THE SOLUTION IS ABSTINENCE

By Giving Drug Addicts a Sterile Syringe and a Warm Place to Shoot
Up, Are We Saving Lives or Condoning Substance Abuse?

Prevention, treatment, enforcement: These traditional policies were
announced in 2007 as the pillars that would uphold Canada's National
Anti-drug Strategy. Pointedly excluded from the government's plan is
the continued reliance on harm resistance, the philosophical darling
of liberal stakeholders in addiction management. Designed as a fourth
pillar to focus on public health and order rather than usage
reduction, harm reduction is defensible as a handmaid to a balanced
portfolio of approaches, supplementing treatment and prevention. But
in Vancouver, it has emerged in the last decade as a free-standing
pillar, now teetering under an unwieldy social burden it cannot sustain.

Harm reduction's social laboratory is the municipal quagmire of
Vancouver's Downtown Eastside. Here, the mentally ill, the culturally
uprooted and the psychologically dysfunctional appease their demons
in a squalid cycle of illicit-drug torpor and crime. Drug consumption
is high -- nearly a third of the 16,000 residents are addicts -- but
evidence of faith in the drug abuser's power to reclaim his portion
of the human estate is low. Funding allocations approved by a series
of mayors speak volumes about priorities. Money abounds for needles,
crack-pipe kits and opiate-giveaway trials, but extended waiting
lists for long-term rehabilitation centres attest to a scarcity of
available beds.

Insite -- the first public facility in North America where addicts
can legally inject illicit drugs under professional supervision --
started up in 2003. In keeping with harm reduction's non-judgemental
ideology, Insite's detox resources were made available only to those
who asked for them. It's just as well that few have done so, since
there are only 12 detox beds for several hundred daily inject ors.
And because they wouldn't have been using Insite, the neighbourhood's
5,000 crack-smoking addicts have been denied even that faint hope of
breaking the vicious cycle.

Harm reduction-friendly researchers claim success for Insite. But
observers of addicts in crisis demur: Dr. Stan de Vlaming, former
head of addiction services at Vancouver's St. Paul's Hospital-- the
main provider of hospital services to Downtown Eastside residents --
says, "The people who refer to Insite as a 'safe injection site' are
perpetuating a dangerous misunderstanding. There is nothing safe
about repeated daily injections that bypass a person's normal defence
systems." He notes that from 2002 -- one year prior to Insite's
inauguration -- to 2005, the number of hospital days utilized for
infectious complications directly attributable to injecting had
escalated from 16,042 to 18,848. Moreover, after evaluating the
most-cited harm reduction studies, Garth Davies, assistant professor
at Simon Fraser University's School of Criminology, also was
unconvinced. In his article A Critical Evaluation of the Effects of
Safe Injection Facilities, published in the Journal of Global Drug
Policy and Practice, Davies concluded that "all claims regarding the
benefits of harm reduction remain open to question."

Many people who find themselves up close and personal with addicts
- --law enforcers, judges, treatment professionals, ministering
volunteers -- see the human wreckage that human wreckage perpetuates.
Retired Vancouver policeman Al Arsenault patrolled the "chemical
gulag" of the Downtown Eastside for more than half of his 27 years on
the job. He calls Insite -- and the needle-exchange program, in
particular --an "abject and utter failure." If injectors were
responsible enough to return needles, he observes, they wouldn't be
in the Downtown Eastside. Ironically, the program has augmented the
presence of used needles in the area. Arsenault wryly sums up the
experiment: "The rich get treatment, the poor get harm reduction."

Pastor Gloria Kieler concurs. She has ministered to addicts since
1984 and deplores "the total disregard for those addicted persons
desperately wanting to escape the Downtown Eastside." Rehabilitation
is the solution she tirelessly urges, acknowledging facilities can't
spring up where there is no moral impetus to build them.

Advocates of harm reduction continue to push the drug-normalization
envelope. Through a volunteer-based research trial for addicts --
overseen by the Vancouver Coastal Health Authority, among other
agencies -- chronic addiction substitution treatment is poised to
offer addicts prescriptions-on-demand for the consumption of legal
opiates such as Dilaudid (hydromorphone hydrochloride) -- virtually a
heroin clone. And selected hard-drug users who "do not benefit from
methadone maintenance therapy" -- as explained on the Canadian
Institutes of Health Research Web page on this topic -- have
participated in the North American Opiate Medication Initiative,
where they were given heroin daily, setting the bar for the addicts'
moral agency even lower.

Harm reduction proponents seem to view addiction as an incurable
disease -- and addicts as victims not only unaccountable for, but
entitled to, their "lifestyles." Do militants truly believe that the
war on drugs is lost, and that containment of crime and of
needle-based Hepatitis C, HIV and AIDS is the best society can hope for?

Harm reduction is therefore the opposite pole to the traditional
abstinence model, which insists that, while the war against the dark
side of human nature can never be won completely, partial victory is
preferable to surrender. Abstinence initiatives have proven to be
effective over the long term. A consistent and persistent message
that cigarettes are unhealthy and would not be socially tolerated cut
the number of youth experimenting with tobacco by half between 1994
and 2004. And the anti-drunk driving campaign has cut the incidence
of drunk driving by 65% since 1981.

Successfully recovered addicts are harm reduction's harshest critics.
Saskatchewan MLA Serge Le-Clerc reversed a lifetime of drug-related
dysfunction and crime following an inspirational encounter with a
prison Samaritan. LeClerc earned two university degrees while behind
bars and has become a passionate crusader for preventive drug
education in schools. He is contemptuous of harm reduction, under
whose rubric he would still be an addict. "The disease model negates
choice, but there is no one who is beyond redemption," he says. In
fact, according to the Portage Rehabilitation Centre in Elora, Ont.,
at six months following discharge from their facility, there's a
nearly 86% decrease in drug use among adolescents and a 92% decrease
for young adults.

Ironically, as Vancouver's infatuation with harm reduction waxes,
some critics are concluding that the program was a costly mistake.
Amsterdam, one of harm reduction's earliest adopters, is mired in
squalor from escalating usage and attendant drug-related evils.
Dozens of European cities, including Athens, Stockholm and Oslo, have
signed a declaration against drugs -- including using safe-injection
sites as a surreptitious way to try to legalize drugs. And all but
renouncing harm reduction outright, Sweden instituted compulsory drug
treatment in a limited number of cases and criminalized the purchase
of sex. The country now boasts some of Europe's lowest drug-related
rates of crime, disease and social problems.

We cannot take pride in a society that chooses to accompany an addict
to the abyss; only in a society that pulls him back from it. True
compassion is expressed through prevention and treatment. It is time
to end the false compassion of harm reduction.