Beyond The Commons

Aaron Wherry covers all the goings-on in and around Parliament Hill. Follow Aaron on Twitter: @aaronwherry

Categories: Beyond The Commons, Capital Read

‘The evidence shows’

by Aaron Wherry on Tuesday, August 31, 2010 5:01pm - 0 Comments

Noting the recent reporting of our John Geddes, doctors Kathleen Dooling and Michael Rachlis release an analysis of Vancouver’s Insite facility they recently compiled for the Canadian Medical Association Journal.

They conclude that “the evidence shows that this public health facility reduces harms of drug addiction while creating positive relationships between users and caregivers which result in more of them entering treatment and rehabilitation programs. Insite also helps to reduce the adverse impact of addiction on the immediate community in various ways, such as decreasing litter like used needles.”

Their full report is available here.

Tags: Canadian Medical Association Journal, CMAJ, drugs, Insite, RCMP, vancouver

More by Aaron Wherry

BGLong

Well, I guess that means we can start writing the obituaries for Insite.
Emily

Evidence? We don't need no stinkin' evidence!

http://dougsamu.wordpress.com doug_rogers

"Evidence? Evidence? We don't need no steenkin' Evidence!"

'Steenkin'. It's spelled 'Steenkin'

Emily

I stand corrected. Sorry. LOL

Mike

Mr Harper makes the rules, Evidence not required (or wanted)
bergkamp

How about those of us who don't believe government should be operating opium dens? It does not matter what 'evidence' is presented if people are against government acting as drug dealer and/or enabler.

Emily

Margaret Thatcher approved ….because it saved a ton of health money.

Now are you into your personal morality….or into saving tax dollars?
bennji

So I am intersted, how does someone who does not support Insite propose that we deal with the drug problem in DTES?

I can see your point about govenrment supporting something that is illegal…so, if you had your hands on the levers of power, what would be your solutions?

E_B_

Clearly, he would prefer that they get thrown in jail.

http://stumblingabordeaux.blogspot.com Pato31

I now understand the need for more jails!

bergkamp

"So I am intersted, how does someone who does not support Insite propose …. "

I think most drugs should be legalized and that's it. If people are capable of getting themselves onto drugs then they can be responsible for getting off them as well. Why does the government have to be involved in every aspect of peoples lives? If people want to be stuck on stupid and be a crack addict, let them.

The government should not be involved in contributing to people harming themselves. We don't give alcoholics free booze whenever they happen to need a drink, we don't give gamblers money to make up for their losses … etc. so I don't see why drugs should be any different.

Emily

And there will go our health costs….through the roof.

bergkamp

If you are concerned primarily by health care costs, shouldn't you be advocating for no Insite because heroin addicts and the like have shorter life expectancy and don't rack up the expensive treatments that healthy people who live to 80 incur. Letting the heroin addicts kill themselves off would save State quite a lot of money, I reckon.
Emily

We'll have to treat them all, through all stages of dependency. Same as we treat alcoholism.

You 'reckon' wrong.
Be_rad

Unfortunately for the fiscal expediancy argument you are throwing out there, before a long time addict finally succumbs to their addiction or the collateral damages that come with it, they have been taken into emergency many times over. As has been pointed out to you on this topic elsewhere, the typical costs of this type of treatment is astronomical compared to managed environments, access to nursing care in advance of catasrophic collapse, etc…

So, questions of your humanity aside, ("Letting the heroin addicts kill themselves off would save State quite a lot of money, I reckon.") you are simply asking to pay more money.

I do, however, tend to support your principle of legalization. Supply becomes sanitized, less expensive and unconnected to the underword. There is no question of supplying addicts for free. And it would give the issue over to the arena it belongs – public health. we would be free to directly address the psychological, sociological and biological vectors involved and probably improve (meaning reduce) overall usage rates.

ZestyMordant

"We don't give alcoholics free booze whenever they happen to need a drink, we don't give gamblers money to make up for their losses … etc. so I don't see why drugs should be any different."

We don't give alcoholics booze, we try to make sure the places they drink are relatively safe. We don't give money to gamblers, we try to give them relatively safe places to gamble. I don't see why drugs should be any different.

ChrisWPG

Now that is sound reasoning!
bennji

I have not been able to find it – does Insite provide "drugs" or do they simply take a don't see, don't tell approach as to how the patients / clients?? come by their stash?
ZestyMordant

They don't provide drugs, they just provide a safe place for addicts to use their own drugs. They do provide equipment such as clean needles, tourniquets and water. They also have nurses to respond to overdoses or other health issues.
http://supervisedinjection.vch.ca/services/servic…
bennji

Thanks!

Stewart_Smith

Actually I think bergkamp has a point. It is legitimate to oppose insite simply because it is facilitating an illegal activity. However, that argument shouldn't be contaminated by claims that insite is not effective.

Personally I see the insite argument a little like the registry. The pro-con arguments are well-trod at this point and those that are interested know most of the facts. It is absolutely clear now that both have value (notwithstanding the morality objection above) It seems equally clear to me that both actually have the potential to achieve quite a bit more. I think perhaps the most compelling argument for them is that in addition to the good value for money being obtained now, both have large upsides.

Olaf

It is absolutely clear now that both have value…

It's absolutely clear that that gun registry has value? I guess that depends on your definitions of "absolutely", "clear", "value", "more", "that" and "both".
Stewart_Smith

What can I say, I have sold out some promo space. From now on expect a lot of things to be "absolut" and "clear" not to mention "crisp" and "refreshing".
Olaf

Damnit. I really wanted to have an epic Olaf v. Stewart battle on the gun registry, but I have to admit that you've turned me with your staunch advocacy for all things crisp and refreshing.
Be_rad

You two need a pre-scheduled, no holds barred octagon cage match a la Wells and Coyne. Hype it up!
Stewart_Smith

Really, Wells & Coyne?? Forget the fact that they have totally run out of things to say, indeed did they ever? Wells & Coyne: when in the history of civilization have so many words been wrapped around so few original thoughts! Wells & Coyne: is like the muppet version of UFC. Cute (in a CR sort of way), occasionally amusing but ultimately just a mild diversion for those with too much time.

Olaf & SS would be much bigger, much badder. Technically we probably have to go the "pay for view route"… not cause we are greedy, money grubbin opportunists , but to protect the kids. After all the children are our future.
Be_rad

and it begins

Jan

The government is not giving addicts drugs. Another strong opinion based on false information.

Lord Kitchener's Own

Where are these opium dens?

You've piqued my interest.

Emily

In his vivid imagination….the one stuck in the 19th century.
tedbetts

They are unreported.

Emily

THEN THROW THEM IN PRISON!

Be_rad

Ah, yes. To return to the halcyon days of my youth, chasing the dragon. It seems like yesterday I was in Burma…

Jenn_

You know we don't sell them the drug at Insite, right bergkamp? I'd be against that, too.

Thwim

He knows. He was hoping we didn't.. or more specifically, that someone unfamiliar with this site would assume he wouldn't lie to try to make his point.

bergkamp

I am still not clear about this but I was under impression they gave out methadone out Insite. I have googled a bit and it's not clear what happens – Vancouver gives out methadone but not certain about Insite. My major objection is giving drugs to addicts but I am still against this type of government program. Even if Insite is not handing out methadone I still have problems with the clinic because it condones illegal behaviour and manages peoples addictions instead of trying to solve them.

I don't believe we should enabling people's bad habits – I really don't want my tax $$$ to pay for beds, blankets, heating, nurses or anything else that encourages addicts to continue on with their self destruction. We want people to get message heroin is bad, not government will provide you with warm bed and round the clock nurse care while you shoot up.

http://stumblingabordeaux.blogspot.com Pato31

"it condones illegal behaviour and manages peoples addictions instead of trying to solve them."

Insite does both. It enables people to take drugs in a safe location, using safe and clean methods, but at the same time, there are nurses and counsellors on hand that try to help the addicts. It seems as though, as the reports say, Insite is quite effective at helping people get rid of their addictions (so long as they ask for help I think). Either way, by getting junkies in a safe environment where their addiction problems can be addressed is probably an excellent way of dealing with it. As opposed to them shooting up in back alleys where nobody can help them.
http://onelinecritic.wordpress.com/ DirtyOldTown

I don't know about Insite, but I do know that methadone is dispensed at almost every pharmacy in B.C, even the ones at your local Safeway. Opting for methadone treatment is a decision that should be made between a patient and a doctor, and that patient should be able to access his/her medication wherever it is most convenient, just like any other patient with any other medical condition.

LaxAtlDfwYow

I'd encourage those interested in the subjerct to read the CMAJ article and the press release. I'd just note that the quote Aaron provided comes, not from the peer-reviewed article, but from the press release.

The paper seems a reasonable overview of Insite, the related research and the CPC efforts to kill it. I don't know enough about the history to be critical of the paper, but the press release is far stronger in its support for Insite than anything in the CMAJ paper. The press release is written such that it is difficult to distinguish quotations taken from the paper from other statements from the authors.

So, caveat lector.

Amateur Hour

There are 20 peer-reviewed studies that support the effectiveness of Insite … if this CMA article isn't your cup 'o tea.

LaxAtlDfwYow

Not my point at all. Just observing that the press release quotes that one would reasonably expect to come from the paper, did not. Further, that the press release is written to leave it to a reader of both to discover that fact.

I'm comfortable with commercial releases pushing manufactured quotes, but was more than a bit surprised to see that same practice in a scientific context.

Emily

And the full report was there for you to see.
http://www.translucid.ca/site/flacklife-the-translucid-blog/ bobledrew

It would be my reading of the release that the quotes are derived from conversations with — or at the very least the approval of — the authors of the article, not that they are quotes FROM the article. I have no doubt that if the release misreprented Rachlis or Dooling that they would be raising high hell. And I wouldn't blame them.

That being said, I assume that the release's quotes reflect the author's opinions as stated in a more colloquial manner than a peer-reviewed journal would use .

LaxAtlDfwYow

I'm sure that's right. (Commercial) releases are typically written by PR or mktng folk and passed by the principals for approval. I'm sure the authors blessed the release.

However, my point is that the release says something that the paper does not. Nowhere in the paper do the authors reach any conclusion similar to that quoted. They may well agree with (or even have provided) the quote but they sure didn't put it in the paper.

I'd also disagree that the release is clear on the origin of the main quote. To my reading , it seems deliberately ambiguous.

Jan

See page 2. Insite Effectiveness.

http://theorangerod.blogspot.com orangerod

Harper doesn't need evidence, just look at the gun registry !

SooperNoob

Is there some "evidence" that the gun registry is something other than a colossal waste of money and unnecessary intrusion? Yeah, I know that the RCMP are still patting themselves on the back with their report about what a smashing job they are doing, but that's hardly convincing.

hosertohoosier

The report is missing something that is critical to scientific analysis – controls. It is one thing to show that Insite users experienced improved results along a range of different metrics. What is critical, however, is to demonstrate that improvements took place relative to those not involved with Insite. This is a non-trivial concern – indeed, the decline in Vancouver HIV rates was actually slower after the inception of Insite in 2003 than before. Deaths from illegal drugs in the Rest of BC (with no Insite) appeared to have dropped as well as those in Vancouver.

Secondly, even if the evidence does strongly support Insite (and it probably does – although the report Wherry linked to was unconvincing), it would be effective at harm reduction. Honest people can disagree over the morality of taking a harm reduction approach to drug-use. Indeed, one can think of many instances where people would reject an effective, utilitarian policy because it requires the government to endorse practices that they find abhorrent.

What if, for instance, we adopted a harm reduction approach to murder. We could legalize murder, but regulate it. Murderers could be required to provide Murderees with documentation indicating their intent to murder. Governments could limit the number of murder licenses issued in a given year, to some number below the current number of murders. Murderers could agree to use instant and painless modes of killing, in order to limit the harm from killing people. Indeed, the government could provide safe spaces where murderers and murderees could go, in order to reduce the likelihood of collateral damage in the course of the murder. While this approach might succeed in reducing the harms of murders, its sheer absurdity suggests that there are limits to the degree to which we are willing to accept a harm reduction approach.

Emily

We do that already.

The state commits murder….it just calls it execution.

The state encourages murder…it just calls it war.

There are varying degrees of murder…accidental, juvenile, in anger but unplanned, and planned.

We even drag in murder in the form of non-prevention. Not preventing people from drinking and driving….or just drinking, or smoking….or eating too much or eating too little or using salt or sugar….etc

Try never to mix your fruits…the salad is often unpalatable.
colin

…umm… the report isn't conducting a study, it is reviewing the conclusions of previously published peer-reviewed studies. Your implication that these, or any other studies, failed to test using controls, or used an incorrect statistical test (you are suggesting they simply reviewed absolute changes rather than conducting a difference of means test, or some more complex analysis) is likely completely false. I've not read the studies, but if a peer-reviewed medical journal published studies which made conclusions on such poor statistical practice I would be utterly shocked – not that that means it isn't worth double checking, but I'm just saying you are likely making a blatantly false assertion.

hosertohoosier

I am sure that the sources in peer-reviewed journals used acceptable methods for making an empirical case. However, when we are talking about the government involving itself in behavior that it does not endorse, and in a matter of life and death, I should think that randomized clinical trials – the gold standard of medicine – would be appropriate. However, as best I can tell, that hasn't happened (see below, esp. last sentence):

"Insite, Vancouver's supervised injection facility for injection drug users, opened in 2003 under an exemption from Canadian federal drug laws. A substantial amount of research has since been conducted on the facility (www.vch.ca/sis/). Although randomized controlled trials have not been possible, the research has indicated substantial public health benefits associated with the facility's operation."

—Jarlais, Aresteh and Hagan (2008) "Evaluating Vancouver's supervised injection facility: data and dollars, symbols and ethics" in Canadian Medical Association Journal 179(11)

Admittedly I am mostly annoyed with the way journalists tend to misrepresent academic consensus. 13 out of 17 studies found positive effects for Insite. However, academic debates are not like elections – even if it was 16 to 1, it would not make sense to discuss a consensus if the sole dissenting article presented serious concerns that others could not address.
hosertohoosier

And Bayoumi and Zaric, perhaps the most influential of the studies, rely on a simulation model. So while they employ Vancouver-specific data whenever possible, the results are dependent upon assumptions. Secondly, they note in their discussion of limitations that:
"Our model has several limitations. First we modelled the efficacy of the facility by focusing on the injecting behaviours of regular users of the facility. We may have overestimated efficacy if injection practises of users injecting outside the facility did not change; however, available analyses to date suggest a general change in injecting practices."

–Bayoumi and Zaric (2008). "The Cost-effectiveness of Vancouver's supervised injection facility" in Canadian Medical Journal 179(11)

The key data source (and the source used by other articles to draw the conclusion that "available analyses to date suggest a general change in injecting practices.") appears to be the Vancouver Injection Drug User's Study (http://www.cfenet.ubc.ca/our-work/initiatives/vidus). The study looks at a cohort recruited through "street outreach" efforts, which has been followed since 1996. Participants provide blood samples every 6 months.

Street outreach does not strike me as a good basis for a random sample. The kind of people that would be willing to participate in such a survey may, for instance, have a greater desire to be rehabilitated than the larger drug-using population.

An additional difficulty (and I'm not sure how they address it) would be the impact of the fact that some members of the sample probably die on a fairly regular basis. Moreover, the people that survive versus those that die may differ along critical dimensions that are relevant to one's conclusions (eg. degree of drug use).

This plus my usual suspicions of the impact of confirmation bias in all academic studies, is not sufficient to discount Insite's effectiveness (it probably IS somewhat effective), but it certainly casts doubts over a program that places the government in a rather controversial role.

http://stumblingabordeaux.blogspot.com Pato31

Awful analogy! Committing harm to oneself is completely different than committing harm to someone else.

hosertohoosier

Thank you for demonstrating my point. You are willing to accept an evidence-based argument for harm reduction, up until the point at which individuals are allowed to harm others. In other words, at some point we go from a discussion rooted in evidence to one rooted in morality. You may have a different critical threshold than the Harper government, but we all have a point at which we cease to be utilitarians.

Thwim

Uh, no. The sheer absurdity of your example comes because there is no "harm reduction" in murder or indeed in any criminal activity with a victim. That's because the harm is a binary state that occurs when one person exerts their will on another against that person's wishes. It either is, or it isn't. And as such there is no reduction in the harm that takes place, which makes your example a load of crap. At best, you may get a reduction in the rate at which the harm is inflicted, but that's a different matter entirely.

That said, I do agree that people can certainly argue the morality of using a harm-reduction approach on victimless crimes. However, that doesn't make it an intelligent argument because, as with most issues of morality, sooner or later it comes down to people butting heads on their fundamental beliefs with generally neither one getting anywhere. Not a terribly productive use of time.

hosertohoosier

Less murder is undoubtedly less harm, and society clearly places some value in "humane" killing – for instance, look at the evolution of capital punishment methods in the United States, or the proscription of certain weapons or techniques of fighting wars under international law. Nor was my point to make an analogy, my point was merely to suggest that there are limits to evidence-based arguments (and limits to the evidence). I also agree that moral arguments tend to go badly because they boil down to fundamentals that cannot be resolved, but we can hardly deny that these exist.

http://stumblingabordeaux.blogspot.com Pato31

I'm not sure there's any harm reduction in your example of state-sanctioned murder. Think of the psychological trauma one would suffer if they had to step into a death chamber knowing they were innocent but because they were part of the quota they must be killed (by someone who just kinda wants you dead) – under the eyes of a government and their own family. I'd shoot myself before I let anyone do that to me.

hosertohoosier

There are three harm reduction mechanisms:
1. Less collateral damage.
2. Less murder overall (due to the quota system).*
3. Less painful/quicker means of killing.
4. Because people knew they would be murdered they would have time to put their affairs in order.

*There would be some unsanctioned (and illegal) murders, but most people would prefer to be waitlisted for the opportunity to kill somebody with no legal consequences.
http://stumblingabordeaux.blogspot.com Pato31

You didn't take into consideration the psychological trauma or possible suicides that could occur as a result. You need to look at the ''net harm". But then how do you weigh each factor? And, I'm not sure I would be putting my affairs in order if I knew I was going to be the victim of a state-sanctioned murder.

The other thing is that many murders, if not the majority, are done on a whim, and people aren't very concerned with the consequences at this point anyways. So why would that make them any more likely to go through a documentation process to achieve their "usually" short-lived goal. Could the murderee counter-act the murderer to try to take him out too? Or would it be first come first serve?

This is so ridiculous. I can't believe I'm arguing about it.
hosertohoosier

It is pretty obvious where the net harm lies. Murderees killing themselves, and perhaps feeling bad is a fairly minor problem. They would have been murdered anyway. Collateral damage and murder reductions are a very big deal, on the other hand.

Of course (and this relates to your second point), you would probably have to run a 10-year long pilot project in some city to see whether the policy was effective :). Crimes of passion probably wouldn't be effected, but not all murders are of that ilk.
http://stumblingabordeaux.blogspot.com Pato31

And if you know you're about to be the victim of a state-sanctioned murder, why wouldn't you just go on a giant shooting rampage, killing off the guy who placed the order and all his friends and family?

I get your point, you wanted to show that morality does have a place in these discussions. But what do we do if our morals don't merge on a particular topic? We look at hard facts. And the hard facts about Insite is that it is doing more good than harm because it is giving a chance to those seeking help to get that help first hand and it is diminishing the amount of diseases transmitted by dirty needles and less-than-hygenic practices.
hosertohoosier

Good point on the shooting rampage, I guess you would have to arrest the murderee, in order to restrain them.

As to moral convergence, we certainly do not turn to hard facts when people disagree. Take abortion, an issue characterized by irreconcilable moral positions for instance. The abortion debate is largely rooted in a rights-based dialog (pro-lifers stress the rights of the fetus, while pro-choicers stress the right to a woman's bodily autonomy). The Morgenthaler decision in Canada, for instance, drew on the right to security of the person, not on utilitarian arguments. Similarly, I doubt many pro-lifers would change their minds on the matter if it were found that legalized abortion had positive effects on society (eg. Levitt's argument that legalized abortion reduced crime rates).

When moral positions do not concord with one another, one set of principles must be chosen over others. Compromise tend to be disingenuous and problematic. For instance a rape exception on abortion would still legalize a type of murder for pro-lifers. We are sometimes saved by the fact that many people have inconsistent values because they think of issues on their own, rather than as part of a broader set of principles. As well, our constitution enshrines certain values as being fundamental, enabling the courts to build on our existing principles in order to carry things forward. The latter is unlikely to take place on the Insite matter, however.

The $64,000 question is whether it is morally acceptable for the government to play a role in the distribution of harmful and illegal products (and to some extent, this relates to the frame we adopt for drug addicts, eg. are they victims or criminals?). Only after answering that question can we discuss whether Insite is an effective tool.
ahm

We have answered this question. Most Canadians seem to accept on moral grounds that in very limited circumstances the government can distribute dangerous substances, and in extremely limited circumstances may distribute controlled substances (which one assumes are dangerous and/or harmful based on their presence on the controlled substances list); there is a significant minority who do not accept it but have not opposed it as of yet in sufficient numbers, or in significant manner as to require a revisitation. We are now discussing, having noted (specifically) your objection on moral grounds, whether it is effective. It seems that from the evidence, it is. I wonder, then, if Olaf below does not have a point. If we're observing this from the perspective of reducing harm – and if we keep banging away at that lovely drum of fiscal responsibility – then why not actually give the addicts heroin and not just the works and place to shoot up?
hosertohoosier

While Canadians do support Insite broadly, the only poll I have seen suggests that there is a deep split on the concept of "harm reduction" with 37% in favour and 37% against.

Secondly, the moral objection is not actually mine. I am okay with harm reduction (and am an extremist when it comes to utilitarianism in public policy). The evidence does seem to suggest that Insite reduces HIV transmission and the number of overdoses, and does not conflict with rehabilitation (although it is debatable as to whether it helps). I think Insite probably is beneficial, but I would like to see more evidence, and it is boring to simply agree with all of the other posters.
hosertohoosier

Poll: http://www.visioncritical.com/wp-content/uploads/…

ex-canuck

One understands that the city fathers of Amsterdam, that holy grail of therapeutic supervised drug taking centres seeing as how they've been at it for a couple of decades, are not at all sure of what benefits if any have accrued to their oh-so-cool and liberated city.
ARM-ME

There is a huge difference between murder-which directly harms another human being without their consent- and using drugs which only DIRECTLY hurts those who use them and is done willing by adults who know the risks! A better analogy would be…oh say…..engaging in sexual intercourse when you are not married. Many people "claim" that it is morally wrong,harmful to society and abhorrent. There are even similar health concerns for people who engage in pre-marital, non-monogomous sex and people who abuse drugs (such as HIV)..and sex (like drug use) can cause INDRIECT harm to others (for instance people who engage in pre-marital sex with someone who is married to someone else). However, in CONSENSUAL adult sex, grown people are willingly partaking and they aren't completely aware of the risks going in. In other words, what we do with our own bodies on our own time should be our own business! Forget trying to prove that it's harmful or safer when it's legal….why not just get very basic and say it's ridiculous to believe that you can control human nature and drug use has been a part of human nature since the beginning of time.

So what we should be doing is making it as safe as possible for people who partake (for them and for society) just as we do with many other dangerous, but part of life, acts that human beings willingly participate in, from DRIVING a car all the way up to risky sex and alcohol use.

Most of the harm that comes to people that use drugs comes from the exact policies that were supposidly (sp?) enacted to PREVENT harm. But, lets just face it, drugs are illegal because people think it's a moral defect to use drugs, not because society really cares what happens to those that use them…that is why insite is such a big deal because no one really wants to prevent harm to drug addicts and really all they want to hear is that insite is making it so drug addicts cost society less money and prevents less of them from hurting other people–as society has come to believe being an addict is equal to being criminal.

If insite were a place people could go to ingest alcohol safely each and everyday…no one would care….oh wait! We already have those places–they are called CLUBS.
ARM-ME

I meant grown people ARE aware of the risks of pre-marital sex, not they AREN'T.

Apparently I have become "addicted" to spell check and am now unable to write without it!
Olaf

Can someone explain to me, if we're so into harm reduction, if that's how we get our kicks, why don't we provide these individuals with the drugs? The whole InSite phenomenon is premised on the notion that no matter what we do, they're going to shoot up, so we might as well make it comfortable and safe for them to do so. Isn't there often a significant degree of harm caused in the process to obtain drugs?

http://stumblingabordeaux.blogspot.com Pato31

I'm not sure we would need to. If Insite does its job properly, which it seems to already be doing by providing "positive relationships between users and caregivers which result in more of them entering treatment and rehabilitation programs." then less users will need to get drugs through dangerous and harmful processes.

Olaf

Insite doesn't create positive relationships between users and dealers, however, nor positive relationships between users and members of the community who may be robbed or assaulted in the quest for a fix.

Are you proposing that because some users enter rehabilitation programs, than the harm caused to a) those users who don't enter rehabilitation programs, b) others who relapse, c) others who start drugs anew, or d) other members of the community, in the process of obtaining drugs, is an acceptable degree of harm because the harm has been slightly reduced from past highs?

If so, I would respond by saying "seriously, dude?"

http://stumblingabordeaux.blogspot.com Pato31

The harm caused to those people in your examples is not acceptable. But if we can reduce the frequency of that harm, without legalizing drugs, why not? It might be a step in that direction but let's see the long term effects of Insite on the community before we do anything drastic. I also tend to believe that less users would seek help if they didn't experience harm in the procurement of drugs.

I think I find solace in believing that the nurses at Insite don't want to shoot their clients up with drugs, but rather want to help them with their addictions problem. It's the easiest way of identifying those who use, monitor usage to a certain degree and help them out.

I don't want the drugs to be legal, I just want those who are stuck on them to have an opportunity to get help.

hosertohoosier

But according to the CMAJ article cited in this thread rehabilitation was not and is not a core goal of Insite. Rather, Insite was aimed primarily at reducing needle-sharing and drug overdoses. In order to prevent dangers associated with people acquiring drugs and/or drug-related robbery you would have to increase the number of people that sought rehabilitation.

I took a look at the some of the articles that addressed the impact of Insite on drug use (most of them deal with the impact on needle-sharing):
-Kerr et al. (2006) found a statistically insignificant increase in the rate of relapse (from 17% to 20%), and an also statistically insignificant decrease in the rate of those stopping drug use (17% to 15%).

-Wood et al. (2007) found statistically significant evidence that Insite users saw an uptake in entrance into detoxification programs. At the same time I am not sure whether this tells us that Insite reduced drug use OR that people with a desire to seek help were also more likely to use Insite. The latter strikes me as a reasonably probable explanation.

If the same resources put into Insite were put into improving treatment programs, it is not clear to me that they would perform any worse than insite.
http://stumblingabordeaux.blogspot.com Pato31

Interesting. I'm not well-read on any of this. But it's good to know. I do find it odd that if rehabilitation isn't a part of Insite's goals they wouldn't have made "6,242 referrals to other social and health services, the vast majority of them were for detox and addiction treatment" in 2009.

YYZ

Well, that's more or less what the legalize marijuana people have been saying isn't it? Legalizing drugs would clean up the value chainallow better regulation and allow the gov't to take it's cut via taxation.
ahm

Well, obviously, we don't right now because of the politicization of harm reduction, and because it would require a much more significant exception to the Criminal Code re controlled substances – which would in turn make the Americans very interested in the case.

In the long run? It's the logical outcome. If you can reduce the amount of petty theft, robbery, aggravated assault/assault/assault with a weapon (to achieve robbery), fraud, prostitution, drug sales, etc., committed to acquire the funds for a hit, then surely it makes sense to do so. The savings alone in insurance, reassigning police to other portfolios, and related healthcare costs strike me as quite large. But, just because it's logical to me doesn't mean it's morally acceptable to others.