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High time for Canada to ‘grow up’ about drugs

Web commentary
|Written By Richard Elliott

Canada’s government keeps missing the mark when it comes to dealing with drugs.

Recent examples include: pushing Bill C-15 through Parliament to impose mandatory minimum prison sentences that have proven disastrous in the U.S.; opposing successful, community-run supervised injection sites, even spending money to fight them in the courts; and refusing to implement proven harm-reduction approaches in prisons.

It’s high time for Canada to grow up regarding its approach to drugs.

At the Symposium on HIV, Law, and Human Rights, held in Toronto on June 12-14, some 200 lawyers, policy-makers, and advocates gathered to consider, among other things, Canada’s drug policies.

Presenting experts included Dean Wilson and Shelly Tomic, individual plaintiffs in the case aimed at keeping the supervised injection site in Vancouver’s Downtown Eastside open.

Both testified in court about their own lengthy histories of addiction, and as Tomic succinctly put it: “All I can say is that Insite has saved my life.”

For those unfamiliar with it, Insite is a facility where people with addictions can inject drugs under medical supervision. It provides sterile needles and emergency intervention in the event of overdose; it also connects people to addiction treatment if and when they’re ready to take that step. The facility thus aims to protect the health of some the most marginalized people.

Over the past five years, studies in many of the world’s leading peer-reviewed medical journals have confirmed Insite’s success. It provides critical health care to a particularly vulnerable population; it has not led to increased injection (contrary to the fears of some opponents); and it has had “public order” benefits for the surrounding community.

Of course, Insite is but one facility with limited capacity. Everybody agrees it cannot possibly respond to all the needs in a neighbourhood that is home to many people with multiple health needs living in deep poverty.

Yet despite all its benefits, Insite’s continued operation is being threatened by the federal government’s attempts to withdraw the exemption by which it operates, allowing its staff and users to avoid criminal prosecution under Canada’s drugs laws.

The B.C. Supreme Court declared that provisions of those laws were unconstitutional because they block access to a health service needed by people with addictions, causing avoidable death and disease. A decision on the government’s appeal of this ruling is expected from the B.C. Court of Appeal in a few months, but either way, the case is likely destined for the Supreme Court of Canada.

The saga of Insite is one aspect of how federal government policy is being driven by an ideological commitment to “get tough” on drugs — and, by extension, people who use them — even in ways that fly in the face of the best available evidence.

Indeed, there is ample research — much of it reviewed at the symposium by Professor Carol Strike, a leading public health researcher from the University of Toronto — demonstrating what works to make people and communities safer, including protecting public health by preventing the spread of HIV linked to risky drug use.

Yet on so many fronts, the government ignores or denies the evidence, and instead wastes huge sums of money on approaches that have been discredited. Tragically, these misguided efforts contribute to disease and distress.

This is painfully obvious when it comes to prisons. As we outline in a recent report, Clean Switch: The Case for Prison Needle and Syringe Programs in Canada, the evidence and legal arguments clearly favour the introduction of needle and syringe programs in Canada’s prisons.

As our report notes:

•    Drug use occurs regularly in prisons, including by injection. This is not surprising, given the widespread incarceration of people for drug offences — disproportionately people with addictions. As early as 1995, a survey by Correctional Service of Canada revealed that at least 11 per cent of people in federal prison had illegally injected drugs since arriving at their current institution. CSC continues to devote increasingly more time and money on efforts to prevent drugs from entering prisons, despite the finding by the federal correctional investigator that it has not worked. In the meantime, many people continue to share needles to inject, which risks spreading blood-borne infections such as HIV and hepatitis C virus.

•    According to repeated studies, the prevalence of HIV is at least 10 times higher among people in prison than in the population as a whole; for hepatitis C, at least 20 times. Since the vast majority of people in prison are eventually released, this should be a public health priority.

•    Implementing needle and syringe programs in prisons is recommended by the Ontario and Canadian medical associations, the World Health Organization, UNAIDS, the UN Office on Drugs and Crime, the Correctional Investigator of Canada, and the Canadian Human Rights Commission, among others. In 2006, the Public Health Agency of Canada reviewed the public health evidence regarding such programs for CSC, and concluded the evidence supported their implementation.

•    Needle and syringe programs have operated successfully in over 60 prisons in at least 11 countries around the world since 1992. They offer significant health benefits and make prisons safer for both staff and those in custody. Evidence shows no negative consequences such as an increase in drug use or injecting, and no reports of syringes used as weapons in any institution with such a program. In fact, studies from numerous countries have demonstrated a reduction in the sharing of injecting equipment and the associated risks.

Building on this extensive evidence, our Clean Switch report outlines in detail the legal obligation to implement such health programs in federal prisons under federal correctional legislation, the Canadian Charter of Rights and Freedoms, and international human rights law.

So far prison authorities have refused to move forward with such initiatives. However, the issue remains on the agenda. Most recently, it was raised at the House of Commons standing committee on public safety and national security as it studies how CSC is addressing mental health and addictions in federal prisons.

In the months ahead, Parliament’s “other chamber” may also have a role to play in bringing reason to bear on Canada’s drug policy. In his closing address at the symposium, Senator Pierre Claude Nolin, who in 2002 chaired the Senate special committee on illegal drugs that recommended decriminalizing marijuana, offered some observations about Canada’s drug laws.

In response to questions about the recent vote in the House of Commons to pass the government’s Bill C-15, imposing mandatory prison sentences for certain drug offences, Senator Nolin assured the audience the Senate would give the bill the “sober second thought” that is one of its key functions.

It is to be hoped that Senators will help Canada adopt a more rational, practical approach to dealing with drugs — both to address the very real harms of problematic drug use and, as importantly, the human and societal damage done by continuing to prosecute the failed “war on drugs” at all costs.

Richard Elliott (LLB, LLM) is executive director of the Canadian HIV/AIDS Legal Network (www.aidslaw.ca), one of the world’s leading organizations working on the legal and human rights issues raised by HIV/AIDS. The Clean Switch report is available via www.aidslaw.ca/prisons (click on “publications”).

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