An independent reviewer has dismissed concerns over a study that shows a 35-per-cent decrease in overdose deaths after the opening of Insite, North America’s only supervised injection facility.

Published in the prestigious British medical journal The Lancet on April 18, 2011, the study, titled Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study, was the first to assess the impact of supervised injection sites on overdose mortality.

The study was led by Thomas Kerr, an associate professor at UBC and co-director of the Urban Health Research Initiative at the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE) and Julio Montaner, director of the BC-CfE and Chair of AIDS Research at UBC.

In a September 2011 letter to John Hepburn, UBC’s Vice President Research & International, a group called Drug Free Australia raised concerns over the interpretation of data in the study. Pursuant to UBC Policy 85 (Scholarly Integrity), Hepburn subsequently appointed Mark Wainberg, professor of medicine and director of the McGill University AIDS Centre, to review the matter.

Wainberg is a past-president of the International AIDS Society, editor-in-chief of the Journal of the International AIDS Society and editor of various other academic journals. He was a recipient of the Canadian Medical Association’s 2009 Medal of Honour and was named a Public Health Hero by the Pan American Health Organization for his work in antiviral treatment of HIV/AIDS.

After reviewing the submission by Drug Free Australia, the Lancet article and the authors’ response, Wainberg concluded:

“In my view, the allegations that have been made by ‘Drug Free Australia’ are without merit and are not based on scientific fact. In contrast, it is my view that the work that has been carried out by the team of Thomas Kerr et al is scientifically well-founded and has contributed to reducing the extent of mortality and morbidity in association with the existence of the safer injection facility. . . . The University of British of British Columbia should be proud of the contributions of its faculty members to the important goal of diminishing deaths due to intravenous drug abuse.”

It has been interesting to observe the fallout from the recent Supreme Court of Canada (SCC) decision which allows Insite, Vancouver’s largest supervised injection facility (SIF), to remain in operation.

In essence, the SCC found that the rights of the clients and staff of Insite to Insite outweigh any salutory effects arresting them for drug possession at Insite might have.

As the SCC put it:

… the effect of denying the services of Insite to the population it serves is grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics.

The court rejected the argument that Insite is a health facility under provincial rather than federal jurisdiction, but they agreed that, in this case, the Controlled Drugs and Subtances Act (CDSA) infringes on Charter rights.

Denial of health services and increased risk of death among drug users outweighs any benefit from absolute prohibition on drug possession

By Peter McKnight, Vancouver Sun

If nothing else, Friday’s unanimous Supreme Court of Canada decision on the future of Insite, Vancouver’s supervised injection site, reveals the federal government’s striking ability to snatch defeat from the jaws of victory. And in spectacular fashion.

The plaintiffs, after all, lost on both of their primary grounds of appeal, yet still managed to win the case. The plaintiffs’ first argument, which previously persuaded the B.C. Court of Appeal, concerned the doctrine of interjurisdictional immunity, while the second argument, which previously convinced the B.C. Supreme Court, concerned section 7 of the Charter. Yet, while these two arguments swayed lower courts, the Supreme Court of Canada wasn’t having any of either.