Pubdate: Wed, 01 Dec 1999
Source: Globe and Mail (Canada)
Copyright: 1999, The Globe and Mail Company
Contact:  http://www.globeandmail.ca/
Forum: http://forums.theglobeandmail.com/
Author: Ronda Bessner
Cited: http://www.aidslaw.ca/

LET'S INJECT SOME NEW THINKING

We've traditionally punished those who use illegal drugs. On World AIDS 
Day, a Toronto lawyer suggests a different course of action

Canada is in the midst of a public-health crisis. Since the AIDs epidemic 
began in the early 1980s, we have seen a steady climb in the number of HIV 
cases attributed to injection drug use. If we are going to deal with the 
spread of HIV, we must rethink the way we deal with those drug users.

In Canada, as in the United States, our approach to illicit drug use has 
focused on compelling abstinence. We take a punitive approach to people who 
consume illegal drugs. But it's not working. In fact, reliance on criminal 
sanctions is exacerbating rather than eradicating many of the problems 
associated with injection drug use.

By 1996, half of the new HIV infections in Canada were among injection-drug 
users. Studies in Vancouver, Montreal, Toronto, and Ottawa have shown that 
between 9 and 23 per cent of injection-drug users are HIV positive. The 
rise in the number of HIV infections is also evident in small towns and 
rural areas. Women, youths, aboriginal people and prisoners are 
particularly at risk.

It's easy to see why. Because drug users fear long prison terms they 
consume drugs by the quickest, most efficient way -- injection. People who 
share needles and other drug equipment expose themselves to a high risk of 
HIV and hepatitis C. The threat of criminal sanctions also pushes drug 
users to the margins of society. This makes it difficult for health 
officials to reach them with educational messages and to provide them with 
access to medical services and treatment programs.

Health-care providers may also be subject to criminal liability in their 
attempts to address drug use. Canada currently has more than 100 needle 
exchange programs (NEPs) which seek to reduce the transmission of 
blood-borne diseases such as HIV and hepatitis by providing injection drug 
users with sterile syringes and needles. However, nurses and other staff 
who work at NEPs and collect used needles which contain traces or residue 
of illegal drugs may be criminally prosecuted for possession under the 
Controlled Drugs and Substances Act.

There are other legal obstacles. Physicians who provide patients with 
illegal drugs to treat their addictions may also be charged with possession 
or trafficking. The maximum sentences for such offences range from six 
months to life imprisonment. In the mid 1990s the Canadian Medical 
Association testified at the Parliamentary hearings on the Controlled Drugs 
and Substances Act that doctors should be permitted to treat drug-dependent 
people with a greater number of options and without exposure to criminal 
liability.

In Canada, methadone is the only opioid approved for long-term treatment of 
drug dependence. Although methadone has many benefits, it is not 
appropriate treatment for multiple addictions nor for people dependent on 
cocaine, amphetamines or other non-opiate drugs. And it is intravenous use 
of cocaine that is one of the growing problems among drug users in British 
Columbia and Quebec.

Drugs other than methadone should be made available for treatment. In other 
countries -- Switzerland, Britain, Australia, and the Netherlands -- health 
workers have found that the prescription of heroin may achieve the same 
objectives as methadone: it can prevent the spread of HIV and hepatitis, 
reduce crime associated with drug use and improve the drug-user's overall 
health.

Canada has been reluctant to prescribe drugs other than methadone to 
drug-dependent persons. In addition the number of spots available for 
methadone treatment is very low compared to other western countries. 
Moreover these treatment centres are not well funded. Both drug users and 
doctors are constrained by a vast array of rules and regulations. Doctors 
are limited by the dosages of methadone that they can prescribe; drug-users 
are generally not eligible to participate in such programs until they can 
prove abstinence. Some programs even require that drug-users subject 
themselves to the humiliation of giving urine samples under observation.

Canada must reassess its current orientation to the problem of injection 
drug use and HIV/AIDS. Stakeholders must endorse a "harm reduction" 
approach which views drug dependence as a public health problem.  Such an 
approach reduces the likelihood that drug users will contract or spread HIV 
and other diseases. It lessens the possibility that they will overdose on 
drugs of unknown purity or potency. A public health approach tries to stem 
unsafe methods of injection, to decrease the rate of drug consumption, to 
reduce experimentation with drugs most likely to cause medical problems, 
and to help users to obtain treatment.

Such an approach, endorsed by Britain, the Netherlands, Australia, and 
Switzerland, gives drug users access to different models of treatment -- 
not only ones that require abstinence. They can find comprehensive needle 
exchange programs that also distribute condoms, provide counselling and 
mental and medical health services. By contrast, Canada often does not even 
offer HIV-positive drug-users a standard medical treatment for their 
illness -- antiretroviral treatment, also known as ART, which has been 
proven to reduce morbidity and mortality, and can significantly improve the 
health and quality of life for HIV-positive people.

Canada's legislators must reassess the laws in this country and develop an 
alternative approach to reduce the harms associated with drug use. In the 
mean time, many actions can be taken immediately within the existing legal 
framework.

Under the Controlled Drugs and Substances Act, the cabinet can change 
regulations with regard to the provision, possession, and administration of 
illegal substances. As well, the Minister of Health can exempt any person 
or illegal drug from the Act if the purpose is medical or scientific or in 
the public interest.

In addition provincial and territorial governments, pharmaceutical 
companies, and colleges of physicians and surgeons can effect change 
without waiting for new legislation.

The spread of HIV through needles is a urgent problem but one that can be 
successfully addressed.

Ronda Bessner, a Toronto lawyer, prepared the report Injection Drug Use and 
HIV/AIDS: Legal and Ethical Issues, released last week by the Canadian 
HIV/AIDS Legal Network.
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