SAFE-INJECTION SITES SHOULDN'T BE FIRST PRIORITY

If we had an unlimited supply of money, safe fixing sites would have little
opposition (Federal panel considers safe-injection sites for addicts, Oct.
5). Who would argue against having a nice, comfortable, fully staffed
facility for people to inject their drugs? But the reality is that money is
limited and we do need to look at priorities.

Those in public health who are proposing these sites would like to put
Vancouver on the leading edge of harm reduction. Those of us who actually
treat addiction understand that there are three other components to
addressing addiction: enforcement, prevention and treatment. Instead of
more harm reduction we would like to see that money directed toward raising
us up to even a mediocre level of treatment services, let alone "leading
edge". Vancouver has been on the leading edge of harm-reduction services
before. During the late '80s and early '90s we had the first and largest
needle exchange in North America (still the largest), yet that failed to
prevent in 1996-97 what became the highest rate of HIV infection among drug
addicts in the developed world. Do we really need more harm-reduction
services before additional treatment and prevention services?

I currently treat about 200 injection drug addicts, most of whom are, or
have been, severely addicted. Currently our most effective treatment
intervention is methadone treatment for the heroin part of their addiction,
coupled with a first-stage recovery house that gets them out of the
downtown open drug scene where they can begin working on the cocaine
addiction and psychological issues. Only one six-bed first-stage recovery
house is currently funded. The rest of the first-stage recovery houses we
use lack funding for food, counsellors, or staff to be present after
business hours. The addict on the street is left with choosing between
numerous well-funded drug-tolerant residential hotels downtown with a
myriad of well-intentioned outreach nurses, street workers, and drop-in
centres, (all under the flag of harm reduction) or a spartan, under-funded
and over-stressed treatment system.

It would be refreshing to see a comparison of European and Canadian
addiction treatment and prevention approaches with a subsequent call to
action, rather than the headline-grabbing comparison of harm reduction
approaches. Who knows -- there might be some who see the dramatic
differences in the addiction scene between Europe and Canada a result of
factors other than harm reduction.

Dr. Stanley de Vlaming
Head of Division of Addiction Medicine
Department of Family Practice
St. Paul's Hospital