Why 'harm reduction' won't work

Vancouver's latest plan -- maintenance for heroin users -- overlooks an
elementary fact: The problem with drug use is, oddly enough, drug use

Vancouver has one of the highest rates of drug abuse and infection in the
world, according to scientific studies published about the city.

That is why Vancouver's latest plan to maintain heroin users on their drugs
of choice -- cornering more addicts into a life of despair and sickness --
is worrying me and scores of public health officials worldwide.

As in most major cities around the world, Vancouver's drug problem is
multifaceted and complex: The regular consumption of multiple drugs by a
significant minority of the population, rising purity rates, and crippling
violence exacerbated by regimented criminal organizations exhaust
policy-makers looking for a "quick fix" to the drug problem.

To make matters worse, a disproportionate number of drug addicts in this
city have HIV (at least 30 per cent) and Hepatitis C (a staggering 90 per
cent), either perpetuated by risky sexual behaviour under the influence of
drugs or as a direct result of sharing infected needles.

Even the most extreme anti-drug hawk, then, might be able to understand why
so many well-meaning officials and social workers would raise the white
flag with policies like government-sponsored drug shooting galleries.

Supporters of these legal injection rooms constantly remind us of the
"great Swiss example." Swiss government-funded scientists hailed their
heroin maintenance project a success since it concluded that addicts
experienced "improvements in health and well-being" and less criminal
behaviour. This single review of the Swiss trials has been showcased
worldwide as a success of government-sanctioned drug maintenance.

But independent evaluations of the program have been less than sanguine.
One of those evaluations -- the official line from the United Nations --
chided the study on the basis of its shoddy design and poorly drawn
conclusions. The World Health Organization concluded that the Swiss studies
"have not provided convincing evidence that . . . the medical prescription
of heroin generally leads to better outcomes."

Science tells us that heroin maintenance is a sloppy alternative to drug
treatment strategies like methadone and buprenorphine. Common sense and
compassion dictate that, no matter how difficult, uneasy, or uncomfortable,
we cannot hide sufferers of addiction in a drug den on the outskirts of
town -- we must confront their disease.

It is astonishing that we must perpetually remind ourselves that
drug-taking behaviour can be changed when thousands of people in recovery
today are living examples of this truth.

So, what is a country or city to do? A lot.

When Sweden found in 1985 that HIV prevalence was more than 50 per cent in
its capital city, it established a comprehensive approach of HIV testing
and methadone maintenance treatment coupled with hospital units, drug
education and counselling for drug users with infectious diseases.

The result? HIV among injection drug users in that city stands today at
five percent. Drug use there is the lowest in Europe.

Evidence from elsewhere suggests that when the criminal justice system and
public health community work together (in the form of specialized "drug
courts," for example), our problems get smaller.

Meanwhile, some officials in this city still respond to this social and
biological disease by prolonging it. HIV and Hepatitis C rates continue to
soar; Vancouver's overdose rate is the highest in Canada. One Vancouver
police drug squad inspector, Mark Horsley, recently said that Vancouver is
the "warehouse distribution centre of drugs in Canada."

Cross-country comparisons are problematic, but giving in to harmful
behaviour by supporting drug use gets us nowhere. So-called "harm
reduction" measures, no matter how well-intentioned, fail to stop drug use
and redirect drug addicts. Instead, these policies accept the inevitability
of addiction when we know this disease can be prevented or at least treated.

Reducing total harm, on the other hand, must begin by cutting drug use.

Rejecting heroin maintenance doesn't mean that restrictive drug policies,
such as those sanctioned and supported by the UN and U.S., are our magic
bullet. They have implementation and effectiveness problems of their own.
But our overarching goal should always be to reduce total harm and to make
our drug policies work better within that context of reducing drug use.

As elementary as it sounds, it seems that some people still need to be
reminded that the problem with drug use is drug use.

A so-called "harm reduction" policy is essentially flawed because it has at
its core narrow goals that deny the complex social, legal and biological
context of drug use and addiction.

Reducing total harm, then -- to one's self, community, and society, users
and non-users -- must be the true goal of prevention and treatment
providers who understand that drug abuse is a treatable, yet fundamentally
preventable, disease of the brain and body.

It is inhumane to perpetuate this disease when history and science tell us
that it can be prevented and its attendant consequences reduced, if not
eliminated.