INSITE WORKS PLEASE COPY AND DISTRIBUTE 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 Contact: 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. Contact: 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: Barbara Kay 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. Additional suggestions for writing LTEs are at our Media Activism Center: http://www.mapinc.org/resource/#guides PLEASE SEND US A COPY OF YOUR LETTER Please post a copy of your letter or report your action to the sent letter list ( ) if you are subscribed, or by emailing a copy to if you are not subscribed. Your letter will then be forwarded to the list so others may learn from your efforts. Subscribing to the Sent LTE list ( ) will help you to review other sent LTEs and perhaps come up with new ideas or approaches as well as keeping others aware of your important writing efforts. To subscribe to the Sent LTE mailing list see http://www.mapinc.org/lists/index.htm#form Prepared by: The MAP Media Activism Team www.mapinc.org/resource =.

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