THE PURGATORY OF PROHIBITION

Though not mentioned in guidebooks, some tours of Vancouver include a
spin through our fresh-air chemical bazaar and shooting gallery at
Main and Hastings where tourists may photograph consumers with
evident under-nutrition, TB and AIDS, many of them homeless, often
with sad histories of childhood violence and mental
illness. Wealthier and healthier consumers shop more discretely from
their cars and shoot up at home.

Dependencies - on jobs, beliefs, gambling, relationships or food or
sex or psychoactive drugs - are complex disorders about which we talk
much but know little. What we know for sure is that not one of us is
immune, and that management is lengthy, costly and uncertain.

Beyond their immediate human damage, chemical dependencies deeply
wound our society in many ways, including theft, violence and
corruption of public servants from cops to cabinet ministers. The
global illicit drug trade moves $400 billion yearly, more than the
GDP of 90% of nations.

The billion Canadian bucks we throw at drug control each year have
trivial effect upon supply but powerfully inflate market value. A
kilo of heroin that costs $3,000 in Pakistan sells for $150,000 on
our streets, which explains why a serious user needs $50,000 spare
change yearly to stay cool.

The drug trade is the conjoint twin of the trade in women and girls.
This vicious synergy has contributed to the disappearance of over 300
of them from Vancouver's darker streets in recent years, more than
100 found dead, many locked in thrall to pimps and gangs from which
few escape except through overdose, suicide or murder.

In 1995 all illegal drugs caused 805 Canadian deaths, alcohol 6,507
and tobacco 34,728. In 2002 the social costs (lost productivity, law
enforcement, health care) of all illegal drugs were $8 million, of
alcohol $15 billion, of tobacco $17 billion. So who's for a War on Tobacco?

The Yanks fought their War on Alcohol from 1920 to 1933 and lost,
during which the Mafiosi honed the social skills that contributed to
their later spectacular marketing success in other chemicals. Hell's
Angels have since adapted these same skills to our sub-arctic environment.

Cannabis is sold openly in Amsterdam, yet Holland's per-capita use is
half that of the United States. The mere mention of
decriminalization of pot possession in Canada elicits dark threats of
tighter border controls that terrify the business sector, knowing
that our prosperity depends on cross-border trade and tourism,
already jeopardized by 9/11. We're seen from the south as a
sub-arctic banana republic.

A Four Pillars Approach has been initiated in several European
countries, in Sydney, Australia, and in Vancouver, B.C.:

- Harm reduction through counseling, sale of medical-quality drugs at
market prices and provision of safe use environments

- Prevention targeting particularly youth through promotion, control
of advertising and sale through tightly regulated frameworks

- Treatment through detoxification, counseling and methadone or
heroin maintenance

- Enforcement of laws against theft and violence

The only medically supervised injection site in North America opened
near Main and Hastings in 2003. It serves 700 clients daily and has
significantly reduced the two greatest user harms; overdose death and
needle-transmitted infections. The New England Journal of Medicine
published a study on June 8 reporting its successful management of
over 200 overdose events and evidence that such support increases the
likelihood of users seeking professional help. A heroin maintenance
program began there in August, and 30 detox beds are planned. Baby
steps, but in the right direction. Only government can take the
necessary giant steps.

Last October the Health Officers' Council of BC released A Public
Health Approach to Drug Control that recommends international
adoption of comprehensive, evidence-based approaches such as the Four
Pillars. These address psychoactive drug dependency as a deficiency
disease requiring social and medical support, resembling diabetes,
rather than as a crime to be punished.

Well-known health-based interventions have been applied to tobacco
and alcohol, far from eliminating but greatly reducing their
harm. It's long past time to apply such methods to other chemicals.
We can't hope to eliminate their use, but can be certain to decrease
their damage to human minds and bodies, reduce our burden of theft
and violence, and remove their vast profits from criminal control.

We'll free our public servants from irresistible temptations and
offers they can't refuse and thus enable them to wage effective war
against the truly mind-destroying drugs such as methamphetamines.
We'll free many of our sex workers from slavery.

George Povey MD

Clinical Professor

Dept. of Health Care and Epidemiology, UBC