Evidence trumps ideology over public health benefits of Insite

The Vancouver Sun
By Dr. Thomas Kerr and Dr. Julio Montaner 

It has been nearly 10 years since Insite, Vancouver’s supervised injection site opened and two years since the Supreme Court of Canada unanimously determined that it should remain open to protect public health.

A large body of scientific evidence demonstrates that Insite and other harm reduction programs, such as needle exchanges, are effective in reducing the harms associated with illicit drug use. Sadly, ideological debate about harm reduction continues, despite widespread agreement among health authorities, including the World Health Organization, that such programs are essential to the fight against HIV/AIDS and other drug-related harms.

A recently released report summarizing 15 years of data on the drug situation in Vancouver provides further evidence that harm reduction programs have helped reduce illicit drug use and improve public health: fewer people are injecting drugs; more are accessing addiction treatment; and HIV transmission related to injection drug use has plummeted.

Likewise, a large body of scientific evidence shows that Insite is meeting its objectives. Peer-reviewed studies involving dozens of researchers from Canada, Australia, Britain and the U.S. demonstrate clearly that Insite does not increase crime or perpetuate active drug use. More than 30 peer-reviewed studies show that Insite saves lives and health care dollars, reduces disease transmission, and promotes entry into addiction treatment.

The program now has the support of leading national health organizations such as the Canadian Medical Association, the Canadian Association of Nurses, and the Canadian Public Health Association. Health organizations in other parts of Canada are now advocating for similar programs in their jurisdictions.

Still, critics continue to launch personal attacks against scientists, misrepresent existing research, and cite bogus reports that have never been subjected to scientific scrutiny or published in recognized journals, reducing public discourse about harm reduction to the same level as past debates about global warming and the harm of cigarette smoking.

The most vocal of those arguing against Insite is the Drug Prevention Network of Canada (DPNC). This is an organization that covertly accepted RCMP funding to produce pseudo-scientific reports on Insite. Ultimately the RCMP acknowledged their wrongdoing and distanced themselves from the reports, admitting the reports were commissioned to “provide an alternative analysis” to existing research and “did not meet conventional academic standards.” Ironically, when a Supreme Court justice asked lawyers representing the federal government if they had any scientific evidence indicating that Insite was not meeting its objectives, they did not offer one of the DPNC reports — they offered nothing.

David Berner and the DPNC continue to get the facts all wrong. Anyone who has spent any time in Vancouver’s Downtown Eastside knows that Insite was opened and continues to be operated by the Portland Hotel Society and Vancouver Coastal Health. It was not created or ever operated by the B.C. Centre for Excellence in HIV/AIDS. Rather, our centre was contracted, through an open and competitive process, to conduct an arm’s-length scientific evaluation of Insite.

Recently, the DPNC has repeated claims that drug overdose deaths in Vancouver’s Downtown Eastside have increased since the facility opened. This is not only false, but in citing data from the B.C. Vital Statistics agency, they continue to recklessly lump all drug-related deaths together, including many causes of death that bear no relevance to Insite.

The claim stands in stark contrast to a 2011 study published in the prestigious medical journal, The Lancet, which showed overdose deaths around Insite had declined by 35 per cent. The Lancet study systematically reviewed each recorded death and involved the use of appropriate statistical methods. Dr. Chris Beyrer, a professor at Johns Hopkins School of Public Health who was invited by The Lancet to write a commentary to accompany the article, stated: “Supervised injection facilities clearly have an important part to play in communities affected by injection drug use. They should be expanded to other affected sites … on the basis of the life-saving effects.”

Harm reduction programs should remain essential components of our response to illicit drug use. Still, we must do more to further reduce drug-related harm.

In doing so we must recognize that we have an ethical duty to base our responses to drug-related harm on the best available evidence.

By now, that evidence should be resoundingly clear: Harm reduction — including Insite — saves lives.

Dr. Thomas Kerr is the is the co-director of the Urban Health Research Initiative at the British Columbia Centre for Excellence in HIV/AIDS and associate professor in the Department of Medicine at the University of British Columbia. Dr. Julio Montaner is the director of the British Columbia Centre for Excellence in HIV/AIDS, the chair in AIDS Research and head of division of AIDS in the Faculty of Medicine, University of British Columbia, and the past-president of the International AIDS Society.