Insite and insight.

The future of Vancouver's Insite Safe Injection Clinic is in doubt and along with it, Canada's harm reduction programs for drug users are also imperilled. The Harper government is moving to a U.S. style approach to solving drug abuse problems--exhortation, police action and imprisonment.

Federal health minister Tony Clement refuses to say if he will continue to exempt the Insite Clinic from drug enforcement laws. However, the odds are that unless there is stronger support, Insite will close at the end of this year. The government shows signs of drifting into another "war on drugs" or in President Bush's lingo, a "surge" in police activity.

Initially, the Vancouver program was intended as a pilot to guide the establishment of similar clinics in Toronto and other cities. The Clinic provides substance injection users with clean needles and equipment. Health care professionals are present to help with any problems that might arise, such as drug overdoses. Literature and staff are available to advise on treatment programs.

Insite requires the cooperation of the federal and provincial health and justice agencies. The federal government gives a dispensation from the narcotics control laws, and police agree to stand back as the heroin users enter these sites with the illegal substances in hand.

After Insite opened, the conservative Harper government came to power. We can now forget about any similar programs in other cities. Federal health minister Tony Clement is not likely to renew the license for the Vancouver injection site at the end of this year. He claims that research does not support the Insite approach and that he will announce a new and more efficient program for the treatment of substance abuse. The outline is not completely clear, except that it will include a stronger measure of law enforcement. The government is going ahead without any real opposition.

A clear voice of reason has emerged. Dr. Stephen Hwang, research scientist at St. Michael's Hospital and a professor in the University of Toronto's medical faculty, issued a statement endorsed by 130 prominent physicians and scientists, suggesting that the government is more concerned with ideology than with science.

Writing in Open Medicine, Hwang states, "The health of a nation is placed in peril if our leaders ignore crucial research findings simply because they run contrary to a rigid policy agenda driven by ideology or fixed beliefs." Hwang points out that in a series of peer-reviewed research articles, the supervised injection facility in Vancouver has been shown to provide a number of benefits, including reduced needle sharing, decreased public drug use, fewer publicly discarded syringes and more rapid entry into detoxification services by persons using the facility. The facility was not associated with any increase in the levels of crime, public disorder or injection drug use. Clement's stubborn response is that these studies are inconclusive.

The Harper government approach is contradictory. They want more law enforcement and more imprisonment. Meanwhile, Correctional Services Canada recently announced that they are reducing staff, even though correctional facilities now house a growing percentage of substance abusers, a very challenging group. However, most people who have been found guilty of a criminal offense, including drug abusers, are serving time outside a custodial institution--in probation, parole or house arrest programs. Does the government plan to expand drug treatment programs for all offenders inside and outside custodial facilities? Not likely.

The Harperites will follow the U.S. lead to ban or seriously limit all other harm reduction programs, especially clean needle exchanges. They are ready to believe, as does the Bush administration, that these services encourage substance abuse, despite all evidence to the contrary.

Hwang and his associates assert that, "We wish to affirm the vital importance of evidence-informed policy-making on issues related to substance use disorders, and to state our grave concern regarding the risks of pursuing health policies that disregard strong and credible scientific data."

Public health authorities and voluntary organizations who initially supported Insite are remarkably silent on the Harper government's implicit approach. Are they trying to use quiet diplomacy to persuade the government to a more rational approach? Do they fear being tarred as "soft on drugs," which could cost them government grants and other funding?

Everyone concerned with public health should stop sitting on the sidelines while the government attacks Canada's health programs. Unless those who worry about public health assert their convictions, they will be giving tacit assent to a serious public health hazard.

--L.K.