Supervised drug consumption sites: a matter of community health

By Cécile Kazatchkine and Janet Butler-McPhee

Cécile Kazatchkine is a Senior Policy Analyst with the Canadian HIV/AIDS Legal Network.
Janet Butler-McPhee is their Director of Communications and Advocacy.

Authors’ note: Thanks to the Canadian Drug Policy Coalition (www.drugpolicy.ca), who co-authored with us the Bill C-2 analysis.

In September 2011, in Canada vs. PHS Community Services Society, the Supreme Court of Canada decided to allow Insite—Vancouver’s life-saving supervised consumption site—to remain open without risk of prosecution.

In its landmark decision, Canada’s highest court made a bold statement about the rights of people who use drugs, and the importance of harm reduction in saving lives and supporting community health.

An historic case, an historic decision

In Canada vs. PHS Community Services Society, the Supreme Court of Canada (SCC) recognized that access to supervised consumptions services, such as Insite, was needed to safeguard the rights to life, liberty and security of people who use drugs. Drug prohibition should not prevent people in Canada from accessing health services that are proven to prevent disease and death.

Unpacking the “legalese,” the Supreme Court of Canada found the Minister of Health’s original decision to deny Insite an exemption was “arbitrary” because it would advance neither public health nor public safety. Furthermore, the harms of denying people safe access to the site would be “grossly disproportionate” to any supposed benefit of maintaining a blanket prohibition on drug possession.

Therefore, the Minister of Health had violated the constitutional rights of people who use drugs — to life, liberty and security of the person — and was ordered to renew Insite’s exemption.

Having intervened in this important case, the Canadian HIV/AIDS Legal Network applauded this rights-based decision, and we were hopeful it would pave the way for similar services in other communities across the country.

Supervised consumption services: the overwhelmingly positive evidence

Health risks associated with injecting drug use are made worse by poor conditions and stressful environments. Supervised consumption services exist worldwide and have been operating for many years. A wide body of international research has demonstrated that such services have many positive impacts for people who use drugs and the community as a whole. Insite, for instance

  • is being used by the people it was intended to serve;
  • has reduced HIV risk behaviour such as needle-sharing;
  • has increased the number of people entering into treatment;
  • has improved public order by reducing public injections; and
  • has reduced overdose risks and prevented overdose deaths.

Like the Supreme Court of Canada said, Insite saves lives.

What has happened since the Supreme Court’s’s ruling?

Alas, four years later, no new supervised consumption services have opened in Canada.

Worse still, the federal government has introduced Bill C-2 (to amend the Controlled Drugs and Substances Act or CDSA), which runs counter to the spirit (and the letter) of the Supreme Court’s decision. We argue this position in this October 2014 Q&A, which was written jointly with the Canadian Drug Policy Coalition. The bill is currently before the Senate.

In Canada, as mentioned above, supervised consumption services need to seek an exemption under section 56 of the CDSA to operate safely. This section allows Canada’s federal Minister of Health to exempt a service or practice from the CDSA when necessary for medical or scientific purposes, or if it is seen to be in the public interest. Without such an exception, clients and staff members of supervised consumption services would be at risk of criminal prosecution for possession of illegal substances under the CDSA.

Bill C-2 seeks to amend the CDSA and make it more difficult for these exemptions to be sought or granted. Bill C-2 would require applicants to submit an onerous amount of information to the federal Minister of Health before (s)he may even be permitted to consider an application for an exemption.

Moreover, and against the Supreme Court’s decision, Bill C-2 says that exemptions will only be granted in “exceptional circumstances.

By focusing on exaggerated risks to public safety, Bill C-2 perpetuates stigma and discrimination already facing people who use drugs, as well as increases the harms against some of the most marginalized members of our communities.

We need progressive drug policy for better community health

Misguided legislation such as Bill C-2 stems from the failed “war on drugs” model of drug policy; it creates an environment in which communities are powerless to take action that could save the health and lives of their members. It denies people who use drugs their human rights, and exacerbates drug-related stigma.

Simply put, Bill C-2 would make it exceedingly difficult for health authorities and community agencies to offer much-needed health services to people who use drugs. It is contrary to the overwhelming evidence that supervised consumptions services save lives, and it is not in keeping with the directive of the Supreme Court of Canada.

The invaluable work done by Insite is a Canadian success story, and the establishment of more supervised consumption services would only benefit people who use drugs, the communities in which they live, and the country’s healthcare system writ large.

For more information:

Canadian HIV/AIDS Legal Network and Canadian Drug Policy Coalition, An Injection of Reason: Critical Analysis of Bill C-2, October 2014.