Pubdate: Fri, 08 Apr 2005
Source: Ottawa Citizen (CN ON)
Copyright: 2005 The Ottawa Citizen
Author: David Reevely
Note: David Reevely is a member of the Citizen's editorial board.
Bookmark: (Harm Reduction)


No serious drug addict has ever decided not to shoot up, smoke, pop or 
snort because he wasn't sure of the purity of his drugs or the cleanliness 
of his gear.

That's the assumption built into the City of Ottawa program that's handing 
out clean kits for the consumption of crack cocaine -- the same thinking 
underlies publicly funded needle-exchange programs and the safe-injection 
site experiment that's working so well in Vancouver that Toronto is 
considering following suit.

It's possible that all the epidemiologists and drug-abuse experts have lost 
their minds, and convinced a lot of politicians, from Vancouver's 
ex-Mountie mayor to prohibitionist Sweden's drug czar, to follow them in 
their madness. Or maybe they're onto something.

The idea is to maintain the goal of getting people off drugs, which are bad 
for addicts and those around them, while acknowledging that it's possible 
to lessen the harm drug use can do -- to make sure that drug users don't 
pose threats to anybody but themselves.

For the record, Canadian and U.S. health authorities agree, after years of 
study, that needle exchanges don't promote drug use and they do cut the 
transmission of diseases.

If someone's going to inject heroin no matter what (as good a definition of 
an addict as any) it's better for him to use a sterile, sharp needle than a 
dull one rinsed out with puddle water.

More to the point, it's better for the rest of us. Using a dirty needle is 
one of the best ways we know to get HIV and hepatitis C. Do that and bang! 
- -- you're the health system's $100,000 problem. Spread it to another drug 
user and the taxpayer's on the hook for another $100,000. That's about a 
dozen knee replacements, at average costs, or nearly a million clean 
needles. Some estimates put the total social cost of one AIDS case as high 
as $500,000.

Diseases spread beyond circles of addicts, too -- to secret users' 
unknowing sex partners, to prostitutes' johns and their families, to police 
officers who get stuck during arrests.

Needle exchanges also provide health professionals with "points of contact" 
with addicts who otherwise might spend their whole lives in a netherworld 
of using and finding money to score and use again. A study centred on the 
Vancouver safe-injection site has shown that drug users there have been 
influenced by nurses' advice to follow safer practices even when they're 
shooting up on their own.

The case for needle-exchange programs and safe injection sites is clear and 
convincing. The case for distributing clean crack pipes is, admittedly, not 
as strong.

For one thing, the health threat from dirty pipes isn't as frightening as 
that from dirty needles. Anyone re-using a syringe injects a tiny amount of 
blood from the last user right into his veins. The danger with a shared 
crack pipe is more distant: germs can spread from one addict's burned, 
split lips to another's, but not all crack users are in shape that bad.

Crack use also tends to be accompanied by more harmful behaviour that clean 
kits can do nothing about. Heavy crack users need a lot more of their drug 
than heavy heroin users do of theirs, which means they're more likely to do 
things like resort to prostitution to fund their addictions. A clean-pipe 
program reduces their risks, but trivially.

And, done badly, such a program could bring other problems. The money's not 
a big issue (Ottawa's medical officer of health, Dr. Robert Cushman, 
estimates the annual cost at $2,500), but just as discarded needles are a 
threat to public safety, so are broken, cast-aside crack pipes. If the city 
gives them out, it must pick them up, too. Like needles, the clean-pipe 
kits should be available widely, through multiple channels, to keep any one 
spot from drawing in addicts who otherwise wouldn't be there and reduce the 
risk of creating new hotspots for predatory dealers.

Some, like my colleague Patrick Dare and Ottawa's police chief, Vince 
Bevan, say a clean-pipe program uses tax money to subsidize (and therefore 
encourage) drug use.

That can only be true if you believe addicts won't use if they can't find 
clean needles and pipes, which is patently false. It's also an argument for 
drug-testing people before they can eat in soup kitchens: if homeless 
addicts had to buy their own meals, maybe they'd make rational choices 
between eating and using.

But we're not dealing with rational behaviour. We're dealing with people 
just functional enough to stay out of jail, but in thrall enough to 
addiction to pose life-threatening, and staggeringly expensive, risks to 
themselves and people around them. The responsible, decent, sound thing to 
do, for addicts and taxpayers alike, is reduce the risk and increase 
treatment programs' chances of helping them before it's too late.
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MAP posted-by: Jay Bergstrom