FROM CLEAN NEEDLES TO JUST PLAIN CLEAN

Consensus is growing in B.C. around how to tackle the province's drug
problems. Hallelujah. Open drug use on our city streets is unhealthy,
unsightly and sad, and it's way past time we got over this delusion that
the problem will go away if we just keep arresting people.

But as we inch toward the kind of change that might one day put a
safe-injection site and a legal supply of drugs in every town, I worry
we're neglecting the ultimate form of harm reduction: Abstinence.

You hear a lot of talk about the "four pillar" approach here in B.C., a way
of thinking about illicit drug use that several European cities have
employed with great success to curb their outdoor drug scenes and improve
public health. Prevention, treatment, harm reduction and enforcement -- the
success of the four-pillar concept comes down to getting the balance right
among all of those elements.

But while I applaud the strides we're making in terms of strategies to keep
drug use safer for hard-core addicts, it's troubling to see treatment
barely being mentioned in the current debate. Safe-injection sites and
clean needles can certainly make a world of difference for active addicts,
but surely we should also be offering them the chance at a life free of drugs.

Not all drugs are equally dangerous, and not all regular users become
addicted. But for those who do -- I've heard estimates of around 13 per
cent of users -- getting clean will be the toughest challenge of their lives.

It starts with detox, generally a week to 10 days. That's enough time for
the drugs to pass out of a person's system and the brutal withdrawal
symptoms to ebb. The waits for a detox bed in the capital region are
several weeks long.

Next comes treatment, which is essentially the much more complex process of
getting to the root of whatever is sustaining someone's addiction.
Residential treatment runs anywhere from a month to a year or more, usually
depending on who's paying. If it's government -- as it typically is for the
people at street level -- the term will likely be no more than 30 days.

Not surprisingly, a month isn't long enough to turn a life around, and
people frequently cycle through four or five rounds of treatment over a
period of years before either getting clean or giving up. Drug use winds
its way around all facets of a person's life, and untangling its myriad
tentacles is a lengthy and immensely difficult process.

But even 30 days is getting harder and harder to find. B.C. has never had
much in the way of residential treatment centres, and it has even fewer
ever since regional health boards assumed responsibility for addiction a
couple years ago. The health authorities quickly recognized that treatment
programs delivered during office hours were a much cheaper alternative to
24-hour residential care, and began switching to the lower-cost model.

People with money -- a month in one of B.C.'s private treatment centres can
cost up to $16,000 -- still have the option of residential treatment. Those
of more modest means, however, now face waiting lists so long to get into a
publicly funded centre that at times it's as if treatment isn't even a
possibility anymore.

The prevailing theory is that a treatment program delivered from an office
building is as good as residential care, and that one method is as
effective as the other. That's not the case for those living in B.C.'s most
desperate neighbourhoods, however.

They've got drug dealers living next door, upstairs and down the block.
They've got reminders of drug use in all aspects of their daily lives.
Their only hope is to get away from it all, but the dwindling number of
residential programs means they're less likely to get the chance.

Nor are all of B.C.'s treatment centres welcoming even if a space can be
had. Most insist on a certain period of sobriety before admission. Few will
take anyone on methadone, the prescription drug that quells heroin
cravings. Pregnant women and the mentally ill are particularly hard to
place. A functional addict with a great deal of support might be able to
make do, but the sickest and most isolated -- the very ones who invoke our
wrath when they end up on the streets -- fall between the cracks.

After decades of flawed drug policy, we have a chance to set things right.
We're contemplating profound changes that will finally redefine drug use as
the health and social concern that it is, rather than a moral failing. Like
many European nations before us, we're beginning to grasp that our reliance
on enforcement alone has been a costly and cruel mistake.

But as we seek more humane policies for those who can't shake their
addictions, spare a thought for those who want to but need help to do it.
Clean needles are good, but just plain clean is even better.