Open letter: Health Canada must act to increase the availability of supervised consumption services like Insite

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      Dear Minister Ambrose:

      September 30, 2013 (9/30) marks the two-year anniversary of Canada’s Supreme Court decision that unanimously granted constitutional protection to Vancouver’s supervised
      injection site, Insite. That decision recognized the improved public health and public order that stems from the implementation of this service. The Court also recognized that, under the Canadian Charter of Rights and Freedoms, people who need such life-saving health services should not face possible criminal prosecution and imprisonment for attempting to use them. The decision created an important precedent supportive of expanding similar services in other communities.

      An overwhelming amount of research evidence on supervised injection sites (SIS) has been published in a wide range of scientific and medical journals since Insite first opened its doors in 2003. The evidence of Insite’s positive benefits is conclusive and these services should be scaled up where needed across Canada. Indeed numerous localities are working towards this goal.

      Supervised consumption services (SCS) have been proven to:

      • decrease overdose death and injury;
      • decrease risk behaviours associated with HIV and hepatitis C infection;
      • increase access to health services for people who are most marginalized;
      • save health care costs; and
      • decrease open drug use and publicly discarded drug use equipment.

      Furthermore, the evidence shows that such services do not increase crime. There are over 90 SCSs operating around the world today, and considerable research about the positive public health and safety outcomes of SCSs. There is also broad agreement among health professionals that SCSs should be part of a comprehensive continuum of health services for people who use drugs.

      On September 30, 2011, the Supreme Court of Canada (SCC) ruled that it would infringe constitutional rights to security of the person to deny an exemption from the provisions of the Controlled Drugs and Substances Act so that Insite could operate without staff or users fearing criminal prosecution when using this health service. The Court declared unequivocally: “Insite saves lives. Its benefits have been proven.” The Court also stated: “Where, as here, a supervised injection site will decrease the risk of death and disease, and there is little or no evidence that it will have a negative impact on public safety, the Minister should generally grant an exemption.”

      As you know, when Bill C-65, the so-called “Respect for Communities Act,” was introduced earlier this year in the last session of Parliament, it was widely criticized as misguided, including by health professionals. Its introduction was also accompanied by a highly objectionable communications campaign that further stigmatized members of our communities who struggle with substance use. Bill C-65’s provisions were designed to put significant barriers in place to prevent other cities from establishing supervised consumption services, undermining the ability of health services to reach people at greatest risk of death and illness. Numerous provisions in the bill created opportunities for community opponents, local police and others to voice their opposition, no matter how ill informed, without requiring them to provide evidence to support their claims.

      We oppose the provisions of the former Bill C-65 and request that your government not reintroduce this bill in the fall session of Parliament.

      Instead, as organizations of people who use drugs, researchers, professionals, service providers, and community members, we are demanding increased access to supervised consumption services across Canada. It is unacceptable that a decade after Insite first opened, Vancouver remains the only city in Canada with a sanctioned supervised consumption service – and only one such service of this sort, which numerous studies have demonstrated is simply inadequate to meet local needs.

      It is unethical, unconstitutional and damaging to both public health and the public purse to block access to supervised consumption services which save lives and prevent the spread of infection.

      It’s time to stand up for people’s lives and take the leadership to ensure that supervised consumption services become a part of the continuum of care for people who use drugs in Canada.

      Donald Macpherson
      Director, Canadian Drug Policy Coalition

      Scott Bernstein
      Lawyer, Pivot Legal Society

      Richard Elliott
      Director, Canadian HIV/AIDS Legal Network

      This letter was also signed by the following Canadian and international organizations:

      AAWEAR, Alberta Addicts Who Educate and Act Responsibly, Calgary, AB
      Africans in Partnership Against AIDS, Toronto, ON
      AIDS Coalition of Cape Breton, NS
      AIDS Coalition of Nova Scotia, Halifax, NS
      AIDS Committee of Guelph and Wellington County, ON
      AIDS Committee of Ottawa, ON
      AIDS Community Care Montreal, QC
      AIDS Saint John, Saint John, NB
      AIDS Vancouver Island, Victoria, BC
      All Nations Hope, Regina, SK
      ANKORS, AIDS Network Outreach & Support Society, Nelson, BC
      AQPSUD, L’Association Québécoise pour la promotion de la santé des personnes utilisatrices de
      drogues, Montréal, QC
      Australian Drug Foundation
      BC Centre for Excellence in HIV/AIDS, Vancouver, BC
      BC Civil Liberties Union, Vancouver, BC
      BC Hospital Employees Union, Vancouver, BC
      BC Poverty Reduction Coalition, Vancouver, BC
      Beyond Prohibition, Vancouver, BC
      Bissell Centre, Edmonton, AB
      Blood Ties Four Directions Centre, Whitehorse, YK
      Boyle Street Community Services, Edmonton, AB
      Breakaway Addiction Services, Etobicoke, ON
      CACTUS, Montréal, QC
      Campaign for Safer Consumption Services, Ottawa, ON
      Canada Wild Productions, Vancouver, BC
      Canadian AIDS Society, Ottawa, ON
      Canadian Association of Nurses in AIDS Care, Ottawa, ON
      Canadian Association of Social Workers
      Canadian Harm Reduction Network, Toronto, ON
      Canadian Students for Sensible Drug Policy, national
      Canadian Unitarians for Social Justice, National
      CATIE, Canada’s Source for HIV/HCV Information, Toronto, ON
      Central Alberta AIDS Network, Red Deer, AB
      Centre for Addictions Research of BC, Victoria, BC
      Centro Caritas de Formafcion para la atencion de las farmacodependencias, Mexico
      Choices for Change: Alcohol, Drug & Gambling Counseling Centre, Stratford, ON
      CIHR Canadian Trials Network, Vancouver, BC
      Committee to End Homelessness, Victoria, BC
      CUPIHD, Colectivo por una politica integral hacia la drogas, A.C., Mexico
      ESPOLEA, Mexico City, Mexico
      Faith in Action, Multifaith Initiative in Support of the Poor, Victoria, BC
      FIRST, Decriminalize Sex Work, Vancouver, BC
      Forum Droghe Italy
      George Spady Society, Edmonton, AB
      Global Platform for Drug Consumption Rooms
      Heads and Hands, Montréal, QC
      Health Officers Council of British Columbia, Victoria, BC
      HIV West Yellowhead, Jasper, AB
      HIV/AIDS Regional Services, Kingston, ON
      Hope Bridge Services, Surrey, BC
      Hope Place Centres, ON
      Indonesian Drug User Network
      Inner Change Foundation, Vancouver, BC
      International Network of People Who Use Drugs
      Isomer Design, Toronto, ON
      Jac’s Voice on Living with Addition and Mental Illness, Toronto, ON
      LEAP Canada, Law Enforcement Against Prohibition, National
      LILA Italian League for Fighting AIDS, Italy
      Lutheran Urban Mission Society, Vancouver, BC
      Mavis McMullen Housing Society, Vancouver, BC
      Megaphone Magazine, Vancouver, BC
      Neighbour Centre, Edmonton, AB
      Northern AIDS Connection Society, Truro, NS
      Ontario Federation of Community Mental Health Addictions Programs, ON
      PACE Society, Vancouver, BC
      Pacifica Housing, Vancouver, BC
      PASAN, Toronto, ON
      Persons Living with AIDS Saskatchewan, Saskatoon, SK
      Point de Repères, Québec, QC
      Positive Living Society BC, Vancouver, BC
      Psicotropicus, Centro Brasileiro de Politicas de Drogas, Brazil
      Red Cedar Law, Vancouver, BC
      Registered Nurses Association of Ontario, Toronto, ON
      Richmond Addiction Services Society, Richmond, BC
      SALOME/NAOMI Patients Association, Vancouver, BC
      Saskatchewan HIV HCV Nursing Education Organization, Regina, SK
      Saskatchewan Public Health Association, Saskatoon, SK
      Sharp Advice Needle Exchange, AIDS Coalition of Cape Breton, NS
      Shepherds of Good Hope, Ottawa, ON
      South Riverdale Community Health Centre, Toronto, ON
      Street Health and the Toronto Street Nurses Network, Toronto, ON
      Streetworks, Edmonton, AB
      Uganda Harm Reduction Network
      Vancouver Island Persons Living with HIV/AIDS, Victoria, BC
      VIVA, Victoria, BC




      Oct 1, 2013 at 8:44am

      Everyone is aware what happens if they choose to stick a needle full of heroin in their arm. Our limited healthcare dollars should be spent on those the are injured or sick by not their own doing.

      Let the others die in the street for all care.

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      Oct 1, 2013 at 12:04pm

      Addicts need help, not Insite.

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      Rick in Richmond

      Oct 1, 2013 at 2:16pm

      This group letter reinforces the madness of our consumer culture.

      By attempting to institutionalize drug addiction, and to create 'consumption centres' across the country, this effort allows people to turn our backs on cause and cure. Instead, its whole focus -- with no apparent embarrassment -- is "consumption".

      No drug addict is helped by rationalizing or systematizing addiction. Drug addiction is not a "lifestyle choice". It is a disease, to be treated as such -- and not to be enabled by this latest mad consumerism.

      Insite is, at best, a suicide prevention bureau.

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      @ Rick

      Oct 1, 2013 at 3:05pm

      I agree with everything you said but the that Drug Addiction is not a "lifestyle choice" drug addiction comes from doing drugs.

      Are you suggesting addicts did not have a choice when first putting the needle in the arm or pipe in their mouth? Are you suggesting they were not aware of possible consequences?

      If you truely believe that then the problem is education, once we have educated people that drugs are bad (i personally think we have), society should not have to flip the bill for deciding to go down that road.

      We cant afford healthcare for those that legitimately need it let alone from those who abuse it by abusing them selfs.

      Let them kill themselfs, and educate the rest.

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      Oct 1, 2013 at 3:39pm

      To the commenter at 3:05PM:

      So if healthcare is not provided to those that abuse themselves, I'm guessing you do not drink alcohol, smoke, spend time with people that are smoking, get less than 8 hours sleep a night, do less than 30 mins of physical activity a day, consume more than 100% of the RDA for salt, sugar, and saturated fat, etc? Cause if you do any of those unhealthy activities(and almost everyone does at least one unhealthy activity), you basically just said you don't get health care. Which is fine with me if you want to decline health care coverage.

      What about if those drug users have mental health issues, as many of them do. Arguably, one could say nearly everyone willing to inject drugs of this type into themselves, has a mental issue of some sort. Should we go back to throwing them all in "insane asylums" as they were once called and start lobotomizing them again? Or do we help them to try and become productive members of society? I say we help them.

      Not to mention some are born addicted and as kids/teens are apt to do, they try things that they are told not to. Which is part of the reason why we don't refer to them as adults until after they reach 18-21. Do we also just leave them to die a horrible death because they fell for the supposed "glamour" of using drugs like x movie or sports star?

      What about the people who become addicted to pain medication after being prescribed it by a doc while they recover from some painful event? Is it there fault that they were injured so badly that they needed strong painkillers? Granted some might be their own fault, but accidents are just that accidental.

      Drug addiction is a lot more complicated than just sticking a needle in one's arm.

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      Oct 1, 2013 at 10:08pm

      Comparing the effect of not getting 8 hours sleep, or having a glass of wine with dinner to shooting heroine is an extremely week argument. Its so week, in fact, I didn't bother reading the rest of what you wrote.

      Unlike the drug addicts I offset my 6 hours of sleep with extra work to help fund the healthcare system with taxes and contributions. Further while i do drink, I also exercise and choose not to share needles. I drink wine, maybe a beer not moonshine bought made in some guys bathtub. If the latter caused someone to go blind I say tell them to listen close before crossing the street in the future, but no free healthcare for you.

      As far as smoking goes people who buy cigarets shouldnt get to use the public medical system to treat lung cancer. Even if that never changes at least they contribute in the form of taxes form the cigarets they buy.

      Obese people should have to pay more in taxes IMO.

      Sorry, tax dollars can be better spent on treating more legitimate things then effects from people trying to kill themselves.

      Unfortunately as nobel as it sounds that everyone should get free healthcare the fact is our country can't afford it. Look at our province. We pay what $75 per month in MSP on top of our our taxes which is a cost that goes up and and up. The system is failing and in order to keep it going we have to make some serious changes on who we help, how and for what.

      The bottom line is people need to be more accountable for their health and not expect others to pay for their stupidity.

      Scott Bernstein

      Oct 2, 2013 at 10:26am

      It is sad to acknowledge that there are people in our society who write "Let the others die in the street for all care." (sic) and "Let them kill themselfs (sic), and educate the rest" without compassion for people who are sons, daughters, sisters, brothers, fathers and mothers to other people. Every heroin addict started with mother's milk. Judgment of others so harshly reflects an unwillingness to acknowledge evidence and a fact that addiction to drugs is a VERY complicated phenomenon. Why not start from a point of compassion towards other members of the human race and go from there?

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      Oct 3, 2013 at 3:47pm

      Sounds nice....but who pays for that? Brake out your calculator and you will see that we cant afford it.

      No one forced a needle into anyones arm.

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