Overdoses

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Naloxone Anti-Overdose Bill Moving in New Jersey

A bill that would expand access to the overdose-blocking drug naloxone is moving in the New Jersey legislature. The bill, Senate Bill 2082, the Opioid Antidote and Overdose Prevention Act passed the Senate Health, Human Services and Senior Citizens Committee Monday on a unanimous vote and now heads for a Senate floor vote.

A companion measure, Assembly Bill 95, awaits a hearing before the Assembly Health and Senior Services Committee.

Naloxone is an opioid antagonist, meaning it blocks and reverses the effects of opioid drugs, such as heroin, morphine, and Oxycontin. A Centers for Disease Control and Prevention report from last February found that some 50 naloxone programs nationwide had reversed more than 10,000 overdoses.

Naloxone is available only by prescription in New Jersey. The bill would expand access to the drug by providing protection from civil and criminal liability to medical professionals who prescribe the drug and laypersons who administer it.

Advocates applauded the bill's clearing the first hurdle and urged the legislature to finish the job.

"We must have a comprehensive strategy to reduce the huge number of tragic and preventable overdose deaths in New Jersey," said Roseanne Scotti, New Jersey state director for the Drug Policy Alliance. "Expanded access to Naloxone is a key component in that strategy. This bill will save lives and should now be acted on by the legislature with all possible speed. Lives hang in the balance."

"Drug overdose continues to be the leading cause of accidental death in New Jersey," said Sen. Joseph Vitale (D-Woodbridge). "Each year it surpasses the number of deaths caused by automobile accidents and guns.  Expanding access to naloxone will allow this medication to reach its full public health potential and will be an important part of New Jersey's comprehensive efforts to address drug abuse."

Patty DiRenzo of Blackwood lost her son, Salvatore, to an overdose when he was 26 years old.

"Sal was a beautiful soul who unfortunately struggled with addiction. If the people he was using with on the night he died had access to naloxone, he might still be alive today. Instead, my son was left alone to die. It's extremely important to have policies like this one in place, so that other families are spared the grief that mine has endured."

Eight states and the District of Columbia have already passed legislation easing access to Naloxone in a bid to reduce drug overdose deaths.

Trenton, NJ
United States

Naloxone Cheap Way to Prevent Drug OD Deaths, Study Finds

Drug overdose deaths are now the leading cause of accidental death in the US, surpassing automobile accidents, but a new study suggests that distributing naloxone to opioid drug users could reduce the death toll in a cost-effective manner. The study was published this week in the Annals of Internal Medicine.

Naloxone package (wikimedia.org)
Opioids, including not just illicit heroin but also widely used prescription pain pills, are responsible for about 80% of drug overdose deaths. Naloxone, an opioid antagonist, works by blocking opioid receptors in the brain, making it possible to reverse the effects of overdoses.

At least 183 public health programs around the country have trained some 53,000 people in how to use naloxone. These programs had documented more than 10,000 cases of successful overdose reversals.

In the study published in the Annals, researchers developed a mathematical model to estimate the impact of more broadly distributing naloxone among opioid drug users and their acquaintances. Led by Dr. Phillip Coffin, director of Substance Use Research at the San Francisco Department of Public Health, and Dr. Sean Sullivan, director of the Pharmaceutical Outcomes Research and Policy Program at the University of Washington, the researchers found that if naloxone were available to 20% of a million heroin users, some 9,000 overdose deaths would be prevented over the users' lifetimes.

In the basic research model, one life would be saved for every 164 naloxone kits handed out. But using more optimistic assumptions, naloxone could prevent as many as 43,000 overdose deaths, saving one life for every 36 kits distributed.

Providing widespread naloxone distribution would cost about $400 for every year of life saved, a figure significantly below the customary $50,000 cut-off for medical interventions. That's also cheaper than most accepted prevention programs in medicine, such as checking blood pressure or smoking cessation.

"Naloxone is a highly cost-effective way to prevent overdose deaths," said Dr. Coffin. "And, as a researcher at the Department of Public Health, my priority is maximizing our resources to help improve the health of the community."

Naloxone has proven very effective in San Francisco, with heroin overdose deaths declining from 155 in 1995 to 10 in 2010. The opioid antagonist has been distributed there since the mid-1990s, and with the support of the public health department since 2004. But overdose deaths for opioid pain medications (oxycodone, hydrocone, methadone) remain high, with 121 reported in the city in 2010. Efforts are underway in the city to expand access to naloxone for patients receiving prescription opioids as well. This study is the latest to suggest that doing so will save lives, and do so cost-effectively.

California Good Samaritan Drug Overdose Bill Signed Into Law

California Gov. Jerry Brown Monday signed into law Assembly Bill 472, the "911 Good Samaritan Bill," aimed at reducing fatal drug overdoses by removing the threat of criminal prosecution for people who seek assistance for people suffering from them. California becomes the 10th state to enact such a law since New Mexico led the way back in 2007.

fatal drug overdose (wikimedia.org)
Sponsored by Rep. Tom Ammiano (D-San Francisco), the bill received bipartisan support in the legislature and was cosponsored by the Drug Policy Alliance, the ACLU of California, and the Health Officers Association of California.

"This is a great victory for parents. None of us want our kids overdosing on drugs, but as I told the legislature, I'd rather have my kid around to yell at than attend a funeral," said Ammiano. "The young friends of those who overdose shouldn’t hesitate to seek help because they fear arrest. With the Governor's signature, they won't have to."

"This is an incredibly special day for the thousands of California family members who worked so hard and for so long to pass this life-saving bill," said Meghan Ralston, harm reduction manager of the Drug Policy Alliance. "This is just a small first step in reducing the number of fatal overdoses in California, but it's a deeply important one."

Drug overdose deaths are the number one cause of accidental death in California, as in many other states. The new law encourages people to seek emergency health services when they witness an overdose by providing limited protections from charge and prosecution for low-level drug law violations, including possession of small amounts of drugs. Those who sell drugs are not protected under the new law.

"I never go a day without thinking of my son Jeff and I never will," said Denise Cullen, cofounder of GRASP (Grief Recovery After a Substance Passing). "Losing a child to a drug overdose is a tragedy in ways I can't explain, but fighting so hard for him and for all the parents just like me, to get this law passed is really the best possible way I can honor him."

"After forty years of the war on drugs, California is finally righting its priorities by putting saving lives ahead of making petty arrests. The message is loud and clear: call for help in case of an overdose. This is an important step toward better drug and public health policies and it will save lives," said Margaret Dooley-Sammuli, senior policy advocate for the ACLU of California.

"The physician Health Officers who provide leadership for public health programs in every county are grateful to Governor Brown for partnering with us on this common sense, no-cost approach to saving lives," said Bruce Pomer, executive director of Health Officers Association of California. "It's urgently needed."

Now the task is to get the word out to those populations where it will do the most good. Advocates from dozens of state and local organizations will be working to do just that, both before the new law goes into effect on January 1, and throughout the following year.

Sacramento, CA
United States

Danes Want Heroin Pills for Addicts

In remarks reported by the Copenhagen Post Sunday, Danish Health Minister Astrid Krag announced that she is proposing that heroin in pill form be made available to addicts. Denmark is one of a handful of European countries that provide maintenance doses of heroin to addicts, but to this point, the drug was only available for injection.

Heroin safer in pill form? Danes thinks so. (wikimedia.org)
It is time to offer users a safer choice, Krag said, adding that the pills should be available next year. She said the Danish Board of Health had evidence to believe making heroin available in pill form would reduce the risks of disease and overdose.

"With tablets, we get a tool that lessens the risk of incorrect dosages, injuries and incidences of cancer," she explained. "This will be an improvement of the current system. It clearly needs to be in place by 2013."

The Danish government approved heroin maintenance in 2008, with the first clinic opening in 2010. There are now five of them. A supervised injection site is set to open in the Copenhagen neighborhood of Vesterbro later this year. In the meantime, a mobile injection site is zooming around the neighborhood.

Opposition conservative party spokespersons said they were open to the proposal, but wondered how it would be paid for. But spokespersons for the government Socialistisk Folkeparti said that was just politics.

"It is remarkable that [the conservative opposition] says that financing must be in place before you make a proposal," said Jonas Dahl, health spokesman for the Socialists. "The working procedure has always been that we first get a professional recommendation from the Board of Health and then find the money."

Copenhagen
Denmark

California Drug Overdose Prevention Bill Passes

A bill aimed at saving the lives of drug overdose victims by protecting those who would come to their assistance from prosecution on drug charges passed the California legislature Monday on a bipartisan vote of 54-22 in the Assembly. It had already passed the Senate. The vote came days before International Overdose Awareness Day.

fatal drug overdose (wikimedia.org)
In recent years, Californians have been dying of drug or alcohol overdoses at a rate of ten a day, with the number of fatal overdoses increasing by 24% between 2000 and 2006, according to supporting documentation within the bill.

Introduced by Assemblyman Tom Ammiano (D-San Francisco), the bill, Assembly Bill 472, provides that neither the overdose victim nor a person who seeks emergency treatment for him shall be charged with the crime of drug possession or being under the influence of drugs, provided the drugs are for personal use.

Such bills are known as "Good Samaritan" bills and have already been passed nine other states.

In asking his colleagues to vote for the measure, Ammiano noted that more people die from drug overdoses than in car crashes. Fewer would die, he said, if witnesses sought prompt emergency help, but some hesitate for fear of being arrested for their drug use or possession. That argument got through to members of both parties.

"This is not going soft on crime," said Assemblyman Donald Wagner (R-Irvine). While he added that he does not condone drug use, he said it was necessary to "overlook some indiscretions for the greater good."

"It's critically important to save lives," said Assemblywoman Kristen Olsen (R-Modesto). "This bill doesn't condone drug behavior."

"It's not going to encourage underage use," noted Assemblyman Mike Feuer (D-Los Angeles). On the contrary, he said, the knowledge that overdose is so life-threatening should encourage users to reevaluate their behaviors.

"It's time we started saving lives in California," said Ammiano.

The bill was lobbied for by the Drug Policy Alliance, and supported by a range of organizations including California Society of Addiction Medicine, California Attorneys for Criminal Justice; California Professional Firefighters, California Association of Alcohol and Drug Program Executives County Alcohol and Drug Program Administrators Association of California, National Council of Alcohol and Drug Dependence of the San Fernando Valley, National Association of Social Workers, Asian Pacific AIDS Intervention Team, Bay Area Addiction Research and Treatment, Families ACT!, Grief Recovery After a Substance Passing and Parents for Addiction Treatment and Healing.

The only group to officially oppose it was the California Sheriff's Association.

The bill now goes to the desk of Gov. Jerry Brown (D).

Sacramento, CA
United States

New Jersey Good Samaritan Overdose Bill Passes

A bill designed to reduce drug overdose deaths by providing some legal protection to people who witness them and summon medical assistance has been approved by the state legislature and now awaits the signature of Gov. Chris Christie (R). The bill passed the Senate Monday on a 21-10 vote; it had cleared the Assembly back in May.

fatal drug overdose (wikimedia.org)
The bill, Assembly Bill 578, also known as the Good Samaritan Emergency Response Act, would provide limited legal protection against drug possession charges for people who witness an overdose and call 911. It is aimed at reducing drug overdose deaths by reducing the fear of arrest for those might call for assistance.

According to the Centers for Disease Control and Prevention, drug overdoses are now the leading cause of accidental death, replacing automobile accidents. More than 27,000 people died from drug overdoses in 2007, most of them from prescription opiates, either by themselves or in combination with other drugs, including alcohol.

Many drug overdose deaths occur in the presence of others and take hours to occur, meaning that there is time and opportunity to call for help. But strict enforcement of drug possession laws against would-be Samaritans discourages some from making that call.

Advocates are applauding the passage of the life-saving bill.

"Calling 911 should never be a crime. Our current policies focus on punishment and drive people into the shadows and away from help," said Roseanne Scotti, New Jersey State Director of the Drug Policy Alliance. "Saving lives should always take priority over punishing behavior.  A Good Samaritan law will encourage people to get help."

"When a life is on the line we can ill afford to waste time weighing the consequences of calling 911 or deciding whether or not to be truthful about what substance was used to overdose," said Senate bill sponsor Sen. Joseph Vitale (D-Middlesex). "By narrowly eliminating the criminal consequences one might face after calling 911 to report an overdose, I hope to diminish any hesitation one might have about doing the right thing."

"I and my family are so grateful to the senate for passing this life-saving legislation," said Patty DiRenzo, whose son Salvatore died of an overdose at age 27. "We, and the other families who have lost loved ones to overdose, will be advocating with Gov. Christie to urge him to sign this bill. It's extremely important that we prevent future overdose deaths and spare other families the grief that mine has endured."

If Gov. Christie signs the bill into law, New Jersey will become the ninth state to enact a Good Samaritan law. The others are Colorado, Connecticut, Florida, Illinois, New Mexico, New York, Rhode Island, and Washington. Similar legislation is pending in several other states.

Trenton, NJ
United States

UN Anti-Drug Body Supports Overdose Prevention Measures

Delegates to the 55th session of the UN Commission on Narcotics Drugs (CND) in Vienna unanimously approved a resolution to promote measures to prevent drug overdose deaths last Friday. The resolution calls on the UN Office on Drugs and Crime (UNODC), the World Health Organization (WHO), and other international organizations to work with individual countries to address and reduce drug overdoses. Crucially, the resolution included mention of naloxone, an opioid antagonist that can effectively reverse opiate overdoses and which does not carry any danger of abuse.

Naloxone can save lives, the CND recognized Friday (wikimedia.org)
The resolution was introduced by the Czech Republic and cosponsored by Israel and Denmark (the latter on behalf of the European Union). Earlier in the week, Gil Kerlikowske, head of the US Office on National Drug Control Policy (ONDCP -- the drug czar's office) affirmed US support for overdose prevention. In his opening statement at the week-long session, Kerlikowske endorsed training public health and medical personnel in overdose recognition and response, as well as the use of naloxone and other overdose reversal medications.

"Every life is worth saving," said Dasha Ocheret, policy and advocacy program manager for the Eurasian Harm Reduction Network. "Everyone knows someone who has died from an overdose. It's thrilling that the United Nations recognizes this is a problem to be taken seriously and something can be done."

"This represents a critical step towards improving global public health," said Donald McPherson, director of the Canadian Drug Policy Coalition and former drug policy coordinator for the city of Vancouver. "The global overdose epidemic can be addressed with meaningful, evidence-based interventions to reduce the immediate potential harms associated with opioid use, and prevent unnecessary death. It is heartening to witness CND member countries take this step together to save lives."

The biggest risk of fatal overdose is around opiates and opioid pain medications. According to the UNODC, "the ingestion of opioids accounts for nearly half of the global drug-related deaths, and the majority of deaths could have been prevented." The UNODC puts the number of user of opium derivatives, both medical and non-medical, at around 21 million worldwide.

Opioid overdose deaths are generally preventable for three reasons: The deaths occur gradually after drug use, there are typically other people present, and the effects of overdose can be reversed with naloxone, also known under its brand name, Narcan.

In some countries, including some states in the US, there are ongoing programs to offer naloxone to drug users, their friends, and family members. Last fall, Massachusetts announced its 1,000th overdose reversal using naloxone. New Mexico has also been a pioneer in expanding the use of naloxone.

"Naloxone is a safe and effective medication that has been available for more than forty years," said Sharon Stancliff of the New York City-based Harm Reduction Coalition. "It's exciting that the UN has officially recognized the importance of making this life-saving medication more widely available. It is vital that it is made accessible to people who need it, both inside the hospital setting and outside, through emergency services and to family members of opioid users."

Vienna
Austria

Tainted Ecstasy Linked to Western Canada Deaths

A cluster of recent fatalities among ecstasy (MDMA) users in western Canada has been linked to tainted drugs. At least five people in Alberta and three in British Columbia have died in the past few weeks. In six of those cases so far, paramethoxymethamphetamine (PMMA) has been found in toxicology reports.

Ecstasy -- or is it? (wikimedia.org)
The outbreak of deaths began last month in Calgary, and by December 29, Alberta Health Services sent out an alert warning that "Ecstasy or a combination of toxic substances sold on the street as Ecstasy is the likely cause of three recent Calgary-area deaths."

Then, in a new joint warning on January 11, the city of Calgary and Alberta Health Services announced that the province's chief medical examiner had confirmed that "paramethoxymethamphetamine (PMMA) and methamphetamine -- not previously associated with street drugs sold in Calgary as 'ecstasy' -- was present in toxicology results for each of five recent Calgary-area street-drug deaths."

On Thursday, British Columbia Provincial Health Officer Dr. Perry Kendall confirmed that PMMA had shown up in one of the BC deaths, while toxicology reports were still outstanding in the two other cases.

PMMA is thought to be a less expensive compound to produce than ecstasy, similar in appearance, and produces similar, though stronger, psychoactive and physical effects. Its use as an adulterant has been linked to earlier clusters of deaths in Norway and the Netherlands.

"There are some important differences in the toxicity of PMMA compared to MDMA" said Dr. Mark Yarema, Medical Director of the Poison and Drug Information Service (PADIS). "Although all have toxic effects, PMMA is considered more toxic than MDMA, with a higher incidence of seizures and elevated body temperature. Also, the onset of action of PMMA is delayed and its initial effect may be milder. This is dangerous as it may result in users ingesting several tablets to achieve a desired effect, with potentially fatal consequences."

If Canada is going to continue to subject recreational drug users to the Russian roulette of buying drugs without quality controls or ingredients labeling in the black market, it behooves drug users to do what they can to protect themselves. They could start by checking in with organizations such as DanceSafe or checking into ecstasy testing kits.

Canada

Chronicle Film Review: Prohibition

Prohibition: A Film by Ken Burns and Lynn Novick (2011, Florentine Films/WETA, 3 discs, 5 ½ hrs., $41.99)

One of America's leading documentarians has done it again. Ken Burns, producer of the widely watched and hailed documentaries, Baseball and The Civil War, has now teamed up with Lynn Novick to examine the rise, fall, and repeal of the 18th Amendment banning alcohol sales and production. It is a worthy effort, and well-executed.

Prohibition "postcards" online at pbs.org/kenburns/prohibition/send-postcards/
The multi-hour must-see premiered over three nights this week on PBS, pulling in nearly four million viewers on its opening night -- very big numbers for public TV. It's also available online at the PBS Ken Burns Prohibition web site.

For most us of Prohibition is ancient history, skimmed over bloodlessly in dusty tomes in high school and undergraduate history courses. My 83-year-old mother, for instance, was still a toddler when revelers across the land tippled with delirious joy to mark repeal. For anyone younger than her -- and that's most of us -- Prohibition is no more than a school lesson, not a thing of living memory, except, perhaps, for an old story or two told by grandpa or grandma.

One of the successes of Prohibition is the way it brings that dry history to life. Through the skillful use of contemporary film, photographic stills, oral history, written remembrances narrated by actors, and a lively narration by Peter Coyote, Burns and Novick are able to recreate the living, breathing reality of second half 19th and early 20th Century America. Staring face to face at the glowering glare of a doughty battle-axe like Carrie Nation or the lizard-lidded, full-lipped gaze of Chicago gangster Al Capone, listening to Al Smith rail against the dries or Mabel Willibrand rally preachers against repeal, helps us put a human face on the  passions and frailties behind the march of the social revolution that was Prohibition and the mass rejection of it that was repeal.

Similarly, vivid scenes of saloon debauchery, with passed out drunks and giddy tipplers, of speakeasies filled with good-time guys and giddy flappers, of mass marches for and against, of political conventions and campaigns in which Prohibition was a burning issue of the day, help put living flesh on the dry bones of history.

The early 20th Century experiment in social control and legislating morality contains many lessons for contemporary activists seeking to undo the damage done by drug prohibition. Burns and Novick deserve our thanks for teasing out the varied strands that turned the 19th Century's temperance movement among mostly rural, Protestant, church-going women into a political powerhouse capable of blunting the power of big booze, shuttering the breweries and distilleries, and eliminating the saloons men saw as their last refuge from the demands of wife and children.

For me, the most important achievement of Prohibition is the way in situates the temperance movement within the broader social and political context of a tension-filled, rapidly evolving America. As Burns and Novick make abundantly clear, Prohibition did not happen in a vacuum. Among the forces propelling it were many of the same forces active today propelling reactionary social movements: racism (directed against newly arrived Irish, German, and Jewish immigrants), nativism (ditto), religious bigotry (aimed at those Catholic immigrants), nationalism (against mainly German-American beer brewers, especially during World War I), and rural vs. urban tensions.

But while it may be easy to ridicule the reactionaries of the last century, the roots of Prohibition also come uncomfortably close for present-day progressives. The temperance movement -- in all its intemperance -- was closely tied to "what about the children!" sentiment and women's suffrage, a cry for healthy living,  as well as the sort of "do-gooderism" conducted by "busybodies" that still informs much of the discourse when it comes to drug policy reform today.

As Prohibition shows most excellently, the politics of morality and social control are deep and twisted, and unraveling them reveals some unflattering facets of progressivism, as well as the more easily derided absolutists of what could fairly be called the Christian Right.

Where Prohibition is perhaps most useful to modern day drug reformers is in its depiction of the social ills it generated. Much as the Drug Policy Alliance likes to say "drug abuse is bad, drug prohibition is worse," viewers of Prohibition could fairly draw the conclusion that "mass drunkenness is bad, mass drunkenness under Prohibition is worse." Burns and Novick sketch the rapid expansion of organized crime under Prohibition, the gang wars of Chicago and New York, the corruption of cops and public officials -- all the side-effects of prohibition so familiar to present day reformers.

Prohibition "postcards" online at pbs.org/kenburns/prohibition/send-postcards/
But they also look at its public health consequences, which -- like current drug prohibition -- were also in many ways disastrous. There were mass deaths from bad bathtub gin, deaths from drinking wood alcohol, outbreaks of "Jake Leg," a neurological disorder caused by contaminated whiskey that crippled hundreds, if not thousands, and while alcohol consumption initially declined, that decline was soon reversed, and with even more unhealthy drinking patterns.

In the end, Prohibition died of neglect, ridicule, and changing social attitudes, forged at least in part by the experience of Prohibition itself. And at the end, it revealed itself to be hollow, crumpling with amazing rapidity after the Great Depression hit and the big city, immigrant-friendly Democrats under FDR took power. Before the end of FDR's first year in office, Prohibition was history.

There are many lessons and parallels for contemporary drug reformers in Prohibition, but they are not exact and may not apply across the board. Alcohol prohibition lasted barely a decade, but drug prohibition is now in its second century. Why one was a flash in the pan and the other remains a painful, enduring legacy are questions that need to be answered if we are ever to leave drug prohibition in the dustbin of history along with Prohibition. Prohibition can help us start to ask the questions that will give us the right answers.

Disappointingly, Ken Burns doesn't appear interested in pursuing the parallels, nor even the dissimilarities, between Prohibition then and prohibition now. He does not reference the prohibition of other drugs in Prohibition (although heroin and cocaine were already criminalized federally and marijuana was being banned in a number of states), nor, as he has made clear in interviews, does he see a useful comparison between the two.

But that disagreement or lack of boldness notwithstanding, Prohibition is still a great viewing experience that brings alive a critical episode in US social and political history, an episode who reverberations still linger and whose contours are still echoed in drug prohibition. This is your history, America -- watch, enjoy, learn, and ponder.

Canada Supreme Court Okays Safe Injection Site [FEATURE]

Rebuffing the Conservative government of Prime Minister, the Canadian Supreme Court Friday ruled unanimously that Vancouver's safe injection site for heroin addicts can stay open. Known as Insite, the Downtown Eastside facility is the only safe injection site in North America.

Vancouver's safe injection site wins a reprieve. (Image: Vancouver Coastal Health)
The Downtown Eastside, centered on the intersection of Main and Hasting, streets, has one of the highest concentrations of injection drug users in the world. An overgrown Skid Row flush with prostitution and destitution, most of its residents live in decaying SRO hotels lining Main Street. Out of 12,000 residents in the area, some 5,000 are estimated to be drug addicts.

At Insite, drug users are provided clean needles and sterilized water with which to mix their drug. Insite does not provide the drugs; users must bring their own. The users inject under medical supervision at one of 12 injecting alcoves.

Insite operates under the auspices of the British Columbia Ministry of Health and the local public health authority, Vancouver Coastal Health. Numerous research reports on Insite have found that it has reduced fatal drug overdoses, reduced HIV and Hepatitis C transmission rates, reduced crime rates in the neighborhood, and increased the number of drug users entering treatment.

It has operated since 2003 under an exemption to Canada's drug laws, but since coming to power, the Harper government has attempted to shut it down, claiming it "enables" drug users. Friday's decision by the Canadian Supreme Court is the final chapter in that effort.

The Harper government argued that the federal drug law took precedence over British Columbia's public health policies. British Columbia and other Insite supporters argued that because Insite is providing a form of health care, its operation is a provincial matter. The federal government's concerns did not outweigh the benefits of Insite, the court said.

"The grave consequences that might result from a lapse in the current constitutional exemption for Insite cannot be ignored," the court said. "Insite has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada."

Hundreds of Insite supporters gathered at the facility at dawn and broke out in cheers after the decision was announced. As the news spread, harm reduction, public health, and drug reform groups in Canada and around the world lined up to applaud it.

"We are absolutely delighted that we finally have a clear decision on the legal framework for Insite," said Dr. Patricia Daly, Vancouver Coastal Health Chief Medical Health Officer. "Since 2003, Insite has made a positive impact on thousands of clients, saved lives by preventing overdoses, and provided vital health services to a vulnerable population. Today's ruling allows us to continue the outstanding work Insite, its doctors, nurses, staff and partners provide."

"This represents a victory for science," said Dr. Julio Montaner, Director of the BC Center for Excellence for HIV/AIDS. "Prior attempts from the federal government to stop the activities of Insite have been ruled unconstitutional. We are thankful for the continued and unwavering support from the provincial government that has allowed us to set an example in Canada and the world for how to deal with addiction which is, indeed, a medical condition."

"We applaud today's landmark decision by the Canadian Supreme Court to uphold the human rights of all Canadians by allowing Insite to remain open," said the Canadian HIV/AIDS Legal Network, CACTUS Montreal, and Harm Reduction International in a joint statement. "We are heartened the Supreme Court of Canada has recognized that criminal laws on drugs must give way to good public health practices and harm reduction."

"This is a victory for science, compassion and public health -- and, given the fiscal benefits of such programs, the Canadian taxpayer. The Supreme Court of Canada recognized that Insite saves lives, and that that should be a guiding principle in deciding drug policy," said Laura Thomas, California deputy director for the Drug Policy Alliance. "Congratulations to the advocates, drug users, researchers, nurses, and elected officials who have campaigned for Vancouver's supervised injection facility for so long. This is a complete validation of their work."

The Supreme Court of Canada's Insite ruling applies only to Insite. Other Canadian localities seeking to establish safe injection sites must win permission from the federal government. Canadian activists urged them to do so.

"In light of today's Supreme Court decision, jurisdictions Canada-wide should act fearlessly on evidence and make harm reduction services modeled on Insite available to those in need in their locales," said the Canadian groups. "The Minister of Health must respect the court's decision and grant similar exemptions to other sites so that people across Canada will be able to access the public health services they desperately need."

There are 67 safe injection sites operating today, with one in Australia, Insite in Vancouver, and the rest in Europe. There are no safe injection sites operating in the United States, although a move is afoot in San Francisco to get one underway there. The Drug Policy Alliance's Thomas said it is time to start pushing harder.

"For communities in the US which have been hard hit by drug use, it is time to look at the evidence from Canada and start opening supervised injection facilities here," she said. "We look forward to implementing the same desire to save lives in the US."

Vancouver, BC
Canada

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