Wednesday, May 28, 2008

Insite ruling and a new way forward on drugs

The ruling on the future of Vancouver's safe injection site should change the way we talk about drugs and addiction.
It will certainly reveal that those who cling to the status quo - like federal Health Minister Tony Clement - place prejudice ahead of evidence and the law.
Justice Ian Pitfield was ruling on an injunction application aimed at preventing the federal government from closing Insite.
The injection site needs an exemption from drug possession laws to operate, so people can bring their drugs to he centre. Vancouver Coastal Health Authority would likely not continue funding if the site was operated illegally.
With barely one month to go before the current exemption expires, the government wouldn't say if it would renew it.
The critical aspect of the judgment rested on one main issue. Would shutting down Insite violate the users' charter rights to "life, liberty, and security of the person"? And if it did, was the violation of their rights justified by the greater good? Governments are allowed, under the charter, to strip individual rights with a good reason.
Answering those questions raised issues fundamental to the way we think about drugs and addiction.
First, Pitfield had to decide if Insite did protect individuals' charter right to safety and security. If not, then closing it would be fine.
Both sides presented evidence. The federal government's established that the scientific debate about whether harm reduction or abstinence-based approaches were most effective continues.
But the evidence and research showed that allowing people to inject in a clean, supervised site reduced death and illness, (as well as public disorder). It was health care to deal with the sickness of addiction; removing it would violate the clients' right to personal security, just as denying care to a lung cancer patient would.
The federal government also raised an important argument. People choosing to use drugs, its lawyers argued. The charter of rights doesn't provide any protection if people make bad choices.
Pitfield reviewed the medical evidence supplied by both sides.
And he found that Insite users weren't making a choice to inject drugs. Addiction is a disease.
"However unfortunate, damaging, inexplicable and personal the original choice may have been, the result is an illness called addiction," he found.
"While there is nothing to be said in favour of the injection of controlled substances that leads to addiction, there is much to be said against denying addicts health care services that will ameliorate the effects of their condition," Pitfield found. "Society does that for other substances such as alcohol and tobacco."
The decision was based on the evidence.
But anyone who looked at the life of a hardcore injection drug user wouldn't see it as a choice. How many people want poverty, homelessness, a one-in-six chance of contracting HIV, almost certain hepatitis, dangerous sex work, abscesses, fear and a constant need to get more drugs?
That left one issue for the court. The government can remove individual rights for the greater good - if it can show a pressing reason.
The federal government argued that the allowing Insite a continued exemption would increase drug trafficking and might violate international treaties.
But it had little evidence. And drug laws, Pitfield ruled, could still prohibit possession while allowing specific exemptions for programs like Insite.
That's an important point. The government can still do as much as it wants to arrest dealers or users. It can ramp up prevention programs and add treatment centres. Insite is no barrier.
Pitfield's ruling doesn't say society should condone drug use. It does find addiction is an illness - a potentially deadly one - and proper health care can help people survive, while reducing the damage to the community.
It is a good starting point for rethinking the way we treat those suffering from that illness, and help stop others from stumbling into that terrible sickness.
Footnote: Clement said the Harper government still doesn't approve, though he did not explain why people should die for its prejudices. The facts, as the court found, support Insite, which is also supported by Premier Gordon Campbell and Health Minister George Abbott and is funded by the province. Vancouver's mayor and police force also back its continued operation.

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