Supreme Court of Canada rules Insite will remain open

Landmark decision heralded as a victory for public health

In the morning darkness on September 30, Insite supporters, staff and clients erupted with cheers, hugs and tears of joy on hearing the Supreme Court of Canada’s historic decision to allow North America’s first supervised injection site to remain operating in Vancouver’s Downtown Eastside.

The unanimous verdict, handed down in Ottawa and relayed quickly to hundreds of people standing outside Insite, ordered the federal health minister to extend an immediate exemption to Insite from federal drug laws and stated that closing Insite would be a violation of the Charter of Rights and Freedoms.

“This is a victory for public health over ideology,” said Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS (BC-CfE) and one of the leading researchers of Insite. “It sends a very clear message to Stephen Harper that the time has come for him to abandon his ideology regarding addiction, HIV and other related matters and move on with the evidence.”

Liz Evans, the executive director of the Portland Hotel Society Community Services, echoed Dr. Montaner. She called the ruling “a giant victory for all of us” during the news conference following the ruling’s announcement.

“It’s been a long journey since we launched the court case,” Evans said. “A long journey during which we’ve been trying to explain to people who don’t know or don’t know how to care, that there are better ways to embrace people living in our society with addictions than to cast them aside and tell them they are better off dead. Today is a testimony to the remarkable abilities of many people from many sectors coming together to make a significant difference.”

The ruling noted that the health and safety of Insite’s users and the community outweighed any benefit provided by anti-drug laws.

“During its eight years of operation, Insite has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada,” the Supreme Court said. “The effect of denying the services of Insite to the population it serves and the correlative increase in the risk of death and disease to injection drug users is grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics.”

Since the facility opened in 2003, the BC-CfE has conducted significant research into Insite and published several peer-reviewed studies in prestigious international journals. The research shows that Insite delivers many life-saving benefits such as reduced needle-sharing and HIV transmission rates, increased uptake into addiction treatment, and improved public order. In April this year, in a study published in The Lancet, BC-CfE researchers found a 35 per cent reduction in overdose deaths in the immediate vicinity of Insite following its opening.

“There is no doubt Insite saves lives,” said Dr. Thomas Kerr, co-director of the Addiction and Urban Health Research Initiative, a program of the BC-CfE. As one of the leading researchers of Insite, he noted that there have been about 1,500 overdoses since the facility opened but no one has ever died at Insite.

Dr. Evan Wood, co-director of the Addiction and Urban Health Research Initiative, expressed relief with the decision and hoped that the province and federal government can now begin to work together to solve the problems of addiction and HIV infection.

“Clearly, Insite is saving tax dollars by helping to reduce the spread of HIV and has the added bonus of channelling people into addiction treatment. With the unanimous Supreme Court decision behind us, hopefully all Canadians will see the benefit of this program and put the legal disagreements behind us.”

Dr. Patricia Daly – chief medical health officer at Vancouver Coastal Health, which operates Insite in partnership with Portland Hotel Society Community Services – was also on hand to celebrate the top court’s ruling. She told The Vancouver Sun that chief medical officers from Canada’s 18 largest cities believe in the evidence behind the effectiveness of Insite.

Montaner pointed out that that this ruling could open the doors for similar facilities in interested cities across Canada and North America such as Toronto, Montreal and San Francisco.

“Insite is a successful example of harm reduction and a key way to implement the BC-CfE-pioneered Treatment as Prevention strategy,” said Montaner. “When you create opportunities for people to be tested for HIV and access treatment, you are not only helping them get better, but also ensuring that they become dramatically less likely to transmit the virus, thus protecting the community as well.”

B.C.’s provincial government has supported Insite and other innovative harm reduction initiatives to effectively address the harms associated with illicit drug use and combat HIV infection and transmission. Last year, the B.C. Liberals announced the expenditure of $48 million to seek out and reach people in marginalized populations, such as injection drug users, to test them for HIV and enroll those infected in treatment. The pilot Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) is currently underway in Vancouver’s inner city and Prince George.