Pubdate: Sat, 15 Sep 2007
Source: National Review of Medicine, The (Canada)
Copyright: 2007 Parkhurst Publishing
Author: Sam Solomon, National Review of Medicine
Bookmark: (Cannabis - Canada)
Bookmark: (Harm Reduction)
Bookmark: (Safe Injecting Rooms)
Bookmark: (Treatment)


Minister's Mind Made Up On Safe Injection Site, Warn Experts

Doctors are failing to warn young Canadians about the dangers of
illicit drug use. Oh, and harm reduction's a sham.

Those were the messages from federal health minister Tony Clement to
doctors at the CMA's annual meeting on August 20. Many healthcare
observers say this is a taste of what we can expect to see in his
national drug strategy, details of which are to be announced this
fall. Disappointment and despair are the chief reactions to his
hardline stance on substance abuse policy from many expert physicians,
researchers and policy makers across the country.

"This is going to be catastrophic for people who have substance abuse
problems, for society, for taxpayers, for crime," says Dr Keith
Martin, a Liberal MP from BC and former substance-abuse physician, who
was at Mr Clement's speech.

Disdain for the government's harm-reduction denialism has been swift
and fierce. Over 130 physicians and scientists signed a petition
released the day after Mr Clement's speech, condemning the
government's "potentially deadly" misrepresentation of the
overwhelmingly positive evidence for harm reduction programs including
Vancouver's Insite safe-injection site, where nurses provide addicts
with clean needles and a safe place to use drugs. Among those who
signed the petition are 2006 International AIDS Conference co-chair Dr
Mark Wainberg, Montreal public health director Dr Richard Lessard and
Dr Robert Brunham of the BC Centre for Disease Control. Doctors and
scientists from nearly every major university in Canada put pen to

The petition endorses a commentary written by Dr Stephen Hwang, of
Toronto's Centre for Research on Inner City Health, in Open Medicine
which condemns the government's handling of the Insite case. "The
current federal government has philosophical objections to harm
reduction initiatives," says Dr Hwang. "They're trying to obscure the
evidence by saying the research on Insite is not clear."

In fact, the evidence is uniformly supportive of Insite. Twenty-four
studies published in journals such as the NEJM, The Lancet, the BMJ
and the CMAJ have proven that to be the case. Zero have found it to be
either unsafe or ineffective.


But with the December 31, 2007 deadline for the renewal of Insite's
federal exemption to allow it to operate fast approaching, Mr Clement
continues to insist that the science isn't clearly in favour of
Insite. At the CMA meeting, he said: "Harm reduction, in a sense,
takes many forms. To me, prevention is harm reduction. Treatment is
harm reduction. Enforcement is harm reduction." Those comments, among
others, worried Dr Isra Levy, of the National Speciality Society for
Community Medicine. In a CMA release, Dr Levy said there's growing
concern about the government's support for stricter legal enforcement
instead of a comprehensive approach including harm reduction

Stephen Harper's attitude about how society should treat drug addicts
was outlined in a 2003 essay he wrote about the Left called
"Rediscovering the Right Agenda," published in Report magazine:

"This descent into nihilism... leads to silliness such as moral
neutrality on the use of marijuana or harder drugs mixed with its
random moral crusades on tobacco. It explains the lack of moral
censure on personal foibles of all kinds, extenuating even criminal
behaviour with moral outrage at bourgeois society, which is then
tangentially blamed for deviant behaviour."

Dr Martin says Mr Harper's position on substance abuse was the reason
he opted not to join the newly formed Conservative Party, though he
had been a member of the Canadian Alliance. "I suspect they see
[substance abuse] as some kind of personal weakness - that people have
a choice," says Dr Martin.


Health Canada continues to repeat that more research is needed on
Insite to determine how safe-injection sites affect crime, prevention
and treatment.

But extensive research has shown Insite is successful at reducing
crime and overdoses, getting addicts into treatment and saving money.

Asked what research Mr Clement still needs to see in order to make his
decision, Erik Waddell, a spokesman for Mr Clement, answers, "To see
if Insite is getting people to programs to help them get off drugs."
However, the NEJM study, published June 9, 2006, concluded that Insite
increased admissions into detoxification programs and addiction
treatment. Just four months later, Mr Clement said in a release,
"Right now the only thing the research to date has proven conclusively
is drug addicts need more help to get off drugs."

At the CMA meeting in August, he repeated his assertion: "There has
been more research done, and some of it has been questioning of the
research that has already taken place and questioning of the
methodology of those associated with Insite." When asked to clarify
what evidence Mr Clement was referring to, Mr Waddell confirmed it was
a commentary published in January 2007 in a non-peer-reviewed journal
called The Journal of Global Drug Policy and Practice, which receives
funding from the US Department of Justice.

The piece, written by Colin Mangham, PhD, argues that the studies
carried out by researchers from the BC Centre for Excellence in
HIV/AIDS and elsewhere have been flawed and misleading. (See "Harper's
new Anti-Drug Strategy is not anti-HIV" on page 16 to read the opinion
of the Centre of Excellence researchers.) Questions about the
article's trustworthiness have arisen. Dr Mangham is the president of
the Drug Prevention Network of Canada, an organization run by former
Conservative MP Randy White, and has previously written commentaries
criticizing the philosophy of harm reduction. In response to questions
about the Ministry of Health's opinion on allegations of the article's
bias, Mr Waddell says only, "We are going to take all research into
account when we make our decision."


Although Mr Waddell insists Insite's future has not yet been decided,
Dr Martin believes the debate is all but over: "I think, given Mr
Clement's comments, they are not going to renew it. And that should be
worrying to Canadians."

A legal challenge was launched just a few days before Mr Clement's
speech to try to wrest control of Insite from the federal government.
Filed by drug addicts Shelly Tomic and Dean Wilson and the Portland
Hotel Society, Insite's operator, on August 17, the suit alleges that
closing Insite would violate addicts' Charter rights to security of
the person and harm their physical and mental health.

Another legal hurdle is the fact that Canada is a signatory to the
1961 Single Convention on Narcotic Drugs, which limits nations'
ability to give drugs except for medical or scientific purposes. A
loophole in the treaty allows the project to remain open because it is
still classified as a scientific study. Dr Martin says Canada must
push other nations to amend the treaty.


Dr Hwang says researchers and physicians must speak out more
forcefully when science is being undermined by politics and ideology,
as he believes is the case with Insite. "We have an obligation to not
just seek scientific evidence or investigate problems but also to
ensure that the best evidence is honestly and fairly presented to the
public," he says.

Unfortunately, he says, the CMA is not doing its part in that regard.
"It's critical as physicians to ensure our professional organizations
and lobby groups represent the good of the public as their primary
objective," he says, "not only the welfare of physicians."
- ---
MAP posted-by: Derek