Safer Injection Sites

The Conservative federal government of Prime Minister Stephen Harper will ask the Canadian Supreme Court to overturn a provincial court ruling that okayed Vancouver's InSite safe injection site. Justice Minister Rob Nicholson said the government will appeal because the case raised important questions about the division of powers among the federal and provincial governments, the CBC reported Tuesday. InSite in the only supervised drug injection site in North America. It has been in place since 2003, when British Columbia health authorities won a temporary exemption from Canada's federal drug law. While the then Liberal government approved, the now governing Conservatives do not. InSite originally won a three-year exemption from the federal drug law. Under tremendous pressure, the Conservatives grudgingly gave InSite a 15-month extension, then extended it to 22 months ending in June 2008. But fearing the Conservatives' intentions, InSite operator the Portland Hotel Society, the Vancouver Area Network of Drug Users (VANDU), and two InSite clients filed a lawsuit in the BC courts seeking to have the provincial government, which under Canadian law is responsible for health care, declared the sole authority over InSite—not the federal government and the federal drug laws. InSite and its supporters won in the BC Supreme Court in 2008 and won again last month in the province's highest court, the Court of Appeals. It is those decisions, which puts decisions on whether to keep InSite open firmly in the hands of BC health officials, that the federal government now seeks to overturn. In his remarks Tuesday, Justice Minister Nicholson said nothing about shutting down InSite, instead saying the appeal was about clarifying provincial versus federal powers. "The case we'll be presenting before the court is to ask for clarification," he said. "I think it is important to do that." But Portland Hotel Society director Mark Townsend was running out of patience with the Conservatives. "The courts have now ruled twice in favor of InSite," he said in a statement Tuesday. "Last time, they thought the feds were so out of line they made them pay all the costs. We wish Stephen Harper would stop wasting court time and the taxpayers' money and start helping to solve the drug problem in our community."

In the Chronicle's review of the top international drug policy stories of the year last week, the slow spread of heroin maintenance was in the mix. This week, its back in the news, with word that a new Canadian heroin maintenance study in Vancouver is about to get underway. The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) will choose a Downtown Eastside location next month and begin taking applications from potential participants in February, according to a Tuesday press release from the Inner Change Foundation, which, along with the Canadian Institutes of Health Research, is funding the trial. With selection of participants supposed to last only three weeks, that means SALOME could be underway by March. SALOME will enroll 322 hard-core heroin addicts—they must have been using at least five years and failed other treatments, including methadone maintenance—in a year-long, two-phase study. During the first phase, half will be given injectable heroin (diacetylmorphine) and half will be given injectable Dilaudid® (hydromorphone). In the second phase, half of the participants will be switched to oral versions of the drug they are using. The comparison of heroin and Dilaudid® was inspired by unanticipated results from SALOME's forerunner, NAOMI (the North American Opiate Medication Study), which began in Vancouver in 2005 and produced positive results in research reviews last year. In NAOMI, researchers found that participants could not differentiate between heroin and Dilaudid®. The comparison of success rate among injection and oral administration users was inspired by hopes of reducing rates of injection heroin use. SALOME was also supposed to take place in Montreal, but Quebec provincial authorities effectively killed it there by refusing to fund it. SALOME researchers have announced that it will now proceed in Vancouver alone. With an estimated 5,000 heroin addicts in the Downtown Eastside and a municipal government that has officially embraced the progressive four pillars approach--prevention, treatment, harm reduction, and law enforcement—to problematic drug use, Vancouver is most receptive to such ground-breaking research. It is also the home of Insite, North America's only safe injection site. The NAOMI and SALOME projects are the only heroin maintenance programs to take place in North America. Ongoing or pilot heroin maintenance programs are underway in Britain, Denmark, Germany, the Netherlands, Spain, and Switzerland.