Advocates for supervised-injection sites are anxiously awaiting a ruling from the country's top court.

The Supreme Court of Canada is set to decide whether Insite, a health-care facility in Vancouver's downtown eastside, falls under provincial or federal jurisdiction, and whether closing it would violate the rights of drug addicts who use the facility.

If the high court rules in favour of provincial jurisdiction, facilities comparable to Insite could quickly pop in cities across the country including Montreal, advocates say.

"We really hope Insite is going to stay open," said Alexandra de Kiewit, a 33-year-old Montreal drug user and member of a 300-member advocacy group.

"Drugs are illegal, I know, but drugs are still there. It's utopian to think it's going to go away, and repression doesn't really work."

Echoing supporters of Insite, de Kiewit said the debate comes down to health and safety. She said supervised-injection sites in Montreal would prevent the spread of disease, fatal overdoses, and give drug users access to care that could help them quit.

Other Canadian cities, including Victoria, Toronto, and Quebec City, have also shown interest in opening safe-injection clinics modelled after Insite.

De Kiewit's group, the Quebec Association for the Rights and Inclusion of People Who Use Drugs, wants to see several supervised-injection sites set up at existing needle exchanges and health clinics around the city.

Quebec Health Minister Yves Bolduc has delayed the decision until the Supreme Court issues its ruling on Insite. The court heard arguments last week but it is not known when the ruling will be handed down.

A downtown Montreal needle exchange site, called Cactus, has vowed to open safe injection site this summer regardless.

Fighting an epidemic

The problem in Quebec, however, pales in comparison to the dire situation in Vancouver. There there were 76 accidental overdose deaths across Quebec in 2008, compared with more than 2,000 in Vancouver alone in the decade before Insite opened.

Still, de Kiewit said drug injections remain a major problem and users often shoot up in public washrooms and back alleys.

And, she said, "they do it fast so there are more risks."

The early results of a Toronto study, meanwhile, suggested there could be sufficient public support to set up supervised-injection site in that city.

Only a small minority of community stakeholders would never support the idea, according to a preliminary report by the city's Centre for Research on Inner City Health.

The full report is expected to be released this summer.

Insite opened in 2003 after an epidemic rise in overdose deaths in Vancouver's downtown eastside, allowing drug addicts to inject their own heroin under the supervision of a nurse.

It was the first supervised injection site in North America and was allowed to operate after the Liberal government of the day granted the facility an exemption from federal drug laws.

The Conservative government has indicated it wants to end the exemption and see the supervised injection site closed.

In May 2008, following a B.C. court ruling in favour of the facility, then-health minister Tony Clement said the Conservative government wanted the facility shut down.

Supporters of Insite, including the B.C. government, which funds the facility, point to peer-reviewed studies that conclude Insite prevents overdose deaths, reduces the spread of HIV and hepatitis, and curbs crime and open drug use.

The federal government has rejected that evidence, arguing the facility fosters addiction, misuses resources, and runs counter to its tough-on-crime agenda.

There have been roughly 2,400 overdoses at Insite, but no deaths.