Supreme Court decision on Vancouver supervised injection site could have broad implications

Arguments will be made Thursday (May 11) in a Supreme Court case that will determine the future of Insite, Vancouver’s supervised injection facility.

While the court’s ruling will decide the fate of the Downtown Eastside clinic, the case could also have broader implications for the future of harm reduction services like supervised injection.

The Dr. Peter AIDS Foundation, which is one of over a dozen intervenors that will be presenting arguments in Canada’s top court Thursday, also does supervised injection, as part of a broad range of health care services for HIV/AIDS patients.

The organization has been offering the service since 2002. Unlike Insite, which in 2003 became the only supervised injection facility in the country to be sanctioned by the federal government, the Dr. Peter Centre did not apply for an exemption under the Controlled Drugs and Substances Act.

According to executive director Maxine Davis, the facility operates under the premise that supervised injection services, for the purposes of preventing illness and promoting health, are within the scope of registered nursing practice, as designated by the B.C. College of Registered Nurses.

“We did not apply for a section 56 exemption, and our perspective on that was we were upholding provincial law and we were doing everything reasonably possible to uphold federal law in that nurses do not touch the drugs, they do not inject the drugs, and they do not provide the drugs,” said Davis.

The Harper government’s decision in 2008 to discontinue Insite’s exemption from federal drug laws granted by Health Canada is what led to the court battle over the facility.

Insite operator the Portland Hotel Society argued in a court challenge that enforcing federal drug laws at the safe injection facility violated section 7 of the Charter of Rights, which protects life, liberty and security of the person. They also argued that federal criminal laws shouldn’t entrench on the provincial health authority.

Two B.C. court rulings have sided with Insite, but the facility’s future now awaits the outcome of the Supreme Court case.

The federal government argues that supervised injection services offered at the provincially funded Insite program are in conflict with drug laws, and that federal criminal laws should take precedence over provincial government jurisdiction.

According to a spokesperson for Canada’s minister of health, the federal government’s national anti-drug strategy focuses on prevention and treatment for people with drug dependencies.

But Davis argues that treatment and injection supervision services for drug users shouldn’t be considered as either/or options.

“We need services on the continuum for injection drug users,” said Davis. “So one part of the continuum is actually getting people in the door with health care, and when they are able to take steps towards treatment, then that’s there for them as well.”

The Dr. Peter Centre also helps HIV/AIDS patients with services such as wound care dressings, medication management, meals and counseling. The Vancouver facility has about 350 registered participants in its day health program and 24 people living in the centre’s nursing care residence.

Davis wants to see supervised drug injection services integrated into public health services, as recommended in a report issued by B.C.’s provincial medical officer in March.

The report by Dr. Perry Kendall showed there are fewer cases of HIV among injection drug users in B.C., and recommended that harm reduction services, including access to supervised injection, be expanded in the province.

The report is part of a growing pile of research that supporters say point to the benefits of Insite. A study published in the medical journal The Lancet in April indicated that fatal overdoses in the Downtown Eastside decreased by 35 percent after the facility opened.

Supporters of the supervised injection facility include Mayor Gregor Robertson and five former city mayors, who signed an open letter this week asking the federal government to drop its appeal of the earlier court decisions that supported Insite.

Insite operators say drug users who inject at the facility are statistically more likely to access detox than those who don’t.

According to Davis, there is also a high correlation between HIV/AIDS patients who use the supervised injection service at the Dr. Peter Centre, and those who get help with their medication.

“The more we can engage people in the door into their HIV treatment and having a place for them to inject where they’re not sharing needles, we are on the path of being very much a part of helping reduce HIV transmission in this province,” she said.

Davis said that while all of the facility’s clients are HIV positive, 100 percent of them have also experienced trauma in their lives.

“Most of the individuals here have long-standing mental illness,” she said. “Their addictions are years of addiction, and a lot of that is literally self-medication to overcome some of the emotional and physical issues in their lives.”

Davis said if the court rules in favour of Insite, there’s the potential for more injection drug users across the country to benefit from similar harm reduction services.

“The Dr. Peter Centre has had health care leaders and health care policy makers from across the province, across the country and internationally at our door, wanting to learn more about how we do this, and there are certainly places in the country that would want to implement this service tomorrow if they could,” she said.

She noted that HIV transmission rates in British Columbia have been reduced by nearly 60 percent, and by 50 percent among injection drug users.

“That’s phenomenal, when there’s areas of the world where HIV transmission with injection drug use is out of control,” she said. “So there’s an opportunity for Canada as a whole to get a grip on HIV transmission, and not just British Columbia.”

Other intervenors in the Supreme Court case include the B.C. Civil Liberties Association, the B.C. Nurses’ Union and the Canadian HIV/AIDS Legal Network.