Insite is increasingly mainstream

Today, federal government lawyers will be in the Supreme Court of Canada putting forward its case for shutting down Insite, Vancouver's internationally recognized supervised injection site for people who inject drugs. The Dr. Peter AIDS Foundation will be there as an intervener.

Study after study have shown the individual and health system benefits of supervised injection service. It is increasingly mainstream thinking in Canadian health care as reflected by other interveners in the Supreme Court case - Canadian Nurses Association, Association of Registered Nurses of British Columbia, Registered Nurses Association of Ontario, Canadian Medical Association, and Canadian Public Health Association.

And it's also becoming increasingly mainstream thinking on our streets as evidenced by a recent Ontario survey presented at the 20th Annual Canadian Conference on HIV/AIDS Research in Toronto last month. Now that Insite has been operating for over seven years, many wonder what all the fuss is about. The sky hasn't fallen.

I hope the Supreme Court will rule in favour of Insite. It would mean one of two things, or both - the Court agrees Insite falls under provincial jurisdiction as a health care undertaking, or the Court agrees that the right to access Insite free from prosecution is protected by Section 7 of the Canadian Charter of Rights and Freedoms for individuals who inject drugs.

Individuals are suffering from the ravages of long standing injection drug use in towns and cities across Canada. The legal and political battles to keep Insite open leaves other cities and provinces reluctant to open supervised injections sites, despite knowing the need. The Dr. Peter Centre experience offers a way for supervised injection service to be integrated into health clinics and communities.

In 2002, a year and a half before Insite opening, the Dr. Peter Centre integrated supervised injection service into its broad range of health care services for people living with HIV/ AIDS. The Centre, a part of Vancouver's downtown West End neighbourhood alongside heritage houses, daycares, an elementary school and, in the midst of a bustling urban life, continues to provide the service in its day health program and 24-hour skilled nursing care residence.

The galvanizing impetus to pursue implementing the service was two overdoses (one in a bathroom, the other in the laundry room), fortunately neither fatal. We were aware there had never been a death in a supervised injection site anywhere in the world. It would have been inconsistent with our mission of care for people living with HIV/AIDS to ignore there was a way to reduce risk of death by overdose.

We proceeded after consultation with the College of Registered Nurses of British Columbia, the entity authorized and required, under B.C.'s Health Professions Act, to establish standards for registered nursing practice. The College confirmed that it was within the scope of registered nursing practice to provide individuals with evidence-based information so they can give themselves injections more safely, and that teaching and promoting such self care prevents illness and promotes health. Nurses do not touch, inject, or provide the drugs.

A March 2011 report from the BC Office of the Provincial Health Officer, Decreasing HIV Infections Among People Who Use Drugs by Injection in British Columbia: Potential Explanations and Recommendations for Further Action, recommends that access to supervised injection services should be incorporated into routine public health clinics throughout BC, using the Dr. Peter Centre model.

Health care leaders and policy-makers from Prince George to Victoria, Saskatoon to Toronto, New York to San Francisco, Kiev to Kaliningrad have visited to gain an understanding of our integrated approach.

The Lancet, a leading medical journal, in its recent online commentary states, "Misplaced moral judgments have underpinned the neglect of people who inject drugs. Yet, it is wholly immoral to let people become infected with HIV or die when evidence based interventions exist to prevent these outcomes. A bold and human response is needed from governments. Lives are at stake."

Maxine Davis is executive director of the Dr. Peter AIDS Foundation.