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Is InSite Really All It's Cracked Up To Be?

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Ten years ago this week, Insite, North America's first supervised drug injection site, opened at 139 East Hastings in Vancouver's Downtown Eastside, thanks mainly to two men, Dr. Julio Montaner and Thomas Kerr of the British Columbia Centre for Excellence in HIV/AIDS.

It's an amazing story.

Since 2003, folks in Canada's most drug-infested neighbourhood have been buying heroin, cocaine and crystal meth on the street, strolling into InSite and shooting-up under the watchful eye of government nurses. All in the name of harm reduction, a philosophy of addiction treatment through enablement.

How'd they do it?

Early last decade, Montaner and Kerr lobbied for an injection site. In 2003, the Chretien Liberals acquiesced, gave the greenlight to B.C.'s Ministry of Health, which, through Vancouver Coastal Health, gave nearly $1.5 million to the BC Centre (that's Montaner and Kerr, you remember them) to evaluate a three-year injection site trial in Vancouver.

Voila! InSite was born.

If the three-year trial was successful, or in other words, if InSite's chief lobbyists, who received $1.5 million from taxpayers to study its pros and cons, concluded that InSite was a good fit for Vancouver, the provincial government would consider funding it in perpetuity. Amazing.

Through Freedom of Information legislation, I obtained a copy of the $1.5 million contract, which tasked the BC Centre to "evaluate the process, impacts and economic elements" of InSite and note "any adverse events that may occur."

Yet every study produced by the BC Centre since 2003 has cast InSite in a positive light. Every study. And the BC Centre is very protective of its conclusions.

For example. In 2009, the BC Centre released a report summarizing 33 InSite studies, all co-authored by Thomas Kerr, all singing InSite's praises. At that time, I interviewed Kerr who bristled at my questions, claiming that his researchers "passed the test of independent scientific peer review and got our work published in the best medical journals in the world, so we don't feel like we need to be tried in the popular media."

I asked him about the potential conflict of interest (lobbyists conducting research) and he ended the interview with a warning. "If you took that one step further you'd be accusing me of scientific misconduct, which I would take great offense to. And any allegation of that has been generally met with a letter from my lawyer."

Was I being unfair? InSite is a radical experiment, new to North America and paid for by taxpayers. Kerr and company are obligated to explain their methods and defend their philosophy without issuing veiled threats of legal action.

In the media, Kerr frequently mentions the "peer review" status of his studies, implying that studies published in medical journals are unassailable. Rubbish. Journals often publish controversial studies to attract readers -- publication does not necessarily equal endorsement. The InSite study published in the New England Journal of Medicine, a favourite reference of InSite champions, appeared as a "letter to the editor" sandwiched between a letter about "crush injuries" in earthquakes and another on celiac disease.

Yet Kerr thunders away like Moses. Where did he obtain this astonishing sense of entitlement?

Two words: the media.

The reportage on InSite by Vancouver's print and broadcast media does not meet, by any definition, basic standards of professional journalism. It's been shameful.

When the BC Centre stages a press conference, it's always the same formula. A handful of Kerr-authored studies and an obligatory recovering addict who owes his life to InSite. The reporters in attendance nod along and write or broadcast the same story with the same quotes and BC Centre statistics.

If a story involves an InSite skeptic such as Dr. Don Hedges, an addictions expert from New Westminster or David Berner, a drug treatment counsellor with more than 40 years of experience, it almost always includes a familiar narrative propagated by the BC Centre. InSite opponents are blinded by ideology; conservative moralists who care little about the poor and addicted. InSite proponents, on the other hand, are pure and unburdened, following the facts and relying on science.

Really? What kind of "science" produces dozens of studies, within the realm of public health, a notoriously volatile research field, with positive outcomes 100 per cent of the time? Those results should raise the eyebrows of any first-year stats student.

And who's more likely to be swayed by personal bias? InSite opponents, questioning government-sanctioned hard drug abuse? Or Montaner, Kerr and their handful of acolytes who've staked their careers on InSite's survival? From 2003 to 2011, the BC Centre received $2,610,000 from B.C. taxpayers to "study" InSite. How much money have InSite critics received?

There has never been an independent analysis of InSite, yet, if you base your knowledge on Vancouver media reports, the case is closed. InSite is a success and should be copied nationwide for the benefit of humanity. Tangential links to declining overdose rates are swallowed whole. Kerr's claims of reduced "public disorder" in the neighbourhood go unchallenged, despite other mitigating factors such as police activity and community initiative. Journalists note Onsite, the so-called "treatment program" above the injection site, ignoring Onsite's reputation among neighbourhood residents as a spit-shined flophouse of momentary sobriety.

Where's the curiosity? Where did these reporters learn their craft? The BC Centre won't answer your questions? Then ask the politicians who, unlike Montaner and Kerr, operate inside the bounds of democratic accountability.

If InSite works in the Downtown Eastside, Mayor Robertson, why not Dunbar, Mount Pleasant or West Point Grey? If, God forbid, you had a child who became addicted to drugs, Minister Lake, would you refer him to InSite? Premier Clark, your government funds InSite yet shuns many abstinence-based treatment programs. Why? And so on.

For the record, my opposition to InSite is based on the countless conversations I've had with Downtown Eastside residents over the past decade, as a journalist, volunteer and friend. In my judgement, public money is better spent on treatment and recovery facilities outside the neighbourhood, which is where the vast majority of addicts settle when they finally decide to quit using drugs.

Ten years later, despite any lofty claims, for most addicts, InSite's just another place to get high.