Hedy's Op-Ed Article in the Calgary Herald
Science says safe injection site a success
Dr. Hedy Fry
For The Calgary Herald
Friday, May 30, 2008
Re: "Vancouver's safe injection site contradiction in name and deed: We should focus on the problem as a moral issue," by Susan Martinuk
I would like to clarify some misconceptions expressed by Martinuk in last Friday's column regarding Vancouver's safe-injection site.
Good public policy should be based on objectively researched evidence, and not on subjective morality or ideology.
Addiction is a medical problem. Extensive medical research has established that over the last 20 years. Effective solutions must therefore be based on good public health principles.
These universally accepted public health principles are: prevention and epidemiology (research and data), harm reduction, treatment and rehabilitation. These principles work together to form a comprehensive, integrated strategy for dealing with public health problems.
Those who exploit the addicted by selling and trafficking in illicit drugs are criminals and should be targeted with effective criminal and law enforcement strategies.
Insite, Vancouver's safe injection site, is a harm reduction project. It is not an original concept. It was patterned on similar, highly successful, harm reduction programs, (sanctioned by the European Parliament) in Switzerland, Germany, Belgium, Portugal and Spain, to name a few, as well as numerous safe injection facilities in Australia.
The project in Vancouver was set up as a clinical trial, to see whether the European and Australian results could be achieved in a North American setting.
The research project was conducted by scientists at UBC and the Centre for Excellence in Clinical Trials for HIV/AIDS.
The protocols followed accepted international scientific standards for clinical research. The chief researcher is Dr. Julio Montaner, a respected clinician and current president of the esteemed Council of the International AIDS Society.
The target population, as in most harm reduction research, was the small but very high-risk IV drug user cohort in Vancouver, who had extremely high overdose mortality rates, peaking at over 200 in the mid-1990s. This group was also at highest risk for HIV and hepatitis C infection, and for frequent hospitalization. They were also the group least likely to seek treatment.
Within six months of the establishment of Insite, the overdose deaths had dropped to zero and remained so among Insite users. Within 18 months, the users of this very resistant group were seeking detox and treatment. There are now 24 beds in the building that provide immediate detox treatment facilities.
Moreover, the rates of illness and hospitalization dropped dramatically, at great savings to the health-care system (Vancouver Coastal Health Authority), and the spread of HIV and hepatitis C was contained in this high risk group.
One of the objectives of the project was also to determine whether public order would be achieved. The Vancouver Police Department's Commander of the drug unit, at the time, Kash Heed (now chief of police for West Vancouver), attests that this is so.
The Chinatown Merchants' Association was adversely affected by the public disorder and were opposed to Insite. Today, they say that within two years, crime and public disorder has decreased markedly.
As per accepted scientific research principles, the Insite research and results were analyzed by 22 international research panels from many countries. They attest to the validity of the research findings: saving lives, decreasing illness and the spread of disease and decreasing public disorder. Some of these reports are published in the May edition of the International Journal of Drug Policy.
Martinuk continues to hold that there are no facts behind Insite's success. I refer her to the body of supporting, scientific literature. If she does not trust science, then I refer her to the chief of police of the District of West Vancouver; to the affected local business community and the experience of Europe and Australia. Then I ask her to compare all of this evidence with the one report cited by the minister of Health (and commissioned by him).
Martinuk holds that this issue should be judged morally and not scientifically. As a physician whose professional ethic -- do no harm -- is based on harm reduction, my view is quite different. I believe that to deny proven life-saving assistance to those who are vulnerable, simply because we disapprove of their lifestyles, is perhaps the greatest immorality of all.
Dr. Hedy Fry is a physician and Liberal MP for Vancouver Centre
© The Calgary Herald 2008
