The Federal Government and Safe Injecting Sites: Why the Ongoing Resistance?

It is no secret that the consequences of drug addiction are severe, sometimes even fatal. Imagine, for a moment, an opportunity that offered a completely different outcome for Canadians suffering from the stigma that surrounds severe addiction.

Imagine an opportunity that provided a welcome environment free of judgment to those most entrenched in their disease.  A setting that has repeatedly proven to substantially reduce the chance of acquiring a life threatening infectious disease or die from a drug overdose.  A place where one could access health care services without shame, engage in medical detoxification and be referred for other addiction treatment.

It would be hard to comprehend why anyone would not be in support of such a program.  Yet that is exactly where we find ourselves with the federal government’s entrenched opposition to Vancouver’s supervised injecting facility, Insite.

ImageDespite a wealth of scientific evidence repeatedly demonstrating the success of Insite in reducing harms associated with illicit drug use and widespread endorsement for the program from numerous health bodies, including the Canadian Medical Association, the federal government went all the way to the Supreme Court of Canada in an effort to have Insite shut down.  They were ultimately unsuccessful when a unanimous 2011 decision stipulated the facility remain open and also described how the government must consider applications for future programs.

The government’s response?  Announcement of its “Respect for Communities Act.” A Bill so onerous it seemed geared towards making it
Imageimpossible for any organization to meet eligibility criteria to even submit a future application.  Ultimately, the Bill did not become law but was quickly succeeded by the introduction of Bill C2

The government’s stark opposition to supervised injecting facilities is rather confusing given their support for other health interventions for intravenous drug users.  At the 2008 International AIDS Conference, former Health Minister Tony Clement made clear the Conservatives’ support for needle exchange programs, which involve handing out clean needles to addicts and have proven effective at reducing the spread of infections like HIV.  In the case of Insite, however, Clement made clear his strong opposition to the program famously calling it an “abomination.”

The irony is that needle exchange programs do essentially the same function as Insite but they don’t regulate how and where the needles are used.  For instance, individuals using a needle exchange may take a needle and subsequently inject in full view of the public and then dispose of the needle in parks or other areas where there is a risk of needle stick injury.  Contrast this with Insite, where injections take place out of the public view, away from vulnerable youth, and onsite disposals ensure used needles can not find their way into public spaces.  Strict rules and nursing supervision also precludes the possibility of a used syringe being passed between users at Insite, a behavior primarily responsible for the spread of HIV among this population and not fully prevented by traditional needle exchange programs.  Locally, Insite has contributed to a 90 percent reduction in new HIV cases in BC, which is remarkable given each new HIV infection costs on average $500,000 in medical costs.  Insite also forces its clients to temporarily remain onsite after injecting where an addiction treatment program is co-located.  As a result a study published in the New England Journal of Medicine demonstrated that weekly use of supervised injecting facilities was associated with a greater than 70 percent increase in the use of medical detoxification among its clients.

Despite these clear successes, and the ability of the program to reduce public drug use and the spread of disease and death, the federal government remains firm in their opposition to supervised injecting facilities.  Unfortunately, many desperately addicted Canadians’ lives currently hang in the balance as a result.

What further evidence does the government need to support this lifesaving program?

Authors: Seonaid Nolan, MD, FRCPC and Evan Wood, MD, FRCPC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Abstinence and Alternatives: Alcohol Harm Reduction

While it works for some people, abstinence is not an effective approach for everyone. So why do the majority of drug and alcohol recovery programs promote abstinence as the only acceptable outcome? What about approaches that support anyone who is looking to make a positive change in their habits, no matter how small?

While working in needle exchange programs, I was struck by how these initiatives met people where they were at and respected the autonomy of the individual. These notions formed the basis of  the HAMS Harm Reduction Network.

HAMS (Harm reduction, alcohol Abstinence and Moderation Support) is a free-of-charge, lay-led support and informational group for people who wish to make any positive change in their drinking habits, ranging from safer drinking to reduced drinking to quitting alcohol altogether. This means it does not matter how much you drink or how little you drink; all that is required is that you are contemplating making a change for the better. If you decide that you want to stop drinking and driving but still want to get drunk every day, you are welcome at HAMS. If you have only one drink per day, but want to go to none, you are welcome at HAMS. We even offer a supportive environment for ex-AAs who have chosen to experiment with moderation, because we believe it is safer for a person to try drinking again with information and support than to try and do it on one’s own.


Individuals are always encouraged to choose their own goals and are supported in these goals. Goals are never assigned to individuals by the organization or other members. In fact, HAMS members avoid giving advice unless it is directly solicited; we find it for more useful to share our experiences and what has worked for us rather than to tell others what they ought to do. There is no sponsorship in HAMS and there are no “old timers;” however, members will often partner up to be “abs buddies” who will choose to do a period of abstinence from alcohol, such as a week or a month. Members also partner up to be “mods buddies” and set moderate drinking goals to share together. Often half a dozen people may be buddying up at a time, each choosing a different abstinence or moderation goal.

Another feature of HAMS is that it offers both in-person meetings and online support via an email support group and a real time chat. While some attend the live meetings, many members express a preference for online support over live meetings both for reasons of convenience and of confidentiality. Our online group has around 1,200 members, although group membership is not required to participate. Around 8,000 people have purchased the HAMS book, How to Change Your Drinking: a Harm Reduction Guide to Alcohol. This means it is likely that many people are using the book on their own without participating in a group.

HAMS owes a great debt of gratitude to all the harm reductionists who have gone before us. By offering a welcoming environment that respects a person’s chosen goals, HAMS aims to reduce alcohol-related harm and potentially save lives.


Author: Kenneth Anderson, Executive Director, HAMS: Harm Reduction for Alcohol

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC