Nazlee Maghsoudi is the Knowledge Translation Manager at the International Centre for Science in Drug Policy, a Board Member at Canadian Students for Sensible Drug Policy, and an Outreach Volunteer at TRIP! Project, a nightlife harm reduction program in Toronto. She holds a Bachelor of Commerce from Queen's University and a Master of Global Affairs from the University of Toronto.
Prime Minister Stephen Harper has a poor track record when it comes to protecting the rights of marginalized communities. So it’s no surprise that improving access to healthcare for people who use drugs is at the bottom of his to-do list. What may come as a surprise, however, is that over the past nine years, Harper has repeatedly taken deliberate action to impede access to healthcare for this stigmatized group. From safer injection sites to heroin-assisted treatment, Harper has put ideology ahead of evidence and turned a blind eye to the countless casualties in his decade-long crusade against harm reduction.
Often characterized as a pragmatic approach, harm reduction interventions recognize that a continuing level of drug use in society is inevitable, and therefore aim to reduce the negative harms associated with drug use – such as overdose and the spread of HIV – without necessarily reducing consumption. There is widespread consensus among scientific experts that harm reduction measures reduce death and disease among drug using populations, and are therefore vital to a health-based drug policy. Even leading organizations in public health, such as the World Health Organization, have encouraged governments to adopt harm reduction strategies.
But Harper’s approach to policymaking is not one of evidence-based, pragmatic solutions. In 2007, Harper’s government removed harm reduction as a priority area in Canada’s drug strategy. To worsen the situation further, in 2008, the leadership of the drug strategy was removed from Health Canada and relocated to the Justice Department – a clear sign that to the Harper government, drug use is a criminal justice issue, not a health issue.
According to Federal Health Minister Rona Ambrose, Harper’s government prefers “harm elimination” to harm reduction. In practice, this has meant that if you are unable or unwilling to eliminate your drug use, Harper is happy to have you eliminated by death or disease. And that is exactly what’s been happening.
Under Harper’s reign, a devastating number of Canadians have been touched by fatal opioid overdose. In Ontario, Canada’s most populous province, drug related overdose is now the third cause of accidental death. Despite the existence of proven harm reduction measures to prevent overdose, Harper has stood by and watched the death tally rise. The Harper government has yet to take steps to increase access to naloxone, an emergency medication that immediately reverses the effects of opioids and saves lives. Although naloxone take-home programs exist in several parts of Canada, laws only permit naloxone to be dispensed by way of a prescription, acting as a significant obstacle to increased access to this essential medicine. Given the urgency of the overdose epidemic, Harper’s lack of action to increase the accessibility of naloxone is concerning to say the least. Other actions could also be taken to reduce unnecessary deaths from opioid overdose, such as implementing national Good Samaritan laws to encourage overdose witnesses to call emergency medical services.
Worse still, Harper has also taken active steps to impede local efforts to curtail the unnecessary loss of lives. There is no clearer example of Harper’s determination to restrict access to life saving health services than his ruthless battle against safer injection sites in Canada. Particularly, Harper has persistently targeted Insite, the only sanctioned safer injection site in North America, despite the mountains of evidence showing the site’s public health and economic benefits.
Since opening in Vancouver’s Downtown Eastside in 2003 in response to skyrocketing levels of overdose and HIV in the community, the public health and economic benefits of Insite have been overwhelming. By allowing people who use drugs to access sterile injection equipment, use pre-obtained drugs under the supervision of trained staff, and connect with health and social services without fear of arrest or harassment, Insite has been proven to prevent fatal overdoses and contain the spread of blood borne infections such as HIV and hepatitis C. Evidence has also shown that Insite increases uptake of detoxification services and decreases the number of public injections and publicly discarded syringes. Importantly, this health service also produces significant cost savings for governments, with the most conservative estimates of efficiency citing incremental net savings of almost $14 million over 10 years. For all these reasons, numerous health experts and agencies in Canada support the implementation of safer injection sites, including the Canadian Medical Association and the Canadian Nurses Association. But Harper remains unconvinced.
Since coming into power in 2006, Harper has been determined to close Insite by refusing to renew its legal exemption from existing drug laws. Proponents of Insite fought this refusal all the way to the Supreme Court of Canada and won in a unanimous 2011 decision. In a landmark ruling, the Supreme Court ordered the government to stop interfering with the clinic, stating that the benefits for drug users and the community far outweighed the government’s concerns regarding the use of illicit drugs.
Despite the clear position from the Supreme Court and recommendations from virtually all health experts, plans to use this decision as a precedent to open other safer injection sites have been halted by Harper’s passing of Bill C-2 (the so-called Respect for Communities Act) in June 2015. This legislation has made it exceedingly difficult (if not impossible) for health authorities, municipalities or other organizations to gain the necessary legal exemption to operate safer injection sites.
No other health service has to go through such an extensive process to be considered for approval to open its doors. As the worsening overdose epidemic has shown, Canada needs safer injection sites from coast to coast. With the Harper government in power, the number of needless deaths will continue to rise unhampered.
But Insite isn’t the only case in which courts have been forced to step in and protect the health and wellbeing of drug using populations from Harper’s battle against harm reduction. In 2008, Canada’s heroin-assisted treatment study – in which medical professionals prescribe pharmaceutical-grade heroin to people that have been unable to combat their opioid dependency with traditional treatments – came to an end. Despite the overwhelming evidence that supervised treatment with heroin enhances the health and wellbeing of participants, reduces illicit drug use and criminal activity, often leads to abstinence, and is highly cost-effective, Canada became the only nation to fail to implement a permanent heroin-assisted treatment program after the end of a pilot.
Even if a permanent program is not instituted, international research ethics state that if a clinical trial is having positive results for participants, they should be able to continue using clinical trial medicines. In order to continue patient access to pharmaceutical-grade heroin after the pilot had ended, doctors applied to Canada’s federal Special Access Programme (SAP). This program allows doctors to request access to drugs for use by patients that have serious or life-threatening conditions that would otherwise not be available for sale. After several months, in September 2013, Health Canada approved access to pharmaceutical-grade heroin for 21 patients.
Rather than complying with the expert advice of their own health department, Harper’s government took almost immediate action to deny participants their right to this medicine. Contrary to all medical evidence and sound public policy, the Canadian Health Minister passed new laws prohibiting Health Canada from approving pharmaceutical-grade heroin through the SAP. In response, a lawsuit was filed to the Supreme Court of British Columbia on the basis that the new laws violate the Canadian Charter of Rights and Freedoms, and in May 2014, the court granted an injunction to patients allowing them to continue accessing pharmaceutical-grade heroin at least until a constitutional challenge is heard.
The Harper government’s ideological opposition to harm reduction has put the health and safety of Canadians at risk for too long. It is time for illegal drug use to be treated as a health issue, not a criminal justice issue, for policymaking to be based on evidence, not ideology, and for the health and wellbeing of those who use drugs to be equally important to the health and wellbeing of those who don’t. Such a future requires harm reduction, and a new prime minister.