Canadian Government Committed 'Breach' Of Scientific Standards By Interfering In Vancouver's Supervised Drug-Injection Site, Researchers Say

Main Category: HIV / AIDS
Also Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 05 May 2008 - 5:00 PST

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Canadian government officials committed a "serious breach of international scientific standards" by intervening in an independent scientific review of the supervised drug-injection facility Insite in Vancouver, British Columbia, according to an article recently published in the International Journal of Drug Policy, Toronto's Globe and Mail reports (Picard, Toronto's Globe and Mail, 5/2).

Insite, which is funded by the British Columbia provincial government and has received research funding from the Canadian government, includes 12 booths for injection drug users to inject drugs as well as a "chill-out" room, in which users can be monitored for overdoses. At the site, drug users receive clean needles, tourniquets, water and cotton balls, and a nurse supervises their activities and provides them with referrals to detox centers and homeless shelters. Vancouver has one of the highest illegal drug use rates in North America, with as many as 12,000 IDUs in the Vancouver metropolitan area, 30% of whom are HIV-positive and 90% of whom have hepatitis C.

When the facility opened in September 2003, it received a three-year exemption from the Controlled Drugs and Substances Act, which bans heroin use, to conduct a pilot study on the site's role in reducing drug use and crime in Vancouver's Downtown Eastside. Health Canada, the country's health ministry, in October of last year announced it would extend the exemption until June 2008 (Kaiser Daily HIV/AIDS Report, 10/4/07). According to the Globe and Mail, Insite operators are currently appealing to the British Columbia Supreme Court to extend the exemption for the facility.

Health Ministry Involvement
An independent scientific body advised Health Canada in 2006 to recommend that funding for the project be extended and that similar programs be established in other cities, the Globe and Mail reports. However, Health Minister Tony Clement said he could not approve the recommendations, citing inadequate research and unsound public health policy. The government later offered grants to further research the effectiveness of drug-injection sites in preventing HIV, under the condition that investigators not release their findings until after the exemption expires. Evan Wood -- a research scientist at the B.C. Centre for Excellence in HIV/AIDS and lead author of the journal article -- said the offer amounted to "muzzling researchers." The University of British Columbia considered that condition ethically unacceptable, and its researchers did not apply for the grants.

The journal article states that Clement's actions were taken on the advice of police organizations and based on political concerns over sound health policy, according to the Globe and Mail. Wood noted that there have been 22 peer-reviewed studies published on the Insite program that found it reduces rates of HIV/AIDS and increases opportunities for IDUs to seek rehabilitation. "From a scientific perspective, it's descipable," Wood said, adding, "Governments should not handpick grants based on ideology."

Rita Smith, a spokesperson for Clement, said on Thursday that the researchers' comments were "completely inaccurate." She added that Clement "commissioned more research" about safe drug-injection facilities and had Health Canada form an independent committee to compile a report on domestic and international research on the subject.

Reaction
Perry Kendall, British Columbia's provincial health officer, said he agreed with the journal article. "I'm a realist enough to know that public policy is not based solely on science, but you would hope that policy would be strongly swayed by science, particularly in health care," he said. Kendall said that injection drug use has caused government to intervene as it would never do in other areas. "If there was a validated intervention for hernia repair, would we accept that the government steps in and says, 'We don't like hernia repair'? I don't think so," he said.

In a related IJDP commentary, Robert MacCoun of the Goldman School of Public Policy at the University of California-Berkeley, called the Insite issue a "policy horror story." He wrote that the evidence demonstrates that a "well-executed piece of policy research on a promising innovation was discontinued for unstated but blatant political reasons." MacCoun also wrote that Clement's questioning of whether Insite lowers drug use and addiction misses the point that such programs are designed to reduce harm that IDUs do to themselves and others, which a law cannot achieve (Globe and Mail, 5/2).

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