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Injection drug problems, infection rates skyrocket in the north

February 18th, 2009 · 12 Comments

I have a story in today’s Globe about a resolution from the Health Officers Council of BC that calls for supervised-injection sites in all B.C. communities that need them. The most interesting part of doing that story, for me, was talking to Dr. David Bowering in Prince George and hearing about the escalating drug problem there — a significant reason why medical health officers there support the concept of an SIS.

I wasn’t able to get any of the opponents of injection sites by the time my story was printed, but Colin Mangham did reach me after my deadline had passed. I append his comments here.

I am not at all surprised there would be no opposition to the call from Medical Health Officers. Most do not know a lot about or really follow the issue and all are very busy.  None I would think would be inclined to stick their neck out the least bit, if they did read up on the issue, or were not partners in the ideology of INSITE. The Provincial Health Officer has long advocated for outright legalization – the necessary partner to harm reduction. He is on record as being so and the MHOC, a separate group of which he is part, also advocates for harm reduction/legalization. Many others more involved with INSITE including some of the researchers, the city drug czar, Centres for Excellence, VCH civil servants dealing with the DTES, are also strong believers in harm reduction ideology and have spoken out for it on many occasions. While having such views and bias is perfectly fine, remember these are also the people responsible for drug policy and public drug program dollars. Their bias has become reality at our expense.  Along with this bias, we have seen treatment dwindle terribly, no primary prevention programs for schools or communities, and for want of a better word, mockery of police and enforcement.  Before INSITE was even planned, these people were calling for drug maintenance programs and injection sites to be a major part of drug policy in future. I for one am willing to state emphatically that not in Canada, nor anywhere else in the world, have these programs proven successful – just about every report one sees shows obvious fundamental problems in controlling behaviour while not dealing with the drug use and addiction themselves. I stand behind what I found when I reviewed the research reports on INSITE. Among all the correlations and suggested effects, I see no actual unique or attributable impact of INSITE on disease, treatment uptake, deaths, or crime. Such is not shown in any of the papers regardless of the journal they are in. Moreover the INSITE research is fundamentally lacking as it compares itself to nothing- there is not a second treatment to which it is being compared other than the status quo, largely created by the people pushing INSITE and its parent philosophy.
Most addiction MD’s you will talk to, if they are not concerned with reputation or job, will tell you treatment remains the only real hope for the addict.  Treatment works. Treatment reduces disease, crime, death. But instead of more treatment, we are being asked to support more INSITES.
I have found it ironic that I and other critics of INSITE have been labelled ideologues, who “trump science” with that ideology. Even though INSITE remains without an evidence base to justify its continuation, these people are willing to push for its replication and attack anyone who disagrees and seem so tied to the ideology of harm reduction that INSITE has become for them a hold at all costs beachhead.
While this is happening, many older institutions in the DTES who have done so much are being pushed aside because the harm reductionists don’t want ‘moral baggage.’   Give them a call.
INSITE is a classic “foot in the door” harm reduction measure. This is why it and its promoters are extolled by about every legalization lobby group on the web, and why if you Google my name you’d think I was a heretic worthy of burning at the stake. (Well maybe not quite burning – just censoring. The intent to permanently ensconce it along with drug maintenance programs – the next step – was made evident in federal discussions 10 years ago – before there was ANY evidence.  Now, with sketchy, weak evidence, and with significant evidence of weak or no actual impacts, it is being pushed ahead. if ever there was science trumped by ideology, this is it.
My heart aches at the hopelessness of a place that exists to provide a place for people to inject themselves with the drug that is killing them, and I feel real anger that supposedly intelligent people are pushing to replicate it at our, and the addicts’ expense. Especially at the addicts expense. I challenge these people’s real belief in the importance of getting people away from and off of drugs, and that doing so provides the only real hope for people, and the only manifestation that we really do care and consider them our brothers and sisters and of great worth.
Yes I am passionate and yes I am angry.
Colin Mangham

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  • Mark

    Please do a follow up piece and include some of his points of view. Extremely wise words.

  • DM

    My heart aches at the wasted energy that this man continues to expend opposing harm reduction interventions that are at their very core the most basic fundamental human expressions of caring and compassion that give severely marginalized injection drug users a tiny glimmer of hope that they too will live to experience better days whether that be as a result of treatment programs, the love and caring of friends and family, a helpful police or criminal justice contact or any number of other compassionate acts towards vulnerable individuals within our society. Please Colin let’s get on with building a truly comprehensive approach. Not one harm reduction worker in the trenches that I know opposses or does not advocate for more prevention and treatment. Let’s get on with it.

  • Travis

    I wonder if Colin has ever talked with Thomas Kerr. I interviewed him last year and was blown away by his frustration with people who seem to completely ignore the more than 8 years of research he has done on safe injection sites and harm reduction. He is getting hoarse trying to convince people that it works and it is time to move on.
    It seems that like many things, there is no convincing someone who opposes a particular position. It doesn’t matter how much research is done or how many case studies find the same result, some people simply do not like the concept of harm reduction and never will.

  • Uhhh….

    ‘Ideology’ aside, I think, perhaps, that folks with enquiring minds may wish to compare Dr. Mangham’s bonafides (of the peer-reviewed kind) with a few other folks in the field, including those of Dr. Kerr.

    I can help you out with that if you’d like to take me up on the offer.



  • LP

    What we need presently are more detox and rehab spaces.

    Anyone who wants off, can’t wait for a bed to open, which is now presently the case.

    Increasing taxpayer funds to INSITE and these types of programs without increasing money to detox and rehab beds is wrong wrong and wrong.

    This one pillar bullshit is nothing more than a bandaid and those to blame are the apologists that continue to advocate for it. See RossK, Travis, Dm, etc…..

  • Travis

    LM, Thank you for calling me an apologist, but you are certainly incorrect in referring to this as “one pillar bullshit”. If you had bothered to look at the research and findings from Dr. Kerr, you would have found that it says nothing about harm reduction being the sole solution. In fact, it has been stated over and over that harm reduction is merely the beginning of the process of helping those cope with addiction. It is about putting those people in an environment that facilitates recovery and ultimately can save lives.

    This is from an piece that ran on CTV last April.

    “… the site had made a contribution to improving public disorder, helped get people into treatment and reduced HIV risk behaviour, he said. … Insite staff have successfully intervened in more than 336 overdose events since 2006 and no overdose deaths have occurred at the service. Mathematical modeling suggests Insite saves about one life a year as a result of intervening in overdose deaths. “

  • Travis–

    It would appear that LP has bought into the spin of the abstinence movement that having SISites will somehow bring all other intitiatives/pillars to a screeching halt.

    Which, of course, is kind of like saying you can’t have curling in the Winter Olympics because it will somehow prevent snowboarding.

    Again, for anyone who is interested, please feel free to compare, for yourself, the critically peer-reviewed work of folks like Dr. Kerr and colleagues, more of which has been recently published, after rigorous peer review, in the Public Library of Science, to the wingnut welfare-assisted abstinence opinion piece of Dr. Mangham published in the United States Department of Justice-funded ‘Journal of Global Drug Policy And Practice’.



  • A. G. Tsakumis

    Dr. Mangham’s words are not only pertinent but trump every single word by any obliviot who has posted such ignorant blather to the contrary.

    I have written extensively on this issue. I was originally a strong supporter of Insite, until I did the research.

    And it is ugly: The doctors who push for harm reduction push for it ABOVE any of the other so-called four pillars. They cite research (fraud) in “peer-reviewed” journals, without explaining how much money they would receive (and some do already) from big PHARMA and ignorant govts. It’s turned into their own little cottage industry. Real research you say? Bullshit. They use flawed studies to back up claims and comparitor arms in studies that are entirely misleading.

    They are dangerous and have created an entire industry of hurt. Harm reduction on it’s own is NOT compassion–it’s dangerous and demeaning.

    It’s a global pandemic of scientists that have banned together to milk us of tax dollars to line their own research bailiwicks. It’s about fame and circumstance.

    It’s about lying, frankly.

    Harm seductionists want treatment one of you have written? Really? Cut the crap. NOT ONE OF THEM has petitioned the govt for $$$ for this. IF they really wanted this, they would have done it synchronously to harm reduction.

    They’ve only had ten years to do this. TEN YEARS!

    Colin Mangham should be Sainted.

  • AGT–

    First off, it’s nice of you to call me names once again (was scary agreeing with you all the time for awhile there).

    Second, please go and read the abstract of PLoS paper cited above and tell me what, exactly, is flawed about the methodology or the conclusions.

    Third, please read the funding statement that follows the abstract tell me, where, specifically, the big pharma money is?

    After I receive your responses I’ll be happy to reconsider whether or not I am, indeed, an ‘obliviot’.



  • A. G. Tsakumis


    My apologies. Of all people, you’re hardly an obliviot, but your opinion on Insite makes absolutely ZERO sense.

    Just because Dr. Mangham’s opinions are distributed in the United States doesn’t make him wrong. Reread his thesis. Insite is beautiful marketing tool that is promoted by Drs. Kerr, Marsh, Kraus, etc., because they do nothing else.

    But to the dozens of addictionologists on the ground on the DTES, the enablers of full of crap and are only hurting the addicted downtrodden.

    Julio Montaner and others have done a massive disservice to the sick. And Don McPherson is disingenious. He is all about legalization.

    Frankly, that’s what all the others are about too.

    Fame and notoriety rule their world. They do not bother to tell you of the failure of their stock the world over.

    They sugar coat the bitter pill, much like early 20th century hucksters, whose elixir bottles rattled in the back of their caravan.

  • Mr. AGT–

    Physical location of a journal’s publication site is not important.

    However, a journal’s editorial policies, especially when they are influenced by their funder, most definitely are.

    You have questioned people’s motives here and I will have to pass on that given that I am not well enough informed to deal with those of all involved.

    Regardless, to my mind that is not the critical issue here.

    Instead, for me, the data are the issue, because they form the basis of the conclusions made (and from which I form my own opinion).

    So again, please, tell me what it is, specifically, that you find to be flawed about the acquisition and analysis of the data in the abstract cited above which was published as part of primary research paper in a journal that has an editorial policy that ensures rigorous peer review that is not influenced by outside forces, funding-driven or otherwise.

    If you can point out what is flawed I’d be happy to reconsider whether or not my own opinion on the matter makes, as you say ‘ZERO sense’.


    With apologies to Frances for the clutter, here is the actual abstract for anyone who wishes to read it without clicking throug on the link (although I purposely chose a paper published in PLoS because it is an open access journal such that you can go there and read the entire work if you so desire):

    Illicit drug overdose remains a leading cause of premature mortality in urban settings worldwide. We sought to estimate the number of deaths potentially averted by the implementation of a medically supervised safer injection facility (SIF) in Vancouver, Canada.

    Methodology/Principal Findings
    The number of potentially averted deaths was calculated using an estimate of the local ratio of non-fatal to fatal overdoses. Inputs were derived from counts of overdose deaths by the British Columbia Vital Statistics Agency and non-fatal overdose rates from published estimates. Potentially-fatal overdoses were defined as events within the SIF that required the provision of naloxone, a 911 call or an ambulance. Point estimates and 95% Confidence Intervals (95% CI) were calculated using a Monte Carlo simulation. Between March 1, 2004 and July 1, 2008 there were 1004 overdose events in the SIF of which 453 events matched our definition of potentially fatal. In 2004, 2005 and 2006 there were 32, 37 and 38 drug-induced deaths in the SIF’s neighbourhood. Owing to the wide range of non-fatal overdose rates reported in the literature (between 5% and 30% per year) we performed sensitivity analyses using non-fatal overdose rates of 50, 200 and 300 per 1,000 person years. Using these model inputs, the number of averted deaths were, respectively: 50.9 (95% CI: 23.6–78.1); 12.6 (95% CI: 9.6–15.7); 8.4 (95% CI: 6.5–10.4) during the study period, equal to 1.9 to 11.7 averted deaths per annum.

    Based on a conservative estimate of the local ratio of non-fatal to fatal overdoses, the potentially fatal overdoses in the SIF during the study period could have resulted in between 8 and 51 deaths had they occurred outside the facility, or from 6% to 37% of the total overdose mortality burden in the neighborhood during the study period. These data should inform the ongoing debates over the future of the pilot project.


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