Pubdate: Thu, 26 Apr 2007
Source: Globe and Mail (Canada)
Copyright: 2007, The Globe and Mail Company
Author: Andre Picard
Column: Health - Second Opinion


Since 1993, at least 2,500 people have died of drug overdoses on the
streets and in the fleabag hotels of Vancouver's Downtown Eastside.

That's three deaths a week from intravenous drug use in a tiny section
of one of the most beautiful and prosperous cities on Earth.

Three deaths a week in a community that numbers only about 9,000
hard-core IV drug users.

It is, by any standard, a shocking number.

It is, by any measure, a public health disaster.

Yet it could be so much worse, but for the work of a few dedicated,
hard-headed and sometimes visionary souls.

One of them is Donald MacPherson, the drug policy co-ordinator for the
City of Vancouver, who last week received a prestigious award from the
Kaiser Foundation.

The National Awards for Excellence in Reducing the Harm Associated
with Substance Abuse, though clumsily named, are nonetheless effective
in drawing attention to groundbreaking and innovative work in the
field of addictions.

Edgar Kaiser Jr., the multimillionaire philanthropist behind the
awards, has a rare talent for wooing the powerful to this unpopular

So there were James Bartleman, Lieutenant-Governor of Ontario; Monte
Kwinter, Ontario Minister of Community Safety and Correctional
Services; Toronto Mayor David Miller; Senator Larry Campbell; Richard
Evans, CEO of Alcan Inc.; and Wendy Slavin, a senior vice-president of

Also attending were various chiefs of police, government mandarins,
public health officers, counsellors, former drug addicts and former
convicts, all mingling, sharing and celebrating their small victories
during a fancy dinner at the swanky Four Seasons Hotel in Toronto.

In this crowd, Mr. MacPherson is a legend because he pioneered the
so-called four-pillar approach to dealing with drug problems.

Vancouver adopted the approach in 2001, becoming the first
municipality in Canada with a comprehensive drug policy.

In doing so, it abandoned the traditional law-and-order approach in
favour of a more effective strategy to the complex problem of drug use
and abuse.

Aspects of the policy, such as needle exchanges and safe-injection
sites, have garnered the most attention - good and bad - but the
policy is much more nuanced than its detractors (and even many of its
supporters) realize.

The four pillars are:


Promoting healthy families and communities; preventing and delaying
the start of substance abuse among young people through education.


Offering individuals access to services that help them come to terms
with problematic substance use, including counselling, detoxification
and other treatment programs, housing support and medical care.

Harm reduction

Reducing the spread of diseases, including hepatitis and HIV-AIDS, and
limiting overdoses by providing clean needles, safe-injection sites
and access to treatment.


Targeting organized crime, drug dealing and drug houses rather than
individual users; co-ordinating the work of police and that of
agencies that provide services.

It is, all and all, an approach brimming with common

However, lawmakers (with the exception of Vancouver City Council) have
been reluctant to implement all pillars.

Rather, there tends to be a misplaced enthusiasm for enforcement, even
though it has proven less than effective, largely because police waste
a lot of time and energy arresting individual drug users - individuals
so sick they are oblivious to the notion of deterrence.

As another of the Kaiser award recipients, Inspector Thomas Carrique
of Ontario's York Regional Police, said: "You can't always arrest your
way out of these situations."

Mr. MacPherson, as he is wont to do, put it more bluntly: "Bad public
policy kills."

In Canada's big cities, where heroin and crack cocaine are huge
problems, and in smaller centres, where abuse of methamphetamines is
soaring, a lot of people have died because of bad public policy.

But only Vancouver bothers to count the carnage.

The flip side of the equation, though, is that good public policy -
such as the four-pillar approach - can save lives.

Mr. MacPherson noted something that those who look down their noses at
street addicts rarely acknowledge: Where services are available, "in
most cases, it's a happy ending."

Yes, a lot of people die on the streets. Many more get sick, and do
horrible harm to themselves and others. But most addicts, even the
hardcore IV drug users, go straight.

Rather than give up on them, we need to give them a fighting chance
with harm-reduction initiatives including clean needles,
safe-injection sites, safe crack kits, and giving addicts free heroin.

To deal with a problem so bedevilling and so destructive, you have to
be bold. It may make people squeamish, but it's good public health

"Let's find, for God's sake, better ways, to deal with this problem,"
Mr. MacPherson said in his concluding remarks.

Better ways than simply stuffing junkies into body bags.
- ---
MAP posted-by: Steve Heath