VANCOUVER - As the deadline approaches for a federal government blessing for Vancouver's supervised injection site, supporters are preparing to head to court to argue that the controversial site is a healthcare facility and, therefore, the sole preserve of the province.
And British Columbia Health Minister George Abbott leaves no doubt that the province wants the site to continue to operate.
Regardless of the outcome of the upcoming court cases, Abbott has given strong indications that the facility may operate even if the federal government should withhold its blessing.
"Should they not renew that exemption I would hope we would be advised with a little notice," Abbott said. "We will then be turning the discussion intensively in another direction.
"I do not want to see Insite closed."
While Abbott steadfastly declined to state whether the B.C. government would operate it in defiance of federal drug laws, he is clearly a staunch backer.
"This is an opportunity for us as a society to reach out to them (addicts), to provide that measure of security and stability, to remind them that mental and physical health supports are available to them."
Abbott said he recently spoke with federal Health Minister Tony Clement.
"I suggested to the health minister that we would like them to renew the exemption and we have formally asked for that.
"He said he'd give full and serious consideration to my case."
Insite opened in 2003 as a pilot project in the Downtown Eastside for intravenous drug users to inject their own heroin and cocaine with clean needles and under the supervision of a nurse.
Addicts who get their fix at the site, instead of in alleys and decrepit hotels, can also access referrals to detoxification and rehabilitation services, including one that recently opened atop the Insite facility.
The federal government has twice exempted the site from federal legislation that would otherwise see operators charged under federal drug laws.
The current exemption expires June 30, when Clement must decide whether to grant another exemption to the Controlled Drugs and Substances Act or amend legislation that prohibits it.
But two lawsuits scheduled to be heard by the B.C. Supreme Court beginning April 28 will argue that the federal government is overstepping its jurisdictional bounds.
Lawyer Monique Pongracic-Speier, who will represent a group of addicts and the Portland Hotel Society in one of the legal challenges, said they will argue that the services provided at Insite are essentially health care and, therefore, the exclusive jurisdiction of the province of British Columbia.
"It is our contention the feds doesn't have a role to play in regulating Insite through section 56 of the (Controlled Drugs and Substances Act) or otherwise," said Pongracic-Speier.
The second part of the challenge is a Charter argument that asks: If the services are removed would it violate the "security of the person" of those using the site?
In addition to the lawsuit by the Portland society, which operates Insite along with the Vancouver Coastal Health Authority, another by the Vancouver Area Network of Drug Users will also challenge the federal juridiction.
Thomas Kerr, a research scientist at the B.C. Centre for Excellence in HIV/AIDS and an assistant professor of medicine at the University of B.C., has conducted or overseen many studies of the injection site and said there are few, if any, other novel public health interventions in Canadian history that have so many published studies supporting their effectiveness.
Kerr said a letter in Open Medicine - an international, peer-reviewed, international journal - that he said was endorsed by more than 130 prominent researchers and practitioners, including the medical health officer of B.C. and the medical health officer of Montreal.
Studies have been published in, among others, the New England Journal of Medicine, The Lancet, the Canadian Medical Association Journal, the British Medical Journal and the American Journal of Public Health.
"These are the best medical journals in the world," said Kerr. "You can't publish junk science in these journals."
But support is not unanimous, and the RCMP and the Canadian Association of Chiefs of Police remain steadfastly against injection sites.
Chief Supt. Derek Ogden, the RCMP's director general of drugs and organized crime, said he would like further research.
"I absolutely cringe when I hear people talk of a safe injection site," he said in an interview from Ottawa.
Ogden says the RCMP position focuses more on enforcement, prevention and treatment, which can result in harm reduction without injection sites.
Colin Mangham, the director of research for the Drug Prevention Network of Canada, wrote in his 2007 critique that other studies' findings of a reduction in "public disorder" were "questionable and so limited in scope as to be misleading."
"The Insite evaluations as reported in various research journals include considerable overstating of findings as well as under-reporting or omission of negative findings, and in some cases the discussion can mislead readers," Mangham wrote.
A Health Canada spokesperson could not be reached but did reply to questions by email to say that after the last exemption was granted in December, the federal health minister "determined that additional research was needed to identify the extent to which supervised injection sites affect crime, prevention and treatment."
"The minister will make a decision on Insite and supervised injection sites once he has had the opportunity to examine the research on how the site affects prevention, treatment and crime," spokesman Stephane Shank said in the email.
A report released Friday by an expert panel appointed by Clement found mixed results in its review of the many studies of Insite.
It said less than five per cent of all injections in the notorious neighbourhood, limiting the direct impact despite the more than 220,000 "clean injections" that have taken place there.
The committee said more than 8,000 people have visited the facility since it opened but only 18 per cent of those account for 86 per cent of the visits and less than 10 per cent used Insite for all their injections.
The committee acknowledged the site had made a contribution to improving public disorder, helped get people into treatment and reduced HIV risk behaviour.
And it found that the general public has positive views of Insite and that users rate the facility as highly satisfactory.
The committee also said Insite staff have successfully intervened in more than 336 overdose events since 2006 and no overdose deaths have occurred at the service. That adds up to about one life a year saved as a result of intervening in overdose deaths.
Perry Kendall, the province's chief medical health officer, said that if the exemption is not extended "you might have to think that it's ideological or political."
However, he admits to a "gut feeling" that it is "still going to be a bit of struggle to convince (Ottawa) about the science."
