Flawed data



, National Post · Oct. 5, 2011 | Last Updated: Oct. 5, 2011 3:05 AM ET

In 2003, Insite, the first experimental supervised injection site in North America, was installed in Vancouver's Downtown Eastside (DTES), Canada's poster district for entrenched substance abuse and addiction. At Insite, addicts may legally shoot up illegal drugs in hygienic, medically protective and non-judgmental circumstances. The controversial clinic instantly became, and remains, a crucible for passionate social and legal debate about public policy in dealing with drug addiction.

Those who argue for Insite believe that its governing philosophy of "harm reduction" for what they regard as an incurable affliction, is both ethical and efficacious in reducing disease and deaths. Opposed to Insite are those who support what one might call the "moral agency" model. This redemptive perspective, which favours pro-active strategies of treatment and prevention, has the support of the federal government, which has tried to close Insite down since 2006.

On Sept. 30, the Supreme Court of Canada ordered the Minister of Health to permanently exempt Insite from the provisions of the Controlled Drugs and Substances Act and, by implication, all other applicants for drug injection sites elsewhere in Canada. In their ruling, the Supreme Court justices explicitly linked the decision to their belief that, "Insite saves lives. Its bene-fits have been proven."

How did they come to that understanding? Well, the Insite hearings were held on May 12. On April 18, a population-based study conducted by University of British Columbia (UBC) researchers and published in the leading medical journal The Lancet was conveniently distributed to the media. The study claims that over the period 20027, drug overdose deaths within a 500-metre radius around Insite reduced by 35%, while the rest of Vancouver reduced by 9%. Lead researcher Dr. Thomas Kerr announced that, "the evidence is clear, Insite saves lives." His words were immediately hailed by Insite's many supporters in the media as proof of the site's success.

However, an anti-drug watchdog group vigorously contests these findings. In an analysis of The Lancet study commissioned by the Drug Prevention Network of Canada and Real Women of Canada, an international team including three Australian doctors, B.C. drug-prevention expert Colin Mangham and Dr. Robert Dupont, president of the U.S. National Institute of Drug Abuse, allege that The Lancet study's findings of decreased deaths in the Insite area are not supported by data from the British Columbia Coroner's office, which indicate that deaths from drug overdoses in the area around Insite not only did not decrease, they in fact increased between 2002-2007 (see graph to the left).

Amongst other allegations, the watchdog group contends that the Lancet researchers, some of whom have advocated for Insite since the 1990s, manufactured an appearance of overdose mortality reduction by including 2001 data in their pre-Insite comparison years, without stipulating that 2001 was a year of unusual heroin availability. They were well aware of the anomaly, since it was the subject of two previous journal articles by three of The Lancet article's researchers. The analysts further maintain that the UBC researchers failed to note that 41% of B.C.'s overdose fatalities are not even injection-related.

More significantly, they affirm, is the UBC researchers' disclaimer of any knowledge of "confounder" policing changes around Insite between 2001 and 2005 that might have affected the rates of overdose deaths. But according to the analysts, the researchers had to have known that since April 2003, 50-66 police officers were added for patrol duties, specifically to a 12-block radius of Insite, where the contested 35% decrease is alleged to have occurred. As evidence, they point to a 2004 journal article, a "detailed analysis of the effects of the changed policing," on which three of the UBC researchers collaborated, which showed a 46% evacuation of drug users from the area as a consequence of the police crackdown.

The analysts conclude that Insite, hosting about 144,000 opiate injections annually, saves 1.08 lives per year, a statistically negligible outcome, but a figure that is proportionally consistent with a 2008 Canadian Government Expert Advisory Committee's international review of injecting sites worldwide. In Germany's 25 injecting rooms, hosting 500,000 annual opiate injections, for example, the cumulative number of lives saved is estimated at about 10 per year.

A complaint about The Lancet study research has been filed with UBC. The question now arises: If it is found, as their critics charge, that serious errors undermine the credibility of the research, invalidating The Lancet study's claims, then the Supreme Court's justification for their ruling in favour of Insite, that it "saves the life and health" of addicts, is also void. In that case, unless the court can point to another source of credible evidence to support it, it should take the honourable course of action and annul its ruling.