THE CASE OF THE MISSING EVIDENCE

If The Federal Government Is Really Waiting For All The Science To Be
In Before Making Drug Policy, It Will Be Waiting A Long Time

Health minister Tony Clement insists the government's only concern is
sound public policy. Does Insite really work? That's all Mr. Clement
cares about. If so, the government will allow the Vancouver
drug-injection facility to stay open. If not, Insite will have to
close when its federal exemption runs out on June 30.

One thing that will not be a factor in the decision, Mr. Clement says,
is politics. Not one bit. Science and evidence will settle it.

Some question Mr. Clement's sincerity.

After all, 22 studies examining various facets of Insite's operations
have passed the rigorous peer-review process and been published in
prestigious scientific journals. Every one of those studies reported
positive results. And recently, in the International Journal of Drug
Policy, researchers from the British Columbia Centre for Excellence in
HIV/AIDS argued that after the government reluctantly granted a
temporary extension of Insite's exemption, it had strangled the
production of research -- by requiring researchers to agree not to
publish any results until after the exemption had expired. The UBC
researcher felt this was unethical and refused to co-operate.

"Taking the facts as presented," wrote Robert MacCoun and Peter
Reuter, respected American policy experts, in the same journal, "a
well-executed piece of policy research on a promising innovation was
discontinued for unstated but blatant political reasons."

But who am I to doubt Tony Clement? He's one of the brighter lights in
Stephen Harper's cabinet, and, as Ontario's minister of health, he
handled the SARS crisis admirably. Besides, drug policy is a matter of
life and death. To put politics ahead of evidence in making a decision
like this, a politician would have to be callous and ruthless.

I'll assume Mr. Clement is better than that. He wouldn't put politics
ahead of lives. The fact that he has balked at declaring Insite a
success despite having those 22 peer-reviewed studies on his desk is
easily explained: He simply has very demanding evidentiary standards.

That's a good thing. All politicians should.

But I've got terrible news for Mr. Clement, Mr. Harper, and all
leaders who base their decisions solely on high-quality scientific
evidence: Almost every element of Canada's approach to illicit drugs
is unsupported by scientific evidence.

Forget Insite and all the other harm reduction programs such as needle
exchanges. They may get all the attention, but they're actually very
minor in the big scheme. They cost peanuts. And they don't change the
underlying approach to dealing with drugs one iota.

That underlying approach is where the real resources
go.

First, there's prevention and treatment. A reasonable person could
argue both are underfunded. And yet both get far more money than harm
reduction and both are far more important to Canadian drug policy.

Then there's law enforcement. It's an elephant among poodles. A few
years ago, the auditor general guesstimated that 90 per cent of all
the money spent on the illicit drug problem by Canadian governments
goes to law enforcement. That figure is probably a little lower today
but there's no question that the lion's share of funding goes to cops,
courts and jails.

Harm reduction is fairly new -- to Canada, at least -- but not
prevention, treatment, and law enforcement. In one form or another,
prevention and treatment have been widely used for many decades. And
law enforcement dates back to the criminalization of alcohol and other
drugs early in the last century.

Given how long these policies have been kicking around, one might
think there's plenty of research on all three. But one would be wrong.

In a 2006 paper published in the journal Addiction, the aforementioned
Peter Reuter -- a professor at the University of Maryland whose work
is respected by all sides in the drug debate -- surveyed the
scientific literature. His results?

"Many studies have found treatment to have large effects on
individuals' consumption and harms," he wrote. "However, there is an
absence of evidence that even relatively well funded treatment systems
have much reduced the number of people in a nation who engage in
problematic drug use."

Oh dear. And prevention? "The scientific literature shows useful and
modest effects at the individual level but there is little support for
substantial aggregate effects."

How unfortunate. But what about the policy that dominates Canada's
approach to drugs? "For enforcement, research has almost uniformly
failed to show that intensified policing or sanctions have reduced
either drug prevalence or drug-related harm. Nor -- outside of the
U.K. -- is there more than a modest effort to improve the evidence
base for making decisions about the appropriate level of enforcement
of drug prohibitions."

Reuter is hardly alone in his assessment. In 2001, a committee of the
U.S. National Academy of Sciences -- the world's premier scientific
institution -- issued a report examining the state of the evidence on
drug policy. In a phrase, the committee said there's very little.
Evidence, that is.

"The nation possesses little information about the effectiveness of
current drug policy, especially of drug law enforcement," the report
concluded. "The central problem is a woeful lack of investment in
programs of data collection and empirical research that would enable
evaluation of the nation's investment in drug law enforcement."

Incidentally, the state of research is actually worse in Canada than
in the U.S. The federal government doesn't even know how much money it
spends on drug policy -- which is why the auditor general had to
guesstimate.

One might think that the police -- who are in the evidence-gathering
business, after all -- would be bothered by the paltry evidence in
support of prevention, treatment and law enforcement. But again, one
would be wrong.

A spokesperson for the Ontario Association of Chiefs of Police said
his organization is opposed to Insite. "We believe this isn't the way
to go," said Toronto Police Superintendent Ron Taverner. What the
chiefs want, naturally, is a stronger emphasis on prevention,
treatment, and enforcement.

And the Harper government agrees. Its drug strategy rejects harm
reduction and instead calls for greater efforts in prevention,
treatment, and enforcement.

Which is why I am sure the news I have delivered today will devastate
Tony Clement. Not even Insite's 22 peer-reviewed scientific studies
are enough to satisfy the minister's demanding evidentiary standards.
Imagine how he will feel when he learns that Insite is supported by
far stronger evidence than almost anything his government is doing
about drugs.

Why, he will be shocked senseless. When his aides bring him round with
smelling salts, shock will turn to outrage.

Imagine spending all that money and having no idea if it's doing what
it's supposed to! Where's the research? Where's the cost-benefit
analysis? This is unconscionable!

No doubt Mr. Clement will leap up and rush over to the prime
minister's office to share the awful news.

A wholesale review of drug policy will follow. And of course, there
will be new money for research -- so politicians will have something
other than politics and prejudice to guide their decisions about what
does and does not work.

Oh, and in the meantime, Insite will be permitted to keep operating.
After all, it would be unconscionable to close a facility supported by
evidence while continuing to pour vast sums into policies not
supported by evidence.

And as we have agreed, Mr. Clement is better than that.