Public health and the Canadian Charter of Rights and Freedoms.

The unanimous decision by the Supreme Court of Canada to order the Federal Minister of Health to exempt Vancouver’s supervised injection site from the Controlled Drugs and Substances Act is a major public health victory for Canada. It will save lives, decrease crime, improve health services, decrease transmission of HIV and hepatitis C, reduce the health and social burden and most likely the societal costs of drug addiction. Provinces must now start systematic implementation of similar and expanded facilities where they are most needed and apply for CDSA exemptions similar to that granted to Vancouver’s Insite. This decision clearly establishes the grounds for similar initiatives across the country. What is most exciting and important about it, however, is that the decision itself was based not on the resolution of some federal–provincial dispute over health care jurisdiction but on the recognition that a major harm reduction strategy targeting an important vulnerable population is in fact protected by the Canadian Charter of Rights and Freedoms. Indeed, the Supreme Court in its 9 to 0 decision affirmed that the refusal of the federal government to renew the CDSA exemption contravened section 7 of the Charter which states: “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.”1 This, I believe, opens the door for public health to consider how the Charter can support public health actions for other vulnerable populations, including low-income groups, recent immigrants and refugees, First Nations and others. Public health also needs to explore how further harm reduction strategies could benefit from the protection of the Charter. For example, if the injection sites also provided safe, pharmaceutical-grade drugs, addicts would be less likely to inject tainted products with the potential to cause harm. While the ruling permits us to contemplate the day when similar facilities will open across the country and when even more services will be offered to their client populations, the road will not necessarily be straightforward. The ruling does allow for the Minister’s discretion for future applications for exemptions, but that discretion according to the ruling must be applied “within the constraints imposed by the law and the Charter.”2 Hence, clear documentation of the need for and safety of such facilities will have to be demonstrated empirically. Careful planning, oversight and evaluation will be required as new facilities are implemented. An important research agenda appears before us to generate further evidence for effective harm reduction in Canada.