Insite: does it incite insight?

And how do we decide whether something is working?

Brian Lilley’s latest piece criticizing Vancouver’s Insite safe-injection facility has been a source of continuing fascination to me since he posted it a couple of days ago. There is a certain courage about the thing, I think, that sets him apart from other Insite objectors. Let’s not get too caught up in the quarrel over the quantitative evidence from Insite, he suggests. This is convenient, to be sure, since the evidence is all against him; but I think he is right to say the question whether Insite should exist can’t quite be settled by means of numbers alone.

In designing a policy, we must always weigh many groups of what it has become trendy to call “stakeholders”, and many kinds of interests and possible consequences. “Just because something may work,” Lilley writes, “doesn’t mean we should do it.” This is a difficult statement to absorb, for those of us who’ve noticed that the drug war involves doing a whole lot of harmful things that obviously don’t, in any specifiable sense, “work”. But he is entitled to raise the prior question of how we decide whether something is working.

Which is, of course, is the point at which everything turns to porridge [emphasis mine]:

Helping junkies shoot poison into their veins and then putting them back on the street is wrong. Would I have as much of a problem if these drugs were administered as part of an ongoing treatment program to help wean addicts off of drugs? Probably not.

But that’s not what InSite does. InSite allows people to enter a government backed facility and use street drugs that they have purchased on the street, drugs that could have anything mixed in, and shoot those illegal drugs into their veins. The addict then leaves the facility and heads back out on the street.

It’s discouragingly common for people, particularly those who have lost loved ones to heroin abuse, to ascribe special demonic attributes to the drug, distinguishing it from other substances of abuse by anthropomorphizing it in a frankly untenable, ridiculous way. Lilley is not to be confused with these people. He has little or no inherent problem with the idea of government letting people inject heroin under supervision, in the name of utilitarian health-care considerations.

What bothers him, it seems, is that the clients bring the “street drugs that they have purchased on the street” with them into the facility. He’s worried about the “poisonous” nature of what they’re shooting. But he’s also admitted it’s not the heroin itself he really has an issue with. So what can he mean? The whole point of Insite is largely to let junkies inject without the fear of AIDS or hepatitis, and with the assurance of immediate medical assistance if they get a too-pure or adulterated batch. Surely it is indisputable that Insite accomplishes that much—that it protects the drug user, while he is within its confines, from the “poisons” that actually threaten his life—whatever other problems may be hazily attributed to it?

It is impossible for me to see what kind of coherent understanding, what non-contradictory set of principles, could lead one to Lilley’s position. If we are going to have the “moral” conversation about Insite, the soundness of the moral reasoning ought to count for something. Lilley doesn’t score high marks here. The “immorality” of Insite, which doesn’t give anybody drugs and has kept plenty of people alive long enough to kick them, has to be located and specified by its opponents rather than just presumed. Personally, I’m damned if I can find it.

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