Canadian Health Minister and Doctors Spar Over Supervised Injection Sites for Drug Addicts

by Gopalan on Aug 22 2008 2:32 PM

Canadian Health Minister Tony Clement has strongly denounced the Vancouver supervised injection site for drug addicts, but doctors say that is the right way to combat the problem.

The minister says the very idea is "profoundly disturbing" and that he is puzzled doctors should be supporting the practice.

He was referring to Insite, the first legal supervised safe injection site in North America, and situated in Vancouver, British Columbia. The site provides a clean, safe location for injection drug use, primarily heroin, cocaine, and morphine.

Medical staff are present to provide addiction treatment, mental health assistance, and first aid in the event of an overdose or wound.

Insite serves more than 7,200 registered clients with 15,000 to 20,000 visits each month – all active intravenous users at the highest risk for HIV transmission and overdose.

Insite has operated in Vancouver since 2003, under an exemption from federal drug laws. Originally it was a Liberal government had given the nod, but Conservatives, who came to power in 2006, also granted a temporary extension, then added a six month extension that ends mid-2008.

The federal government is appealing a B.C. Supreme Court decision that struck down sections of Canada's drug laws as unconstitutional, because they prevent Insite from operating. 

Monday the federal Health minister carried the battle right into the medical fraternity, the annual meeting of the Canadian Medical Association in Montreal.

"Is it ethical for health-care professionals to support the administration of drugs that are of unknown substance, or purity or potency — drugs that cannot otherwise be legally prescribed?" Clement asked.

In any other medical setting, supervised overdoses would be considered "highly unprofessional," he asserted.

"In this way, supervised injection sites undercut the ethics of medical practice, and set a debilitating example for all physicians and nurses, both present and future in Canada, who might begin to question whether it's OK to let someone overdose in their care."

Vancouver's Insite safe-injection centre has not noticeably reduced drug overdose deaths, because narcotics use in "back alleys and seedy motels" is still high, he claimed.

Clement also questioned the validity of calling supervised injection sites palliative care for addiction, a concept put forward by the British Columbia medical association in the late 1990s.

"Imagine for a moment a doctor that has a patient with a serious but treatable case of cancer. Would it be ethical for that doctor to automatically give that woman morphine and otherwise make her comfortable until she died of her disease, rather than offering the patient an attempt at treatment, and a chance at recovery?

"Why do we limit ourselves to palliative care?" he continued. "There is a better alternative for injection drug users, and that is treatment. Even if they fail treatment the first time, we can help them to get up and try again."

But CMA president Brian Day retaliated saying that Clement did not know what he was talking about when he made those comments.

"The minister was off base in calling into question the ethics of physicians involved in harm reduction," Day told reporters.

"It's clear that this was being used as a political issue."

The centres have successfully curbed illegal drug use, Day stressed and added that nearly 80 per cent of association members supported harm reduction through supervised injection sites.

It has also been argued that the economic cost of closing InSite will far exceed the cost of operating it – by millions of dollars per year.

“The available data on the economic impact of Insite (in addition to the preventable deaths and disease that the programs closure will cause) indicate that the end of the program will cost Vancouver and British Columbia between $ 3,862,000 and $8,780,000 in additional health care expenses over the next two years. In addition to the increased demands that InSites closure would place on already scarce health care resources, Insites termination would also lead to thousands of additional arrests (which cost more than $10,000 apiece) court adjudications (another $10,000) and all the jail and probation time (not to mention public displeasure) associated with a return to public drug use by this large group,” said Ernest Drucker, an expert in an article published in Harm Reduction Journal.

Robert Ouellet, a radiologist in Montreal, said safe injection sites are an important point of entry for addicts into the health care system. He said the goal is harm reduction — by lowering the risk of disease transmission through dirty needles — as well as by providing education about drug addiction.

"We doctors think that we need to take care of patients and this is quite different. He's doing politics, we're doing health care," he said.