringe, cooker, alcoholic swab, tourniquet — and are assigned to one of 13 mirrored, and constantly disinfected, booths in plain view of nurses and support staff.

    Nurses won’t perform injections for clients but may offer guidance on certain techniques to reduce risks, Day said.

    Afterwards, clients can grab a coffee or juice in the “chill lounge” before leaving.

    Clients are never pressured to use the detox facility upstairs or enrol in addiction treatment. Most of them are entrenched in their drug use and have extensive histories of trauma and abuse, Day said. It takes time to build relationships with them.

    “Some people are really marginalized and they’re not going to go to a walk-in clinic … (or) a regular family physician. For some people, this is that starting point.”

    The Liberal government has clearly been won over. Health Canada last week granted Insite a four-year exemption from federal drug laws. (Under the Conservatives, it had to apply annually for the exemption).

    Talk to frontline staff and they’ll tell you the harm-reduction model is making a difference, said Jennifer Vishloff, a registered clinical counsellor. She was given unprecedented access to Insite nurses for her Simon Fraser University master’s thesis, which was published last year.

    Vishloff said she was struck by their compassion, resilience and ability to win the trust of clients.

    “They were working hard to show there are no disposable people,” she said. “That’s what motivates them day to day.”

    Further, nurses recognize the need to give clients freedom to make their own choices, she said.

    “Allowing people to be independent … and make their own decisions about their health, goes a long way in people actually wanting to seek out help.”

    continued below

  34. Nurses shared with Vishloff how rewarding it was to teach clients even small things, like how to inject properly and independently.

    But they were also candid about the challenges, including the unpredictable behaviour of some clients.

    One time, a client was face down and had a bent needle in his mouth, Vishloff was told. His arm was still tied with a tourniquet.

    A nurse grabbed his shoulder and called for help. But another nurse yelled, “Don’t touch him!” Apparently this was normal behaviour for the client and touching him could make him violent.

    Nurses also shared the ethical dilemmas they face, like whether or not to turn away someone who is a recreational user. One time, a drunk party reveller who had never injected before walked in.

    “I didn’t feel comfortable signing them up because they definitely weren’t entrenched,” a nurse told Vishloff. “Yet at the same time they were intoxicated which increases their overdose risk. … I made the call to let them use the site, and there wasn’t a consensus on the team.”

    One nurse described to Vishloff how she had to suppress the urge to tell young women to “run out of there!”

    “It’s just hard to reserve judgment because having worked for many years and knowing what I know, you’re just like … Ooh, don’t do it! Like, ahhhh! But in reality what I have to kind of remember is that it’s safer for the girls to know how to inject themselves than it is for them to be injected by their boyfriends or pimps.”

    Nurses also spoke of the helplessness they felt when clients came in looking worse than their last visit. “You just see people waste away sometimes,” one nurse said.

    The work of Insite staff has, without question, paid off, said Thomas Kerr, director of the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS.

    “The evidence is pretty clear. There’s no real serious academic debate.”

    Kerr co-authored a 2011 study that showed overdose deaths in the immediate area fell 35 per cent during the first two years of operation.

    In a 2007 study, Kerr and his colleagues surveyed more than 1,000 Insite clients. A majority reported being less rushed when injecting, were injecting less frequently outdoors, and were more careful about syringe disposal.

    Criminologists at SFU estimated in a 2010 study that Insite, on average, prevented 35 new cases of HIV and almost three deaths per year, saving more than $6 million annually.

    “You’re not risking dying; it’s a lot safer,” said Cody Zutz, 32, a drug user who has lived in the neighbourhood for 15 years. “In the back of your mind, you know if (you’re) going to overdose, those people are there to save your life.”

    So why do people still shoot up in the alleys? Usually because they don’t want to line up to get in, he said, admitting moments later: “If you’d been here 20 minutes ago, I shot up (crystal meth) outside because I didn’t have the patience.”

    However, if he was going to inject heroin that he was “unsure” about, he’d go in “just to be safe.”

    Street-level drug use in the neighbourhood is less visible and there have been fewer overdose deaths and medical calls since Insite was introduced, said a Vancouver police spokesman.

    “It has taken people out of alcoves, alleys, stairwells,” Sgt. Randy Fincham said. The facility can also alert drug users to new dangers, such as the recent spike in fentanyl-related deaths.

    Fincham added that the disproportionately large number of officers in the Downtown Eastside is not because of Insite.

    “These officers were there before Insite. We have not had an increase in officers as a result of its introduction.”

    Buy-in from officers does not appear to be universal, however. One officer responding to the man wielding the hammer just let out a chuckle when asked for his views on Insite.

    “You don’t want to know our opinion.”

  35. Treating addiction with hydromorphone saves lives and money, experts say

    'I'm not getting stoned, I'm not getting that kind of effect from it,' addict says of hydromorphone

    By Greg Rasmussen, CBC News April 06, 2016

    A longtime heroin addict named Max winds a band of blue rubber around his bicep.

    "So my veins will stick up," he explains before quickly sliding the needle beneath his skin and injecting a powerful drug called hydromorphone.

    This isn't happening in a back alley. Instead, Max is inside a brightly lit room where injection drug users are taking part in a clinical trial where they are given their drugs and needles.

    The facility is called the Crosstown Clinic in Vancouver's downtown eastside.

    The trial is the first of its kind in the world and one addiction expert is urging jurisdictions across the country to quickly follow suit.

    Max, who didn't want his last name used, injects at one of several stations set up for drug users. A box of tissues and other supplies sit on a stainless steel counter gleaming under crisp, bright lights. Watchful medical staff dispense the needles, check identification and watch for medical problems.

    "I get the itchies really bad for about 30 or 60 seconds. My face will totally change colour," he says, describing the immediate impact of the drug flowing through his veins.

    True to his word, Max then slips a back scratcher under his shirt as the itching hits right on schedule.

    But it's a minor price to pay compared to the very real pain of heroin addiction.

    Powerful tool

    A new study says the drug used by Max, hydromorphone, is a powerful tool that could helps thousands of other Canadians battling opioid addiction.

    Max is part of a subset of drug users that don't respond to methadone, the drug most widely used to treat addicts.

    Researchers say about ten per cent of addicts don't find relief from methadone, so they often keep using street drugs.

    This new study involving 202 participants shows hydromorphone does work, and Max says it's changed his life.

    When he was selected for the drug trial, things were looking grim.

    "I was homeless, I was committing crimes to get my fix." He also didn't think he had long to live.

    Since being enrolled in the trial, he has put on weight, works out every day and says he can function more or less normally after injecting hydromorphone.

    "I'm not getting stoned, I'm not getting that kind of effect from it."

    He says heroin addiction is incredibly powerful and that he fell into using it after getting addicted to prescription painkillers following a car accident.

    "Your body starts to crave it to the point where almost nothing will stop you from getting it. There's a real dire need to get that into your system, and your body is screaming for it from every angle."

    continued below

  36. Preventing deaths

    Dr. Scott MacDonald is the lead physician at the Crosstown Clinic. He says hydromorphone substitution prevents overdose deaths from street opiates, including fentanyl and heroin.

    "In December, over 60 people in British Columbia died from fentanyl overdoses," MacDonald said. "Not one of the patients receiving care at our clinic on injectable opioid treatment died. The number was zero. I think that's relevant."

    He says it's especially important now that overdose deaths are spiking to record numbers across Canada.

    A report last year by the Ottawa-based Canadian Centre on Substance Abuse said, in some jurisdictions, deaths jumped by more than 20 times previous levels. An exact national number is difficult to determine, but about 300 died in British Columbia alone in 2014, a large increase from the previous year.

    In addition to the hydromorphone trial, the Crosstown clinic has also been the only site allowed under a special permit to dispense a drug very similar to street heroin.

    This recent trial was to find out if hydromorphone was just as effective.

    MacDonald says the advantage is that hydromorphone is already licensed in Canada. That means other jurisdictions wouldn't need special permission from Ottawa to open up clinics and supply the drug to addicts.

    Addiction not a 'second class' illness

    Addiction researcher Dr. Eugenia Oviedo-Joekes says this trial is the first of its kind in the world and she is urging an expansion of clinics modeled on Vancouver's Crosstown.

    "We are trying to provide alternative treatments for people that are continuing to inject in the street, and we are not serving them well with the few options we have," Eugenia Oviedo-Joekes says.

    She says addiction should not be treated as a "second class" illness because of the social stigma attached to it.

    She says access to drugs such as hydromorphone or even the medical equivalent of heroin are now proven to be the best form of treatment. And she said supplying the medication to patients in a controlled setting does not encourage people to use drugs.

    "I really hope the government is willing to listen to the evidence. I really hope some people stop playing to the fear of what it means. This treatment is for those we are leaving behind, the poorest, the most vulnerable."

    Researchers also point to other benefits from the trial, showing participants were much less likely to get involved in crime because they no longer had to scramble to pay for heroin. They also spent less time in emergency wards and were not as costly to the criminal justice system.

  37. Increase in overdose deaths prompts B.C. to declare public health emergency

    Province had 474 drug-related deaths in 2015, a 30 per cent rise over previous year

    CBC News April 14, 2016

    A public health emergency has been declared in British Columbia over a "significant" increase in drug-related overdoses and deaths.

    The announcement was made Thursday morning by Provincial Health Officer Dr. Perry Kendall. It is the first time he has exercised his emergency powers.

    Kendall said that overdose deaths have climbed steadily since 2010, reaching 474 in 2015, a 30 per cent increase over the 365 overdose fatalities in 2014.

    The medical emergency status triggers new powers that will allow officials to collect real-time information on reported overdoses. That data will help pinpoint new spikes quickly, allowing medical service staff to warn and protect those at risk.

    This year in B.C. there were 76 drug-related deaths in January alone, the largest number of deaths in a single month since at least 2007.

    If that pattern continues this year, it could mean as many as 600 to 800 fatal overdoses in 2016.

    As the rate of overdoses has grown, so has the proportion of illicit drug-related deaths due in part — or entirely — to fentanyl, which was involved in five per cent of deaths in 2012 and approximately 31 per cent in 2015.

    Kendall said he will be conferring with a range of medical personnel in the coming weeks to work out the best way to collect and disseminate this information.

  38. BC declares public health emergency as overdoses surge again

    by SUNNY DHILLON AND KAREN HOWLETT — The Globe and Mail April 14, 2016

    British Columbia has declared a public health emergency after another surge in drug-related overdoses and deaths, making it the first province in the country to take such a step as others, including Ontario and Alberta, work to combat the effects of fentanyl.

    “This is, frankly, a crisis,” provincial health officer Perry Kendall said.

    Dr. Kendall’s decision comes after B.C. recently suffered its highest monthly total of overdose deaths in nearly a decade.

    “We in Canada have been watching with dismay as the number of overdose deaths associated with opioid drugs, in fact all illicit drugs, increases,” Dr. Kendall said, adding that despite the efforts of B.C. officials, the number of deaths has continued to climb.

    A recent Globe and Mail investigation found that online suppliers have exploited gaps at the border to get illicit fentanyl into Canada, devising ways to conceal the drug and skirt inspection rules. Fentanyl was developed as a prescription painkiller, but gained popularity as a street drug after OxyContin was removed from the market in 2012.

    B.C. had 76 illicit drug overdose deaths in January, the highest total in a single month since at least 2007. At its current rate, the province could have 600 to 800 overdose deaths this year, Dr. Kendall said in a news conference on Thursday. B.C. had 474 such deaths last year, a significant increase from 211 in 2010.

    The number of B.C. illicit drug overdose deaths linked to fentanyl, an opioid up to 100 times more potent than morphine, has also surged, from 5 per cent in 2012 to about 31 per cent last year. Of the 201 overdose deaths in B.C. so far this year, 64 were associated with fentanyl.

    Declaring a public health emergency – the first time B.C. has ever done so – allows officials to collect real-time data on all overdoses, Dr. Kendall said. Overdose information is currently released only when a person dies.

    Dr. Kendall, who was joined at the news conference by B.C. Health Minister Terry Lake, said compiling real-time data was a key recommendation in a recent report by the B.C. Drug Overdose and Alert Partnership, which is led by the B.C. Centre for Disease Control.

    “We have determined that in order to assist us in providing an enhanced response, a key need is for more information and more detailed information on the who, the where, the when of these tragic incidents,” he said.

    Dr. Kendall said knowing more about overdoses more quickly will allow health officials to provide a better response. He stressed the medical information will be treated confidentially.

    The emergency declaration did not immediately spur other provinces that have been hit hard by fentanyl to follow suit.

    A spokesperson for Ontario Health Minister Eric Hoskins referred questions to the province’s chief medical officer of health, who could not be reached for comment on Thursday evening.

    continued below

  39. Health care workers in Ontario said the province should treat the increase in overdose deaths with the same urgency as B.C. is doing. Several communities have sounded the alarm in recent weeks about a spike in overdoses from street drugs that appear to have been laced with fentanyl.

    “If this isn’t a public health emergency, then Ontario needs to redefine what constitutes an emergency,” said Michael Parkinson, community engagement co-ordinator with the Waterloo Region Crime Prevention Council, which has issued local alerts about the prevalence of illicit fentanyl.

    The most recent information on fatal opioid overdoses in Ontario is from 2014, when 173 people died of fentanyl overdoses, accounting for one in four opioid fatalities.

    “I think there’s enough of a rise in fentanyl that we should be seriously looking at whether this meets the definition of a public health emergency,” said Kieran Michael Moore, associate medical officer of health for KFL&A Public Health, an agency representing Kingston and neighbouring communities.

    A spokesperson for Alberta’s minister of health said the province sought legal advice last fall to determine whether a public health emergency should be declared. The spokesperson said the government decided a declaration was not necessary to move forward with attempts to combat fentanyl and other opioids.

    A statement attributed to Alberta Health Minister Sarah Hoffman said her government has taken steps to address the illicit use of fentanyl, including more than doubling the province’s supply of take-home naloxone kits.

    Hakique Virani, an assistant clinical professor in public health and addiction at the University of Alberta’s Faculty of Medicine, has called fentanyl the No. 1 public health concern in the province. He said B.C.’s announcement was welcome, although he would like to have seen such action sooner.

    Dr. Virani said it was unclear if other provinces will be encouraged to do the same.

    “Why now is it more of an emergency after B.C. has called one than it was last month, when we were still losing somebody every single day ... to opiate overdose? It would be a difficult thing, I think, for a minister or a chief medical officer of health to explain, ‘Well, now it’s an emergency because B.C. said it was.’

    “It’s been an emergency for years.”

    B.C. health officials will work together over the next few weeks to sort out the logistics of collecting the data. Dr. Kendall said a conference will also be held in early June to look at other programs and policies to reduce overdose deaths.

    Mr. Lake, who said B.C. leads the country on harm reduction strategies, added the crisis has taken a toll on families.

    “To lose a loved one to an overdose is indeed a tragedy,” the minister said. “These are our sons, our daughters, our mothers, fathers, brothers, sisters, and friends. We have to do everything we can to stop this toll.”

  40. Fentanyl overdoses rise emergency reporting takes effect

    by Tom Fletcher - BC Local News May 12, 2016

    Drug overdose cases continue at high levels as an emergency order to report them immediately takes effect for hospitals, paramedics, police and firefighters across B.C.

    Health Minister Terry Lake said Thursday there were 56 overdose cases reported in April, and the province has seen an average of 60 a month since January. Half of those cases are related to fentanyl, a potent synthetic opioid increasingly showing up in street drugs.

    "People don't know they're taking it, and it's 100 times more powerful than other opioids," Lake said. "They think they're taking oxycontin or something like that, and it's fentanyl, and there are tragic consequences."

    Provincial Health Officer Dr. Perry Kendall sent out B.C.'s first-ever public health emergency order this week to emergency wards and first responders. Real-time reports of clusters of overdoses are to allow local public warnings and deployment of naloxone, an antidote for opioid overdoses.

    Lake said the real-time information has been shown to work.

    "In Kamloops a couple of weeks ago, we were lucky enough to be able to collect data from the emergency department, and we had about seven treated overdoses in 24 hours," he said. "We were able to get that word out quickly, and in that case I think we were able to avoid deaths."

    Fentanyl has been traced to illicit drug labs in China. Considered 100 times more potent than heroin and other opioids, its strength makes it easy to smuggle and to reach dangerous levels when mixed with other drugs.

  41. Overdose deaths up from 40 a month in 2015 to 64 a month this year

    Public health emergency was declared last month

    By Liam Britten, CBC News May 12, 2016

    Drug overdose deaths have reached an average of 64 per month, up from 40 per month last year despite a public health emergency called last month.

    Provincial health officer Dr. Perry Kendall also says the percentage of overdoses involving fentanyl has jumped to 49 per cent from less than a third in 2015.

    Kendall says better info is going to be needed to get a handle on the overdose crisis, and on Thursday morning, orders for information gathering went out to ERs and ambulances across the province.

    "With the mapping we're getting from B.C. Ambulance, we can get to location. We can get to time of day where they're responding to overdoses, and that will tell us exactly where we should target our resources," he told On The Coast guest host Gloria Macarenko.

    Kendall says the declaration of a public health emergency has seen some positive results, including more awareness, more Naloxone being given to drug-using patients when they are discharged from hospitals and discussions at the municipal level to request supervised injection sites from Health Canada.

    The data also shows overdose deaths have jumped 327 percent since 2008, and Kendall says long-term solutions might require more than medical action.

    "The logical answer, if we didn't have moral qualms or political qualms or ethical qualms, would be to offer people a safer alternative," he said.

    "But that means a prescription alternative and that is completely contrary to most of our drug policies … so that is a political or policy challenge."

    Kendall says he's hopeful about the wider availability of Suboxone in B.C., an opioid replacement drug safer than methadone, and he's hopeful it will become even more widely available in the future.

    With files from CBC Radio One's On The Coast

    To hear the full story, click the audio labelled: Despite declaration of health emergency, opioid overdose deaths growing at:

  42. Proposed regulations would allow doctors to prescribe heroin to addicts

    Move reverses 2013 Harper decision banning BC doctors from prescribing to addicts

    The Canadian Press May 13, 2016

    Health Canada is planning to change regulations to allow doctors to prescribe heroin to some opioid addicts who do not respond to treatments such as methadone.

    The move reverses a 2013 decision under the Harper government, which banned a group of British Columbia doctors from prescribing the drug to a small group of addicts.

    In 2014, a B.C. judge granted an injunction exempting the doctors and patients from the ban.

    Health Canada now plans to allow access to heroin in special cases, according to a regulatory amendment published in the Canada Gazette.

    Interested parties have 30 days to comment on the proposal.

    Under the change, heroin would be covered under what the department calls its special access program, or SAP.

  43. While we're at it why not legalize all drugs?

    by Michael Enright, CBC Radio May 15, 2016

    In 1994, the American writer Dan Baum interviewed John Ehrlichman, henchman to Richard Nixon and Watergate co-conspirator, about the opening volleys of the US War on Drugs in the 1970s.

    Erlichman quite openly explained that the war on drugs was directed at two groups, which Nixon felt were his mortal enemies; young people and blacks.

    Then, in a moment of extraordinary candor Ehrlichman said this: "By getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities, arrest their leaders, raid their homes and vilify them night after night on the evening news."

    Baum's gripping story in the April edition of Harper's Magazine underlines how the war on drugs was three things; a lie, a put up job and a complete failure.

    Canada has never had a declared war on drugs, although we have always chosen interdiction and heavy law enforcement over common sense.

    The Trudeau government is moving, carefully and cautiously, to decriminalize marijuana. And this week, a former prime minister, Jean Chretien, said such a change was long overdue.

    Actually a review of all our drug laws is long overdue. And if the stars and planets are properly aligned, Canada will, in the not too distant future, legalize all drugs, not just marijuana.

    That's right, all of them — heroin, methamphetamines, cocaine, crack and powder and everything else in the illegal pharmacopeia.

    Legalization would have, I submit, immediate and lasting benefits.

    In the first place, it would tear a huge hole in the network of drug dealers here and abroad. Take away the demand, the supply dries up. Reduce the supply, no more drug dealers.

    On top of which, because illegal drug users often resort to crime to pay for their habit, decriminalization would bring down those crime rates.

    We might learn a thing or two from Portugal. Throughout the 1980s and 1990s, Portugal had the highest rate in the European Union of HIV among injecting drug users. Then in June 2001, Portugal passed a series of laws decriminalizing all drugs within its border — everything.

    Rather than an epidemic of drug tourism, as everybody feared, drug usage actually went down. For example, Portugal has the lowest rate of marijuana usage in the EU, about 10 per cent of people over the age of 18. By contrast, in the United States with some of the toughest drug laws in the world, the figure is 40 per cent. Experts now say that Portugal now manages and controls its drug problem better than any other country in the West.

    It should be clear by now that prohibition doesn't work. It didn't work for alcohol in the Twenties and it doesn't work for drugs nearly a century later. Think of the billions now spent on enforcement, interdiction, court time, police resources, and imprisonment. Now think of that amount of money being spent on treatment and education.

    This will only happen, though, when governments come to the understanding that drug use is a medical, not a criminal problem.

  44. Light Years Ahead of the US on Drug Reform, Canada Will Allow Prescription Heroin

    It was first in North America with safe injection sites and heroin maintenance studies. Canada plows ahead

    By Phillip Smith / AlterNet May 15, 2016

    Health Canada announced Friday that it is proposing new regulations to allow access to prescription heroin under its Special Access Program (SAP). That program allows for emergency access to drugs for serious or life-threatening conditions when conventional treatments have failed or are unsuitable.

    "A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic, relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine," the statement said.

    The move is yet another reversal of hardline Conservative drug policies by the Liberal government headed by Prime Minister Justin Trudeau, which was elected last fall. The Trudeau government has pivoted sharply away from Conservative positions in favor of mandatory minimum drug sentences and against marijuana legalization, and now is moving to undo Conservative efforts to block the limited use of prescription heron.

    Canadian scientists had laid the groundwork for prescription with the North American Opiate Medication Initiative (NAOMI), which first tested "heroin-assisted maintenance" in Vancouver a dozen years ago, and which was followed by the Study to Assess Long-Term Opioid Maintenance Effectiveness (SALOME) between 2005 and 2008. SALOME examined whether giving hard-core heroin users heroin was more effective than giving them methadone.

    SALOME showed that the users in the study were more likely to stay in treatment, reduce other illegal drug use, engage in fewer other illegal activities and have better physical and mental health outcomes if given heroin than if given methadone. But when that study ended in 2008, researchers were faced with the ethical dilemma of cutting off the patients whose lives were being improved by prescription heroin.

    The doctors began applying for, and receiving, permission under the Special Access Program, and Health Canada approved those applications in 2013. But that infuriated the Conservatives, and then-Health Minister Rona Ambrose introduced new regulations to bar doctors from prescribing "dangerous drugs" such as heroin, cocaine, and LSD.

    Former SALOME participants launched a constitutional challenge to the ban and in 2014 won a temporary injunction giving them the right to continue to receive prescription heroin while the case was being decided. Now, with Health Canada's move, the federal government will no longer attempt to block prescription heroin.

    That was good news for the Pivot Legal Society, which argued the case for continuing the prescriptions, and for Providence Health Care, in whose Crosstown Clinic in Vancouver's Downtown Lower East Side the heroin was administered.

    "Allowing access to diacetylmorphine, or medical heroin, to patients who need it, ensures that life-saving treatments get delivered to vulnerable people suffering from chronic opioid use," the two groups said in a joint statement.

    Canada is leading the way on cutting edge responses to heroin addiction in North America. In addition to the groundbreaking NAOMI and SALOME studies, which cannot be replicated in the US under current law and regulations, Canada has also had safe injection sites operating in Vancouver for more than a decade. We still don’t have any of those in the US.

  45. Solving Canadas opioid epidemic must include tackling what got us into the predicament in the first place

    By Alan Cassels, an expert advisor with and the author of the just-published, The Cochrane Collaboration: Medicine’s Best Kept Secret.

    A version of this commentary appeared in the Toronto Star, the Huffington Post and Vancouver Province

    By all accounts we are in the midst of a deadly drug epidemic so severe and widespread few people in North America will remain untouched by it. In case you think I’m exaggerating, right now we have probably the highest rates of narcotic abuse and deaths in modern history.

    Critics have begun pointing the finger at the medical system and its prescribers – well-meaning doctors and specialists who’ve been giving too many patients excessively powerful opioid medications to deal with modest pain. But we can dig deeper and look at the relationship between medical education and pharmaceutical company influence as a significant contributing factor.

    Typically the suggestion of an epidemic is hyperbolic, but it doesn’t seem so in this case. Last week, Dr. Perry Kendall, the provincial Health Officer in British Columbia said that BC has a bona fide “public health emergency” on its hands, mostly due to the alarming number of overdose deaths linked to prescription opioids.

    Opioids include prescription narcotics like Oxycontin, hydromorph Contin and fentanyl (which some say is 100 times stronger than morphine). Dr. Kendall said that there were more than 200 opioid-related overdoses so far this year in BC, and if those numbers continue, there’ll be 800 by the end of the year.

    What’s happening in BC is just a small microcosm of what is happening across Canada, where we have some of the highest rates of prescription opioid consumption in the world. From 2006 to 2011, use of opioids in Canada rose by 32 percent and that rise has continued unabated, despite efforts to slow it down.

    The United States is also in full-on damage control mode, trying to stem the incredible numbers of deaths due to opioids. In 2012, there were 259 million prescriptions written for opioids — enough to give every American adult their own bottle of pills. Since 2000, the overdose death rate in the U.S. has risen by 200 percent and there were nearly 19,000 opioid-related overdose deaths in 2014. Two weeks ago, I sat in a room while Dr. Vivek Murthy, the new Surgeon General of the United States, told the assembled crowd that he was driven to make the opioid epidemic a top priority in his administration due to the devastation he’s seen in communities all across the country.

    continued below

  46. He told us the US experiences an overdose death every 24 minutes and the life expectancy of white, male, middle class Americans is dropping.

    The problems, as well as potential solutions, are incredibly complicated but I agree with Dr. Murthy when he says that curbing society’s exposure to opioids — particularly those that come from a prescription pad in a doctor’s office — is absolutely vital. As he said: “Physicians need to be retrained to think twice — or three or four times — before writing that first opioid prescription.”

    It’s important to recognize that liberal prescribing of opioids is a very recent problem and, since the mid-1990s, can be linked to the message-crafting activities of the pharmaceutical industry which helped shape both patient perceptions of pain and influence how doctors thought about the safety of these drugs. Doctors were increasingly encouraged — sometimes through industry-funded educational activities or by using textbooks on pain management paid for by the makers of opioids — to prescribe the drugs for a much wider population of patients experiencing pain.

    If revising the messaging around opioids was a business-oriented strategy of the opioid makers, we cannot place the blame solely upon them. Some of that blame has to do with the co-dependent relationship between physician education and the drug industry, which funds a substantial portion of physician education in Canada.

    Is this epidemic not dire enough to finally build the absolute firewall we need between physicians education and the pharmaceutical industry?

    We need unbiased, safety-oriented messages around the appropriate use of opioids and knowledge of their wicked addiction potential. We also need to remind ourselves, both patients and prescribers, that any incredibly powerful and effective drug can also be incredibly dangerous and destructive.

    The focus to tackle the addiction problem has to be serious, multifaceted source control. We need greater access to addiction treatment facilities, and methods to rescue people from the depths of addiction, certainly. But we also need to curb society’s underlying dependence upon drug company money for doctor training.

  47. Are You in Pain and Getting the Help You Need? The Opiate Addiction Dilemma That Obama Truly Grasps

    And if our other politicians don't follow Obama's lead, they're unlikely to make strides in solving America's addiction problem.

    By Stanton Peele / AlterNet May 20, 2016

    Throughout the 20th, and now the 21st, centuries, public health officials and politicians have announced new drug scares. These scares have usually—but not always—involved opiates, also known as narcotics, but they’ve also in recent decades included cocaine and its derivative, crack, methamphetamines, Ecstasy, and other substances.

    Today, the villain is prescription painkillers, as deaths associated with them reach new heights. And, so, once again, politicians and public health officials want to make it harder for people to receive legitimate prescriptions for painkillers.

    Does this sound familiar? As painkillers proliferated in American society throughout the 1990s and 2000s restrictions were placed on the prescription and purchase of painkillers, making it both harder to obtain drugs such as oxycodone (OxyContin) and fentanyl, while also making these drugs more expensive relative to illegal narcotics. Guess what happened next? Many painkiller users turned to ... heroin.

    And, so, we got a phenomenon not previously observed. Whereas health professionals (like CNN’s Sanjay Gupta) tended to see one form of narcotics as replacing the other, we managed to create the unprecedented situation in the U.S. of having simultaneous epidemics of both heroin and painkiller deaths—and, while we were at it, adding in a record number of tranquilizer-related deaths.

    Not a good result. And, yet, here we go again.

    We can go back a hundred years to see how our policy was formed, to 1914 and the passage of the Harrison Act, technically a taxation bill, but one that had the effect of making narcotics (and cocaine) illegal. The result? Whereas heroin users had been supplied the drug by individual physicians or at hospital clinics, previously ordinary citizens habituated to heroin were now thrown onto the streets to seek their drug supplies, becoming the “addicts” who created the drug underworld Americans came to fear and loathe.

    Along with this shift, heroin use became lodged in inner cities, creating drug ghettos, whereas earlier opiate use was more likely to be found among middle-class and white Americans. Much is now being made that the narcotic addiction tide has been partially reversed to include more white, and perhaps somewhat more middle-class, users. But heroin addiction is still heavily concentrated in inner cities, like Baltimore, while painkillers are rampant in impoverished white enclaves, like Appalachian West Virginia.

    This is the United States on drugs, the United States of heroin/narcotic addiction, which Yale psychiatrist David Musto termed “The American Disease.”

    Flash-forward to the present. The opioid death epidemic “unexpectedly dominated” the bipartisan governors’ conference this year, with the governors passing a resolution to make it harder for people to obtain and use prescription painkillers. Finally, something both Republicans and Democrats agree on!

    Only one notable political figure, not up for re-election, opposed the governors’ consensus:

    “If we go to doctors right now and say ‘Don’t over-prescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” President Obama said during his meeting with the governors. “In some cases, addiction is already there.”

    What the hell?!

    This statement is prescient and nostalgic at the same time. Prior to the Harrison Act, those addicted to narcotics were supplied their drug by medical providers.

    continued below

  48. Currently prescribing heroin or providing sites where heroin can be safely administered under medical supervision, is the leading edge of drug policy reform in Britain, Denmark, the Netherlands, Switzerland, Germany, and—in North America—Vancouver.

    Why not in the United States? Because “heroin is bad, and injecting heroin is bad, so how could supervised heroin injection be a good thing?” This question was asked rhetorically by Ithaca’s Democratic Mayor, Svante Myrick (age 29). Rhetorically, because Mayor Myrick was actually proposing a plan for establishing a site where people could legally shoot heroin.

    But the plan is a nonstarter, because probably every other politician in America who mouthed the words Myrick did would actually mean them. Keep in mind, however: Virtually no deaths have ever occurred at supervised heroin injection sites or in places where heroin is provided by prescription.

    Which brings up a strange anomaly. While heroin deaths have reached a peak, heroin purity has declined since the 1990s. And as painkiller deaths slowly rose in the 2000s, the use of painkillers did not rise. And while somewhat more people are using tranquilizers, deaths associated with their use have quadrupled. In other words, the problem isn’t in the drugs, but in how we use them.

    Heroin use, in itself, is not toxic. People have taken opiates safely for centuries. The ratio of strength for a fatal injection of heroin relative to a typical street dose is 50-1, or more. Drug users die, in over 90 percent of cases, from combining depressant drugs, including different narcotics (which may have caused Prince’s death) or tranquilizers or alcohol or other drugs. Amy Winehouse drank alcohol while using tranquilizers. Philip Seymour Hoffman died from taking heroin mixed with benzodiazepines, amphetamine, and cocaine.

    At the same time that they assure drug purity, drug-administering sites (where drugs are tested) and drug-providing sites offer ready access to treatment for those who want to remit or reduce their drug use. No such assisted remission is available to street users—although many do ultimately outgrow narcotic addiction—“mature out”—on their own.

    So, in rejecting injection sites, or prescribed heroin, our concern obviously isn’t to reduce drug fatalities or to support people in quitting drugs. It’s a way for us to repeat, as we have been for a hundred years, the mantra that “drugs are bad.”

    Let’s return to Obama’s remarkably prescient statement. He recognizes that people have reasons, whether physical or mental (as though we can separate the two), for using painkillers—including perhaps their having become addicted to them. The president’s keen insight is that the greater damage occurs when people are denied a reliable supplier and are forced to ferret drugs out for themselves, on the street or from multiple medical sources.

    Or else the users are forced to deal with pain and emotional problems without them. What gives us the right to force this choice on them?

    Assisting people safely to take drugs, on the other hand, represents the policy of harm reduction. This isn’t American drug policy—harm reduction is backed by neither drug czar Michael Botticelli nor the director of the National Institute on Drug Abuse, Nora Volkow.

    Yet, President Obama enunciated this harm reduction perspective in his response to the governors’ seat-of-the-pants action plan for prescription painkillers. We’re going to miss a person able to form such a calm, rational, empathic perspective on drugs—one that neither Donald Trump nor Hillary Clinton is capable of. (Is it too late for Svante Myrick to run for president?)

    Stanton Peele is the author, with Ilse Thompson, of "Recover! Stop Thinking Like an Addict and Reclaim Your Life with the PERFECT Program." He is the developer of the Life Process Program.

  49. Little — if any — heroin left in Vancouver, all fentanyl: drug advocates

    Dangerous opioids cheaper and easier to smuggle

    By Geordon Omand, The Canadian Press May 22, 2016

    For Hugh Lampkin, fentanyl's surge to all but replace heroin on the Vancouver drug scene calls to mind a curious image: a rainbow.

    "Traditionally, heroin comes in about four different colours," said the longtime drug advocate, describing a bland palette of beiges, browns and blacks.

    "Well now you're seeing multiple colours, like colours of the rainbow: green and pink and orange and white. ... Right away, when you see these colours that's a pretty good indicator that it's fentanyl that you're doing."

    As government data tracks a spike of fentanyl across Canada, people who use illicit drugs in Vancouver's Downtown Eastside say there is virtually no heroin left on the street after it has been pushed out by the cheaper and more potent fentanyl.

    Martin Steward of the Western Aboriginal Harm Reduction Society said fentanyl's takeover is evident by how easily people are overdosing on small amounts of what is being sold as heroin, and simply by people's physical response to the drug.

    Fentanyl posing as heroin

    "I know people who use heroin and they'll inject what they normally do. And the next time they'll do exactly the same thing of what they think is heroin and they're out. Like, they're going under from it," Steward said in an interview, referring to an overdose.

    "They're using the same thing, the same product, but getting a different result. That's a forerunner for me to see that it's not heroin."

    There have been 256 fatal overdoses from illicit drugs in the first four months of this year, already more than half the 480 that occurred for all of 2015. Fentanyl's connection to those deaths has been surging at a staggering rate.

    The B.C. Coroners Service reported last week that the presence of fentanyl in cases of illicit drug overdose deaths rose from a third in 2015 to nearly 50 per cent so far this year.

    Speaking anecdotally, Lampkin said he doesn't believe anyone in Vancouver has used real heroin in more than a year and that many users don't appear to be aware of it.

    He's observed overdose victims needing three full vials of the overdose-reversing drug naloxone to recover, he said.

    'Growing trend'

    "I think it's not so much as they're moving to it as a case of not having any choice," said Lampkin, who sits on the board for the Vancouver Area Network of Drug Users.

    "The people who are controlling the supply, they're passing off what should be heroin as fentanyl because of the close proximity of the high."

    continued below

  50. Vancouver police report heroin-related drug seizures and criminal charges in the city have remained relatively stable over the past five years, but Lampkin said drugs are only tested when charges are laid or usually in the event of a fatal overdose.

    Sgt. Darin Sheppard, who heads up a British Columbia RCMP division that investigates organized drug crime, said that while heroin is still present in the province, fentanyl is increasingly taking over the market.

    "It's a growing trend," he said, pegging 2014 as the first year fentanyl was noticed in a significant way.

    Mark Haden, a public health professor at the University of British Columbia, draws a parallel to alcohol prohibition, which he said led to stronger, more concentrated booze that was often toxic.

    Dangerous opioids: low cost, easy to smuggle

    "Dealers will always want small packages. That's the natural process of drug prohibition," he said, dismissing the war-on-drugs policy approach taken by governments as shortsighted and ineffective.

    There are multiple explanations offered for the rise of the dangerous opioid, centring on its low production cost and the simplicity of smuggling it across the border in its compact, concentrated form.

    Jane Buxton with the Centre for Disease Control said money plays a key role in fentanyl's upward trend line.

    "Whoever is importing or selling drugs, they're doing it presumably for a profit and therefore if there's a substance that is easy to access and cheap, and can be sold for a great profit, that's what's going to be focused on," she said.

    The manufacturer of the prescription opioid OxyContin designed a tamper-resistant version of the prescription drug that becomes inert when meddled with, making it impossible to grind and snort, for example.

    The effectiveness in disabling OxyContin as a drug source has in turn contributed to a spike in black market opioids, Buxton said.

    More data needed

    Still, it's difficult to know exactly what is happening on the ground without effective and timely data collection, she added.

    Michael Parkinson of the Waterloo Region Crime Prevention Council in Kitchener, Ont., lamented that no province, territory or the federal government gathers real-time data on opioid overdose fatalities.

    That is seriously hampering their ability to craft fast and effective responses to drug crises, he added.

    "(With) other causes of accidental death, for example influenza, we know how many people died or were hospitalized last week," said Parkinson.

    Alberta and B.C. now have more up-to-date numbers on fentanyl overdose deaths, he said, but other opioids aren't included.

    "It's an international mystery. It really is. It's scandalous," Parkinson said, pointing out that there have been 4,984 deaths in Ontario due to opioids over a 13-year period.

    "We get three people dropping off from anaphylaxis and it's all hands on deck," he added. "That hasn't happened with opioid overdoses."

  51. Remembering Bria - Victoria woman dies from fentanyl overdose

    Health officials to meet in Vancouver next week to assess response to overdose crisis that has gripped B.C.

    By Megan Thomas, CBC News June 02, 2016

    After trying to help his daughter break free from a drug addiction for more than a decade, Fernand Magnin says he had to prepare for the possibility he would one day lose her.

    But it didn't make it any easier.

    His daughter, Bria Magnin-Forster, 30, died from a fentanyl overdose in early May.

    She was using alone in a bathroom at a shelter in Vancouver at the time, the Victoria father says.

    "In the end, it was the police at the door at 5 a.m. telling you that she had died from an overdose the night before."

    More than 250 people in B.C. died from drug overdoses in the first four months of the year. The death toll is nearly double what was reported during the same time period last year.

    In April, shortly before Bria died, B.C. took the unprecedented step of declaring a public health emergency over the rise in drug overdoses.

    Bria's family chose to share in her obituary notice that her death was caused by a fentanyl overdose to help raise awareness about the human toll of the crisis.

    "We felt that there are too many families that are being impacted by overdoses," Magnin says.

    "We see very few obituaries, if any, where people talk about the fact that the person died from a drug addiction."

    Few warning signs

    Magnin says there were few warning signs that his bright, creative child would fall into a life of addiction.

    She did well in school. She was a talented musician and excelled at writing.

    "We never had any particular incident or troubles during her childhood," he said.

    But in her teenaged years, Bria dealt with an eating disorder. Issues with anxiety followed, her father says.

    By 2005, the family realized she was using drugs. It was crystal meth at first, Magnin believes.

    "From then on it was really a kind of ongoing struggle for many, many years."

    continued below

  52. There was hope after Bria hit a new low in 2010 and was hospitalized for several months.

    Following treatment, Magnin says she was placed in a Victoria group home where she found the right support and managed to stay clean.

    But he says the space was soon needed for someone else and Bria moved to her own apartment.

    "It was a critical moment. She was not ready to be on her own," he said. "To be left on your own to pull your life back together; it just wasn't enough for her."

    When things fell apart again, Bria returned to the streets. That was followed by a stay in jail.

    Upon her release in January, Magnin says there was a spot in a treatment program in the Lower Mainland.

    But there was no legal requirement that kept her there, he says. The family later found out she left the three month program after three days.

    On May 2, she was found dead from an overdose. Bria Magnin-Forster was 30 years old.

    No easy answers

    On June 9, addiction experts, drug users, health officials and police will meet in Vancouver to examine the response to B.C.'s overdose crisis and determine next steps.

    As Magnin grieves the loss of his daughter, he is also reflecting on what some of those steps should be.

    He supports making supervised drug consumption services widely available as an immediate safety measure but hopes solutions will address more than just preventing overdose deaths.

    Magnin is calling for stronger mental health services and better communication with families of addicts as they navigate the system.

    He says he was often in the dark about his daughter's treatment because of confidentiality requirements.

    He would also like to see more of a focus on addressing illicit drug use as a mental health issue rather than as a crime and less emphasis on providing those services in the community, rather than structured facilities.

    "It's not locking up everybody. It's providing enough support that they will be able to function and move in the right direction," Magnin said.

    "It is a very tricky path to follow, but we just know that what has been done up until now has not worked."

  53. Fentanyl overdose epidemic spurs call for safe injection sites across BC

    Group advocating supervised consumption facilities

    By Deborah Wilson, CBC News June 01, 2016

    A Victoria-based advocacy group is calling for health officials to move beyond monitoring overdoses and start reducing them by expanding access to supervised drug use services.

    To make its point, on Wednesday morning the group, called Yes2SCS (Yes to Supervised Consumption Services), planted 600 white crosses on the Harris Green, next to a busy commuter route into Victoria's downtown.

    The crosses were erected, according to Yes2SCS spokesman Mark Willson, "to represent the amount of folks we believe could be lost in the coming year, according to the provincial health officer."

    Willson said a letter was also sent Wednesday to B.C. Health Minister Terry Lake and regional health authorities, urging the immediate creation of supervised injection sites in communities across the province.

    Currently, Vancouver's Insite and the Dr. Peter Centre are the only supervised injection sites approved in Canada.

    The chair of Victoria's Society of Living Illicit Drug Users, Katie Lacroix, said there is "a lot of fear" among users in Victoria about overdoses — which caused as many deaths in the first four months of 2016 as in all of 2015.

    "People may be overdosing but not dying; they're having lack of oxygen to the brain," Lacroix said in an interview with On The Island's Gregor Craigie. "There are long term physical and psychological effects of that."

    Safe place needed

    "People are trying to use together and spreading that message, but with the increase in fentanyl, people just never know what's going to happen when they're using," she said.
    "People need to have a safe place they can use so they're not scared and using behind dumpsters."

    British Columbia's provincial health officer says he supports expansion of safe injection services under the public health emergency he declared in April.

    Dr. Perry Kendall said heath authorities and local governments including Victoria and Nanaimo are developing plans to put a supervised consumption room into an existing health care facility.

    However, he said, getting formal federal approval for such a facility is extremely difficult without the repeal of the Respect for Communities Act (Bill C-2) enacted by the federal Conservative government in 2015.

    Anti-overdose drug recommended for shelters

    As an alternative, Dr. Kendall said, "if you have enough naloxone kits in a shelter or subsidized housing where you knew you had an issue with overdoses, you could be providing, as it were, a very low barrier supervised consumption site."

    "If you're injecting with somebody who does have a naloxone kit, then they are in some respects just monitoring your health and if they need to they can deliver the naloxone," Kendall said. "So that's a strategy that we're pursuing as well."

    With files from On The Island and Megan Thomas.

    To hear the interviews with Mark Willson of Yes to Supervised Consumption Services (Yes2SCS) and Katie Lacroix of the Society of Living Illicit Drug Users (SOLID), click the link below and the audio labelled: Group plants 600 crosses to push for overdose prevention measures

    To hear the interviews with Dr. Perry Kendall, British Columbia's Provincial Health Officer, click the link below and the audio labelled: Province's top doctor says emergency measures could include safe injection sites

  54. Drug users call for more supervised injection sites during fentanyl crisis

    Advocacy groups say supervised injection sites needed to reduce explosion in opiod overdose deaths

    By Liam Britten, CBC News June 08, 2016

    Despite the declaration of a public health emergency in B.C., opioid overdose deaths are not going down and and advocacy groups for current and former drug users want action.

    Laura Shaver, president of the B.C. Association of People On Methadone, says the best solution to the problem is more supervised injection sites and she wants to know what's taking so long.

    "We don't need any more data. We don't need any more research," she told On The Coast host Stephen Quinn

    "What we need is ... [to] give some healthcare funding to open some more sites, so we can save lives."

    Shaver and others, including the Vancouver Area Network of Drug Users (VANDU), marched on Vancouver's Downtown Eastside Wednesday to demand action.

    They called on the federal government to permit more special exemptions to the Controlled Drugs and Substances Act to allow an increase in the number of supervised injection sites.

    Shaver fears there could be up to 800 overdose deaths in 2016 after the 474 in 2015 and says supervised injection services are a proven model that could reverse that trend.

    Health authorities also call for more services

    Shaver is not alone in calling for more supervised injection services in B.C.

    Health authorities on the Lower Mainland, Vancouver Island and the Interior have either called for more services in their jurisdictions or expressed interest in such services.

    However, Provincial Health Officer Dr. Perry Kendall said last week that getting formal federal approval for such facilities is extremely difficult without the repeal of the Respect for Communities Act enacted by the federal government in 2015.

    As an alternative, Kendall said, "if you have enough naloxone kits in a shelter or subsidized housing where you knew you had an issue with overdoses, you could be providing, as it were, a very low barrier supervised consumption site."

    "If you're injecting with somebody who does have a naloxone kit, then they are in some respects just monitoring your health and if they need to they can deliver the naloxone," Kendall said. "So that's a strategy that we're pursuing as well."

    With files from CBC Radio One's On The Coast

    To hear the full story, click the link below and the audio labelled: Fearing even more OD deaths, methadone users call for more supervised injection sites

  55. 5 new supervised injections sites coming to fight Vancouvers fentanyl overdose crisis

    Health officials say location of new supervised injection sites won't be released before they are approved

    By Mike Laanela, CBC News June 10, 2016

    Five new supervised injection sites could be opening somewhere in the Vancouver area, but health officials will not release the locations until they are approved by Health Canada.

    Health Minister Terry Lake says the province wants to open the new sites — similar to the Insite facility in Vancouver's Downtown Eastside — to stop the soaring number of overdose deaths.

    But according to Vancouver Coastal Health spokeswoman Anna-Marie D'Angelo none of the new sites would be stand-alone sites like Insite.

    Instead, all would be located inside existing facilities that already provide services for drug users.

    There are already two supervised injection sites operated by Vancouver Coastal Health. One is Insite. The other is a smaller location at the Dr. Peters Centre at St. Paul's Hospital. That one is only open to clients of the centre, which serves people with HIV/AIDS.

    Both have Health Canada permits, which are required in order to legally allow doctors and nurses to monitor users at a supervised drug site, she said.

    Overdose rates spiking

    Along with the five new sites planned by Vancouver Coastal Health, health authorities across the province are looking at similar options, according to the health minister.

    Lake says he wants the federal government to reconsider laws that restrict these types of facilities so that health authorities can create more of these services. Under existing laws all the proposed sites still require Health Canada approval.

    "We have seen the evidence. We know that we can reduce overdose deaths. We can reduce other related harms, reduce hospitalizations and connect people to services once they're ready to accept that help," said Lake.

    Yesterday a report released by British Columbia's chief coroner said illicit drug overdoses have become the leading cause of unnatural death in the province, outpacing fatalities from vehicle crashes.

    The report said there were 308 illicit drug overdose deaths from January through May of this year, compared with 176 deaths in the same period last year.

    Fentanyl was involved in 56 per cent of deaths in the first four months of this year compared with just five per cent of drug-related deaths in 2012.

    Chief Coroner Lisa Lapointe said that overdose deaths could amount to 750 people by the end of 2016 if the trend continues.

    In comparison, there were 300 fatalities from motor vehicle incidents in the province in 2015.

    The province's public health officer declared a state of emergency in April because of the rising number of drug-related deaths.

    Overdose kits distributed

    Meanwhile, to prevent more deaths from overdoses, the BC Centre for Disease Control has distributed 8,000 kits containing the opioid antidote naloxone.

    The kits are now available at over 100 establishments across the province and 1,200 kits have already been used to reverse overdoses, said Dr. Mark Tyndall, the centre's executive director.

    Health Canada removed the prescription status on naloxone in March to improve accessibility.

    "The option to get it out of pharmacies has also been very helpful and we need to make sure people are aware they can pick it up," said Tyndall.

    The kits have a larger dose of the antidote than what was previously prescribed for opioids in order to be effective on the more dangerous substance fentanyl, he said.

    But more services are needed, including rapid access to detox programs, to help people with addictions, he added.

    The health minister acknowledged there is a gap and said the government is investing in new services and centres for mental health and substance abuse.

    However, Lake said "you can't flip a switch" and it will take time for new services to have an effect.

  56. Health Canada will reduce barriers to safe injection sites says Philpott

    Health minister says communities that want harm-reduction facilities should be able to get them

    By Peter Zimonjic, CBC News September 22, 2016

    Federal Health Minister Jane Philpott is asking her officials to make it easier for communities to approve and set up safe injection sites because of what she calls a public health emergency.

    "I've made it very clear to my department that there should be no unnecessary barriers for communities who want to open supervised consumption sites," Philpott said during question period in the House of Commons. "They are working with communities that are interested in this."

    "Clearly, it's important that this is done right."

    The minister made the comments in response to a question from Vancouver Kingsway MP Don Davies. He said Canada was on track for 2,000 overdose-related deaths this year and wanted to know what Philpott was doing to make safe-injection sites easier to set up.

    The Liberals have long supported the expansion of safe injection sites as a means of harm reduction for addicts, but have been slowed in approving new sites by legislation brought in under the Conservatives.

    The Respect for Communities Act, which came in in 2015, requires 26 criteria to be met before the federal government can begin considering a new safe consumption site.

    Critics of the law say that meeting all 26 criteria is onerous and takes so long that addicts literally die in back alleys because there is no supervised location where they can be treated when they overdose.

    Philpott has told officials to take into consideration the public health emergency that is occurring in many communities and directed staff to review all 26 criteria and remove or amend anything that poses an unnecessary barrier to getting a site up and running.

    After question period Davies told reporters he welcomed the government's decision as "excellent" and "long overdue," but urged the Liberals to move quickly.

    Davies said the opioid overdose crisis has been going on for months if not years, and every stakeholder in the country is unanimous that getting more supervised injection sites up now will save lives.

    "This is a national health crisis, and in that kind of situation I expect the government to move very quickly, and they haven't moved quickly enough," he said.

    On Thursday Philpott said that she was determined to see progress.

    "We're also looking at the legislation under the Controlled Drugs and Substances Act," she said. "And if it becomes clear to us that we need to make some further amendments to that act to ... ensure that there are no barriers, then we will certainly do that."

    Communities need a say: Tory critic

    Conservative health critic Colin Carrie accused the Liberals of hypocrisy, saying they are keen to get social licence from communities when building pipelines, but are happy to circumvent the consultation process when it comes to safe injection sites.

    "The Respect for Communities Act gives police, residents and municipal leaders a say when it comes to opening an injection site in their community," he said.

    "Instead of making it easier for drug addicts to consume drugs, the Liberal government should support treatment and recovery programs to get addicts off drugs, and enact heavy mandatory minimum sentences to crack down on drug traffickers."

  57. BC clinics free heroin enables addicts to have a meaningful life again co-ordinator says

    Goal is to give addicts just enough heroin to take away their desire to seek out street drugs

    By Nick Purdon, Leonardo Palleja, CBC News September 28, 2016

    If you met Lisa James, chances are you'd never guess she injects herself with heroin twice a day.

    She's a devoted mom to her daughter Tia, 24, who has a rare neurological disorder that causes tumours to grow on her spine and brain.

    She comforts Tia when she's overcome with nausea. She's by her side when she visits doctors.

    "My relationship with my daughter is better than it's ever been," says James, 48.

    But James says it wasn't so long ago, her days were spent doing absolutely anything to score heroin.

    She used to steal hundreds of dollars' worth of meat from grocery stores and sell it on the streets.

    She even stole from Tia.

    "I took $500 out of her account and because of the lovely girl that she is, she never wanted to make me feel bad," James says. "If someone had told me I would do something so despicable — I never would have believed it."

    She says that all changed when she was accepted to the Providence Crosstown Clinic in Vancouver's Downtown Eastside, where she's buzzed in every morning at 9 a.m.

    She sits down in a sterile room and injects a syringe full of free heroin into her arm.

    "Nobody knows I am an addict," James says. "I share with some people and they are always shocked. 'You're an addict? Really? A heroin addict?' They would just never know. And that's a nice feeling."

    Crosstown has been operating for seven years and is the only harm-reduction treatment centre in North America where addicts get actual heroin.

    The program is for longtime addicts who've been unable to get off opioids using other treatments, including methadone.

    Each participant goes through a titration process, supervised by a physician, to determine their tolerance level. The idea is to give addicts just enough heroin to take away their desire to acquire street drugs.

    The clinic is at capacity and serves 130 addicts. Research co-ordinator Kurt Lock estimates there are at least 500 opioid addicts in the Downtown Eastside alone who could benefit from the program.

    He says addicts approach him every day to see if they can get into the clinic.

    "I see desperation," Lock says. "When they come and see me, this is their last straw."

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  58. Decades of addiction

    James got high for the first time when she was 12.

    "My grandma, who was actually an opiate addict and probably wasn't aware of that, gave me some Tylenol with codeine in it just to help because I had a terrible headache," James says.

    "I just remember the warmth coming over me. I loved it and I wanted more."

    After that, James started stealing pills from pharmacies and friends' houses.

    "I crushed them up and snorted them, trying to get that feeling again."

    In her 20s, she tried heroin.

    "I was in heaven, absolute heaven."

    Then one night, heaven turned to hell.

    She and two friends overdosed.

    "I couldn't see for about 20 minutes or so," she says.

    Her friend Otis died in the middle of the night.

    "It was horrific. I still think about him."

    The reality is death is never very far away if you're an opioid addict.

    Statistics from B.C.'s coroner service reveal there were 433 overdose deaths across the province in the first seven months of 2016.

    Fentanyl, an extremely powerful opioid, was detected in 238 of those cases.

    Controversial harm reduction

    Conservative Health Minister Rona Ambrose tried to shut down Crosstown in 2013. Her government argued the clinic enables addicts and that the goal should be to get heroin out of the hands of drug users.

    It took an order from B.C.'s Supreme Court to keep the clinic open.

    Lock agrees that Crosstown enables addicts.

    "We are enabling them," he says, "but we are not enabling them to continue doing evil in that simplistic sense. We are enabling them to have a meaningful life again."

    Lock says the clinic's goal is to stabilize the lives of addicts rather than push them to quit.

    He says the negative health effects of heroin addiction have nothing to do with the drug itself, but rather what it takes for a user to feed the habit.

    He says most addicts forego food, sleep and medical attention in their search for drugs.

    "A lot of people, they think that there's something intrinsic within the heroin that's harming people and that's just not the case," Lock says.

    "We've been brought up to think of heroin as the killer drug, but heroin itself, if you take it in proper conditions, and you are eating food, and you are getting sleep, there's no reason you couldn't get to live to 100 years old on the drug."

    These days, James and Tia spend as much time together as they can. They make dinner and go to movies.

    "We appreciate the little things together," James says.

    Usually when people talk about the "little things," it's because they're trying to savour life. And that's exactly what mother and daughter are doing.

    Tia has had several surgeries, but her prognosis is still uncertain.

    "She has an army of doctors," James says, "and basically I try to be there for her."

    James gets her second shot of heroin in the mid-afternoon.

    She insists the treatment has brought stability to her life and without it she wouldn't be able to look for a job. "I did my shot an hour ago," James says. "Do I look high? I am just normal."

    It costs British Columbia taxpayers $27,000 for the clinic to supply a year's worth of heroin to a single addict.

    The societal benefits are harder to calculate, but James insists, for her, they are crystal clear.

    "We all need our moms," she says. "I am able to be her mom."

  59. Seattle Could Become the Home of the First Safe Injection Sites in the US

    A broad-based heroin and opioids task force has recommended them. The mayor, the county executive, and the county sheriff are on board.

    By Phillip Smith / AlterNet September 21, 2016

    Seattle and surrounding King County are on a path to establish the country's first supervised drug consumption sites as part of a broader campaign to address heroin and prescription opioid misuse. A 99-page report released last week by the Heroin and Prescription Opiate Addiction Task Force calls for setting up at least two of the sites, one in the city and one in the suburbs, as part of a pilot project.

    The facilities, modeled on the Canadian government-funded InSite supervised injection site in Vancouver, just 140 miles to the north, would be places where users could legally inject their drugs while under medical supervision and be put in contact with treatment and other social services. There have been no fatal overdoses in the 13-year history of InSite.

    Although such facilities, which also operate in various European countries and Australia, have been proven to reduce overdose deaths and drug use-related disease, improve local quality of life, and improve the lives of drug users, they remain controversial, with foes accusing them of "enabling" drug use. Thus, the report refers to them not as "safe injection sites," or even "supervised consumption sites," but as the anodyne "Community Health Engagement Locations" (CHELs).

    "If it’s a strategy that saves lives then regardless of the political discomfort, I think it is something we have to move forward," said County Executive Dow Constantine, discussing the plan at a news conference last week.

    The safe sites will address the region's high levels of opioid and heroin use, or what the task force called "the region’s growing and increasingly lethal heroin and opioid epidemic." As the task force noted, the number of fatal overdoses in the county has tripled in recent years, with the rate of death rising from roughly one a week (49) in 2009 to one very other day (156) in 2014. The current wave of opioid use appears centered on young people, with the number of people under 30 seeking treatment doubling between 2006 and 2014, and now, more young people are entering detox for heroin than for alcohol.

    continued below

  60. Overdose deaths actually dropped last year to 132, thanks to Good Samaritan laws that shield people who aid overdose victims from prosecution and to the wider use of the opioid overdose reversal drug naloxone. But that's still 132 King County residents who needn't have died. Task force members said the CHELs would help reduce that number even further.

    "The heroin epidemic has had a profound effect not just on our region, but across our country as a whole," said Seattle Mayor Ed Murray. "It is critical that we not only move forward with meaningful solutions that support prevention and treatment, but that we remove the stigma surrounding addiction that often creates barriers to those seeking help.

    Not only are key local elected officials on board, so is King County Sheriff John Urquhart. He said the safe site plan was workable.

    "As long as there was strong, very strong, emphasis on education, services, and recovery, I would say that yes, the benefits outweigh the drawbacks," he said. "We will never make any headway in the war on drugs until we turn the war into a health issue."

    The region may willing to embrace this ground-breaking harm reduction measure, but it is going to require some sort of federal dispensation to get around the Controlled Substances Act and the DEA. How that is going to happen remains to be seen, but Seattle is ready.

    The task force wasn't just about CHELs. In fact, the safe sites are just a small, if key, component of a broad-based, far-ranging strategy to attack the problem. The task force report's recommendations come in three categories:

    Primary Prevention

    --Increase public awareness of effects of opioid use, including overdose and opioid-use disorder.
    --Promote safe storage and disposal of medications.
    --Work with schools and health-care providers to improve the screening practices and better identify opioid use.

    Treatment Expansion and Enhancement

    --Make buprenorphine more accessible for people who have opiate-use disorders.
    --Develop treatment on demand for all types of substance-use disorders.
    --Increase treatment capacity so that it’s accessible when and where someone is ready to receive help.

    Health and Harm Reduction

    --Continue to distribute more naloxone kits and making training available to homeless service providers, emergency responders and law enforcement officers.
    --Create a three-year pilot project that will include at least two locations where adults with substance-use disorders will have access to on-site services while safely consuming opioids or other substances under the supervision of trained healthcare providers.

    Will Seattle and King County be able to actual implement the CHELs? Will the federal government act as obstacle or facilitator? That remains to be seen, but harm reductionists, policy-makers, and drug users in cities such as Portland, San Francisco, and New York will be watching closely. There have been murmurs about getting such sites up and running there, too.

  61. Seattle task force wants to use Insite as model for first supervised injection site in US

    Washington having overdose crisis; task force says it's time for supervised injection site

    By Liam Britten, CBC News October 05, 2016

    A task force wants the Seattle area to become home to the first supervised injection site in the United States and experts are looking to Vancouver as a model.

    Last year, 229 people died from drug overdoses in King County, which includes Seattle, home to about two million people.

    "It's super alarming," Brad Finegood, co-chair of the Heroin and Prescription Task Force, told On The Coast host Stephen Quinn.

    "We've seen the trend steadily go up over time. Any time you have a situation where you have a public health epidemic like we do, people dying of drug overdoses, it's something we need to take hold of and take action on quickly."

    Finegood says authorities have seen fentanyl on Seattle's streets but aren't affected by it to the same extent as Vancouver, yet, "but we know it's on its way."

    He says InSite is a "foundational" example for supervised injection sites, because there have been no deaths there. He says it breaks the grip of isolation and connects people with other services.

    "It's beyond amazing," he said.

    'That's somebody's sibling; that's somebody's parent'

    Finegood says reaction to the call for supervised injection services has been mixed.

    "It's never easy to recommend something where people have some deep moral beliefs," he said. "But we've also seen a ton of public support."

    For Finegood, seeking a supervised injection site has a personal dimension. His brother died of an overdose 12 years ago on New Year's Day.

    "Knowing today or tomorrow, somebody's going to die of a drug overdose in our community, that's somebody's brother, that's somebody's sibling, that's somebody's parent," he said.

    "We need to be able take action as fast as possible and do what we need to do in order to keep people from dying and give people a chance to recover."

    In addition to calling for the injection sites, the task force has expanded availability of the anti-overdose drug naloxone in the area and is also calling for more addiction treatment services.

  62. PopUp supervised injection tent in Downtown Eastside sees steady stream of users

    People were overdosing all around us, say organizers

    By Belle Puri, CBC News October 12, 2016

    Janet Charlie's 26-year-old son Tyler died of a fentanyl overdose in August so she knows the need for facilities like a pop-up supervised injection tent opened by a pair of community activists in a Vancouver Downtown Eastside alley.

    "I think it would have saved him," said Charlie.

    "He'd have somebody watching him, somebody who knows narcan training."

    Narcan is the brand name for naloxone, an opioid used to reverse the effects of a drug overdose.

    It's available at the tent which is a place for overdose-prevention, harm reduction and outreach.

    Big need

    Organizers Sarah Blyth and Ann Livingston estimate volunteers at the tent have had to use narcan at least 24 times to save a life since the facility opened on Sept. 20.

    "We're not going to stand by and watch people die in the alley and that's what we would be doing if we didn't do anything," said Blyth, who is a former Vancouver park commissioner.

    The tent has a few clean tables, chairs and supplies for intravenous drug users.

    Between 10 a.m. and 9 p.m., it averages 110 injections a day.

    "We're getting the stuff from Vancouver Coastal Health and from the B.C. Centre for Disease Control," said Livingston.

    "And we're saving all the ambulance calls, the emergency room visits."

    GoFundMe campaign

    It costs approximately $100 a day to operate the tent. All of the money comes from donations.

    A GoFundMe campaign called Overdose Prevention in the Downtown Eastside has been started to raise $3,000 to keep the facility open for at least another month.

    "We need lots more cleaning supplies. We could use some funding for brooms to clean up the alley," said Blyth.

    "Before we were in the alley, there were needles on the ground. Now, we make sure that they're gone."

    Great idea

    A DTES resident who would only give his name as John says he's been clean from drugs for awhile but thinks the pop-up site is a great idea if it prevents fatal overdoses.

    "I've lost friends this way. It's not something I want to see again," said John.

    Vancouver Coastal Health runs Insite on the DTES.

    But drug users say lineups and waits at that supervised drug injection site are too long.

    VCH also plans to open two new sites in early 2017.

    "I wish they had this in August back then. My son would be still here," said Janet Charlie.

    "He was only 26 years old."

    Charlie is a regular volunteer at a coffee stand that helps fund the supervised injection tent.

  63. Bill to make it easier to create supervised drug-consumption sites becomes law

    Jane Philpott says the country is facing an opioid crisis of 'unprecedented proportions'

    By Kristy Kirkup, The Canadian Press May 18, 2017

    Canada is dealing with an opioid crisis of "unprecedented proportions", Health Minister Jane Philpott said Thursday as she spoke in defence of a new law that removes 26 strict requirements for new supervised injection sites.

    Under the former law, new sites had to provide medical and scientific evidence of benefit and letters of support from provincial health ministers, local police and regional health officials — criteria established by the previous Conservative government that advocates argued created far too many barriers for harm-reduction facilities.

    The government said Thursday the new law streamlines the application process to align it with five factors set out by the Supreme Court of Canada, adding that evidence of a site's intended public health benefit will be required for applications.

    One letter of support from a provincial or territorial minister will still be required and if the federal government refuses a site application, it will be required to make the rationale public.

    "The evidence on supervised consumption sites is absolutely clear," Philpott said outside the House of Commons.

    "In communities where they have been well-established and maintained, including of course Insite in Vancouver, . . . it has been shown to, of course, save lives and reduce infections but it has shown to have no negative impacts on crime rates in the community."

    The new law also includes measures to restrict the import of pill presses and encapsulators — two machines commonly used in the production of illicit drugs, Public Safety Minister Ralph Goodale said.

    It also lifts a restriction that prevented border guards from inspecting packages under 30 grams in weight even if they had reason to believe the packages held illegal drugs, he added.

    "Bear in mind that a 30-gram package can include enough opioids to kill . . . 15,000 people," Goodale said. "That is a reasonable measure to put in the law to allow (the Canada Border Services Agency) to have the authority, if they have reasonable grounds to suspect an offence, they will have the authority to inspect the package."

    Health officials and political leaders have been sounding the alarm about a dramatic spike in opioid deaths across Canada — the focus of a national summit in Ottawa last fall that pulled together experts from across the country.

  64. Debate over drug consumption sites might be coming to end

    An increase in sites has not been matched by an increase in complaints

    By Aaron Wherry, CBC News November 05, 2017

    In the space of two years, the number of supervised consumption sites approved to operate in Canada has gone from one to 22, plus three interim sites.

    In November 2015, when Justin Trudeau's new Liberal government was sworn in, there was only Vancouver's Insite.

    Health Canada has now granted approval to two dozen new sites in 11 cities. There are permanent or mobile facilities approved for Victoria, Surrey, Kelowna, Kamloops, Vancouver, Calgary, Edmonton, Lethbridge, Toronto, Ottawa and Montreal. Another five applications are pending.

    That simple count alone might suggest that the debate over supervised consumption sites, or at least the most pitched and divisive version of that debate, is rapidly receding into the past.

    There also appears to be a difference of tone in the partisan discussion.

    Measuring political opposition

    Interviewed by CBC News in British Columbia earlier this year, Conservative Leader Andrew Scheer ranged from being somewhat critical to unenthusiastic about such facilities. And while his comments this week to the Globe and Mail fall short of a full endorsement for such facilities, there does seem to be something like openness.

    "My message to people in British Columbia and Vancouver is a sincere desire to find policy that works, balancing the legitimate and proper concerns of families and individuals who have real concerns about [supervised consumption] in their community with the need to save lives, the recognition that addicts are in a type of place where they will do what they can to get their hands on narcotics and take them," Scheer said.

    Liberals still jumped on Scheer's other comments about dealing with drug addiction — he suggested prosecution for drug use can move people towards rehabilitation — and Conservatives responded by alleging the Liberals are somehow planning to decriminalize all narcotics.

    But perhaps there is some measure of progress here anyway.

    Compare Scheer in 2017 with Tony Clement's declaration in 2008, when he was the ruling Conservative Party's health minister, that Vancouver's Insite was an "abomination."

    A Supreme Court ruling kept Insite operating. But when the Conservative government tabled legislation to establish new tests and requirements for establishing a similar site, the Tories sent a note to supporters entitled, "Keep heroin out of our backyards."

    "Do you want a supervised drug consumption site in your community?" wrote Jenni Byrne, the party's campaign manager. "I don't want one anywhere near my home."

    In the midst of the 2015 election campaign, a Conservative note warned supporters that a Liberal or NDP government would "actually expand these injection houses to neighbourhoods like yours, all across Canada."

    Back in December 2016, Scheer was warning supporters of his leadership campaign that the Liberal government "wants to impose heroin injection facilities on neighbourhoods."

    That emphasis on public consultation is still there, outright opposition may still exist in the Conservative ranks and the party might yet return to its previous tone, but Scheer's comments this week lacked a certain stridency.

    And that lack of objection may extend beyond the Conservative Party.

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  65. Opioid crisis changes context

    "Whereas it took many, many years of advocacy and civil disobedience to establish a supervised injecting site in Vancouver, it's become a lot less politicized, a lot less controversial and I think there are no really sane actors who are sitting around questioning whether there is a role for these initiatives anymore," says Dr. Thomas Kerr, a researcher at the University of British Columbia who has studied Insite, noting that temporary facilities have been allowed to set up in Toronto and Ottawa.

    The deadly opioid epidemic and the emergence of fentanyl have no doubt changed the context. At least 2,458 deaths in 2016 have been linked to opioid-related overdoses. And, unfortunately, it sometimes takes a widespread crisis to make change.

    As such, it is possible a re-elected Conservative government would have also ended up expanding the number of supervised drug consumption sites. But the Liberal government, while rewriting Conservative legislation around such sites, has at least not hesitated.

    The rapid increase in approvals may, in fact, result in Canada being a world leader in the use of supervised sites. According to a count from earlier this year, the Netherlands had 30 of the world's 92 consumption sites, followed by Germany with 24.

    In her previous role as health minister, Liberal Jane Philpott reversed a ban on the medical use of pharmaceutical grade heroin to treat some people with addictions (Conservatives loudly touted that ban in 2013, but were quiet when Philpott reversed it).. Another drug, hydromorphone, is being used in Ottawa.

    Kerr says new approaches are being tested as the number of sites increases, including checking drugs for unknown contaminants.

    Not a panacea

    It is tempting to wonder whether such a significant expansion of sites, which exist to save lives, reduce the spread of disease, improve public safety and encourage treatment, could invite a backlash: if improvements aren't apparent, or surrounding neighbourhoods somehow seem to suffer.

    But both Philpott and Kerr point to a different risk: that communities will think a consumption site is a solution in and of itself.

    "What I might be concerned about is that I worry that people will get the message somehow that this is a panacea or a silver bullet, that it's going to somehow magically address the really complex circumstances that we're facing as a country in terms of the rising rates of overdose deaths," Philpott said in an interview earlier this year. "This is one of a really broad range of tools that fall into the classic four pillar response to drug policy."

    (Those pillars being harm reduction, prevention, treatment and enforcement.)

    What about decriminalization?

    In terms of what else can be done, Kerr is among those who believe a different system of regulation and decriminalization is best for those dealing with addictions to drugs like heroin.

    "It's really, really hard to engage people in care when society treats them like a criminal and when they have to endure all the stigma, including in health-care settings, that arises from criminalization," Kerr says.

    The Liberal government has repeatedly ruled out decriminalization of hard drugs.

    If the Canadian experience is any lesson, it might be deeply controversial and loudly opposed until, all of a sudden, it isn't.