Pubdate: Sat, 19 Mar 2005
Source: Vancouver Sun (CN BC)
Copyright: 2005 The Vancouver Sun
Author: Kevin Sabet
Bookmark: (Harm Reduction)
Bookmark: (Hepatitis)
Bookmark: (Heroin)
Bookmark: (Methadone)
Bookmark: (Treatment)
Note: Kevin A. Sabet is a Ph.D. student at Oxford University. He was a 
senior drug policy speechwriter in both the Clinton and Bush 
Administrations. His book, Dealing With Drugs, will be published this spring.

Why 'harm reduction' won't work

Vancouver's latest plan -- maintenance for heroin users -- overlooks an 
elementary fact: The problem with drug use is, oddly enough, drug use

Vancouver has one of the highest rates of drug abuse and infection in the 
world, according to scientific studies published about the city.

That is why Vancouver's latest plan to maintain heroin users on their drugs 
of choice -- cornering more addicts into a life of despair and sickness -- 
is worrying me and scores of public health officials worldwide.

As in most major cities around the world, Vancouver's drug problem is 
multifaceted and complex: The regular consumption of multiple drugs by a 
significant minority of the population, rising purity rates, and crippling 
violence exacerbated by regimented criminal organizations exhaust 
policy-makers looking for a "quick fix" to the drug problem.

To make matters worse, a disproportionate number of drug addicts in this 
city have HIV (at least 30 per cent) and Hepatitis C (a staggering 90 per 
cent), either perpetuated by risky sexual behaviour under the influence of 
drugs or as a direct result of sharing infected needles.

Even the most extreme anti-drug hawk, then, might be able to understand why 
so many well-meaning officials and social workers would raise the white 
flag with policies like government-sponsored drug shooting galleries.

Supporters of these legal injection rooms constantly remind us of the 
"great Swiss example." Swiss government-funded scientists hailed their 
heroin maintenance project a success since it concluded that addicts 
experienced "improvements in health and well-being" and less criminal 
behaviour. This single review of the Swiss trials has been showcased 
worldwide as a success of government-sanctioned drug maintenance.

But independent evaluations of the program have been less than sanguine. 
One of those evaluations -- the official line from the United Nations -- 
chided the study on the basis of its shoddy design and poorly drawn 
conclusions. The World Health Organization concluded that the Swiss studies 
"have not provided convincing evidence that . . . the medical prescription 
of heroin generally leads to better outcomes."

Science tells us that heroin maintenance is a sloppy alternative to drug 
treatment strategies like methadone and buprenorphine. Common sense and 
compassion dictate that, no matter how difficult, uneasy, or uncomfortable, 
we cannot hide sufferers of addiction in a drug den on the outskirts of 
town -- we must confront their disease.

It is astonishing that we must perpetually remind ourselves that 
drug-taking behaviour can be changed when thousands of people in recovery 
today are living examples of this truth.

So, what is a country or city to do? A lot.

When Sweden found in 1985 that HIV prevalence was more than 50 per cent in 
its capital city, it established a comprehensive approach of HIV testing 
and methadone maintenance treatment coupled with hospital units, drug 
education and counselling for drug users with infectious diseases.

The result? HIV among injection drug users in that city stands today at 
five percent. Drug use there is the lowest in Europe.

Evidence from elsewhere suggests that when the criminal justice system and 
public health community work together (in the form of specialized "drug 
courts," for example), our problems get smaller.

Meanwhile, some officials in this city still respond to this social and 
biological disease by prolonging it. HIV and Hepatitis C rates continue to 
soar; Vancouver's overdose rate is the highest in Canada. One Vancouver 
police drug squad inspector, Mark Horsley, recently said that Vancouver is 
the "warehouse distribution centre of drugs in Canada."

Cross-country comparisons are problematic, but giving in to harmful 
behaviour by supporting drug use gets us nowhere. So-called "harm 
reduction" measures, no matter how well-intentioned, fail to stop drug use 
and redirect drug addicts. Instead, these policies accept the inevitability 
of addiction when we know this disease can be prevented or at least treated.

Reducing total harm, on the other hand, must begin by cutting drug use.

Rejecting heroin maintenance doesn't mean that restrictive drug policies, 
such as those sanctioned and supported by the UN and U.S., are our magic 
bullet. They have implementation and effectiveness problems of their own. 
But our overarching goal should always be to reduce total harm and to make 
our drug policies work better within that context of reducing drug use.

As elementary as it sounds, it seems that some people still need to be 
reminded that the problem with drug use is drug use.

A so-called "harm reduction" policy is essentially flawed because it has at 
its core narrow goals that deny the complex social, legal and biological 
context of drug use and addiction.

Reducing total harm, then -- to one's self, community, and society, users 
and non-users -- must be the true goal of prevention and treatment 
providers who understand that drug abuse is a treatable, yet fundamentally 
preventable, disease of the brain and body.

It is inhumane to perpetuate this disease when history and science tell us 
that it can be prevented and its attendant consequences reduced, if not 
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MAP posted-by: Beth