AIDS 'A REAL DISEASE'

Addiction, on the Other Hand Is Not, an Author Argues

Prime Minister Stephen Harper didn't attend the AIDS conference and so
far he's declined a visit to North America's first safe-injection
site. Located in Vancouver's Downtown Eastside, the scientific
research pilot project known as Insite will close on Sept. 12 if its
mandate isn't extended.

More important than Harper's absence will be the lack, in either
locale, of discussion about human agency or personal responsibility.
These, finally, may be humanity's best hopes in the wars against an
AIDS virus and substance-abuse problem whose capacity to mutate,
replicate and find new markets knows no bounds.

To be sure, the efforts of science and law enforcement in these wars
are considerable and cannot be diminished. But a startling new book by
a British writer and psychiatrist experienced in general hospital and
prison work shows we're seeking answers in the wrong places. While the
central thesis of Romancing Opiates: Pharmacological Lies and the
Addiction Bureaucracy by Theodore Dalrymple has implications for the
AIDS war, its principal target is the thinking behind facilities such
as Vancouver's Insite.

Insite is Canada's poster organization for the provision of supervised
facilities where addicts can inject their own drugs and access
services. Its primary objective is "harm reduction," that is, the
reduction of incidences of overdose, disease, crime, and shooting-up
detritus. According to its advocates, Insite is a resounding success
with peer reviewed, measurable data in all areas to support their case.

But behind this sanitized picture a disturbing reality nags.
Harm-reduction policy is inherently infantilizing, says Dalrymple,
because it assumes the authorities ought to be responsible for the
negative results of chosen behaviour. "If consequences are removed
from enough actions, the very concept of human agency
evaporates."

If treating people as "inanimate objects rather than as agents of
their own destiny" isn't bad enough, Dalrymple presents yet more
disturbing arguments, among them that opiates have been dishonestly
romanticized by writers such as Coleridge and De Quincy and that
heroin use is a consequence, not a cause, of crime. His most
eye-popping revelation? Heroin withdrawal is trivial compared with the
real dangers of alcohol withdrawal. He says most addicts and most
doctors know this.

Progress is difficult because of the self-serving nature of
bureaucracies but the general public is complicit too. The
blamelessness of victim groups confers high moral standing and
absolution for weaknesses while at the heart of the issue is an
existential angst that afflicts everyone. "The temptation to obscure
life's [difficulties] by means of chemically induced oblivion has
always been, and will always be, great," writes Dalrymple, "at least
until the meaning of life has been found."

Most vulnerable are those believing that immediate satisfaction of
personal desires is the only good, but with no prospects for its
realization. Disaffected, they lack either interests or the
consolation of intellectual, cultural or religious pursuits.

"The addict has a problem," says Dalrymple, "but it is not a medical
one: he does not know how to live." Instead, he pursues his daily fix,
which at least keeps him busy.

Arguments to legalize drugs merely suggest the cause of crime is the
existence of laws, he says, while comparisons with the prohibition era
are simply invalid. Subject to abuse to be sure, alcohol use is
supported by established custom in a way that other substances are
not.

Is the war on drugs winnable? No, but neither is the war on death and
no one's given up on that fight. But we should definitely close the
clinics that institutionalize bad romantic ideas, and end the pretense
addicts are ill and need treatment.

Like the war on drugs, the war on AIDS must continue. Unlike
addiction, AIDS is a real disease that humanitarians must address. Yet
funding treatment that often results in the willful transmission of
disease to multiple partners presents another challenge, and here
Dalrymple's arguments warrant consideration.

In Canada such behaviour is illegal but in Africa and India, where
AIDS runs rampant, we apparently believe inhabitants are incapable of
making responsible decisions about their behaviour and that drugs and
condoms will solve the problem. Like safe injection harm-reduction
policies, this denies human agency, insults human dignity and smacks
ominously of a soft totalitarian entry by the western world into a new
era of Third World colonialism.