Resolution InSite? Liveblogging the Health committee on harm reduction

9:52:07 AM
As it turns out, it’s a good thing I showed up early to beat the crowds – when I arrived, the media table had been taken over by staffers, leaving no room for your intrepid liveblogger. After a brief tete a tete with the slightly harried clerk assistant at the door, the all-important Reserved for the Media signs came out and the table was recaptured for the fourth estate. (For anyone about to chastise me for bad manners, the displaced staffers were fine with moving back one row. I’m not one of those reporters, imperious and convinced that she is entitled to her journalistic entitlements.)

10:01:09 AM
The chair, Joy Smith, a mild-mannered Conservative, starts the committee with a disturbing announcement: apparently, one of the witnesses who was supposed to appear today was targeted by protesters earlier this week.

His office, she tells the committee, was picketed by “about twenty people” – angry people, who identified themselves as “addicts”, intimidating his presence and forcing him to beg off from appearing before the committee. She reads from the letter he apparently sent to explain his absence, which is basically a diatribe against InSite, against addicts, against ideologues—you name it, he’s against it. He claims it’s this sort of incident that makes it “impossible” to discuss the merits and drawbacks of InSite. “This is not science, this is bullying,” the witness snarls, via proxy.

Christiane Gagnon from the Bloc Québécois isn’t impressed. It’s not the letter itself, but the chair’s handling of it. By springing it on the committee, she says, the chair is creating the perception that all addicts are dangerous, poisoning the atmosphere before the debate even gets underway. Smith doesn’t really argue. She does sniff that she is “disappointed” by the response from the committee, but agrees that it’s probably best to move on to the witnesses, since they’ve traveled “all the way from BC” to be here.

10:09:48 AM

With that, the floor is turned over to the witnesses, starting with Scott Thompson, a Vancouver police officer and former supervisor and planner for the city’s pilot supervised injection program. In late 2002, Larry Campbell took over as mayor, he recalls, and drove the process that made InSite, which he refers to as ‘SIS’ (Supervised Injection Site), a reality. When Health Canada asked the Vancouver police what the position was on the program, he says the response was that addicts who weren’t violent or wanted on criminal charges would be “unlikely” to be arrested while using the SIS.

The gist of his testimony seems to be that the VPD supports the program, but also urges further research into the medical issues.

10:16:27 AM
Next up: Dr. MacPherson, an expert in harm reduction, who gives an overview of the ongoing debate over the philosophy, which is global in scope, and points to the fact that many respected non-governmental organizations, including several United Nations programs and the Red Cross, have endorsed policies that reflect that approach.

10:20:18 AM
Okay, room check. Because some of the witnesses, which would have included the anti-InSite doctor who was allegedly terrorized out of his appearance by two dozen picketing “addicts,” are testifying via teleconference, there are flat screen TVs strategically placed around the table, one of which is currently doing double duty as a PowerPoint theatre.

Committee members on deck include outspoken InSite supporter Libby Davies, Michel Guimond, Hedy Fry, Carolyn Bennett, and Robert Thibault, the author of the motion to hold this hearing in the first place. On the government side, we have the parliamentary secretary for Health, Stephen Fletcher, Patrick Brown, Rob Clarke and—oh, this could be interesting—David “Cranky” Tilson, who I’ll also see later today at Ethics.

10:27:25 AM
A Vancouver nurse, Liz Evans, gives a stirring account of the life of one addict. Then the city’s former mayor, Philip Owen, delivers an impassioned defence of harm reduction programs—not just InSite, he stresses—as the most effective way to protect public health and public order. I apologize for not recapping the opening statements, point by point, but it’s more interesting, to me, to see how the witnesses interact with the MPs in back-and-forth discussion, not to mention how the MPs interact with each other, and the chair, and the audience.

Oh yes, the audience. Full house, as predicted, including nearly two rows of Health Canada staffers. No idea how many from Team NIMBY. I see a Free Marc Emery t-shirt in the crowd, so I’m guessing they weren’t able to pack the audience completely.

Incidentally, someone asked me last night what the point was of stacking a committee gallery, other than to provide moral support for sympathetic witnesses. It’s actually a fairly savvy strategy as far as media messaging: reporters, particularly at a committee covering a controversial issue like this, will be looking for people to interview afterward, so the more philosophical fellow travelers are on hand to provide clips, the more chance that you can shape the narrative. (The same thing happened during the hearings on Jack Layton’s climate change bill last spring.)

10:39:22 AM
Oh, there is still one anti-InSite witness willing to testify: Dr. Colin Mangham, who huffs and puffs over the “bad science” and sloppy journalism behind support for the program. He also seems to suggest that he too has been threatened, but is nonetheless willing and able to speak out.

At one point, he mentions in an offhand way that he’s a graduate of UBC, but his accent is glaringly American. Not that there’s anything wrong with that, of course.

“I’ve been called many names on this,” he says. “The intolerance just makes me sad.” He then goes into a rant about how people who support InSite, including some in this very room, are, in fact, part of a larger movement towards drug policy reform. He demands that “elected representatives” stop these “activists.” By this point, there are hisses and catcalls coming from the visitors’ gallery. David Tilson glares at the perpetrators and seems ready to break out the activist-whacking stick, but Joy Smith intervenes. The chair—who is already losing control of the room, I fear—warns the audience to behave, and show respect for every witness.

10:48:16 AM
“I’m not an activist,” the next witness says, as a preface to his presentation. “I’m a scientist.” In fact, not just a scientist, but Philip Kerr, one of the scientists whose research on harm reduction have been attacked by the very man sitting next to him, Dr. Mangham. Dr. Mangham falsely suggests that the papers were not subject to peer review. They were, according to Kerr, and not only that, but Mangham only publishes in faux-academic journals and is involved with groups like Drug Free America.

The tension at the witness table is rising by the second, but the chair is saved by the bell, literally—there’s a vote in the House. “I’ve just been given the rulebook,” she says, as opposed to the Conservative dirty trick book, I assume. According to the rules, the meeting has to be suspended as soon as the bells go off. The opposition cry foul. Apparently, the committee can keep going during a vote call, but that requires unanimous consent, which the government members are only too happy to deny, so she adjourns.

Well, that was convenient.

11:02:27 AM
Oh, this is just too much: apparently, the vote, which is going to basically eat up all the rest of the time allotted for the witnesses, is actually the result of a Conservative attempt to shut down debate on an NDP motion to protect war resisters. Buggering up the InSite hearings was, I guess, just a bonus.

It will be interesting to see what happens when the committee reconvenes. It won’t be for another half hour, at the very least, since it was a thirty minute bell and they’ll have to actually hold the vote. My guess: mutiny from the opposition, who may well bump the minister in order to give the InSite witnesses a couple of rounds of questions.

11:28:26 AM
Alright, I’m back in the room, and I have to tell you that the atmosphere has taken on a distinctly warlike feel. Not violent—despite Joy Smith’s ominous words at the beginning of the meeting—but resolute. The witnesses are mingling with the crowd, even Mangham, the lone InSite sceptic.

It occured to me as I was scurrying back from the foyer that this is the *second* meeting this week where the only witness on hand to defend the government’s policy on a controversial issue is an import from the United States—and not just the U.S., but the United States of Right-Wing Think Tanks. Apparently, even our conservative-leaning think tanks aren’t always fellow travellers. First Khadr, now harm reduction. One more example, and it’s officially a trend.

11:37:52 AM
Okay, the meeting is back on, and Joy Smith is ineffectually waving people back to their seats. She wants to start the video portion. There are two witnesses appearing by webcast, but Carolyn Bennett suggests that the meeting be extended by an additional forty minutes. Her idea to let the minister appear as scheduled and bring the witnesses back afterward would be a boon for the opposition, since they would be able to quiz the experts on what the minister had to say. Instead, Clement will delay his appearance, which I’m told includes a 25 minute PowerPoint presentation—oh boy!—until 12:20.

11:42:25 AM
On to the virtual witnesses, starting with Neil Boyd, SFU criminology professor and impassioned, long-time drug policy reformer. He describes the benefits of harm reduction, both as a boon for public health but also a tool to preserve public order. In an ideal world, there would be no need for a supervised injection site, he notes, but this is not an ideal world.

Joy Smith cuts him off—five minutes per witness is a tight schedule—and points out that a delegation from the Czech Republic is in the audience. I wonder what they think of harm reduction? Or, for that matter, our special blend of parliamentary democracy?

11:47:19 AM
The next virtual witness is Dr. Julio Montaner, the head of the BC Centre for Excellence in HIV/AIDS. Unsurprisingly, he’s supportive of harm reduction, partly as a way to control and prevent HIV from becoming AIDS, but also to reduce transmission.

Out of all the committee members, the most intrigued by his testimony appears to be the Bloc’s Luc Malo, who has swung around in his chair, and is staring at the nearest flat screen, with his arms crossed in what is either a defensive or introspective posture.

11:52:01 AM
Well, this is interesting: a shadowy PMO staffer, whose name I don’t think I’ve ever caught, just arrived. It’s always worth noting which committees attract attention from the higher-ups, although you’d think that the two rows of Health staffers—ministerial, but also departmental—would have the government’s messaging under control.

11:54:08 AM
Finally, it’s time for questions. First up, Carolyn Bennett, who says it’s “sad” the committee had to hold this hearing and then asks about nineteen questions, on everything from the silence from Canada’s chief public health officer to the move towards abstinence-based programs—a “Bushism,” she says.

Kerr tells the committee that he was invited to present his research at a conference of Canadian medical health officers and the response was quite positive. His group was not consulted, however, on the decision to remove harm reduction as a pillar of Canadian drug policy. In fact, it doesn’t seem like any of the groups represented by these witnesses were consulted. I’m sure it was just an oversight.

11:58:57 AM
The Bloc’s Christiane Gagnon, who, as you might recall, was thoroughly displeased by the chair’s opening remarks on the non-appearing witness, has a few questions for Mangham. Like, for example, does he have any data to support his contention that the vast quantity of research that supports harm reduction policies is worthless?

Well, no, not exactly. He provided a “second opinion” on research produced by other people, to “critique” it, just like a first year university student would do.

So, what did he find? “Non-findings,” like the fact there hasn’t been a single death at InSite doesn’t actually mean that lives have been saved. Wait, what? Any graduate student in statistics, he says, would come to the same conclusion. What about a graduate student in medicine? Or psychology? Or public health?

It’s also just a wee bit ironic that he keeps chiding the scientists behind the research for being “ideologues” when ideology clearly seeps through his every statement on drug policy—like just now, when he lamented the move towards a “liberal” drug policy. At least, I assume that was a small l.

12:05:46 PM
Libby Davies is up now. Like Carolyn Bennett, she’s stunned that Canada is lagging behind the eighty-some countries moving towards harm reduction policies. InSite is in her riding, she notes, and while it was controversial when it first opened, the facility is now overwhelmingly supported by government, law enforcement and local businesses.

She invites the witnesses to discuss “low-threshold services,” and Heather Hay — the regional director for Vancouver Coastal Health—describes it as, fundamentally, bringing health care to the people, wherever they are. Without InSite, these people would be in alleys, in hotel rooms, and not getting the medical treatment they need.

Liz Evans describes it as a triangle, and notes that raising the threshold would exclude hundreds, perhaps thousands, of people. Since building the on-site detox program on top of InSite, they’ve had over fifty people go into long-term treatment – people who wouldn’t have been there if they hadn’t initially walked through the door.

12:12:10 PM
Fletcher, who will be splitting his time with David Tilson—oh boy to the nth—wants to clarify what the exemption actually does. If it isn’t extended, he notes, the treatment portion of the program will still be intact. It’s only the illegal drug use that would be affected. But that’s what draws people into the facility in the first place. He then wonders about the 5% number—Mangham’s repeated point that only five percent of injections are happening at InSite—and wonders whether that doesn’t argue against the efficiency of the program, since 95% are happening elsewhere. Wouldn’t that be a good argument in favour of opening more InSites?

Not according to Mangham, of course. Somehow, he turns this into a ramble about the status quo, and how anyone who opposes harm reduction is ignored.

12:16:37 PM
Fletcher just claimed that his constituency office was vandalized by “InSite activists.” How he knows this, he doesn’t specify, but it goes nicely with Joy Smith’s tale of the terrorized doctor.

12:17:37 PM
Huh? The minister has arrived, apparently, so no more questions for the witnesses. But they barely got started! David Tilson didn’t even get to fume about addicts!

12:23:01 PM
I was momentarily puzzled by the disembodied voice of Tony Clement, who is talking about the BC court decision and how he “respectfully disagrees” with the ruling. He’s not sitting in the usual witness seat; he’s up by the chair, which is disorienting.

On the other hand, he’s about to offer us his analysis of InSite, based on science and public policy. First, he dismisses the research by actual scientists as suspect, prepared by people who “plough the ground with regularity.”

Researchers still aren’t sure, he says, if InSite prevents the transmission of blood-borne diseases. “Still” is an interesting word. It suggests that preliminary data may demonstrate just that, but that the same scientists so excoriated by the Manghams of the debate aren’t willing to make a conclusive finding without more research.

He thinks that Canada can do better than saving one life per year.

Apparently, “many” police officers believe that the only reason InSite hasn’t brought terror, chaos and crime to the streets of Vancouver is because of all the additional police resources. I guess that “many” doesn’t include the Vancouver police officer who testified earlier this morning, who said exactly the opposite.

“Walking” addicts to InSite, rather than arresting them and throwing them in jail, creates a “culture of entitlement” among drug abusers. That’s according to John McKay, who, I gather, is the voice of the “many” cops to which Clement was referring.

The opposition side of the table is getting restless, especially when Clement goes into Conservative infomercial mode, pointing to the hundreds of millions of dollars that has been invested in treatment programs, as well as prevention and law enforcement.

12:39:31 PM
Hedy Fry has had it. She persuades, with difficulty, the chair to take her point of order. “With respect to the minister…” she says. “You have no respect for the minister,” snarls David Tilson, who continues to goad her as she points out that Clement has been talking for more than fifteen minutes; the preceding witnesses, she notes, were cut off promptly, even when they still had more to say.

12:41:49 PM
Okay, I don’t want to be a spoiler, but I just flipped to the end of his speech, and it turns out that Clement isn’t ready to turn the streets of Gotham to judicially-inflicted anarchy. He’s ordered the justice minister to appeal the InSite ruling “as soon as possible.”

12:43:48 PM
Grumbling from the opposition getting louder: Tilson is gesticulating with menace, but the minister is winding down: he gets to the part about appealing the decision, and the room explodes. Mostly boos, but a smattering of cheers as well.

Interesting. I wonder if the anti-InSite emailers knew that this was coming, and wanted to make sure there was no embarrassing outburst that would make it into the ensuing media coverage.

12:46:48 PM
Hedy Fry has been simmering with rage for nearly half an hour, and she’s got a lot to unload during her fifteen minute slot, starting with her version of the history of InSite. Reading from the Pitfield decision, she notes that he also found several provisions in the current law do, indeed, infringe the Charter, and wonders why Clement so casually dismisses the opportunity to save a single life.

Clement argues that it is because he believes every life is precious that he wants to save more. Tilson heckles Fry from across the table and Joy Smith reminds us again that a witness was terrified out of appearing, prompting a few sighs of impatience from the opposition benches, and implores everyone to behave themselves.

12:51:43 PM
In response to Fry’s question on whether the anti-InSite research was peer-reviewed, the minister admits it was not, but assures her that these were scientists. So… trust them? Didn’t he just tell us that scientists can’t always be trusted?

Tilson fumes, in point of order format, over Fry “heckling” the minister, and eats up still more time before the chair finally gets the meeting under control. Why don’t they just make him chair?

12:55:41 PM
Does the minister, Fry wonders, believe in harm reduction? He reminds her that harm reduction hasn’t been removed from the four pillars. Just hollowed out and left for dead, I guess.

Fry moves to the Chief Public Health Officer. Hey, David Butler Jones. He’s at the other end of the table—I didn’t even notice. She asks what he thinks of the science behind harm reduction, which could be awkward, since I believe his view is somewhat more nuanced than his minister’s, who is sitting just two seats down from him.

I wonder how Linda Keen’s lawsuit is going? I can’t imagine what made me think of that.

12:59:44 PM
Poor Dr. Butler Jones. His official line must be so unsatisfying. He doesn’t disagree with the science. But the decision, he tells Fry, has to be made by government. “What about advocacy?” she wonders. Does he have an obligation to speak out when lives, or public health, is at risk due to government decisions? Sometimes.

1:01:51 PM
The Bloc Québécois is up, and Gagnon notes that Clement was conspicuously absent from a recent conference on HIV/AIDS, which would, presumably, have focused on harm reduction. She also excoriates him for withdrawing a mostly innocuous book that provided information on drug use and practices.

Tilson has his Point of Crankiness face on, but so far, he’s letting her talk. And talk. And talk.

Honestly, I wish opposition members wouldn’t deliver these extra-long diatribes. It leaves so little time for the witnesses to respond, which is unfortunate whether it’s meant to be hostile or friendly. Not to mention the fact that if you ask thirty-seven questions, intermingled with commmentary, the witness can pick the one that best fits his talking points.

1:09:38 PM
Gagnon accuses the minister of sticking his head in the sand, and points to the lack of funding, even money that was promised by this very government. Then there’s the booklet: why was it taken off the market? Why does the minister not want people to be informed? There were things in the book, he says, that are not the policy of the government. Or society, he adds, as an afterthought.

1:12:09 PM
Finally, Libby Davies gets her shot. At the heart of the debate, she says, is how the minister makes a decision based on public policy. This is a “very serious situation,” she notes. A minister shouldn’t cherry-pick from one police officer or one study that wasn’t even peer-reviewed.

No one is saying that treatment is not a “critical part” of the solution, she notes. But these low threshhold services are vital, and she just can’t see why he doesn’t understand that. It can only be ideological.

She has two questions: what is the obligation for the remaining 80% who wouldn’t qualify for treatment, and would be abandoned without harm reduction programs like InSite, and what is the minister’s understanding of low threshhold services, and what is he doing to help those addicts?

1:18:02 PM
First off, Clement wants to stress that this is not about closing InSite, it was never about closing InSite. He doesn’t have the power to close it, for one thing, but he doesn’t want to close it either, because there are all sorts of other services that it provides, from needle exchanges to condom distribution. He wants to make sure there are more beds available for sex workers, for heaven’s sake. He may as well be waving a banner that says, ‘I’m no right-wing ideologue!’

Davies points out that you can hardly blame InSite for providing injection services for only 5% of addicts. Surely, she says, that argues in favour of more facilities.

1:22:00 PM
And now, over to the government side: Steven Fletcher thanks the minister for adjusting his schedule. He could have cut his appearance short, after all. It’s a refreshing change from other health ministers in the past, he notes, who tried to dodge the issue. Wait, dodge the InSite issue? Who is he talking about? I’m honestly baffled.

Anyway, Fletcher hands the minister an opportunity to recap the highlights of his speech, but my fingers are getting sore, so I’ll just note if he says anything new.

1:27:06 PM
Oh, misfire by the parliamentary secretary. He asks whether the minister knows if it’s possible to live a “normal” life while using cocaine or heroin. What about the effects of those drugs? Clement makes Butler-Jones field the question, and the answer is probably not what he was hoping. The doctor says that most of the harm results from the criminality. As for the drugs, it’s “complex”. Nicotine, alcohol, heroin, it depends on the circumstances, and the individual, to a large extent.

He’s obviously not prepared to swallow himself whole to support the minister. His answers, when parsed, are careful, but revealing.

With that, the meeting comes to a close.

Looking for more?

Get the Best of Maclean's sent straight to your inbox. Sign up for news, commentary and analysis.