NEEDLES AND THE DAMAGE DONE

As the Conservatives Pursue a Drug Policy Eschewing Harm Reduction,
Provinces Are Moving the Other Way

Long before Edmonton got its first needle-exchange program in the
1980s, a group called the Non-Beverage Alcohol Coalition lobbied for
inner-city liquor stores to open longer hours and against merchants
who knowingly sold cans of Listerine and Chinese cooking oil for the
purpose of intoxication.

The idea behind their efforts was part of a movement dubbed harm
reduction that has been part of the fight against addiction and
substance abuse for decades, spawning such controversial phenomena as
free crack paraphernalia in Ottawa, wine for the homeless in Toronto
and, most notably, supervised drug-injection sites in Vancouver's
notorious Downtown Eastside.

"We had store owners in the city of Edmonton who were selling Lysol
to aboriginal people with a nail so they could puncture the can and
get the alcohol and making a lot of money doing it," recalled Hope
Hunter, the executive director of the Boyle Street Community Health
Services, which for 37 years has operated programs for sex trade
workers and drug addicts in a low-income swath of the Alberta
capital. "A harm-reduction approach says, 'I'm not trying to stop you
from drinking. I'm trying to make sure what you're drinking is safe.' "

This philosophy has become the orthodoxy among front-line outreach
workers who say it saves lives and prevents the spread of disease,
but is decried by critics, including a drug-enforcement agency
connected to the United Nations, as enabling addicts to continue
their dangerous lifestyles in violation of the law.

Harm reduction plays no part in the Conservative government's new
$64-million National Anti-Drug Strategy, which sets aside money for
prevention campaigns, law enforcement and treatment, and would
institute mandatory minimum sentences for traffickers, producers and
dealers who sell to young people.

But even as the federal government pursues a get-tough approach, some
of Canada's biggest cities and many provinces are moving to the
opposite extreme.

This week in Toronto, Mayor David Miller gave the opening address at
a conference of social-service agencies, community groups and even
some addicts, where the consensus was that prohibiting drugs makes
the trade more lucrative, stiffer sentences punish the sick and the
best way to reduce crime around substance abuse is to give junkies a
safe place to smoke and shoot up.

"We know from research around the world that harm-reduction programs
work," Mr. Miller said at the event in council chambers.

The City of Toronto offers three harm-reduction programs. Since 1989
it has distributed clean needles to intravenous-drug users and since
2006, it has handed out "safer crack kits" to crack-cocaine smokers
- -- which include glass stems, mouthpieces and metal screens to keep
users from burning or cutting their lips. Wine is also provided to
the homeless at Seaton House, a city-run men's shelter.

Such programs continue to run despite the federal government's
opposition, funded by various other levels of government where they
find sympathy.

The City of Ottawa began distributing "safer inhalation kits" for
crack users in 2005, but when council revoked its support last year,
the province rescued the program, which continues through the
Centretown Community Health Centre.

If there is a showdown looming between those who view harm reduction
as non-judgmental realism and those who see it as condoning crime, it
is likely to be over Insite, the supervised injection site in
Vancouver's Downtown Eastside.

Run by the Vancouver Coastal Health Authority as a pilot project
since 2003, the program is funded by the city and the province, but
the federal government holds the licence.

Insite has more than 7,000 registered users and an average of 600
individuals a day stop in to get high -- 12% on morphine, 27% on
cocaine and a staggering 40% on heroine -- under the watchful eye of
public health nurses. As of 2006, there were 453 overdoses but no
fatalities and more than 4,000 junkies were referred for counselling.

The UN's International Narcotics Control Board disapproves of Insite
for violating anti-drug conventions. A leaked report in 2006 from the
RCMP's Drugs and Organized Crime Awareness program criticized the
project for encouraging injection-drug use. The Conservative
government threatened to pull Insite's licence and, after a battle
last year, it extended the permit, but only until June.

Supporters, such as Senator Larry Campbell, a former Vancouver mayor,
have personally vowed to keep Insite open if the federal government
tries to shut it down -- "even if they arrest me," he said in a phone
interview this week.

"I'm not going to stand by and watch citizens die and our disease
rates go up because we have a bunch of dinosaurs for a prime minister
and a government," he said.

Despite the support of front-line experts, residents in most
communities remain unconvinced of the merits of programs that provide
addicts with the tools and space to feed their high-risk habits.

The distribution of crack-pipe supplies had to be suspended in
Nanaimo, B.C., recently after a public outcry to allow for proper
consultation with the local community, including the mayor and city council.

A needle exchange in Victoria will have to go mobile after complaints
that a brand new downtown facility where it was to be housed with
other programs was too close to a private school.

Richard Stanwick, the chief medical officer for the Vancouver Island
Health Authority, said that harm-reduction strategies don't just
protect the drug-users from HIV, Hepatitis C and abscesses, they also
prevent the outbreak of diseases that can spread to the rest of the
population, like tuberculosis and drug-resistant bacteria, as well as
reduce costly hospital stays for infected heart valves and
complications that come from contaminated or makeshift supplies.

"The real art of public health now," he said, "is going to be finding
ways to ensure that these programs are implemented in a fashion that
benefit the population we're targeting but at the same time addresses
the concerns of the broad population about where and how these
programs are going to be delivered."

At the Toronto symposium, Anna Costa said she wants to be
compassionate, but she witnesses drug deals from her balcony in a
neighbourhood east of downtown and has repeatedly had to eject people
who use her store bathroom to smoke rock.

"I'm 30 years old. Education and harm prevention has existed since I
was born and it doesn't feel like anything more than lip service,"
said the frustrated business owner. "I hear about problem after
problem. One thing I didn't hear here are solutions."