ADMITTING OTTAWA HAS A DRUG PROBLEM IS FIRST STEP

The city's free crack pipe program proved its value this week. Not because
of the potential benefits of giving safe smoking equipment to crack users,
but because the controversy over the city plan finally got people talking
about the problem of drugs and how they destroy lives.

The actual crack pipe program is of probably of limited utility, although
city councillors were right to continue it. The premise is shaky, in that
it relies on crack users to make rational decisions about their health. If
they were capable of that, they wouldn't be using crack. At best, the crack
pipe kits introduce a few more blanks into the game of Russian roulette
that crack users play.

The statistics are extremely discouraging. Ottawa has between 3,000 and
5,000 injection drug users, most using crack in liquid form. Of that group,
80 per cent also smoke crack. Twenty-one per cent of street drug users in
Ottawa are HIV-positive, and 76 per cent are positive for hepatitis C.
Those rates are second only to Vancouver in Canada. The longer they use,
the greater the chance of infection. Use crack long enough, and you're
almost sure to be exposed to one or both of those diseases.

The problem is what to do about it. Toughen enforcement? Treat it as a
health problem? Legalize drugs?

Police Chief Vince Bevan primarily argued the law enforcement case. He told
about the many suspected crack houses in Ottawa's neighborhoods, and they
damage they do. Louise Logue, who does outreach with youth for the police,
talked about how drugs are destroying teenagers' lives.

"Drug abuse is not a health problem. It's a behavioural problem with health
consequences," Bevan said.

Medical officer of health Rob Cushman took the opposite point of view. Drug
use is a health problem, he says, and it's not the job of people in the
health care system to judge the drug users, but rather to help them by
reducing the harm their addiction does. That's the goal of the crack pipe
program.

Crack smokers typically make pipes of old pop cans with a piece of copper
pipe as a stem. The crack is set on Brillo pads, which disintegrate with
the heat and can be sucked into the lungs. The metal pipe stems cause burns
and sores, making it easier to get infected from their hep C-positive
smoking pals.

The city kit offers pyrex stems, which don't heat up so much, and brass
screens to hold the crack. They also supply a latex mouthpiece that's only
to be used once, and not shared. So the theory goes.

One of the strongest points made by people who work with addicts is that
the crack pipe and needle exchange programs offer a first point of contact
with drug users. People who are thinking about smartening up often begin by
trying to reduce the likelihood of contracting disease from their drug use.

City councillors found the arguments from Cushman and a variety of front
line health care providers persuasive, and so they should have.
Instinctively, most of us would think that using taxpayers' dollars to buy
crack pipes is wrong, but what the city is really buying is a little time
for drug users to straighten themselves out before they contract diseases
that are more serious than their drug use.

One thing councillors, Cushman and Bevan agreed on is that they don't want
the free crack kits to be given to teenagers and Cushman went to some
trouble to say they aren't. The average "client" for the crack kits is 37
years old. And yet, Cushman also said that about three per cent of our high
school students use crack. Because of the controversy over giving clean
equipment, we will choose to ignore them, until they get to be mature crack
users. By that time, they will have been exposed repeatedly to the risks of
hepatitis C and HIV.

Bevan says the crack pipes and needles enable drug use. Kids seem to be
using the drugs without public help.

The big point is how little is being done to actually help drug addicts.
Real help only comes from treatment, but the number of local drug
rehabilitation and treatment beds is inadequate.

Some worry that free crack pipes send a pro-drug message. The real problem
is the lack of an anti-drug message. Most of what you see in the media is
about whether to decriminalize, maybe even legalize, drugs. Any criticism
of drugs is old fogey, reefer madness stuff.

Cushman suggested that it would have been better if the crack pipes had
just been added to the needle program as a "clinical decision" without the
public being aware. He's wrong about that. What we need is lots more public
discussion about drugs. We need enforcement, harm reduction and treatment,
too, and there isn't enough of any of them.

The first thing is to wake up and admit that there is a drug problem in
Ottawa. This week might be the first small step towards that.