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An appeal to humanity: legal victory in favour of North America's only supervised injection facility:… Small, Dan Oct 9, 2010

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BRIEF REPORT Open AccessAn appeal to humanity: legal victory in favour ofNorth America’s only supervised injection facility:InsiteDan Small1,2AbstractCanada’s federal government has once again failed to shut North America’s only authorized supervised injectionfacility: Insite. A majority ruling issued by the BC Court of Appeal on 15 January 2010 upheld an earlier BritishColumbia Supreme Court ruling in 2008 that protected the rights of injection drug users (IDUs) to access Insite asa health facility as per the Charter of Rights and Freedoms component of the Constitution of Canada. The majoritydecision from Honourable Madam Justices Rowles, Huddart and Smith also established a jurisdictional victory safe-guarding Insite as most appropriately run under the authority of the province of British Columbia rather than thefederal Government of Canada. The Federal Government has appealed the case to the Supreme Court of Canada.A hearing date has been set for 12 May 2011. The appeal will be a legal one but even more so, it will be anappeal to humanity.Canada’s federal government has once again failed toshut North America’s only authorized supervised injec-tion facility: Insite. A majority ruling issued by the BCCourt of Appeal on 15 January 2010 upheld an earlierBritish Columbia Supreme Court ruling in 2008 thatprotected the rights of injection drug users (IDUs) toaccess Insite as a health facility as per the Charter ofRights and Freedoms component of the Constitution ofCanada.The majority decision from Honourable Madam Jus-tices Rowles, Huddart and Smith also established animportant jurisdictional victory emerging from the crossappeal by the operators of Insite: the PHS CommunityServices Society (PHS). The ruling further safeguardsInsite as most appropriately run under the authority ofprovince of British Columbia rather than the federalGovernment of Canada.Insite opened on 21 September of 2003 under anexemption granting it status as a scientific pilot studyuntil 12 September 2006. The primary goals of the pro-gram are: (1) to reach a marginalized group of IDUs withhealthcare and supports who would otherwise be forcedto use drugs in less safe settings (2) to reduce dangerousinjection practices (syringe sharing) thereby reducing therisk of infectious diseases like HIV and HCV; and (3) toreduce fatal overdoses in the population of people thatuse the facility. The program also aims to provide refer-rals to treatment and detoxification, reduce public disor-der (public injection) and validate the personhood of adeeply stigmatized target population [1].The legal battle began near the end of Insite’s three-year exemption for scientific study when a minorityconservative government was elected in Canada on 6February 2006. The new government voiced oppositionto the program during and after the election [2-4]. On 1September 2006, the program was given a temporaryextension to operate until 31 December of 2007. Beforethis reprieve, the community waited in apprehension.The photograph below (Figure 1) shows an announce-ment of support for the supervised injection facilityfrom a humble church in the inner city of Vancouverwhere Insite makes its home. This same church opensits pews up each night for the homeless to sleep andhas held many services for local residents who died ofpreventable overdoses before Insite was opened. [insertfigure here] For the people living with addictions andtheir families who face the dangers of preventable over-doses and infections in their everyday lives, the fate ofCorrespondence: dansmall@interchange.ubc.ca1Director PHS Community Services Society Vancouver, CanadaFull list of author information is available at the end of the articleSmall Harm Reduction Journal 2010, 7:23http://www.harmreductionjournal.com/content/7/1/23© 2010 Small; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.the injection facility is neither academic nor legal. It isrisk that is lived [5].On 2 October 2007, the project was given an additionalexemption to operate under the Controlled Drugs andSubstances Act until 30 June 30 2008. A looming threatof closure by the conservative led government led thePHS to take the Government of Canada to court in late2007 [6]. The outcome of this first legal case determinedthat the Controlled Drugs and Substances Act (CDSA) inCanada is unconstitutional as it pertains to Insite becausethe closure of the program under the Act would impedepeople with addictions from receiving life saving health-care. BC Supreme Court Justice Ian Pitfield ruled that theuse of the CDSA to shut Insite would undermine thefundamental right, under Canada’s Charter of Rights andFreedoms to life, liberty and security of the person [7].Since its inception, Insite has been subject to an inde-pendent review by a team of physicians and scientistsput in place to provide an “arm’s length” evaluation ofthe program. The results of this scientific evaluationhave been published in peer-reviewed academic journalsand have indicated that Insite has reduced unsafe injec-tion practices, public disorder, overdose deaths andHIV/Hepatitis while increasing uptake of addiction ser-vices and detox [8]. To date, there have been overthree-dozen peer-reviewed papers evaluating Insite pub-lished making it one of the most evaluated healthcareprograms in the history of Canada [9-38]. In light of theevidence, the program has garnered widespread supportfrom Canadian physicians, scientists and healthcare pro-fessionals [39].Despite this support from the scientific and medicalcommunity, the Conservative government of Canadaremains entrenched in its position having served thePHS with court documents indicating their intention toappeal the case of Insite to the highest court in thecountry: the Supreme Court of Canada [40]. A courtdate to hear the case has been set for 12 May 2011 bythe Supreme Court of Canada. It appears that scienceand ideology are once again at odds while Canada’shighest court is asked to determine whether the earth isflat or round in the universe of addiction. When Insitereaches the end of its legal journey in Canada, hopefullythe courts will once again rule that addiction is princi-pally an issue for the Chief of Medicine rather than theChief of Police. As a result, the case is more than anappeal to the Canada’s highest court; it is an appeal tothe country’s humanity.Author details1Director PHS Community Services Society Vancouver, Canada. 2Departmentof Anthropology University of British Columbia Vancouver, Canada.Competing interestsThe author declares that they have no competing interests.Received: 6 July 2010 Accepted: 9 October 2010Published: 9 October 2010References1. Small D: Looking in the cultural mirror: addiction, secret lives and lostpersonhood. Visions Journal 2005, 2:29-30.2. Small D: Fools rush in where angels fear to tread: Playing God withVancouver’s supervised injection facility. International Journal of DrugPolicy 2007, 18:18-26.Figure 1 Photograph of church marquee advertising an upcoming sermon in Vancouver’s downtown eastside. Photograph by D. SmallSmall Harm Reduction Journal 2010, 7:23http://www.harmreductionjournal.com/content/7/1/23Page 2 of 33. Canada: Standing Committee on Health: Transcript of Meeting Thursday,May 29, 2008.Edited by: Health SCo. Ottawa: Government of Canada; 2008:.4. Galloway G: Clement seeks appeal of Insite decision. Globe and MailToronto: CTV globe media 2008.5. Gifford SM: The Meaning of Lumps: A Case Study of the Ambiguities ofRisk. In Anthropology and Epidemiology. Edited by: Janes CR. D. ReidelPublishing Company; 1986:213-246.6. Small D: Fighting addiction’s death row: British Columbia Supreme CourtJustice Ian Pitfield shows a measure of legal courage. Harm ReductionJournal 2008, 5:1-18.7. Pitfield THMJ: PHS Community Services Society v. Attorney General ofCanada, 2008 BCSC 661. The Supreme Court of British Columbia 2008.8. Small D: Amazing grace: Vancouver’s supervised injection facility grantedsix-month lease on life. Harm Reduction Journal 2008, 5:1-6.9. DeBeck K, Wood E, Zhang R, Tyndall M, Montaner J, Kerr T: Police andpublic health partnerships: Evidence from the evaluation of Vancouver’ssupervised injection facility. Substance Abuse Treatent, Prevention and Policy2008, 3:1-5.10. Fairburn N, Small W, Shannon K, Wood E, Kerr T: Women’s Experiences inNorth America’s First Medically Supervised Safer Injection Facility. SocialScience and Medicine Forthcoming .11. Kerr T, Kimber J, DeBeck K, Wood E: The Role of Safer Injection Facilitiesin the Response to HIV/AIDS Among Injection Drug Users. Current HIV/AIDS Reports 2007, 4:158-164.12. Kerr T, Small W, Moore D, Wood E: A Micro-Environmental Intervention toReduce Harms Associated with Drug-Related Overdose: Evidence fromthe Evaluation of Vancouver’s Safer Injection Facility. International Journalof Drug Policy 2007, 18:37-45.13. Kerr T, Stoltz J, Tyndall M, Li K, Zhang R, Montaner J, Wood E: Impact of aMedically Supervised Safer Injection Facility on Community Drug UsePatterns: A Before and After Study. British Medical Journal 2006,332:220-222.14. Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E: Drug-Related OverdosesWithin A Medically Supervised Safer Injection Facility. InternationalJournal of Drug Policy 2006, 17:436-441.15. Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E: Circumstances of FirstInjection Among Illicit Drug Users Accessing a Medically SupervisedSafer Injecting Facility. American Journal of Public Health 2007,97:1228-1220.16. Kerr T, Tyndall MW, Li K, Montaner JS, Wood E: Safer Injecting Facility Useand Syringe Sharing Among Injection Drug Users. Lancet 2005,366:316-318.17. Kerr T, Wood E, Small D, Palepu A, Tyndall MW: Potential Use of SaferInjecting Facilities Among Injection Drug Users in Vancouver’sDowntown Eastside. Canadian Medical Association Journal 2003, 169:1-5.18. McKnight I, Maas B, Wood E, Tyndall MW, Small W, Lai C, Montaner JSG,Kerr T: Factors Associated with Public Injecting Among Users ofVancouver’s Supervised Injection Facility. American Journal of Drug andAlcohol Abuse 2007, 33:319-325.19. Milloy MJ, Wood E, Small W, Tyndall M, Lai C, Montaner J, Kerr T:Incarceration experiences in a cohort of active injection drug users. Drugand Alcohol Review 2008, 1-7.20. Petrar S, Kerr T, Tyndall MW, Zhang R, McKnight B, Montaner JSG, Wood E:Injection Drug Users’ Perceptions Regarding Use of a MedicallySupervised Safer Injecting Facility. Addictive Behaviors 2007, 32:1088-1093.21. Stoltz JA, Wood E, Small W, Li K, Tyndall M, Montaner J, Kerr T: Changes ininjecting practices associated with the use of a medically supervisedinjection facility. Journal of Public Health (Oxford) 2007, 29:35-39.22. Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E: Attendance,Drug Use Patterns, and Referrals Made From North America’s FirstSupervised Injection Facility. Drug and Alcohol Dependence 2005,83:193-198.23. Tyndall MW, Wood E, Zhang R, Lai C, Montaner JS, Kerr T: HIV Sero-prevalence Among Participants at a Supervised Injection Facility inVancouver, Canada: Implications for Prevention, Care and Treatment.Harm Reduction Journal 2006, 3:1-5.24. Wood E, Kerr T, Buchner C, Marsh D, Montaner JS, Tyndall MW:Methodology for Evaluating Insite: Canada’s First Medically SupervisedSafer Injection Facility for Injection Drug Users. Harm Reduction Journal2004, 1:1-5.25. Wood E, Kerr T, Montaner JS, Strathdee S, Kerr T, Wodak A, Spittal P,Hankins C, Schechter MT, Tyndall M: Rationale For Evaluating NorthAmerica’s First Medically Supervised Injecting Facility. Lancet InfectiousDiseases 2004, 4:301-306.26. Wood E, Kerr T, Small W, Li K, Marsh D, Montaner JS, Tyndall MW: ChangesIn Public Order After The Opening of a Medically Supervised SaferInjection Facility for Injection Drug Users. Canadian Medical AssociationJournal 2004, 171:731-734.27. Wood E, Kerr T, Stoltz J, Qui Z, Zhang R, Montaner JSG, Tyndall MW:Prevalence and correlates of hepatitis C among users of North America’sfirst medically supervised safer injection facility. Public Health 2005,119:1111-1115.28. Wood E, Kerr T, Tyndall MW, Montaner JSG: The Canadian government’streatment of scientific process and evidence: Inside the evaluation ofNorth America’s first supervised injecting facility. The International Journalof Drug Policy 2007, 1-6.29. Wood E, Montaner JS, Kerr T: Reflection and Reaction: Illicit drugaddiction, infection disease spread, and the need for an evidence-basedresponse. Lancet 2008, 8:142-143.30. Wood E, Tyndall MW, Lai C, Montaner JSG, Kerr T: Impact of a MedicallySupervised Safer Injecting Facility on Drug Dealing and Other Drug-Related Crime. Substance Abuse Treatment, Prevention and Policy 2006,1:1-4.31. Wood E, Tyndall MW, Li K, Lloyd-Smith E, Small W, Montaner JSG, Kerr T: DoSupervised Injecting Facilities Attract Higher-Risk Injection Drug Users?American Journal of Preventive Medicine 2005, 29:126-130.32. Wood E, Tyndall MW, Montaner JS, Kerr T: Summary of findings from theevaluation of a pilot medically supervised injecting facility. CanadianMedical Association Journal 2006, 175:1399-1404.33. Wood E, Tyndall MW, Qui Z, Zhang R, Montaner JS, Kerr T: Service Uptakeand Characteristics of Injection Drug Users Utilizing North America’sFirst Medically Supervised Safer Injection Facility. American Journal ofPublic Health 2006, 96:770-773.34. Wood E, Tyndall MW, Stoltz J, Small W, Lloyd-Smith E, Zhang R,Montaner JSG, Kerr T: Factors Associated with Syringe Sharing AmongUsers of a Medically Supervised Injecting Facility. American Journal ofInfectious Diseases 2005, 1:50-54.35. Wood E, Tyndall MW, Stoltz J, Small W, Zhang R, O’Connell J, Montaner JSG,Kerr T: Safer Injecting Education for HIV Prevention Within a MedicallySupervised Safer Injecting Facility. International Journal of Drug Policy2005, 16:281-284.36. Wood E, Tyndall MW, Zhang R, Stoltz J, Lai C, Montaner JSG, Kerr T:Attendance at Supervised Injecting Facilities and Use of DetoxificationServices. New England Journal of Medicine 2006, 354:2512-2514.37. Wood E, Tyndall MW, Zhang R, Montaner JS, Kerr T: Rate of detoxificationservice use and its impact among a cohort of supervised injectionfacility users. Addiction 2007, 102:916-919.38. Wood RA, Wood E, Lai C, Tyndall MW, Montaner JSG, Kerr T: Nurse-delivered safer injection education among a cohort of injection drugusers: Evidence from the evaluation of Vancouver’s supervised injectionfacility. International Journal of Drug Policy 2008, 19:183-188.39. Hwang SW: Science and ideology. Open Medicine 2007, 1:E99-101.40. Hall N: Federal government appeals ruling on safe-injection site tonation’s top court. Vancouver Sun Vancouver: Canwest Publishing 2010.doi:10.1186/1477-7517-7-23Cite this article as: Small: An appeal to humanity: legal victory in favourof North America’s only supervised injection facility: Insite. HarmReduction Journal 2010 7:23.Small Harm Reduction Journal 2010, 7:23http://www.harmreductionjournal.com/content/7/1/23Page 3 of 3


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