On Drug Addiction, Harm Reduction and Governing In The Dark

Scott Findlay argues for evidence-informed decision-making, on the basis of which the federal government should grant the Dr. Peter Centre in Vancouver an exemption to Canada’s Controlled Drugs and Substances Act so that clients can continue to receive supervised injection services.

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Since 2002, nurses at the Dr. Peter Centre in Vancouver have been providing supervised drug injection services for people living with AIDS.  In Canada, supervised drug injection sites require an exemption from the prohibitions of possession and trafficking of controlled substances under the Controlled Drugs and Substances Act.  Recently the Dr. Peter Centre has applied for such an exemption.

Safe injection sites are one of a set of strategies (including heroin maintenance programs, methadone treatment, and needle exchange programs) implemented to reduce the harm associated with illicit drugs.

Unsurprisingly, harm reduction is not universally embraced. Some believe that such strategies implicitly encourage illicit drug use by implying that such behavior is acceptable.  Others believe that such programs do not in fact reduce harm, and may even increase it through, for example, prolonging addiction.

Insite- Vancouver

Insite- Vancouver

In 2008, Insite, a facility located in Vancouver’s downtown east side, applied for a new exemption.  Tony Clement, the Minister of Health at the time, indicated that he would deny the application.  In an effort to keep Insite open, a case was brought before the BC trial court arguing that the application of several sections of the  Controlled Drugs and Substances Act violated the rights of Insite clients under the Charter of Individual Rights and Freedoms.  Justice Pitfield found in favour of the plaintiffs, and granted Insite a constitutional exemption.

Unhappy with the decision, the Attorney General launched an appeal, which was dismissed.  The case eventually wended its way to the Supreme Court, which upheld the decision of the original trial judge.

Part of the argument advanced by the Attorney General was that harm reduction sites and similar initiatives increase, rather than reduce, harm to clients and the general public. In the Court’s view, however, the evidence overwhelmingly pointed the other way.  Said the Supreme Court:

“Insite saves lives. Its benefits have been proven. There has been no discernible negative impact on the public safety and health objectives of Canada during its eight years of operation…”

This evidence was critical to the Court’s decision.  Section 1 of the Charter guarantees individual rights and freedoms subject only to infringements that can be “demonstrably justified in a free and democratic society”. If indeed there was compelling evidence that Insite’s operations increased harm, either to its clients or to the general public, then deprivation of Charter rights could be justified (“saved”) by the countervailing positive effect on public welfare.  No such salvation was forthcoming, because in the Court’s view the evidence pointed the other way.

The Insite example is just one of many examples where the federal government has pursued a course of action inconsistent with the weight of existing scientific evidence.

Of course, there is no obligation on governments to take decisions consistent with scientific evidence.  Other factors do – and indeed, probably should – enter into the equation.

But democracy depends on the twin principles of accountability and transparency.  Transparency requires, among other things, that the rationale given by governments for laws, regulations and policies, reflect their true motivation and intent.

And it is here that science plays a critical role.  Laws and policies are attempts to manage behaviour – either individual or collective – to achieve some stated goal, one consistent (or so we hope) with the pubic good.  Their success depends critically on the validity of the scientific hypotheses that underlie them.

If, for example, the federal government truly wishes to increase voter turnout, a law that restricts Elections Canada’s advertising solely to informing Canadians where and when to vote, will achieve the desired goal only if indeed many Canadians do not vote because they are ignorant of the mechanics of voting.  If, on the other hand, Canadians do not vote because they feel disconnected, disempowered or disenfranchised, such a law will have no appreciable effect.

What then are Canadians to make of laws or policies that fly in the face of the evidence?  Either the government: (1) is not interested in laws or policies that actually work; (2) hopes that Canadians are too disengaged or disinterested (or stupid) to notice any inconsistencies; or (3) has misrepresented – either willfully or otherwise – its full intentions.  None of these explanations are very reassuring.

Indeed, to repudiate evidence-informed decision-making is to govern in the dark.  Without the light of evidence, those who would govern have, perhaps, a path they can feel their way along by virtue of some collective sense or sensibility. But what about the governed, those poor unfortunates who do not possess this same sense or sensibility? For them, to move along this same path can be nothing more than an act of blind faith.

Blind faith in government is not only unscientific, it is dangerous. We have seen this movie many times over the course of human history, and the ending is never happy.

In the case of the Dr. Peter Centre, current Minister of Health Rona Ambrose has a golden opportunity to show that she has seen the light by granting a constitutional exemption to the Controlled Drugs and Substances Act.  To do otherwise would be yet more evidence that the current government prefers governing in the dark.

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Scott Findlay is co-founder of Evidence for Democracy and an Associate Professor of Biology at the University of Ottawa

2 comments

  1. […] as well a recent blog post by my University of Ottawa colleague Scott Findlay where he argues that the Supreme Court of […]

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