Capital News Online: The politics of health

Proponents of supervised injection sites are expecting fewer obstacles as they push for the opening of facilities under the new federal government, despite existing policy that has prevented their start in several communities

The newly-elected Liberal government campaigned on their support of the drug consumption facilities during the election and their win has given hope to advocates of supervised injection sites advocates.

Supervised injection sites are legally sanctioned facilities monitored by health workers and researchers. They are designed to centralize drug use, to provide sterile equipment and to be a connection to drug addiction recovery services.

Canada’s only such facility, Insite, opened its doors in 2003.

Insite reported its services led to a 35 per cent decrease in fatal overdoses in its immediate area. It also provides sterile needles, which has helped stop the spread of infectious diseases such as HIV/AIDS.

Other cities have attempted to follow in the footsteps of the Vancouver facility, citing the possibilities for harm reduction and a public-health need. In Montreal, a spike of deaths related to intravenous drug use in May 2014, alarmed the public and health workers.

Montreal politicians, health workers and activists are determined to open facilities—soon. The city is awaiting the federal government’s decision on opening four locations, including one mobile location.

Cactus Montreal would host the first site in the city, according to the community centre’s founder.

Louis Letellier de St-Juste said he is confident the new government will approve the bid. He said he hopes to start offering services in 2016.

“We could not have any communication . . . any intelligent discussion with the Conservatives before,” he said. “It’s clear in my mind that it will be different.”

But some have questioned if the new government will be able to navigate existing policy that quickly.

Opponents—including the former government—have voiced concerns about increased use of drugs and the expenditure of taxpayer money on materials for substance abuse.

The Conservative government passed legislation earlier this year that made it more difficult to open these types of facilities.

Communities wishing to provide safe injection supervision must be granted an exemption to the Controlled Drugs and Substances Act by the federal government, according to Bill C-2. Proponents are required to consult police, local politicians, provincial governments and public health officials. They are also obligated to compile crime and drug statistics on the surrounding area.

“It’s not going to be done without some expenditure of political capital. The question is does the federal government want to spend it on this file this fast?”

— Patrick Fafard, health policy and federal politics expert

How could Liberals navigate existing policy?

The new government could navigate supervised injection sites in several ways, and according to one expert, it will come down to how much effort Jane Philpott, the new Minister of Health, is willing to allocate to the file.

It is still unclear where safe injection sites sit on the new government’s list of priorities, as the issue was not mentioned in the federal health minister’s mandate letter.

“It’s not going to be done without some expenditure of political capital. The question is does the federal government want to spend it on this file this fast?” said Patrick Fafard, a health policy and federal politics expert and professor at the University of Ottawa.

The government could simply grant exemptions under existing policy, but Fafard said opponents could slow down the process.

“If I was an opponent and . . . thought that people were trying to play fast and loose with the legal framework, I could seek legal relief to say the parties are not respecting the legal obligations under the legislation,” he said. “They wouldn’t necessarily win, by they would slow down the process.”

And although many activists are calling for Bill C-2 to be repealed altogether, reversing or rewriting legislation is a lengthy process.

Dawn Moore, a Carleton law professor with expertise in addiction and drugs, said laws are only useful as long as as they are enforced.

“The government has said they have the desire to work amicably with the provinces, and the province of Quebec has said that it wants to move forward with safe injection sites,” she said. “I put those two things together and I think they are unlikely to enforce legislation from a previous regime, and probably will move forward to change that legislation eventually.”

Moore said the federal government could also argue safe injection sites fall under provincial jurisdiction, citing the Supreme Court’s landmark decision to keep Insite open after the federal government refused to renew its exemption to the Controlled Drugs and Substances Act.

Although drug use has criminal implications, which falls under federal jurisdiction, The Supreme Court found supervised injection to be a health-care issue and therefore under provincial control.

Quebec has given Montreal the green light to go ahead with the project.

Montreal’s mayor Denis Coderre has stated regardless of federal support, the city will go ahead with the plan to provide these facilities. The centres have been given the green light by the province

Data suggests there is a need for supervised injection sites. Infographic © Rachel Collier and Tanya KirnishniData suggests there is a need for supervised injection sites. Infographic © Rachel Collier and Tanya Kirnishni

Montreal could lay the groundwork that Insite did not

When the Supreme Court of Canada unanimously ruled in 2011 that Insite could remain open, many proponents of supervised injection sites believed the road for more facilities had been paved.

But Fafard said the ruling didn’t create the precedent many had hoped it would.

“If you get one win in one province then it becomes impossible to justify shutting down a similar initiative in any other province.”

— Dawn Moore, Carleton law professor with expertise in addiction and drugs

“The court said, having offered a service to this group of people, to take it away would do them harm and that would be a violation of their Charter rights,” he said.

He added that under this ruling, the federal government did not have an obligation to provide supervised injection sites that did not yet exist.

If Montreal successfully opens one of these facilities, the city would set a precedent for the rest of Canada, according to Moore.

“When the Conservatives brought in the legislation, the sentiment was that, ‘We just need one win,’” she said. “If you get one win in one province then it becomes impossible to justify shutting down a similar initiative in any other province.”

Sean LeBlanc, chairperson of Ottawa’s Drug Users Advocacy League, said he hopes that’s exactly what happens.

LeBlanc used intravenous drugs for 14 years and was only able to change his life because of access to services such as sterile needle distribution.

“People get to the point that I did, but they need to be alive and relatively healthy in order to make that decision,” he said. “Supervised injection ensures that, or at least improves it an awful lot.”

He said people will continue to use, but access to supervised injection sites can save lives.

“I’m just tired of my friends dying,” he said.

Rachel is currently attempting her fourth-year as a journalism major at Carleton University. When not in her natural habitat (any functioning newsroom), at work or in class, Rachel can be found getting yet another cup of coffee or compulsively checking her phone for the latest scoop.

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