PRAGMATIC ECONOMICS SAY WE SHOULD DEAL WITH ALL FORMS OF SUBSTANCE ABUSE

VICTORIA - The mushiness of our thinking about drugs is astonishing.

Substance abuse will cost every British Columbian -- man, woman and
child -- more than $1,400 this year, according to a recent report.

The study was the first attempt in a decade to nail down the cost of
substance abuse in Canada. It found that the problem cost Canada
$39.8 billion in 2002, about 21/2 times more than we spend on defence.

Most Canadians accept the moral obligation to help people who are
suffering -- not just the people abusing substances, but their
families and friends and neighbours.

But leave that aside. The economics of addiction point unarguably to
investments in prevention, treatment and harm reduction. The business
case is clear: Significant investments now will produce greater
savings in coming years.

We barely comprehend the problem. Many readers have likely made it to
this point in the column assuming that it's about harm from street drugs.

But the centre adopted an economic definition, holding that abuse
occurs any time use of a substance imposes greater costs on society
than it does on the individual user. By that measure, alcohol and
tobacco are by far the greatest problem substances.

The study found that tobacco abuse created direct and indirect costs
of $17 billion; alcohol $14.6 billion; illegal drugs $8.2 billion.
The numbers are staggering, but so are the opportunities.

B.C. has the fourth-lowest per-capita cost attributable to tobacco
among Canadian provinces, at $563. But if we could match Ontario,
which has the lowest cost among provinces, our tobacco-related costs
would fall by $252 million.

Alcohol abuse cost B.C. slightly less, at $536 per capita, but that's
still the second highest among the provinces. Ontario has the
third-lowest cost in the country. If B.C. could match its
performance, we would cut costs by $393 million.

And illegal drugs cost B.C. significantly more per capita than any
other province. Bringing costs in line with Ontario -- which still
has the fourth-highest costs -- would save $505 million.

It's not a question of ending abuse, or even aiming for some
breakthrough. If B.C. could find a way to hold the damage from
substance abuse to the same level as Ontario or a comparable
province, costs would have been $1.1 billion lower in 2002.

The benefits would be sweeping. The study, supported by federal and
provincial governments, found substance abuse resulted in $24.3
billion in lost productivity costs, $5.4 billion in law enforcement
costs and $8.8 billion in health care costs. (About 20 per cent of
acute care hospital days result from substance abuse.)

Remember, we're not talking about eliminating substance abuse, or
even making radical progress. Just modest improvements would save us
more than $1.1 billion a year.

Anyone in business knows that kind of return justifies a major
investment. It simply makes economic sense.

Instead we fumble along, with occasional bursts of commitment and
much more denial and dithering. Defenders of the status quo are quick
to trot out spending on this program or that project. But the study,
while warning of the difficulties in making comparisons with the
results of a decade ago, concludes things have gotten worse. Deaths
and number of days spent in hospital as a result of substance abuse
have increased, as have other costs.

If we're doing such a good job, why are we going backward?

The biggest reason is an ugly combination of wilful blindness to the
evidence about what works and a determination to rely on vague and
unstated moralism instead of pragmatism and common sense. (But that
reason goes unstated, because it's impossible to develop an effective
moral argument for allowing people to suffer and die needlessly.)

Which leads inevitably to Prime Minister Stephen Harper's willingness
to ignore the evidence that Vancouver's safe injection centre has
saved lives, made the community safer and resulted in more addicts
entering rehab. Despite those findings, Harper is still considering
cutting off funding to the centre. His opposition has stalled plans
for a badly needed safe injection centre in Victoria.

It should be enough that we can save lives and reduce suffering by
tackling substance abuse. But if that's not enough reason, there
remains a compelling economic argument for investing heavily in
prevention, treatment and harm reduction.

Or we can stay on the same course and wait for another study in 10
years to tell us that we are wasting even more money and lives.