Pubdate: 05 Nov 2011 Source: National Post (Canada) Contact: http://drugsense.org/url/wEtbT4yU Copyright: 2011 Canwest Publishing Inc. Website: http://www.nationalpost.com/ Details: http://www.mapinc.org/media/286 Author: Natalie Alcoba, National Post ABOVE ALL, DO NO HARM There was a point in Frank's life, after numerous rides on the merry-goround of painful sports injuries, powerful pain killers and gruelling withdrawal, that he was ready to surrender to his addiction. Then four years ago he walked into the Toronto Public Health needle exchange office known as "The Works" and made the connections that helped him turn a new leaf. He tapered off OxyContin once and for all, started working as a health outreach worker, and now carries the latest "tool" in the city's drug strategy arsenal with him where ever he goes. For about two months, public health has been handing out special kits in eyeglass-like cases that contain two doses of naloxone, a drug that can stop an opiate or opioid (one is natural, one is synthetic) overdose because it knocks it off the brain receptors. So far, about 75 kits are in the hands of current or former drug users who have been trained on how to identify an overdose from substances such as heroin, OxyContin and morphine, and how to react. "How would you feel if it was your brother, or your mother, or your child, who had made a couple of wrong decisions in their life or had taken more medication than they thought they needed to take and then all of a sudden they collapsed on the street in respiratory arrest?" asked Frank, a lanky healthcare worker, while seated in a modest meeting room at The Works this week. "You got to keep the patient alive before you can treat the disorder." While proponents hail it as a life saver, critics group it in with other harm reduction strategies they contend feed, rather than quash, the addiction. Harm reduction is indeed a cornerstone of efforts to deal with drug use in Toronto; public health has been handing out clean needles to heroin users and pipes to crack addicts for years at its glass-encased Works office at Victoria Street, north of Dundas, and through 36 other agencies. "We recognize some people are going to continue using drugs despite all the prevention efforts, so we are providing them with the tools to prevent disease transmission," said Shaun Hopkins, who runs the needle exchange program at Toronto Public Health. She says the naloxone kit has been well received, but another raucous harm reduction debate may be just around the corner. Toronto researchers will release a study next year that may suggest the city consider opening a place where addicts can shoot heroin or smoke crack under the supervision of trained staff, similar to Vancouver's controversial Insite, in the Downtown Eastside neighbourhood. Mayor Rob Ford has said publicly he does not support such approaches. And others agree. "We're in favour of helping [drug users], not killing them, to be frank with you," said Gwen Landolt, president of the Drug Prevention Network of Canada and vice-president of REAL Women, both groups that advocate for an abstinence-based drug policy. DPNC wants more money to be spent on treatment programs, not programs Ms. Landolt believes exacerbate the dependence. "It doesn't seem to solve any of the problems. If you're a professional, an airline pi-lot, you'll get treatment. If you're a poor drug addict shuffling along the street, they just push you in the injection site to get more of the same," said Ms. Landolt, a lawyer who is Toronto-based. She believes that drug courts, of which Toronto has one, are the best way to deal with addicts. The addict is charged and presented with an option: treatment or incarceration. "It does open a window of opportunity," she said. In 2008, while attending the XVII International AIDS Conference, then health minister Tony Clement called Insite an "abomination," adding that "allowing and or encouraging people to inject heroin into their veins is not harm reduction ... we believe it is a form of harm addition." The Supreme Court of Canada recently ruled that Insite should remain open. Holly Kramer, co-ordinator of the Toronto Harm Reduction Task Force, sees a supervised injection site as another way of doing the same thing that a needle exchange program offers. Just like crack pipe kits are a way for health workers to reach marginalized folks, a centre like Insite acts "like a carrot," hooking people up with services they would not have otherwise sought, she argues. But she recognizes the concept remains controversial, and is likely to spur opposition from residents if it is ever proposed in Toronto. A proposal to set up a methadone clinic in Cabbagetown was recently scrapped after neighbours reportedly raised strong objections to a project they feared could increase crime and decrease property values. As for the anti-overdose kits, Edmonton has been offering them since 2005 and several cities in the United States also offer them, such as New York, Boston and San Francisco. In Toronto, the naloxone kits have stopped overdoses in four instances so far, say officials. Out in his west-end neighbourhood of Parkdale, Frank, who is limping these days from an old cycling injury, is ready to plunge a syringe with the antidote into a muscle if the situation calls for it. He reasons that the health-care system saves money by helping a drug user before the person makes it to the emergency room. Each naloxone kit costs about $21. "I hope I never have to use it, but I'm quite prepared to," he said. "Harm reduction is all about keeping people alive, keeping them healthy, and then at some point hopefully they will see that this is not working for them, that this is not a good lifestyle choice." - --- MAP posted-by: Richard R Smith Jr.