DRUG-FIGHTING MD DOESN'T MOLLYCODDLE

"Social work is the last refuge of the curious notion that man is basically
good ... Its proponents, in their boundless good nature, excuse the
aberrants from all responsibility for their actions. It's never the fault of
the offender, always his environment: his home, the consumer society, the
media ... At a stroke we can rid the world of crime, since there are now no
criminals, only clients." -- Civil War: From L.A. to Bosnia, by Hans Magnus
Enzensberger.

The above quote was provided to me by Dr. Douglas Coleman, a 47-year- old
doctor who, in his work at an addiction clinic in New Westminster,
subscribes to the unfashionable notions of abstinence and personal
culpability when it comes to treatment.

He does not mollycoddle. He encourages, and expects, his clients to stay off
drugs. He does not try merely to lessen their cravings; he does not provide
them with sociological alibis to remove their sense of personal
responsibility. He tells them to stop. He tries to cure them.

Sometimes, he does cure them. Even so, Coleman warned, the battles won
against drug addiction are slow, hard fought and long in coming. There are
no panaceas. You win them one at a time.

"Sometimes I balk at using the word 'cure,' " he said. "I see lots of
patients over and over again trying to quit. But at least they're trying."

This school of thought -- that puts the onus of responsibility on the
addict, that sees addiction as a medical problem rather than a legal and
sociological one -- has put Coleman, and many Lower Mainland medical
practitioners like him, on the Out List when it comes to the provincial
government's latest philosophy on the drug problem.

That philosophy, which goes by the euphemistic name of "harm reduction,"
accepts the addict's condition as a constant, and then tries to lessen the
harm addicts can do to themselves and the collateral damage they do against
society in trying to maintain their habits.

Thus we see the first concrete suggestions from a Vancouver/Richmond health
board committee for "safe injection sites" for the Downtown Eastside. Give
the junkies a controlled environment so they don't kill themselves or
somebody else in the process.

Sounds neat and reasonable enough, Coleman said, except for a few things.

One, it will legitimize addiction, which is all right if you see addicts as
disposable commodities, but is troubling if you, like Coleman, see them as
human beings who need help.

Two, it will ghettoize the drug and crime culture in the Downtown Eastside
even more than it is now, which will attract a critical mass of addicts,
which will solidify into a self-sustaining drug and crime economy, which
will perpetuate the hundreds of millions of tax dollars in social services
spent in the Downtown Eastside every year.

"Recovery won't happen while they're down in the Downtown Eastside," he
said.

Three, this laissez-faire, anything-goes form of harm reduction, Coleman
said, (and there are lesser forms of harm reduction Coleman supports) came
into being in B.C. with no input from the local frontline medical addiction
community. Rather, it was formulated by social engineers like psychologists,
sociologists and medical health officers without any clinical experience.
Coleman's offers to provide training and direction, he said, were ignored,
along with the offers from other addiction treatment doctors.

Shut out by policy makers, he and the three other doctors in the clinic have
been reduced to asking social agencies in the Downtown Eastside in regular
contact with addicts to refer them to his clinic. "We, as physicians, have
let the appropriate people in the Downtown Eastside know that we will
maintain every effort we can to move addicts into recovery programs and out
of the Downtown Eastside."

And so how many have they sent his way? "They haven't referred anybody to
us," Coleman said. "No one."

Pete McMartin can be reached at pmcm@pacpress.southam.ca or at 605-2905.

Checked-by: Don Beck