BEYOND HARM REDUCTION

Let's Set Aside Ideology and Agree on Ways to Counter Drug Abuse

The use of illegal drugs is a serious health and social problem in
Canada. The economic burden of the problem - on health care, law
enforcement and productivity - was estimated to be $8.2-billion in
2002. Such a burden is most acutely felt in locations such as
Vancouver's Downtown Eastside where the use of illegal drugs is most
prevalent, and among certain populations such as those where risk of
blood-borne disease and injection-related infections is a constant concern.

Margaret Wente's recent series on drug policy demonstrated that "harm
reduction" has become a polarizing term. The debate is often based on
ideology, with opposing sides seeing harm reduction as either a way
to help drug users minimize associated harms, or as an approach that
encourages drug use through more liberal drug policy. In truth,
interventions such as needle exchange programs and supervised
injection facilities do not preclude abstinence-based programs or
interventions.

Vancouver's Insite facility is often cited as the flagship for harm
reduction in Canada and as evidence of either the success of this
approach or its failure, depending on your perspective. What's often
overlooked is that Insite is just one intervention with limited
capacity for impact in the greater context of social, health, mental
health, and economic concerns faced in that community. Insite should
be evaluated according to the objectives for which it was
established, not by its ability to resolve the socio-economic
difficulties faced by the neighbourhood.

Evaluations have been conducted not only by the B.C. Centre for
Excellence in HIV/AIDS, as discussed in Ms. Wente's first column, but
also by the federal government in a report by a panel of independent
experts who largely supported the centre's findings.

The evidence illustrates that no single intervention can be relied on
to address the broad spectrum of risks and harms associated with
substance use. What we need is a broad continuum of services and
supports that encompasses the abstinence-based programs highlighted
in Ms. Wente's final column as well as harm reduction programs such
as needle exchange and methadone maintenance. This continuum should
also connect the specialized addictions field to the full range of
sectors that are involved in dealing with substance use problems -
including primary health care, housing, corrections, and mental
health - in order to deal with contextual factors that may be present
such as mental health and homelessness.

Canada can learn a great deal from other countries' experiences, as
Ms. Wente showed. However, we need to be mindful of different social,
political and economic contexts. Sweden's collaborative approach, for
example, is, indeed, a best practice toward which Canada is working
through the National Treatment Strategy being prepared by a group of
more than 30 organizations from across the country. However,
implementing the mandatory treatment approach seen in Sweden without
first ensuring that adequate treatment services and resources are in
place would only push drug users away from, rather than toward,
access to the health and social supports needed to reduce use and
minimize harm.

Earlier this month, at a forum in Vienna, 300 delegates representing
non-governmental organizations from around the world reached
consensus on a historic declaration that defines harm reduction as
"efforts primarily to address and prevent the adverse health and
social consequences of illicit/harmful drug use, including reducing
HIV and other blood-borne infections." What is groundbreaking is not
only the fact that all agreed on this definition, but that they then
moved on to further consensus on resolutions to deal with substance
abuse that will be presented to the United Nations' Office on Drugs
and Crime, and Commission on Narcotic Drugs.

Perhaps those involved in Canada's debate on drug policy can look to
this example and agree to set ideology aside in favour of advancing
evidence-based programs, policies and interventions regardless of the
label applied to them, and to work together toward a common goal of
providing a comprehensive approach to substance use.