Dr. Thomas Kerr: 'public health hero'

Today we introduce a new regular interview feature that we're calling <em>All Talk, All Action</em>. Each week we'll bring you a conversation between correspondent Am Johal and a leading thinker or activist for social change. It's talk that we're sure wi

Dr. Thomas Kerr is a Research Scientist with the BC Centre for Excellence in HIV/AIDS and an Assistant Professor in the Department of Medicine at the University of British Columbia. In his current role at the BC Centre, Dr. Kerr is a principal investigator of several large cohort studies involving injection drug users, HIV-positive individuals and street-involved youth.

Dr. Thomas Kerr has been called a "public health hero" for his work in a controversial area âe" Vancouver's Eastside medical injection site program. Dr. Kerr's research evaluating North America's first safer injecting facility, Insite, has contributed significantly to academic, public and government discussions, both nationally and internationally. He spoke on the phone with Am Johal.

Am Johal: You were involved with the supervised injection site, prior to it being open. Iâe(TM)m wondering if you can talk to the period prior to the site being opened?

Dr. Thomas Kerr:I was working as a counsellor at the Dr. Peter Centre. I was working with people living with HIV/AIDS including many injection drug users. We experienced first-hand the frustration of dealing with their challenges without being able to deal with their addictions.

There was a growing pressure to set up a pilot project. I was doing my PhD at the University of Victoria and was gaining more experience in research. A number of community-based AIDS organizations and organizations serving drug users wanted to develop a pilot study of a safe injection site. Given that I had a background in both health care and research, people thought I was an appropriate candidate. I travelled overseas, went through the literature and developed a model that would work in Vancouver.

From the outset, we wanted to implement a pilot project and evaluate it rigorously. It was always the plan to proceed cautiously. We wanted to ensure the appropriate level of scientific evaluation.

You recently won a research award related to your work with Insite. Can you tell me about that?

I was awarded a Canadian Health research award in the area of knowledge translation. There is now a growing pressure on researchers to make sure that their work is translated into language that people can understand and that it is transferred to appropriate people, not just other researchers, but the broader public, policy makers and others. Weâe(TM)ve tried to communicate our findings in a way that the broader public can understand. Itâe(TM)s a credit to our entire research team to have our work recognized by the national research community.

There have been well over 20 peer-reviewed articles supportive of the site in terms of what the intent was and the outcomes have been. Can you speak to that?

The main findings were that the site was having a positive effect [on] reducing public disorder, HIV/AIDS risk behaviour such as needle sharing, assisting people in getting into detox and addiction treatment. Weâe(TM)ve also looked at studying whether adverse effects were occurring âe" but we did not find that the site led to an increase in drug use, new drug users starting to inject, drug related crime or open drug use.

Have the rates related to communicable diseases tailed off?

We havenâe(TM)t really looked at that closely enough yet. From an epidemiological perspective, Iâe(TM)m sure thatâe(TM)s the way to go about it. This is a tiny pilot facility. With 12 seats open 18 hours a day, we have a small pilot facility and only a small number of injections that happen every day in this neighbourhood. The site only covers about five to ten per cent of injections that happen in the neighbourhood each day.

For many, the wait is too long or the site is closed when they want to use it. The way to investigate this is not to look at the population level, but rather to look at a sub-population who uses the facility. At that level, we have some relevant examples. There have been close to 1000 overdoses and nobodyâe(TM)s died. Weâe(TM)re continuing to look at numbers like that.

A recent federal government study attempted to place conditions on your research on Insite. Can you speak to that?

Health Canada put out a request for proposals. We were offered one contract. The contract contained an intellectual property clause that stated that the researchers could not utilize the information produced under the contracts unless approved by Health Canada, and it was said that this approval was expected to be given within six months. Our lawyers at UBC and community partners had major issues with that. We contacted a lawyer at UBC, since most of the members of our research group are faculty at UBC, and we were told that as faculty we are prohibited from taking the contract. In essence, it would be taking part in research in secret. We felt it had to be undertaken in a transparent way.

We requested Health Canada make an amendment. We didnâe(TM)t receive a formal reply. Our request was ignored. We never heard from Health Canada again.

Do you view this as a politicization from the previous research you were engaged in related to the supervised injection facility?

It is interference in the natural evolution of evidence-based policymaking. They were essentially putting a gag order on researchers. We could not communicate our research or speak to the media. We werenâe(TM)t prepared to work under such draconian conditions.

There has been criticism from both the U.S. government and the International Narcotics Control Board regarding Insite. Can you speak to this international dimension of this debate?

The U.S. drug czar [John Walters] made a trip to Vancouver and called the safe injection site âe~state-sponsored suicideâe(TM) before we even opened the doors. He wasnâe(TM)t prepared to take an evidence based approach or to take a look at a rigorous approach to a complex issue. Itâe(TM)s very unscientific.

The INCB is an archaic and irrelevant body. The international drug conventions were created long before we had the problem of HIV/AIDS. These policies are not relevant in this era of pandemics of infectious diseases. There were legal assessments carried out for the INCB by UN experts on whether supervised injection sites violated international law. Those expert lawyers said that no âe" there were no international law being broken here. Despite the fact that they had elicited this opinion, members of the INCB continued to state that they were in contravention, which is totally irresponsible. Making public statements that are incongruent with their own expert legal opinions is outrageous. Itâe(TM)s sad that a UN body like the INCB takes positions that are incongruent with the policies of UNAIDS and the World Health Organization.

Anything else?

We have a very serious public health problem here. It exists locally, nationally and internationally. This one intervention seems to be working really well. There is no debate about whether this works or not. We shouldnâe(TM)t allow this issue to be politicized and allow it to overshadow the scientific evidence.

We need to disengage from this misrepresentation of the science and the research. Other jurisdictions should be allowed to move forward with their proposals. We need to end the human suffering associated with drug addiction rather than engage in these predictable debates that are distorted by politics.

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