Pubdate: Thu, 16 Jun 2016
Source: Globe and Mail (Canada)
Page: S2
Copyright: 2016 The Globe and Mail Company
Author: Andrea Woo


Committee Tries to Understand Supervised Clinic Concept As Crosstown 
Clinic Physician Testifies to Its Efficacy

Members of a U.S. Senate committee looking to confront drug abuse 
struggled with the concept of prescription heroin and raised concerns 
about supervised-injection sites increasing crime as they heard 
testimony on Wednesday from a B.C. doctor who helped lead one of the 
most radical interventions in North America.

Scott MacDonald, physician lead at Providence Health Care's Crosstown 
Clinic in Vancouver's Downtown Eastside, testified before the U.S. 
Senate Committee on Homeland Security and Governmental Affairs at a 
hearing in Washington titled "America's Insatiable Demand for Drugs: 
Examining Alternative Approaches." He was one of four experts invited 
to speak, and the only one from outside the United States.

Dr. MacDonald spoke of clinical trials conducted at the Crosstown 
Clinic on prescription heroin treatment, which involves giving 
pharmaceutical-grade heroin to people who are severely addicted to 
inject in a medical setting under the supervision of doctors. This 
keeps them from using potentially contaminated street heroin, reduces 
their risk of blood-borne illnesses, reduces their rate of criminal 
activities and has them interacting with physicians every day.

Senator Ron Johnson, chair of the committee, appeared to struggle 
with the concept, asking what the difference is between the 
prescription heroin offered at the clinic and "natural heroin," 
likely referring to street heroin.

"So we have one form of heroin that's produced artificially, that's 
basically identical to heroin, and that one's legally - because it's 
medically controlled ..." Mr. Johnson said as he attempted to work 
through the concept.

Like Canada, the United States is in the grip of an opioid crisis 
fuelled by the abuse of prescription drugs, heroin and the surge of 
illicit fentanyl on the black market. In 2014, more than 47,000 
people died of drug overdoses in the United States, due mostly to 
opioid pain relievers and heroin, according to the U.S. Centers for 
Disease Control and Prevention.

Mr. Johnson also asked Dr. MacDonald about the location of the 
Crosstown Clinic, along with Vancouver's two supervised injection 
sites. Vancouver's largest and oldest supervised-injection site, 
Insite, was the first of its kind in North America, and the United 
States has no similar facilities.

"Your injectable sites: Have they been magnets for drug dealers and 
crime and that type of thing?" he asked.

"There has been no increase in social instability around the 
clinics," the physician replied. "They stabilize. There's been no 
'honeypot effect,' where people come from other jurisdictions to seek 
the treatment."

"Was there resistance by the neighbourhoods in terms of establishing 
those sites?" Mr. Johnson inquired.

"With our first study ... yes, there was," Dr. MacDonald said, 
referring to the Crosstown Clinic. "But having seen the success and 
the benefits both to the individuals and to the community, I think 
those have fallen away now."

Senator Rob Portman asked about success rates.

"How many severe heroin addicts were able to return to work or 
school?" he asked.

Dr. MacDonald said about 5 per cent had returned to work, but that he 
was hopeful the figure would grow as the two-year-old program continued.

The other three speakers were Ethan Nadelmann, executive director of 
the Drug Policy Alliance; David W. Murray, senior fellow at the 
Hudson Institute; and Frederick Ryan, chief of police in Arlington, Mass.

Dr. Murray, who previously was chief scientist and associate director 
of supply reduction in the White House Office of National Drug 
Control Policy, said he was not convinced about harm reduction 
outcomes, including those of heroin-assisted treatment and supervised 
consumption sites.

"The true task of any good public policy, it seems to me, must meet 
two criteria: It must be effective - and the case is not made, when 
you look at the literature, that these things are effective as 
advertised ... and the second criterion is it must be humane," he said.

"I would say ... that for the government to step into the role of 
officially providing addictive heroin to its citizens so transforms 
the relationship of the citizen to the government that we should fear it."
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MAP posted-by: Jay Bergstrom