INSITE UPROAR A BLESSING AND CURSE

Harm Reduction Should Be Debated On Its Merits Rather Than Turned
Into A Divisive Political Issue

Those of us who care about lively and informed
public debate of Canada's drug policies see Vancouver's supervised
injection site as both a profound blessing and a wretched curse. This
month's International AIDS conference continued to highlight the
polarizing impact of Insite.

Insite is a blessing because its operation - and particularly the
federal government's opposition - has highlighted drug policy
questions like never before. At the centre of these questions is harm
reduction - a general term used to describe programs that seek to
reduce drug-related harm without requiring an immediate end to drug
use.

Harm reduction programs enjoy broad public acceptance; in Ontario, for
example, 60 per cent of adults support safe, supervised drug
injection. That level of acceptance rises if these facilities increase
drug users' contact with health and social workers.

Yet Insite has also cursed the public discussion on harm reduction by
narrowing and oversimplifying a critical public debate.

Most Canadians would equate their support for harm reduction with
their opinion on Insite's right to exist. This is understandable,
given media coverage.

Yet Insite is of one of hundreds of harm reduction programs delivered
by Canadian health practitioners and community agencies over the past
20 years, many of which were equally controversial when first
introduced. These include needle exchange programs, methadone and
other replacement therapies, and even the nicotine patch recommended
by family doctors for smokers unable to stay quit.

Public discussion of harm reduction should be rooted in facts, and go
far beyond one supervised injection site, or one approach.

We should recognize the vast majority of costs and harms associated
with substance use result from legal substances - tobacco and alcohol.
In fact, harm reduction programs constitute a small portion of the
public funds devoted to drug use.

For every dollar spent on harm reduction programs targeting illicit
drugs, $25 is spent on enforcement.

The Centre for Addiction and Mental Health (CAMH) believes that
decisions about drug policy belong in the public sphere, and should be
informed by the best available research evidence.

Harm reduction is rooted in a pragmatic approach that focuses on
improving the overall health and well-being of individuals. It's meant
to focus on a problem that is causing a harm. And if our approach to
the problem is a pragmatic one then our evaluation of harm reduction
should also be pragmatic.

It should be conducted dispassionately and it should report on both
the pros and cons of the intervention.

The assessment of the Insite facility conducted at the request of
Health Canada performed such an evaluation. Where Insite has had
documented, empirically proven success, the review committee presented
the evidence; where other Insite objectives cannot yet be proven, the
committee recommended further research.

Across this country we have had success in implementing harm reduction
programs that have improved the health of Canadians. These initiatives
should be measured on their merits.

It is contrary to the interests of both scientific inquiry and
informed public debate to categorically reject supervised injection
sites. I regret that the Government of Canada has adopted this position.

Let's try a different approach: Let's use the debate about supervised
injection sites to discuss the most appropriate public responses to
problematic use of drugs, including some legal ones like prescription
opioids.

Informed public discourse could be a long-term, pan-Canadian legacy of
Vancouver's supervised injection site.

Dr. Paul Garfinkel heads CAMH, Canada's largest addictions and mental
health teaching hospital.