#378 Insite Works – DrugSense Drug Policy Reform Blog

Date: Mon, 28 Jul 2008
Subject: #378 Insite Works

INSITE WORKS

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DrugSense FOCUS Alert #378 – Monday, 28 July 2008

Today Canada’s second largest national newspaper reprinted from the
Canadian version of Reader’s Digest two opposing viewpoints about
Insite, Canada’s supervised injection site.

The future of Insite is in doubt. Your letters to the editor will help
keep the issue in front of the Canadian public. The National Post has
printed letters as long as 250 words. The average printed letter is
about 135 words in length.

Canadians may also wish to contact their MP to express their
views.

You may read much more about the Insite debate here
http://www.mapinc.org/topic/Insite

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Contact: letters@nationalpost.com

Pubdate: Mon, 28 Jul 2008
Source: National Post (Canada)
Copyright: 2008 The Reader’s Digest Canada Magazines Limited.
Reprinted by permission from the August 2008 issue of Reader’s Digest.
Author: Anne Mullens

INSITE WORKS

By Giving Drug Addicts a Sterile Syringe and a Warm Place to Shoot Up,
Are We Saving Lives or Condoning Substance Abuse?

To illuminate the double standard surrounding “harm reduction,” Dr.
Stephen Hwang, a medical researcher and associate professor of
medicine at the University of Toronto, offers the following scenario:

Suppose that an innovative but controversial intervention is launched
to reduce complications of Type 2 Diabetes, and 7,000 subjects take
part in a trial. Researchers, funded by Health Canada to study the
intervention’s effectiveness, find that while not curing diabetes, the
intervention improves health, reduces infections and prevents
premature deaths — with no adverse effects. The findings are
published in the world’s leading medical journals.

But the federal government deems the findings inconclusive and says
the only acceptable therapies for diabetes are those that either
prevent or cure the condition — even though no such therapies exist.
Columnists, community leaders and national organizations expound that
the intervention “enables” bad lifestyle choices, and that without the
dire complications of diabetes, people with the condition would eat
more, exercise less and become increasingly obese. And those who
didn’t have diabetes would forgo healthy diets and exercise because
they’d no longer fear the disease. The government considers banning
the intervention.

Sound far-fetched? Not, says Hwang, if you replace the word diabetes
with drug addiction, and the word intervention with Insite, the
safe-injection site pilot project that began in Vancouver’s Downtown
Eastside in 2003. Insite has allowed addicts to inject drugs under
secure, clean conditions, and all under the supervision of a nurse.

“I wanted people to see how hypocritical we are in the way that we
treat two chronic conditions that have a lot of associated harms,”
says Hwang. A specialist in inner-city medicine, he wrote the diabetes
scenario for the peer-reviewed online journal Open Medicine, arguing
that when it comes to drug abuse, ideology trumps science in a way
that would not be tolerated with other chronic health conditions.
Hwang’s treatise was endorsed by more than 130 prominent Canadian
scientists, doctors and public-health professionals.

Think there’s a huge difference between drug addiction and diabetes?
There isn’t, says Hwang: Both arise through a complex mix of
predisposed genetic and environmental factors — triggered by
lifestyle choices, behaviour and bad luck — that result in disorders
of body chemistry. Both have potentially severe complications, such
as infections or premature death, that can be reduced with good
medical care. Just as some addicts can kick their addictions, some
people with diabetes, through weight loss, gastric bypass surgery or
extreme exercise, can eliminate their symptoms and their need for
medication — though drug-free addicts and insulin-free diabetics
both risk relapse. Yet do we refuse to treat the health complications
of people with diabetes who cannot wean themselves off medication? Never.

“A heroin addict needs heroin as much as a diabetic needs insulin,”
says Norm Stamper, a former chief of the Seattle police department.
“That need is real. It is physiological.” After witnessing the failure
of the United States’ strict “war on drugs” to stem narcotic use and
its associated problems, Stamper is now a leading advocate of
safe-injection sites, methadone-treatment, needle-exchange and other
harm reduction programs that aim to refocus efforts from policing to
medical management.

Here’s what more than 20 studies –all by independent evaluators,
published in prominent journals — have found: Insite has reduced
instances of needle sharing and drug injecting in public places, and
there has been a decrease in the amount of injection related litter.
In the Insite neighbourhood, there have been no increases in drug
trafficking or assaults, and instances of vehicle break-ins and car
theft have decreased. Despite almost 900 overdose events at Insite —
a common hazard of drug use — no overdose deaths have occurred at the
facility, compared with an average of 60 a year in Metro Vancouver.
Additionally, since Insite began, the number of drug addicts who have
entered detox programs, addiction counselling and drug-addiction
treatment has increased by over 30%.

Dr. Perry Kendall, the B. C. Health Officer, says opposition to Insite
is not based on evidence of effectiveness but on the notion that drug
addicts have made bad choices and must change or live with their fate.
“The belief,” he says, “is that if health providers remove or lessen
the harms of addicts’ behaviour, addicts won’t hit bottom and
therefore won’t have the motivation to go clean.”

“The issue is not whether the addict would be better off without his
addiction–of course he would–but whether we are going to abandon
him to illness or death if he is unable to give it up,” says Dr.
Gabor Mate, who has served as staff physician at Insite and is the
author of In the Realm of Hungry Ghosts: Close Encounters with
Addiction. Mate’s book is a must-read for those who reject harm
reduction as “coddling” drug addicts or who believe “Just Say No” is
a realistic policy. In his book, Mate shows his patients’ struggles
and demons, how they became addicts and how they found a way out. The
book illustrates a central premise of HR: accepting those with drug
addictions and trying to move them along the continuum to better
health — keeping them alive and well long enough to have a chance to
quit later.

Some who were once adamantly against Insite have come to support it.
One such person is George Chow, former president of the Chinese
Benevolent Association of Vancouver. Chow successfully ran for city
councillor on a ticket of rejecting Insite — the centre was on China
town’s doorstep — gathering some 18,000 signatures from the Chinese
community. Yet, after Insite had been in operation for three years, he
changed his mind. “I am keenly aware of the debate surrounding
[Insite]. But I am pleased to say that the initial fears of the
community — a potential increase in crime and public disorder — have
not materialized,” Chow wrote in a letter to Prime Minister Stephen
Harper in the fall of 2007.

If only more of us were willing to change our positions based on
evidence, we might finally begin to make progress against this
terrible affliction called drug addiction.

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Contact: letters@nationalpost.com

THE SOLUTION IS ABSTINENCE

By Giving Drug Addicts a Sterile Syringe and a Warm Place to Shoot Up,
Are We Saving Lives or Condoning Substance Abuse?

Prevention, treatment, enforcement: These traditional policies were
announced in 2007 as the pillars that would uphold Canada’s National
Anti-drug Strategy. Pointedly excluded from the government’s plan is
the continued reliance on harm resistance, the philosophical darling
of liberal stakeholders in addiction management. Designed as a fourth
pillar to focus on public health and order rather than usage
reduction, harm reduction is defensible as a handmaid to a balanced
portfolio of approaches, supplementing treatment and prevention. But
in Vancouver, it has emerged in the last decade as a free-standing
pillar, now teetering under an unwieldy social burden it cannot sustain.

Harm reduction’s social laboratory is the municipal quagmire of
Vancouver’s Downtown Eastside. Here, the mentally ill, the culturally
uprooted and the psychologically dysfunctional appease their demons in
a squalid cycle of illicit-drug torpor and crime. Drug consumption is
high — nearly a third of the 16,000 residents are addicts — but
evidence of faith in the drug abuser’s power to reclaim his portion of
the human estate is low. Funding allocations approved by a series of
mayors speak volumes about priorities. Money abounds for needles,
crack-pipe kits and opiate-giveaway trials, but extended waiting lists
for long-term rehabilitation centres attest to a scarcity of available
beds.

Insite — the first public facility in North America where addicts can
legally inject illicit drugs under professional supervision — started
up in 2003. In keeping with harm reduction’s non-judgemental ideology,
Insite’s detox resources were made available only to those who asked
for them. It’s just as well that few have done so, since there are
only 12 detox beds for several hundred daily inject ors. And because
they wouldn’t have been using Insite, the neighbourhood’s 5,000
crack-smoking addicts have been denied even that faint hope of
breaking the vicious cycle.

Harm reduction-friendly researchers claim success for Insite. But
observers of addicts in crisis demur: Dr. Stan de Vlaming, former head
of addiction services at Vancouver’s St. Paul’s Hospital– the main
provider of hospital services to Downtown Eastside residents — says,
“The people who refer to Insite as a ‘safe injection site’ are
perpetuating a dangerous misunderstanding. There is nothing safe about
repeated daily injections that bypass a person’s normal defence
systems.” He notes that from 2002 — one year prior to Insite’s
inauguration — to 2005, the number of hospital days utilized for
infectious complications directly attributable to injecting had
escalated from 16,042 to 18,848. Moreover, after evaluating the
most-cited harm reduction studies, Garth Davies, assistant professor
at Simon Fraser University’s School of Criminology, also was
unconvinced. In his article A Critical Evaluation of the Effects of
Safe Injection Facilities, published in the Journal of Global Drug
Policy and Practice, Davies concluded that “all claims regarding the
benefits of harm reduction remain open to question.”

Many people who find themselves up close and personal with addicts
–law enforcers, judges, treatment professionals, ministering
volunteers — see the human wreckage that human wreckage perpetuates.
Retired Vancouver policeman Al Arsenault patrolled the “chemical
gulag” of the Downtown Eastside for more than half of his 27 years on
the job. He calls Insite — and the needle-exchange program, in
particular –an “abject and utter failure.” If injectors were
responsible enough to return needles, he observes, they wouldn’t be in
the Downtown Eastside. Ironically, the program has augmented the
presence of used needles in the area. Arsenault wryly sums up the
experiment: “The rich get treatment, the poor get harm reduction.”

Pastor Gloria Kieler concurs. She has ministered to addicts since 1984
and deplores “the total disregard for those addicted persons
desperately wanting to escape the Downtown Eastside.” Rehabilitation
is the solution she tirelessly urges, acknowledging facilities can’t
spring up where there is no moral impetus to build them.

Advocates of harm reduction continue to push the drug-normalization
envelope. Through a volunteer-based research trial for addicts —
overseen by the Vancouver Coastal Health Authority, among other
agencies — chronic addiction substitution treatment is poised to
offer addicts prescriptions-on-demand for the consumption of legal
opiates such as Dilaudid (hydromorphone hydrochloride) — virtually a
heroin clone. And selected hard-drug users who “do not benefit from
methadone maintenance therapy” — as explained on the Canadian
Institutes of Health Research Web page on this topic — have
participated in the North American Opiate Medication Initiative, where
they were given heroin daily, setting the bar for the addicts’ moral
agency even lower.

Harm reduction proponents seem to view addiction as an incurable
disease — and addicts as victims not only unaccountable for, but
entitled to, their “lifestyles.” Do militants truly believe that the
war on drugs is lost, and that containment of crime and of
needle-based Hepatitis C, HIV and AIDS is the best society can hope
for?

Harm reduction is therefore the opposite pole to the traditional
abstinence model, which insists that, while the war against the dark
side of human nature can never be won completely, partial victory is
preferable to surrender. Abstinence initiatives have proven to be
effective over the long term. A consistent and persistent message that
cigarettes are unhealthy and would not be socially tolerated cut the
number of youth experimenting with tobacco by half between 1994 and
2004. And the anti-drunk driving campaign has cut the incidence of
drunk driving by 65% since 1981.

Successfully recovered addicts are harm reduction’s harshest critics.
Saskatchewan MLA Serge Le-Clerc reversed a lifetime of drug-related
dysfunction and crime following an inspirational encounter with a
prison Samaritan. LeClerc earned two university degrees while behind
bars and has become a passionate crusader for preventive drug
education in schools. He is contemptuous of harm reduction, under
whose rubric he would still be an addict. “The disease model negates
choice, but there is no one who is beyond redemption,” he says. In
fact, according to the Portage Rehabilitation Centre in Elora, Ont.,
at six months following discharge from their facility, there’s a
nearly 86% decrease in drug use among adolescents and a 92% decrease
for young adults.

Ironically, as Vancouver’s infatuation with harm reduction waxes, some
critics are concluding that the program was a costly mistake.
Amsterdam, one of harm reduction’s earliest adopters, is mired in
squalor from escalating usage and attendant drug-related evils. Dozens
of European cities, including Athens, Stockholm and Oslo, have signed
a declaration against drugs — including using safe-injection sites as
a surreptitious way to try to legalize drugs. And all but renouncing
harm reduction outright, Sweden instituted compulsory drug treatment
in a limited number of cases and criminalized the purchase of sex. The
country now boasts some of Europe’s lowest drug-related rates of
crime, disease and social problems.

We cannot take pride in a society that chooses to accompany an addict
to the abyss; only in a society that pulls him back from it. True
compassion is expressed through prevention and treatment. It is time
to end the false compassion of harm reduction.

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