Supervised consumption facilities – meeting a community need

Illegal psychoactive substances cover an array of products from cannabis to opioids to synthetic chemicals whose uses lie along a spectrum of activities from abstinence to addiction. Their use represents a complex and important legal, social and public health issue that requires a variety of intervention strategies based on the target populations. Prevention is the ideal to which we subscribe, while at the other extreme are people who use injection drugs over the long term and participate in unsafe injection practices. Supervised consumption facilities are one proven way of meeting the health and safety concerns raised by injection drug use.

There are currently 90 supervised consumption facilities in the world. Each one has an enviable and proven record of addressing the specific needs of the people they serve, and in improving the social fabric of the community where they are located. Vancouver’s supervised consumption facility, Insite, operates under an exemption to the Controlled Drugs and Substances Act that is provided by the Minister of Health. Compelling evidence substantiating the benefits of Insite was compiled in the 2008 Expert Advisory Committee Report by Health Canada. The results demonstrated that, since the opening of that facility, there has been a reduction in crime, drug-use-related litter and public injection in the area. This facility also addresses the health needs of its service-shy and marginalized clientele by providing regular health care, educating them on safer injection practices and, when the opportunity presents itself, referring clients to Onsite, the treatment program associated with the facility. An economic analysis has shown that every dollar spent on Insite saves between $0.97 and $2.90 in government spending on other services.

It must be noted that supervised consumption facilities do not provide the drugs their clients inject, nor do they knowingly provide consumption services to first-time users.

Attempts to restrict Insite’s activities appeared to be addressed when, on September 30, 2011, the Supreme Court of Canada ruled that the Federal Government’s hesitancy to renew Insite’s exemption was unconstitutional. The Court concluded that closing the facility would deny health services to vulnerable Canadians and discriminate based on disability. It also provided the Minister with five criteria to consider when evaluating an application for a similar facility. Several Canadian cities have now begun the process for obtaining an exemption to establish a supervised consumption facility, including Montreal where officials have recently announced that they will be submitting an application for four facilities in that city.

The recently introduced Bill C-2, the Respect for Communities Act, sets criteria regarding the ministerial obligation for approving such applications, and lays out 27 information requirements that are required before the Minister of Health can permit the establishment of a supervised consumption facility. These requirements are in stark contrast to the five criteria identified by the Supreme Court.

It is CPHA’s viewpoint that if enacted in its current form, Bill C-2:

• will impede development of supervised consumption facilities in communities where they are needed,
• will prevent the continuing operation of the only supervised consumption facility in Canada, and
• fails to honour the spirit of the unanimous Supreme Court of Canada decision.

As such, it is CPHA’s position that Bill C-2 should be withdrawn or amended to reflect the spirit of the Supreme Court of Canada’s decision. The Bill, which has already proceeded through second reading in the House of Commons, has been sent to the Standing Committee on Public Safety and National Security for review. CPHA has appealed to the Clerk of the Committee as well as the Chair and the opposition members to be granted standing before the Committee to voice our opposition. The Association is developing a brief that will be presented to the Committee and is working with like-minded organizations to broaden our base of support.