Safe drug injection site rules emphasize local input

The federal government says it is giving a voice to local communities with a bill introduced today that lays out criteria for getting permission to open a supervised drug injection site in Canada.

Health Minister Leona Aglukkaq introduced the proposed respect for communities act in the House of Commons and at a press conference she said the proposed rules are in line with a Supreme Court decision in 2011 that allowed Vancouver's InSite clinic to stay open.

The bill lays out what information and input Aglukkaq would take into consideration when deciding whether to grant an exemption to the Controlled Drugs and Substances Act. The exemption allows for illegal drugs to be used for medical and scientific purposes and for activities that are in the public interest. 

"The respect for communities act would ensure Canadians could make their voices heard when a new supervised drug consumption site is being considered," Aglukkaq said.

"In terms of supervised drug consumption sites, we all have a stake in determining if such a facility is right for our communities. That's why the proposed legislation includes a strong, local, public consultation component."

It is up to Aglukkaq to grant the exemption and the new criteria she will consider are as follows:

• Stakeholder views including letters from provincial ministers responsible for health and safety, local government, head of police force for the area, and the lead health professional for the province.
• A report of consultations with licensing authorities for physicians and nurses as well as a broad range of community groups.
• Indication of financial sustainability.
• Staff information including criminal record checks.
• Describing the need for the clinic including scientific evidence of a medical benefit, relevant data on drug use, infectious diseases, overdose deaths and drug-related loitering, as well as any relevant official reports.
• Potential impacts of the site on public safety.
• Description of measures and procedures to protect the health, safety and security of staff and the local community, including measures to mitigate the risk of diversion.
• Description of available drug treatment services, if any.
• Description of other procedures, such as record keeping for the disposal, loss, theft and transfer of controlled substances left at the site.

The bill also contains criteria that must be met in order to maintain an exemption. The new system also gives the minister the authority to issue a notice of application, which is another way to gather public input.

"We all have a voice when it comes to our health and safety. I encourage Canadians to make theirs heard when it comes to supervised consumption sites," she said in her remarks Thursday.

Prime Minister Stephen Harper's government was prompted to come up with the proposed legislation because of a Supreme Court ruling that it lost. The Conservatives were fighting InSite and wanted it shut down, but Aglukkaq was directed to grant it the exemption. Aglukkaq said at the time that the government was disappointed with the ruling.

Aglukkaq was asked whether a single group that is opposed to a new site could essentially veto the application under the proposed criteria. Aglukkaq responded that the bill lays out who needs to be consulted, that "the community support has to be there" and that she can't answer hypothetical questions.

There was swift reaction to the bill, including from the Canadian Medical Association. The CMA said that it seems to go against the essence of the Supreme Court ruling.

"In a preliminary assessment based on initial review of the bill, the CMA is deeply concerned that the proposed legislation may be creating unnecessary obstacles and burdens that could ultimately deter creation of more injection sites," the statement said.

Mixed reaction to proposed criteria

The CMA's position is that supervised drug injection sites help save lives and should be included in a national drug strategy.

"The CMA's position is founded upon clinical evidence. Bill C-65, it would appear, is founded upon ideology that seeks to hinder initiatives to mitigate the very real challenges and great personal harm caused by drug abuse," it said.

The Conservative Party of Canada also made its position on the clinics known, sending out a letter encouraging people to "keep heroin out of our backyards."

"Do you want a supervised drug consumption site in your community? These are facilities where drug addicts get to shoot up heroin and other illicit drugs," it reads. The letter says the NDP and Liberals are "against us" and want more clinics like InSite "maybe even in your community."

The letter, and the bill, are not going over well with the Canadian HIV/AIDS Legal Network.

"It's hard to imagine how anyone could expect good faith on the part of the government in considering applications when it's simultaneously demonizing people with addictions and stoking misinformed fear as a way to block health services for some of the most vulnerable Canadians," Gilleen Witkowski said.

She also said the government isn't following the directions of the Supreme Court and predicted that future applications that are denied will end up in more legal battles. Witkowski said Aglukkaq's criteria will allow her to use opposition, that isn't based on any evidence, as a reason to deny an exemption.

A Montreal organization called CACTUS is in the final preparations for applying for an exemption, according to its president Louis Letellier. He said in an interview that he's concerned about everything that is being asked for in the new criteria and the threshold of support that needs to be met. 

"We don't have the support of the municipality, that's one thing clear," he said.

The Canadian Police Association was invited to speak alongside Aglukkaq at her press conference and Sgt. Matt Skof said his group is pleased with the proposed legislation.

"We certainly appreciate that this government has taken steps to ensure that the concerns of the law enforcement community are taken into account before any new supervised consumption site might be opened," he said. "It is absolutely appropriate that the bar for opening these drug sites should remain quite high."