Supreme Court ruling opens doors to drug injection clinics across Canada

[Flash Walken]

Supreme Court ruling opens doors to drug injection clinics across Canada

The Supreme Court of Canada has opened the door to supervised drug injection clinics across the country in a landmark decision on Friday that ordered the federal government to stop interfering with Vancouver’s controversial Insite clinic.



The Court was persuaded by evidence that drug addicts are considerably safer administering their own injections under medical surveillance rather than obtaining and injecting hard drugs on the streets of the city’s troubled Downtown Eastside.


In its 9-0 decision, it said the federal government has the jurisdictional right to use criminal law to restrict illicit-drug use – but that the concerns it cited in an attempt to close Insite were “grossly disproportionate” to the benefits for drug users and the community.



“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 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.”



In ordering the Harper government to exempt the clinic from prosecution for its activities, the Court said that the government cannot simply close down clinics based on its own distaste for legally sanctioned drug injections.
It said that the consequences of interrupting the work of the clinic could have such “grave consequences” that only a direct court order can be assured that the spirit of the judgment would not be circumvented.

...

Montreal may soon follow Vancouver’s lead in setting up a supervised injection site. Jean-François Mary of Cactus Montreal, a community group that has been pressing to operate supervised injection sites for years, says today’s ruling removes the group's last remaining obstacle.


“The scientific merit was proven long ago, there was only the question of the legality,” Mr. Mary said in an interview. “This decision brings us a big step forward – a Supreme Court ruling we can rely on.”

http://www.theglobeandmail.com/news/...rticle2186191/

[THE SCUD]

great news!

1) This is a good idea medically, financially (health care costs wise) and ethically

2) Mieky et al's heads may explode!


Looking forward to the debate this one brings!!

ding ding!

[Daradon]

Gotta agree, it just makes sense medically and financially.

[VO #23]

Not necessarily. This particular clinic will stay open under an exception to the Controlled Drugs and Substances Act, but only because the SCC found that the decision to not renew the exception was based on the Minister's improper use of discretion as it contravened s. 7 of the Charter. However, because it was not decided based on federalism principles (which most lawyers thought it would be decided upon), it remains to be seen whether similar clinics could be opened in other jurisdictions and survive a legal challenge of their validity.

Either way, an awesome day for Canada. I am really quite happy with this decision.

[zuluking]

Next up: Bars and pubs for kids under age. Now this I could've used!

[Caged Great]

This is good because all the data shows that the best way to reduce/eliminate drug use in an individual is to treat them, instead of jailing them.

Hopefully this does get used everywhere.

[THE SCUD]

Originally Posted by VO #23

Not necessarily. This particular clinic will stay open under an exception to the Controlled Drugs and Substances Act, but only because the SCC found that the decision to not renew the exception was based on the Minister's improper use of discretion as it contravened s. 7 of the Charter. However, because it was not decided based on federalism principles (which most lawyers thought it would be decided upon), it remains to be seen whether similar clinics could be opened in other jurisdictions and survive a legal challenge of their validity.

Either way, an awesome day for Canada. I am really quite happy with this decision.

Since no lower court cannot turn in a verdict in contradiction to this ruling, and the government has been told they cannot deny a license, I think it effectively allows for the clinics to open up in other jurisdictions.

//accountant.

[VO #23]

Originally Posted by THE SCUD

Since no lower court cannot turn in a verdict in contradiction to this ruling, and the government has been told they cannot deny a license, I think it effectively allows for the clinics to open up in other jurisdictions.

//accountant.

This has certainly helped open the door somewhat, and there definitely could be more clinics like Insite opened in the future. But it is not a slam-dunk, and even Insite's lawyer has said this doesn't necessarily mean new clinics are going to be able to pop up all over the place now. If you think the Conservatives are going to take this lying down, you don't know them very well.

//lawyer (soon)

[Azure]

Originally Posted by Caged Great

This is good because all the data shows that the best way to reduce/eliminate drug use in an individual is to treat them, instead of jailing them.

Hopefully this does get used everywhere.

Does it? Not saying you're lying, but I'm just curious.

If it does, then I agree with the decision.

[Barnet Flame]

There is now no excuse for diabetics injecting at the dinner table.

[Bring_Back_Shantz]

I'm not a fan of this.

While I agree that treatment is a much better option to prison, I don't like the idea of a sanctioned injection sight.

If someone can show me that a significant number of users are kicking the habit because of this site then I'll gladly change my mind.
However if that can't be shown then in my mind all this site is, is a way of ignoring the problem.

Yes you're giving users a site to inject their drugs cleanly, but a lot of the damage is still being done. Not to mention the fact that I think it sends a horrible message.

What if there was a sight where men could legally beat their wives in the persence of a nurse? Should that be allowed. Clearly having a nurse on staff would mean the battered wives would get immediate treatment and we would certainly be reducing the harm to the victim. Plus we could provide counselling to those who wanted to stop beating their wives.
Would that be tollerated?

I know that's an extreme example, but when you've set a precedent of turning a blind eye to a pretty damaging criminal behavior just because it's being done in a certain spot, how can you not justify doing it for something else?

I realize that's an extreme example, but either it's a crime or it isn't, there shouldn't be a literal grey area.

[Knut]

Originally Posted by VO #23

This has certainly helped open the door somewhat, and there definitely could be more clinics like Insite opened in the future. But it is not a slam-dunk, and even Insite's lawyer has said this doesn't necessarily mean new clinics are going to be able to pop up all over the place now. If you think the Conservatives are going to take this lying down, you don't know them very well.

//lawyer (soon)

Essentially, the provincial government, municipal government and local police department all have to agree on it for there to be in. Even then there are restrictions (for instance no inhalation drugs).

[Knut]

I should add.

It is real tough to say just how many deaths this has averted vs. how many deaths averted by spending the same amount of money on awareness and treatments.

Only time will tell.

[VO #23]

Originally Posted by Bring_Back_Shantz

I'm not a fan of this.

While I agree that treatment is a much better option to prison, I don't like the idea of a sanctioned injection sight.

If someone can show me that a significant number of users are kicking the habit because of this site then I'll gladly change my mind.
However if that can't be shown then in my mind all this site is, is a way of ignoring the problem.

Yes you're giving users a site to inject their drugs cleanly, but a lot of the damage is still being done. Not to mention the fact that I think it sends a horrible message.

What if there was a sight where men could legally beat their wives in the persence of a nurse? Should that be allowed. Clearly having a nurse on staff would mean the battered wives would get immediate treatment and we would certainly be reducing the harm to the victim. Plus we could provide counselling to those who wanted to stop beating their wives.
Would that be tollerated?

I know that's an extreme example, but when you've set a precedent of turning a blind eye to a pretty damaging criminal behavior just because it's being done in a certain spot, how can you not justify doing it for something else?

I realize that's an extreme example, but either it's a crime or it isn't, there shouldn't be a literal grey area.

That's a really bad example because assault is not analogous to drug use at all. Assault requires the application of force on an unconsenting second party. And in fact, this is allowed in some circumstances (sanctioned boxing and MMA matches, and even bar fights where 'consent' is an available defence in some factual circumstances).

The issue here is that Harper and Co. see fit to throw drug users in jail, where they are left to rot under the false belief that they will come out clean and reformed. Insite at least acknowledges there is a problem not only with drug use, but rampant HIV-rates that are accelerated largely by sharing infected needles. Do you think it is a good idea, as part of public policy, to turn a blind eye to the fact that Vancouver's DTES has the highest HIV-infection rates in the industrialized world? Insite gives those with serious addiction issues a place that they can safely inject themselves without risking infection to themselves and further spread infection in the area.

Ultimately, this is a cheaper and more effective way to deal with the problem than building jails and filling them with sad, broken, poor people who have unfortunate and hellish addiction issues.

[mykalberta]

I am fine with it so long as there is no direct Federal funding (all from BC) and so long as it doesnt cross into Alberta.

BC can do what they want as Health Care is a provincial responsibility.

The SCC is a different story altogether, eventually you just have to learn to work around them.

[Knut]

I fully support the Supreme court ruling as the Federal government should be hands off when it comes to medical care in the individual provinces.

However, even after 8 years of having the safe injection site it is uncertain just how cost effective they are.

From Wikipedia... Follow the links for sources. It basically states 1 life is saved per year.

Calculations of Lives Saved
The European Monitoring Centre (EMCDDA) 2004 Review of Drug Consumption Rooms[3] calculated the number of lives saved for all 25 drug consumption rooms across Germany. It calculated from known overdose mortality rates per 100 dependent heroin users (2%) and the number of injections per 100 person years per dependent heroin user (1,000 injections per year per user). Their calculation indicated that 100 dependent heroin users, cumulatively injecting 100,000 times a year, would statistically have 2 overdose fatalities annually. Thus 500,000 injections results in 10 expected fatalities averted by the entirety of injecting facilities across Germany.
Drug Free Australia has noted that the EMCDDA review’s 2% overdose fatality rate appears excessive in light of mortality studies done by the EMCDDA for 5 European countries, (Germany was not included, but Spain, with the highest heroin overdose mortality, was still well below 2%). The percentages by country were Barcelona, Spain 1.4%; Rome, Italy 0.2%; Sweden 0.7%; Amsterdam, Netherlands unknown; Vienna, Austria 0.2%.[57]
The Canadian Expert Advisory Committee 2008 review of Insite did not declare the method by which it concluded that 1.08 lives are saved by the facility each year,[58] but Drug Free Australia claims that the EMCDDA method, used with Canadian data and assumptions, yields the same result.[59] Canadian heroin mortality in 2002/3 was roughly the same as Australia’s at 1% (958 deaths from more than 80,000 dependent heroin users)[60] and mortality percentages for 2006 or 2007, Drug Free Australia claims, might well be expected to be little changed. Further, the Expert Advisory Committee clearly state their assumption that a typical Canadian heroin user injects 4 times daily.[61]
Consequently 100 Canadian heroin users would cumulatively inject 146,000 times annually, and the 144,000 opiate injections in Vancouver’s Insite would avert the death of the one injection in 146,000 which would likely have been fatal.
The conclusion of the 2003 Sydney MSIC evaluators was that “a small number of opioid overdoses managed at the MSIC might have been fatal had they occurred elsewhere”, calculating that the centre had saved 4 lives per annum during the evaluation period.[62] Estimates were directly calculated from the 329 heroin overdose interventions in the centre. A later SAHA International evaluation of the MSIC calculated 25 lives saved by the facility in a single year.[63]
Drug Free Australia cites two statistics together which demonstrate that the Sydney MSIC cannot statistically claim to save even one life per year. The first is that 1% of dependent heroin users die from fatal overdose each year in Australia. The second is that a dependent heroin user averages ‘at least’ three injections per day according to the MSIC 2003 evaluation’s researchers. Taking these two statistics together, it is clear that the injecting room would need to host 300 injections per day (ie enough heroin injections for 100 heroin addicts injecting 3 times daily) before they could claim they had saved the life of the one (1%) of those 100 who would have died annually. But the injecting room averages just half that number with less than 150 opiate injections per day. Drug Free Australia has shown that the 2003 and 2008 MSIC evaluators indefensibly failed to factor the vastly elevated number of overdoses in the centre into their calculations of lives saved.[64]

[VO #23]

Originally Posted by Hesla

I fully support the Supreme court ruling as the Federal government should be hands off when it comes to medical care in the individual provinces.

However, even after 8 years of having the safe injection site it is uncertain just how cost effective they are.

From Wikipedia... Follow the links for sources. It basically states 1 life is saved per year.

Calculations of Lives Saved
The European Monitoring Centre (EMCDDA) 2004 Review of Drug Consumption Rooms[3] calculated the number of lives saved for all 25 drug consumption rooms across Germany. It calculated from known overdose mortality rates per 100 dependent heroin users (2%) and the number of injections per 100 person years per dependent heroin user (1,000 injections per year per user). Their calculation indicated that 100 dependent heroin users, cumulatively injecting 100,000 times a year, would statistically have 2 overdose fatalities annually. Thus 500,000 injections results in 10 expected fatalities averted by the entirety of injecting facilities across Germany.
Drug Free Australia has noted that the EMCDDA review’s 2% overdose fatality rate appears excessive in light of mortality studies done by the EMCDDA for 5 European countries, (Germany was not included, but Spain, with the highest heroin overdose mortality, was still well below 2%). The percentages by country were Barcelona, Spain 1.4%; Rome, Italy 0.2%; Sweden 0.7%; Amsterdam, Netherlands unknown; Vienna, Austria 0.2%.[57]
The Canadian Expert Advisory Committee 2008 review of Insite did not declare the method by which it concluded that 1.08 lives are saved by the facility each year,[58] but Drug Free Australia claims that the EMCDDA method, used with Canadian data and assumptions, yields the same result.[59] Canadian heroin mortality in 2002/3 was roughly the same as Australia’s at 1% (958 deaths from more than 80,000 dependent heroin users)[60] and mortality percentages for 2006 or 2007, Drug Free Australia claims, might well be expected to be little changed. Further, the Expert Advisory Committee clearly state their assumption that a typical Canadian heroin user injects 4 times daily.[61]
Consequently 100 Canadian heroin users would cumulatively inject 146,000 times annually, and the 144,000 opiate injections in Vancouver’s Insite would avert the death of the one injection in 146,000 which would likely have been fatal.
The conclusion of the 2003 Sydney MSIC evaluators was that “a small number of opioid overdoses managed at the MSIC might have been fatal had they occurred elsewhere”, calculating that the centre had saved 4 lives per annum during the evaluation period.[62] Estimates were directly calculated from the 329 heroin overdose interventions in the centre. A later SAHA International evaluation of the MSIC calculated 25 lives saved by the facility in a single year.[63]
Drug Free Australia cites two statistics together which demonstrate that the Sydney MSIC cannot statistically claim to save even one life per year. The first is that 1% of dependent heroin users die from fatal overdose each year in Australia. The second is that a dependent heroin user averages ‘at least’ three injections per day according to the MSIC 2003 evaluation’s researchers. Taking these two statistics together, it is clear that the injecting room would need to host 300 injections per day (ie enough heroin injections for 100 heroin addicts injecting 3 times daily) before they could claim they had saved the life of the one (1%) of those 100 who would have died annually. But the injecting room averages just half that number with less than 150 opiate injections per day. Drug Free Australia has shown that the 2003 and 2008 MSIC evaluators indefensibly failed to factor the vastly elevated number of overdoses in the centre into their calculations of lives saved.[64]

Dude, those stats talk about OVERDOSE deaths. Overdoses aren't the critical issue in DTES Vancouver - the spread of HIV is. Insite is designed to give drug users a small space with sterilized equipment to inject themselves so they aren't doing it in back alleys, passing around dirty needles and transmitting HIV all over the place.

[VO #23]

Originally Posted by mykalberta

The SCC is a different story altogether, eventually you just have to learn to work around them.

LOL! So what you are saying is that you think elected officials are above the rule of law and should seek out ways to circumvent it?

[Knut]

Originally Posted by VO #23

Dude, those stats talk about OVERDOSE deaths. Overdoses aren't the critical issue in DTES Vancouver - the spread of HIV is. Insite is designed to give drug users a small space with sterilized equipment to inject themselves so they aren't doing it in back alleys, passing around dirty needles and transmitting HIV all over the place.

ok..

Impact on blood-borne viruses
The 2003 evaluators of the Sydney MSIC found that it “had not increased blood-borne virus transmission”[18] with the data more specifically showing no improvement re HIV infection incidence, no improvement in Hep B infections,[36] either worse or no improvement (depending on the suburb studied) in new Hep C notifications,[37] no improvement in reuse of others' syringes and injecting equipment, no improvement in tests taken for HIV and Hep C and initial improvement in tests taken for Hep B but worsening again in 2002.[38] The 2010 evaluation found no measurable impact on blood-borne diseases.[39]
The Expert Advisory Committee for Vancouver’s Insite found that journal studies with mathematical modeling by researchers from self-reports of users generated a wide range of estimates for HIV cases averted, but they were not convinced that the assumptions were valid.


Seems to me it is still all over the place on if there is actually a benefit.

[Flash Walken]

Originally Posted by VO #23

Dude, those stats talk about OVERDOSE deaths. Overdoses aren't the critical issue in DTES Vancouver - the spread of HIV is. Insite is designed to give drug users a small space with sterilized equipment to inject themselves so they aren't doing it in back alleys, passing around dirty needles and transmitting HIV all over the place.

Also Hepatitis C.