From Just Say No to Be Careful

It's time to recognize reality and put drug education focus on harm
prevention doctors

By SHAUNE MacKINLAY The Daily News

The Just Say No approach to drug education might be out of step with
the times, say two metro doctors in an article published today in a
leading medical journal.

Dr. Christiane Poulin and Dr. David Elliott say it might be time to
focus instead on minimizing the harm teenagers do to themselves with
drugs.

"Traditionally, schoolbased drug education and prevention programs
have been premised on a dichotomy of choices abstinence or abuse
and have sanctioned only one option abstinence.

"Integrating harm reduction into schoolbased drug prevention programs
would represent a paradigm shift, from the `problem of use,' as viewed
by adults, to the `problems with use,' as experienced by adolescents,"
says the article in the Canadian Medical Association Journal.

The article points out that the same "harm prevention" approach is
commonly used in sex education.

"For example, the inclusion of promoting condom use in school sex
education programs does not condone sexual activity; instead, it
recognizes that sexual activity is the reality among adolescents and
helps them choose safer less dangerous options," it says.

Poulin, an assistant professor at Dalhousie medical school's community
health department, and Elliott, a medical consultant with the
provincial Health Department, have conducted extensive research on
adolescent drug, alcohol and tobacco use in Nova Scotia.

Their findings, released by the Health Department last November,
showed a sharp rise in teenage drug use.

In their study of nearly 4,000 Nova Scotia high school students in
1991 and 1996, they found the percentage of students who use cannabis
more than once a month had nearly tripled, from 4.4 per cent to 12.3
per cent. Smoking rose from 26 per cent to 35 per cent.

The number of students who used alcohol, tobacco and cannabis together
jumped from 12 per cent to 22 per cent.

Although many students reported problems related to substance abuse,
most often alcohol, just as many students said they had no problems.

Use and abuse are not the same thing, Poulin said.

"If we can stop labelling the use as being a worry in itself, then
maybe we can get to the real issue, which is there are different ways
of living life here," she said.

A harmprevention approach is largely about giving young people the
information they need to make decisions, she said.

"That means as adults we must accept that they may make mistakes, or
may make decisions we don't like," Poulin said.

She said their findings do not speak for Dalhousie or the Health
Department.

Although there is still little data on the success of the harm
reduction approach, both the United Kingdom and Australia are using it
Poulin said.

Any program should be tailored to the population it serves, she said.

"This is so new we need to figure out where we really stand as a
society and as communities on the issue of experimentation of drug use
by our adolescents and the issue of the really bad problems that can
arise from that," she said.

An editorial in the same edition of the medical association journal
offers support for Poulin and Elliott's view.

In it, Patricia Erickson, a University of Toronto sociology professor
who is also a senior researcher with Addiction Research Foundation,
says harm reduction provides accurate information about drugs so
teenagers can make responsible decisions.

"While the dust swirls over the ideological debate as to who should
control what is taught in our schools, Poulin and Elliott are correct
to ask whether the time has come to change our reliance on
preventionbased drug education," she says.

While some researcher say drugprevention teachings in schools don't
work because their message runs contrary to the message teenagers get
elsewhere, she says, critics believe "anything but a strict abstinence
message may be viewed as surrender in the war on drugs."

Erickson says society does its youth a disservice by not equipping
them for the real world where drugs, both legal and illegal, are
everywhere.