Insite’s success causes problems for morality-based opposition

Posted on May 17, 2011 in Health Debates

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May 16, 2011.    David Berry

Before the Supreme Court case to decide Insite’s future began, government lawyers requested the court ignore the piles of evidence that suggest the inexplicably embattled facility does exactly what it purports to do: reduce overdoses, stop the spread of disease, encourage rehabilitation — you know, generally just save lives.

A day into the proceedings, we quickly learned why the government would make such a request: they had no way to respond. Justice Louis LeBel stated it outright to government lawyer Paul Riley: “In the end this program somehow, while not being perfect, works. Have you got anything that tends to demonstrate that this program doesn’t work?” Riley’s reply? “I think that’s a fair observation.”

Which brings us back to the question of why this proceeding is taking place at all. Since it refused to grant an extension to Insite’s exemption three years ago, the government has had plenty of time to back up its moralistic position with a practical argument. That it has evidently decided to go with furrowed brows and grade-school reminders that drugs are bad — in the highest court of the land, by the way — suggests it’s in the wrong on this one.

It is no surprise that a harm-reduction facility like Insite would be controversial, and worthy of a public discussion. Though it’s not the end goal of such a facility, the fact is that it provides government-funded care and compassion to a section of society that, even if they are now in the grips of a disease, have made some obviously bad choices somewhere along the line. I personally think that compassion is the mark of an enlightened society, but I can understand the argument that these people should be left to sleep in the bed they made, even if that particular bed is in an alley next to the dirty needle with which they just shot up.

The problem is that, from Insite’s 2003 founding to today, analysis of its impact has repeatedly reached the same conclusion: Insite helps, and not just the people who come through its doors. Besides the widely reported 35% drop in overdoses, it’s also been shown to reduce HIV transmission, by as many as 35 cases a year, which is no small savings to our health-care system: the International Journal of Drug Policy finds the cost-benefit ratio just in this instance to be 1 to 5.12. Just something to keep in mind next time we talk about alternative health-care delivery methods. We should be debating whether to expand on Insite’s successes, not over its right to exist.

Oh, but wait, sorry, right: we’re not supposed to use evidence to make this case. Evidence is only for evaluating military procurement and economic policy, though of course then only in setting corporate tax rates, not, like, indirectly reducing health-care costs or anything. Here we’re supposed to stick to a misbegotten morality that prizes punishment for transgressions over saving lives.

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