Health Committee on May 29th, 2008

[Dr. Colin Mangham]

--and elected officials need to set drug policy.

Thank you.

[The Chair, Conservative, Joy Smith]

Dr. Bennett, I'm going to ask you to please be respectful of all witnesses.

I read a statement here before committee for a reason this morning.

Mr. Tilson, I'm going to bring you to order, please.

I ask that everybody listen very carefully to every single witness in a respectful manner. We're all grownups here, and I think we can do that.

Thank you, Dr. Mangham, and all the rest of the people who are here.

We will now go to Dr. Kerr.

[Thomas Kerr, Research Scientist (Chief Researcher for Insite), British Columbia Centre for Excellence in HIV/AIDS]

Good morning. It's a pleasure to be here. I'm not an activist. I'm a professor in the Department of Medicine at the University of British Columbia and a research scientist for the British Columbia Centre for Excellence in HIV/AIDS.

I'm here today because in September 2003 our research group was contracted to conduct an arm's-length scientific evaluation of Insite. Before sharing the results of our work, I'd like to say a few things about science and the structure of our evaluation.

Let's be clear: peer review is modern science's greatest asset and provides the greatest protection against biased reporting. The scientific credibility of any given piece of research is therefore established only after a study has been subject to external scientific review by international experts and published in recognized public health and medical journals.

Given the controversial nature of the Insite initiative, we sought to conduct an evaluation that would stand up to the highest level of scientific scrutiny. To this end, we sought publication of our work in the world's top medical and public health journals, and only after a study passed the test of peer review and was published did we discuss it publicly. To date, there have been over 25 peer-reviewed published studies derived from our evaluation. I will summarize only some of the main findings today.

First, we have published three studies, including a paper in the Canadian Medical Association Journal , showing that the establishment of Insite led to reductions in public disorder related to injection drug use.

Second, in a paper in the prestigious British journal The Lancet and a follow-up paper in the American Journal of Infectious Diseases, we showed that the use of Insite was associated with large reductions in syringe sharing, the behaviour that leads to HIV and hepatitis C infection among injection drug users.

Third, we published two papers showing that the staff at Insite have reduced risks for overdose and successfully managed hundreds of overdoses. Remarkably, now over 1,000 overdoses have occurred at Insite and nobody has died.

Fourth, studies published in the New England Journal of Medicine and the journal Addiction revealed an increase greater than 30% in the use of detoxification programs among Insite users in the year after Insite opened. These works also show that Insite is connecting drug users with other forms of addiction treatment.

Recognizing the controversial nature of several studies of Insite, we also published studies that ruled out whether Insite was having negative effects. In a paper published in the British Medical Journal we showed that Insite was not promoting relapse or discouraging people from quitting drug use. A paper in the American Journal of Public Health revealed that Insite is not sending the wrong message and encouraging vulnerable individuals to take up injection drug use.

We have also shown, using police statistics, that the establishment of Insite did not lead to increases in crime. And to correct Mr. Mangham, many drug users have used Insite. In fact, over 8,000 have registered, and over 35% of injections involved cocaine.

In other words, a large body of research that has been accepted and endorsed by the international scientific community shows that Insite is really doing what it's supposed to do. It's reducing public disorder and HIV risk behaviour, promoting entry into abstinence-based addiction treatment programs, and saving lives that would otherwise be lost to overdose. The research also shows that Insite does not appear to be having any negative effects on the community.

I respectfully submit that this is the only research on Insite that has passed the test of independent scientific peer review and has been published in recognized medical or public health journals.

Today you have heard of studies that have criticized our research and you were told that these studies have been peer-reviewed. This is utter nonsense and factually incorrect. The only manuscripts that have criticized our work and Insite are those that appeared in the Journal of Global Drug Policy and Practice, including a paper written by Mr. Mangham.

Sadly, the mission of the host institution of the journal states that it supports efforts that vigorously oppose policies based on the concept of harm reduction. This is not a forum for academic debate; it is simply a website operated by a well-known anti-harm-reduction lobby group, namely the Drug Free America Foundation. The journal is not recognized by or indexed on MEDLINE databases, and the papers in question contain numerous factual errors.

Instead of doing what academics normally do, submit critical comments in the journals where individual studies are published, as in the debate over global warming, detractors like Mr. Mangham have merely aired their complaints in non-mainstream, fringe venues, such as the website operating under the name of the Journal of Global Drug Policy and Practice.

Today you'll hear anecdotes and opinions regarding the limitations of Insite. I urge the committee to remember that we are discussing very important public health issues, life and death issues, HIV infection, and overdose. Decisions regarding the response to such issues cannot be based on mere opinion and anecdotes; they must be based on the best available scientific evidence. All our studies contain sections that describe the limitations of the individual works. They would not have passed the test of peer review if they did not.

When it comes to Insite, the science is clear. Insite works and does not compromise other efforts related to prevention and treatment of addiction. Insite clearly must remain open. Accepting anecdote and opinion in this instance would be akin to recommending untested herbal remedies for life-threatening cancers.

Again, this is an evidence-based public health program that must be supported.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you.

We're going to go to two videos.

While our technicians are hooking them up, I want to thank all of you for your insightful comments.

We'll listen to the two videos and then we'll go to questions. We'll take one minute.

[The Chair, Conservative, Joy Smith]

We are now going to go to the two videos.

I have to tell the audience there is never a dull moment in the House of Commons. Those bells indicate a vote. I am now trying to find out how long we have.

I understand it's 25 minutes, and the videos are each five minutes long. We do have time to watch the two videos. I would ask the committee to take their seats. Mr. Temelkovski and Mr. Tilson, could you please be seated.

Sorry, ladies and gentlemen, I've just been given the rule book. The rule book supersedes everything. As I said, there's never a dull moment in the House of Commons. Therefore, when the bells are sounded for a recorded division, the committee meeting must be suspended immediately. The meeting is suspended until after the votes.

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

On a point of order.

[David Tilson, Conservative, Dufferin—Caledon, ON]

He can't even make a point of order. You're out of order.

[The Chair, Conservative, Joy Smith]

If I could finish, please.

In order for the committee to continue, I need unanimous consent from the committee.

[Christiane Gagnon, Bloc, Québec, QC]

On a point of order, the message said we have to go to the chamber as fast as possible. To me, that's the time we vote.

[The Chair, Conservative, Joy Smith]

Do I have unanimous consent?

I won't have unanimous consent.

We will suspend until after the vote.

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

I have a point of order, Madam Chair.

[The Chair, Conservative, Joy Smith]

I said go ahead, Dr. Martin.

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

Thank you, Madam Chair.

There are two things. First, it is your jurisdiction to allow this to continue. That always happens in committees. Second, if you want to determine if unanimous consent exists, then you've got to ask.

You have two choices. One, allow this to go on for the next fifteen minutes, or two--

[The Chair, Conservative, Joy Smith]

I will ask.

Thank you, Dr. Martin.

Is there unanimous consent to continue this committee meeting right now?

[Some hon. members]

No.

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

A recorded vote.

[The Chair, Conservative, Joy Smith]

Dr. Martin, if you don't have unanimous consent, the meeting is suspended until after the vote.

[The Chair, Conservative, Joy Smith]

Ladies and gentlemen, I would ask that we begin the meeting. Could you all take your seats?

We will now go into the video conference. We're going to have two different people. The first one is Dr. Neil Boyd.

Go ahead, Dr. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I would like your advice, Madam Chair, in terms of the 40 minutes that we've now missed, as to whether we could move to extend the hearings by 40 minutes. Obviously the minister's time is quite often the least flexible, but would this panel be able to reconvene after the minister's appearance so that there could be a more extensive period of questioning by parliamentarians? It would be a move to extend by 40 minutes.

[The Chair, Conservative, Joy Smith]

Thank you.

Go ahead, Mr. Fletcher.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Madam Chair, I can do better than that. If there's agreement with the committee, the minister is able to come at 12:20 and stay until 1:30, so the original amount of time is still there.

[The Chair, Conservative, Joy Smith]

Thank you.

I realize we were interrupted, and certainly we can accommodate that.

Our revised schedule will be to have our two witnesses on the video conference from 11:35 to 11:45. Can we please begin?

Dr. Neil Boyd, please go ahead.

[Professor Neil Boyd, School of Criminology, Simon Fraser University]

Good morning.

[The Chair, Conservative, Joy Smith]

Good morning, Dr. Boyd. Can you hear us? I'm Joy Smith, the chair of the committee. Welcome.

[Prof. Neil Boyd]

Yes, I can hear you. Thank you.