Health Committee on May 29th, 2008

[The Chair, Conservative, Joy Smith]

Order, please.

Ladies and gentlemen, good morning. Welcome to the health committee and welcome to our witnesses. We are happy to see you here this morning. I also want to welcome everybody in the gallery.

I would like to take a moment to read to you something that has been brought to my attention. I have to tell you, fellow committee members, that as an elected member of Parliament representing constituents in my riding of Kildonan—St. Paul, and as chair of this committee, I take great pride in the service we provide to Canadians as a committee and the important work that our committee does. We are one small but crucially important cog in the wheel of the democratic process that has enabled Canada to develop as one of the world's great nations.

I have to tell you that it troubles me gravely to tell you that for the first time in my career as an elected representative in Canada, and for the first time in living memory, our democratic process has been subverted by physical intimidation and threats of violence. I wanted to inform the committee of what happened here this morning.

One of the witnesses scheduled to appear today has been targeted for protest and intimidation at the site of his own professional practice. The witness, a doctor in addictions medicine who has treated more than 7,000 people in the past 18 years, was subject to a disturbing protest and an invasion of his office on Tuesday. He has received advice from the B.C. College of Physicians and Surgeons and his own legal counsel that he not appear before this committee, owing to concerns for his physical health and safety.

On May 27 he wrote that his office was being picketed by 20 angry people identified in their leaflet as “addicts”, accusing him of not listening to anyone and having his own ideas derived from an addiction to “drinking his own bathwater”.

He also indicates that staff at his pharmacy and his building and his own patients described demonstrators saying “vile and vulgar things” to them as they put leaflets in the faces of people entering and leaving the building, upsetting patients who were forced to cross the picket line and run an angry gauntlet. He says that some of his patients are middle-aged, and older patients felt quite intimidated and upset.

The doctor said, and I quote:

I hereby request that l not be required to give live testimony on Thursday morning. l am very concerned that if l do so l will be subject to attacks including not only picket lines and vicious slander but also physical attacks at work or elsewhere.

These people, presumably using addicts, are liable to attack me again, including, l believe, physically or in terms of my property in order to get what they want, which is to make sure that no one opposes them.

This certainly makes the point that there is no way to engage in reasonable discussion about Insite. Anyone who says anything against Insite is vilified and attacked publicly.

The fact that my office has been picketed today and I have been personally vilified and slandered, merely for voicing my professional opinion, speaks volumes about who the real 'ideologues' are in this matter and why so few people are willing to voice their misgivings about Insite. There is no room for dispassionate discussions about the merits of Insite, because so many of its proponents attack the person in order to stifle debate.

That is not science. That is bullying.

Unfortunately, because he intended to testify by video conference, Dr. Donald Hedges' statement has not been translated. However, the full text of his English version is here, and I will provide it to the clerk for translation.

I hope I speak for the entire health committee as I extend my apology to Dr. Hedges for the distress he is enduring, and a hope that as a committee we never lose a witness to threats and intimidation again.

I wanted to bring this before my health committee today. I know each and every member of this committee is very distressed to hear the threats and intimidation that this professional doctor has undergone because he wanted to come and appear as a witness at this committee.

Thank you, ladies and gentlemen.

[Christiane Gagnon, Bloc, Québec, QC]

I have a point of order, Madam Chair.

Why did you make that statement before hearing the witnesses? It's as though you wanted to stamp the proceedings with the Conservatives' ideology.

[The Chair, Conservative, Joy Smith]

Thank you, Madame Gagnon.

I made that statement--

[Christiane Gagnon, Bloc, Québec, QC]

I'm a bit disappointed by your attitude, Madam Chair. When you speak on the committee's behalf, you should ask us what we think. You decided to make that statement on your own initiative. We would have liked to be notified in advance so that we could express our view of the situation. We can't say that we are concerned or that we disapprove. We weren't even aware of the statement. Before even hearing the witnesses, we appear alarmist because you stated that an invited witness had apparently received threats. You leave the impression that drug addicts who go to the Insite site could be dangerous to the public. That's at least what I understood from the interpretation. I'm a bit disappointed in your conduct this morning.

Thank you.

[The Chair, Conservative, Joy Smith]

Well, that is regrettable, but as chair of this committee I will say that when we invite guests to come to this committee, Madame Gagnon.... Dr. Hedges should have been able to come to this committee. He informed the clerk that he was fearful of physical abuse and intimidation and that he couldn't come.

[Keith Martin, Liberal, Esquimalt—Juan de Fuca, BC]

I have a point of order.

Madam Chair, we have witnesses who have come from a long way away. I think you've made your point; maybe we should move on and listen to them.

[The Chair, Conservative, Joy Smith]

Indeed we should, Dr. Martin. Thank you.

Pursuant to Standing Order 108(2) and the motions adopted by the committee on May 8 and May 13, I'd like to welcome you to this briefing session on harm reduction programs in Canada. We're very happy you're here, and we're looking forward very much to all your presentations, with particular focus on the safe injection site in Vancouver.

I'd like to take one minute to go over the schedule for today's meeting. Until approximately 10:40 a.m. we will be hearing the presentations from the witnesses present in this room. From 10:45 to 10:55 we will be hearing from our other two witnesses by video conference. From 10:55 to 11:45 we will proceed with questions from members, and from 11:50 a.m. to 1 p.m. the Minister of Health will appear before the committee.

I would like to welcome all the witnesses who are here with us today, and I'd like to thank you for travelling all the way from British Columbia. It's a long way.

We have with us Dr. Thomas Kerr, research scientist with the B.C. Centre for Excellence in HIV/AIDS. We have Inspector Scott Thompson from the Vancouver Police Department. We have Mr. Donald MacPherson, the drug policy coordinator with the City of Vancouver. We have Ms. Liz Evans, executive director, PHS Community Services Society; Mr. Philip Owen, former mayor of the City of Vancouver; Ms. Heather Hay, regional director, Vancouver Coastal Health; and Dr. Colin Mangham, director of research, Drug Prevention Network of Canada.

Let's begin with Inspector Thompson.

I have to tell you that you each have five minutes for your presentation, and then we'll go into questions after hearing all the witnesses.

Go ahead, Inspector Thompson.

[Inspector Scott Thompson, Youth Services Section, Drug Policy and Mental Health Portfolios, Vancouver Police Department]

Good morning, and thank you for the opportunity to speak here today on behalf of Chief Constable Jim Chu and the Vancouver Police Department.

My name is Inspector Scott Thompson. I'm in my 28th year of combined police service as a current member of the Vancouver Police Department and a former member of the Royal Canadian Mounted Police. In 2003 I was part of the Vancouver Coastal Health project team for the supervised injection site, or SIS. In 2003 I was the author of the Vancouver Police Department's policing and operational plans for the SIS. I also developed and delivered the SIS orientation packages to both VPD members and Vancouver Coastal Health staff.

I was then on the ground in the downtown eastside for the first year of the supervised injection site's operation. I am currently in charge of the VPD's youth services section, as well as the drug policy and mental health portfolios.

For the VPD, the story of the SIS began in early 2002. Philip Owen was the mayor and chair of the Vancouver police board at that time. The VPD examined the question of an SIS during a facilitated managerial and executive process and came to two conclusions: one, that our expertise is in policing and public safety, not in health and health research, and therefore we should always be cautious when and if we choose to support or criticize public health initiatives and/or research, given that our expertise lies elsewhere; two, that regardless of whether we agreed with the concept of an SIS or not, we needed to be at the table.

As you likely know, in late 2002 a civic election in Vancouver resulted in Larry Campbell, now Senator Campbell, becoming mayor. The primary election issue was the SIS, and Mayor Campbell and others subsequently drove the process to make this concept become a reality.

As part of the application process for an exemption under the Controlled Drugs and Substances Act for medical research at the SIS, Health Canada asked the VPD what its position was. We replied that if a drug user is not engaged in disorderly, unlawful, threatening, and/or violent behaviour on the street or is wanted on an outstanding arrest warrant, it is unlikely they would be prevented or impeded by the Vancouver police from accessing the supervised injection site.

Just before the SIS opened, the VPD operations plan stated the following to Vancouver police officers:

Police members have a broad range of discretion when dealing with drug use and drug possession in the City of Vancouver. This discretion includes options such as seizure of the drug, and/or arrest and charging of the person(s). This discretion lies solely with the police officer on the street.

When dealing with an intravenous drug user found using drugs within a four block radius of the SIS...it is recommended that our members direct the drug user to attend the SIS to avoid a future contact with the police.

Our orientation package for SIS staff, and later our VPD drug policy, stated that “on a fundamental level, all health initiatives must be lawful”.

I submit that during the past five years members of the Vancouver Police Department have performed their duties in an exemplary manner in relation to the supervised injection site and that this performance represents the best traditions of a neutral, apolitical, and professional police service in a free and democratic society.

This brings me to the position of the Vancouver Police Department and the key messages I have been asked to deliver to you today. These key messages are the following.

One, the VPD agrees with the Canadian Association of Chiefs of Police position that illicit drugs are harmful. The high incidence of addiction to illicit drugs in Vancouver contributes to an inordinately high property crime rate.

Two, when the supervised injection site opened, the VPD position was that we were in favour of any legal measure that might have a chance of reducing the drug problem in Vancouver's downtown eastside. We're on record as supporting the SIS as a research project.

Three, the VPD's primary interest and mandate around the SIS has always been and remains public safety, not public health.

Four, our position is that as a police agency focused on public safety, it would be inappropriate for the Vancouver Police Department to comment on the medical merits of the SIS.

Five, we are reviewing the various studies on the SIS and the linkages to crime and disorder. We believe that further research needs to be focused first on whether the SIS and other services potentially facilitate and perpetuate the cycle of addiction and whether this has a negative impact on addicted individuals seeking treatment.

Secondly, it needs to be focused on determining the degree to which locating the SIS amid a concentration of other services hinders the neighbourhood's reputation, capacity, and ability to recover and flourish.

Third, it needs to focus on whether the SIS and this concentration of services facilitates the easier entry to, development of, and maintenance of a cycle of addiction.

Fourth, it should focus on whether the SIS, access to services, and/or the ready access to drugs in the neighbourhood draw vulnerable people from elsewhere in the region and country.

Finally, further research should be focused on determining whether the SIS and the concentration of services increases the geographical concentration of addicts into a small area, which may or may not increase the likelihood of communicable disease transmission.

In closing, the Vancouver Police Department is not going to be an active participant in the debate about the medical merits of the supervised injection site. We do urge further research into the areas we have identified.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you so much, Inspector Thompson, for your comments.

We'll now go on to Mr. Donald MacPherson.

[Donald MacPherson, Drug Policy Coordinator, Drug Policy Program, City of Vancouver]

Thank you for allowing me to present my views to the committee today.

I'm going to give some contextual information about our issues with harm reduction and the injection site in Vancouver.

It's an honour and a privilege to be able to speak to this committee.

l've been with the City of Vancouver for the past 20 years and have spent considerable time working with a wide range of individuals, non-governmental organizations, senior governments, and the private sector in seeking solutions to the issues we face in Vancouver regarding injection drug use, addiction, and mental health issues.

Let me first start with some contextual remarks regarding harm reduction in more of a global context.

l have just been to the 19th international conference on the reduction of drug-related harm in Barcelona, Spain, May 10 to 14. At this conference the global state of harm reduction was discussed and reports were heard from a variety of locales around the globe and from the executive director of the United Nations Office on Drugs and Crime.

Prior to the 1970s, injection drug use was primarily reported in North America and western Europe. By 1992, 80 countries reported injection drug use. By 1995, there were 121 countries reporting injection drug use, and in 2008, 158 countries now report injection drug use among their citizens. Injection drug use is on the rise globally and is contributing significantly to the global HIV pandemic and other health problems, not to mention the health care costs around the world.

The discussions and debates over harm reduction are also taking place around the globe. We are not at all unique in this regard in Canada. Since the early 1970s, a significant amount of research has been conducted on harm reduction interventions globally, and the evidence is clear that harm reduction interventions work to reduce disease transmission, protect the health of individuals and communities, and provide positive engagement of marginalized populations with the health care system.

The evidence that harm reduction works is sufficiently robust that major governmental and non-governmental organizations endorse harm reduction as an essential component of a comprehensive health approach to the problematic use of drugs. These include the joint United Nations program on HIV/AIDS, UNAIDS; the United Nations Office on Drugs and Crime; the United Nations Children's Fund, UNICEF; the World Health Organization; the World Bank; the National Institutes of Health in the U.S.; the Institute of Medicine of the National Academies in the U.S.; and the International Red Cross, to name a few.

Currently, 82 countries worldwide explicitly support the development of harm reduction interventions, including syringe exchange and outreach programs. My point here is that the threat of HIV/AIDS worldwide has forced governments to rethink the ways in which we deal with problematic drug use and how to balance strategies to address both the problematic drug use and issues of drug dependence or addiction and the transmission of HIV/AIDS and other blood-borne diseases among citizens who use drugs.

The UN itself is rethinking its approach, and this brings me to the comments made by Antonio Maria Costa, the executive director of the United Nations Office on Drugs and Crime, in Barcelona earlier this month. Mr. Costa clearly affirmed that the first principle of drug control efforts is public health and that the principle of public health within the international treaty system “has over time, receded from that position, over-shadowed by the concern with public security and law enforcement actions that are necessary to ensure public security”.

On the international stage, the language of international drug control intended to unite the global community around enforcement of prohibitions against certain substances. According to Costa:

The unintended consequence of this was that the demand for illicit drugs and related public health issues did not get the international focus and attention they would have if they had been detailed in the Single Convention on Narcotic Drugs of 1961.

These are significant words from the head of the UNODC. Fortunately, at the international level things are changing, and there is beginning to be much more of a focus on the rights of marginalized populations of drug users to adequate and appropriate health care.

Moving to the Vancouver context, what we are trying to achieve with the development of the four pillars drug strategy is to firmly acknowledge the importance of harm reduction to the development of a comprehensive approach that also includes drug treatment, prevention, and policing as critical components to the strategy. The supervised injection site is simply one piece of this effort to build a comprehensive approach to address this problem. There is a significant level of support for the full implementation of the four pillars drug strategy among the residents of Vancouver, including the supervised injection site.

From the perspective of the City of Vancouver, we have been satisfied with the remarkable amount of research completed to date on the injection site project, the oversight of the project by our local health authority—Vancouver Coastal Health—the cooperation of the Vancouver Police Department in implementing policing protocols for the project, and the level of community engagement that has been conducted throughout the implementation of the project.

Considering that over 2,000 individuals have died since the early nineties in Vancouver alone and that many more have acquired HIV, hepatitis C, and other medical complications as a result of injection drug use, we view the injection site project as an important part of our collective efforts to engage this population in health care interventions, to save lives, and to protect the community. We are working extremely hard at the local level in Vancouver to overcome the serious issues we face.

At this time, I would urge the committee to consider ways to move beyond this debate over harm reduction or injection sites, as it is costing us valuable time, energy, and, most importantly, the lives of Canadians. I urge the committee to consider the scientific evidence for all interventions and to find a way for all parties to work together to provide the leadership necessary to implement a truly comprehensive approach to problem drug use that acknowledges and demonstrates the right of all Canadians, including those who use drugs and their families, to have access to the highest quality of health care.

Thank you

[The Chair, Conservative, Joy Smith]

Thank you, Mr. MacPherson.

We'll now go to Ms. Liz Evans.

[Liz Evans, Executive Director, PHS Community Services Society]

Thank you very much for allowing me to be here today to address what I believe is an extremely important issue for Canada.

Growing up, I was never aware of the people who lived with severe addictions, whom I now know from working as a nurse in Vancouver's downtown eastside. When I was growing up, they didn't exist. They didn't exist within the same medical system, school system, dental offices, parks, or swimming classes I went to. But for the last 17 years, I've come to know hundreds of people who, for many Canadians, have never really been there.

I believe Canada needs a comprehensive, evidence-based drug policy in order to really “see” those suffering from addiction, a policy that understands the roles of prevention, treatment, enforcement, and harm reduction; one that is humane and defers to sound public health policies; and one that understands that death does not bring hope.

Unfortunately, like many decision-makers on this issue, 17 years ago when I arrived in the downtown eastside, I was out of touch. But I didn't realize it; I assumed I knew, and those I met taught me that things were far more complicated, that there were no perfect solutions—rather, many real-life individuals with stories.

I met Mary, who as a child spent many hours locked in a room by her foster family, emaciated, sexually abused, with a giant scar across her throat from where she had cut herself at age 13. By age 15, she was addicted to pills and alcohol, and by age 16, heroin and cocaine. To feed her habit, she worked the sex trade. She was raped, and unlike many other people, she felt she deserved what she got, that it was all her fault. For Mary, prevention failed. When she was alone as a small girl and had no one to talk to about her suffering, the expensive and poorly evaluated “just say no” ad campaigns didn't make any difference. She needed a human being. Prevention is critical, but it needs to be evidence-based and it needs to be relevant.

My father was a doctor, and as I was growing up, he always expressed the view that addiction was a tragedy. But his overriding sense was that addicts had failed. Not only was their addiction a failure, but it also spoke somehow to their moral character failing, making the criminal justice approach reasonable and necessary.

Mary, in her sex trade work and life of addiction, was arrested hundreds of times. She believed she was a criminal. Her interactions with law enforcement merely reaffirmed her self-hatred. Over the years of her life as a drug addict, enforcement failed to curb her habit. While enforcement touched Mary's life, it could not reach out to her. Policing alone cannot address the complex reality of her life and her health needs.

As a nurse, I had the naive and simplistic idea that treatment was the solution. I believed that help was just within reach and that people needed someone like me with the dedication to make it happen. I believed that people only had to ask and that health care would be there for them when they wanted it.

I realized after watching Mary and hundreds of others like her that trying to access the detox and recovery system with no long-term success was not so simple. Many hurdles exist, and if you live on the street, accessing detox and treatment feels like climbing Mount Everest. Treatment failed Mary. Treatment programs failed her because we desperately need treatment to be accessible and to work in tandem with other strategies. As a stand-alone response, treatment fails.

I have now understood that the vital piece that's been missing is harm reduction policy. Harm reduction begins by seeing the person in the context of their life and their pain, their ability, their fear, and their strengths. It starts from a place that says, I see where you are today and that's where we'll start.

Mary couldn't get counselling, because she was addicted. She couldn't find a safe house, because she was addicted. She developed HIV due to years of unsafe needle sharing, due to her addiction. She was often homeless, because she was addicted. Harm reduction says this isn't good enough. We watched Mary die of AIDS, and hundreds of others like her.

Harm reduction programs ultimately failed Mary, due to their lack of support and funds. As a result, Mary and hundreds of others became HIV-infected, reusing the same dirty needles when needle exchange programs were not supported. Harm reduction initiatives are there to see the marginalized drug addict's life as one to be helped and not to be ignored.

As we assemble the pieces of this puzzle, I understand more clearly where Insite fits. Insite, the supervised injection site, provides the vital link between the street and desperately needed support. It connects people to treatment. It acknowledges the challenges that street-entrenched addicts face head-on. Then it offers real help—help to stay healthy and help to stay alive.

Over one million injections have taken place at Insite since it opened, off the streets and away from local businesses. Not one of the “Marys” who stopped breathing during their drug use at the site died, because a nurse was there.

I wish as much as anyone else in this room today that this problem did not exist, but sticking my head in the sand will not make it go away.

Canada needs a drug policy based on wisdom and maturity, not fear and hatred. Without this, thousands will suffer, HIV will spread, violence will escalate, and thousands of needless deaths will continue across the country—deaths of citizens whom we don't see: children, sisters, brothers, mothers, and cousins who could easily have been us, and who have been with us all along.

Thanks.

[The Chair, Conservative, Joy Smith]

Thank you so much, Ms. Evans.

We'll now go to Mr. Philip Owen.

[Philip Owen, Former Mayor of the City of Vancouver, As an Individual]

Thank you for the opportunity to be here today to speak about illegal narcotics, emphasizing harm reduction and the supervised injection site, Insite, in Vancouver. It is difficult to cover this huge subject comprehensively in five minutes, but I will try.

Vancouver City Council unanimously passed an 85-page document called A Framework for Action in May 2001, seven years ago. It's a four-pillar approach to Vancouver's drug problems, and it emphasizes prevention, treatment, enforcement, and, most importantly, harm reduction—the four pillars.

This document is still intact, it is still accepted, and no one who has read this or commented on it has said to throw out this or that part, or that this is wrong, or that this assumption is wrong. It's an 85-page document; it's the foundation of our success in Vancouver.

All the harm reduction programs, facilities, and initiatives are essential and have proven to be justified and successful in this regard. The supervised injection site—I want to emphasize this—is just one of the many tools in drug policy reform. People think this whole thing revolves around the supervised injection site. I will explain the many other important aspects in a few minutes.

Harm reduction and a supervised injection site are cost-effective and they save lives. They improve public health and public order. What is the biggest problem we have in our cities today? Public health and public order. Think about the volume of money rolling around and getting in the hands of people who shouldn't have it. We must engage the addict and develop an exit strategy. That is the goal: to rescue these people.

These people start using drugs for a variety of reasons, and therefore many services are needed for them to change their lifestyle. The user is sick. And we have a national health care system. That's something we have to think about; it's a health issue, public health, public order. The user is sick, no question about it.

The goal of drug reform is abstinence. I hear over and over again that this whole issue is to enable and encourage the use of drugs, and that's not what it's about at all. The goal is to rescue, get them in the health care system, and create an abstinence-based program for users.

The war on drugs has failed in Canada and the United States. That's an absolute fact. I haven't time to prove it, but it's true. We cannot afford it any more. We cannot incarcerate our way out of this. People who have worked on the war on drugs--and I emphasize that--think you can incarcerate your way out of this. You cannot. You have to listen to the mayors. We should not be allowing more death, disease, crime, and suffering.

In June 2007, the United States mayors had their annual meeting in Los Angeles; 220 mayors were there. Rocky Anderson, the mayor of Salt Lake City, Mormon country, put forward a motion on the floor of that convention, and all the major mayors were there. The motion was that the war on drugs had failed. What was the vote? Two hundred and twenty to nothing. Every single mayor who was there said the war on drugs had failed. So we have to get down to the municipal level to find out what's really going on and get close to the reality.

We have to ask ourselves, are the current drug laws working? No. Are they effective? No. Do they make any sense? No, not at all.

There are over 100 supervised injection sites in over 50 cities in the world. I could talk to you about my discussions with the mayor of Frankfurt, Germany, and the mayor of Sydney, Australia. I've been to five international conferences in Europe. I've been to Kabul, Afghanistan; New York; around the United States; Stanford University; and across this country. I've visited lots of these supervised injection sites.

The media in Canada are playing up the fact that this is the only one in North America; therefore it's unique. That is not true. They've been in Switzerland for over 20 years and are very successful. You couldn't close the one in Frankfurt, Germany, or in Sydney, Australia.

How bad does it have to get before we act on drug policy reform? The operative word here, as I said earlier, is to develop an exit strategy that's abstinence-based.

The third main issue is engagement--

[The Chair, Conservative, Joy Smith]

I'm sorry, Mr. Owen. We do have time for questions. You are over time now, so if you would be so kind, you can save your comments for during the questions.

[Philip Owen]

Thank you.

[The Chair, Conservative, Joy Smith]

We will now go to Ms. Hay.

Ms. Hay, go ahead.

[Heather Hay, Regional Director, Addiction, HIV/AIDS, Aboriginal Health, Vancouver Coastal Health]

Thank you.

Thank you for the opportunity to present today. I am here representing Vancouver Coastal Health.

I've been a nurse for the past 35 years, and I've had senior leadership experience in health care. Most recently, for the past 11 years, I've been leading the public health response to the public health crisis on the downtown eastside.

Vancouver Coastal Health delivers a broad range of health care services. We have an operating budget of approximately $2.4 billion, and we serve over a quarter of the population of British Columbia. We invest over $110 million a year in the treatment of individuals with mental health and addictions issues. For every dollar spent in harm reduction, four dollars are spent on treatment.

The goal of our mental health and addictions services is first and foremost to keep people alive, second is to prevent the use of harmful substances, and third is to assist people to stop the abuse of all substances.

I'm here today to take you through a little bit of history. I'm here today to talk about a public health emergency that was announced in September 1997 in the poorest neighbourhood in the country, a neighbourhood that has an overrepresentation of aboriginal peoples, a neighbourhood that has 10 times less access to family physicians than any other neighbourhood in Canada, a neighbourhood that has a mortality rate 14 times the rest of the province, and a neighbourhood where people live in single-room occupancy hotels that have no access to handwashing or toilets. It's also home to 4,600 IV drug users. Ten years ago it was home to several epidemics--hepatitis A, hepatitis B, hepatitis C, transferrable TB, and overdose deaths--and the primarily underlying epidemic of intravenous drug use.

This is the context in which the supervised injection site came to exist. It was a public health response to a health emergency akin to a third world disaster zone. Traditional health care wasn't working to stem the tide; an innovative continuum of health care services was required.

The supervised injection site, known as Insite, is part of that solution. In June 2000, the Vancouver Coastal Health board of directors voted to support the supervised injection site as a vital part of our continuum of health care. The decision was a product of extensive consultation and research, which led us to believe that there was a public demand for safe injection sites in Vancouver. Such a site would assist Vancouver Coastal Health in meeting its health care mandate of providing appropriate and necessary health care to all the populations it served. The supervised injection site would facilitate contact with high-risk IV drug users, provide us with the means to reduce the spread of disease and deaths, and allow clients to access health care services and other social services.

The supervised injection site is operated by Vancouver Coastal Health in partnership with the Portland Hotel Society. Insite provides a clean place for people to inject drugs under a nurse's supervision. Insite offers clean injecting equipment and safe injecting education, which helps reduce the risk of transmission of infectious, blood-borne diseases like HIV/AIDS and hepatitis C. Insite offers treatment of wound infections and TB, inoculations for pneumonia and the flu, and access to addiction counselling and treatment on demand.

While clients of the supervised injection site may not choose to immediately access all the health care services offered at Insite, regular attachment to this health care facility, where clients develop trusting relationships with health care providers, makes them more likely to pursue detox, addiction counselling, and treatment.

Vancouver Coastal Health's direct experience in treating marginalized people with chronic addictions is that few people move to abstinence overnight. Few people go from being vulnerable and marginalized to becoming fully engaged in treatment and care. Few people get better without help and support.

Insite serves as a low-threshold access point for treatment services. For many people, Insite is the door from chronic drug addiction to recovery, from being ill to becoming well.

Vancouver Coastal Health has recently opened Onsite, which is directly upstairs from Insite, so that Insite clients can access treatment on demand with no wait time. Onsite provides transitional housing, home detox, a day treatment program, nursing care, one-on-one counselling, and support to Insite clients who are homeless and want to stop using drugs.

In addition to Insite and Onsite, over the last five years Vancouver Coastal Health has opened four other first-point-of-contact health care services. They are designed to be accessible to people whose chaotic lives and complex mental health and addictions issues make it practically impossible for them to access traditional health care services.

Currently, we're involved in the development of a 100-bed, long-term residential treatment facility for the clients of Insite who have both mental health and addictions issues. Without a doubt, the health care needs of people living in the Vancouver's downtown eastside are complex, and no single intervention is enough to transform this community--

[The Chair, Conservative, Joy Smith]

Ms. Hay, I have to interrupt you.

Thank you so much.

Ms. Hay, you will have the chance to answer questions. I gave you extra time.

[Heather Hay]

Sorry, I don't hear very well.

[The Chair, Conservative, Joy Smith]

Oh, I'm sorry. I'm just trying to be fair.

[Heather Hay]

Thank you.

[The Chair, Conservative, Joy Smith]

Dr. Mangham.

[Dr. Colin Mangham, Director of Research, Drug Prevention Network of Canada]

I'm glad to be here, but I came with some trepidation, being the only person at the table who is not all for this whole philosophy. But that's well known. While I've had similar treatment in some ways, at least my life hasn't been threatened yet.

I want to speak to the broader agenda and point out a few things for the committee, especially for those whose minds are not made up, especially for the elected representatives who should be setting drug policy with the people. I'll speak to you.

I was the author of one of three academic papers that all said essentially the same thing. I was embarrassed as a professional and as a graduate of UBC by the poor science and the misuse of data. It was allowed to stand in the media without correction. The media was making very positive, glowing statements without evidence.

The most telling thing I saw that never found its way into the media was that only a small percentage of drug users use Insite. It's not reaching the cocaine users. An even smaller portion use it for the majority of their injections. As I told CNN, it's like building a dyke out of chicken wire.

Why, then, is this still being clung to? I believe it's because it was never intended to be just a trial. In the year 2000, a Health Canada meeting in Mont Tremblant, Quebec, said, “The future of harm reduction among injection drug users lies with safe injection sites and drug maintenance programs”. In science, that's called coming to conclusions and then making everything fit.

From the body of people involved with Insite, you will not hear anything negative. I believe it's part of a larger thing that has had negative effects on treatment and prevention.

In the work I did, I found that the principal impact of Insite and the establishment of its parent philosophy, harm reduction, is that it has produced a void in incidence-reducing prevention. Whatever else anybody says, there is no incidence-reducing prevention. The program being worked on in Vancouver is a harm reduction program for high school students.

I've heard only criticism of primary prevention. One of the leaders said that prevention makes users feel deviant, while harm reduction makes them feel respected. As with many of these statements, that is very misleading.

There has been no expansion or innovation in treatment in Vancouver. There are people who aren't here because they would be intimidated and lose funding. They have told me that. They've said they have been told to stop asking for more treatment beds or they will lose their funding. The cost of $40 a day for a client hasn't changed in 40 years. “By their fruits ye shall know them”. I don't understand why treatment has languished, other than that there's not really a valuing of it.

It's on a collision course with enforcement. You will soon be hearing calls for changing the drug laws. It's wrapped up together. We're hearing it today. Public proponents of drug policy reform in the form of legalizing and regulating drugs include many policy-makers and advisors at the provincial and federal levels. They leave little doubt they want to change the drug laws.

I want to say to Mr. Owen, respectfully, that enforcement and treatment and prevention do work if they are used properly. Enforcement has operated largely through sanctions. The incidence of illegal drug use is only a tiny fraction of that of legal drugs, and the costs are less than half, even including enforcement costs. Why would we want to change that?

Simply put, Insite and its parent philosophy make the assumption that we can control outcomes in a free population without getting people off drugs. I've been called many names on this. There's a real intolerance of other views that makes me sad. I believe if you look into it you will see that many of the people involved with Insite are themselves involved in a broader movement. There are people in this room who've been given awards by the Lindesmith Center and the Soros Foundations for their work in drug policy reform and who have publicly called the drug laws the Berlin Wall.

These people have called me and people like me ideologues and themselves scientists. To such views they're entitled, but the assertion is made frequently by Insite supporters that they are following science; that the government ideology is hypocritical and false, and so is the unilateral engineering of policy.

I call on the committee, especially the elected representatives, to stop allowing a group of activists, whatever else they're clothed in, to dictate Canada's drug policies. The people of Canada--

[The Chair, Conservative, Joy Smith]

Dr. Mangham, I have to interrupt you now. My apologies.