HELP ISN'T THERE, SAY HARM REDUCTION ADVOCATES

Harm reduction has long been touted as a way to reduce the problems
associated with street-level drug and alcohol abuse, but opponents
argue that governments' increasing reliance on the strategy merely
sweeps problems under the carpet.

Rob DeClark, program director at the private Cedars treatment
facility at Cobble Hill, argues harm reduction amounts to a "bronze
level" of addictions treatment. People who are valued by society get
abstinence-based treatment followed by counselling and continuing
care, but the poor are given clean needles.

"Why do we give those that can afford it the gold standard of
treatment - the doctors, lawyers, pilots, safety sensitive positions
like marine workers? They all have to be abstinent," DeClark says.

"People who can't afford it, we just give them safe needles. That I
disagree with," he says.

David Berner, executive director of the abstinencebased Drug
Prevention Network of Canada, agrees. He says that politicians and
policy makers, under fire for the visible problems of homelessness,
open drug use and petty crime in cities, advocate harm reduction
because they need a silver bullet solution - much in the same way an
alcoholic looks for all his answers in a shot glass.

"They want a quick and ready answer for this scourge and their answer
is free needles. Free heroin."

Even those who advocate for harm reduction say the system isn't
working correctly.

"I support the idea of Insite [Vancouver's safe consumption site] or
safe injection sites as long as there's immediate availability of
treatment for people who want it. Otherwise they're just passing up a
very important opportunity for people to get into treatment," says
Dr. Meldon Kahan, director of addictions medicine at St.

Joseph's Hospital in Toronto.

Handing out clean needles without immediate access to treatment
amounts to nothing more than palliative care, he says, adding that
society shouldn't give up on people that easily.

"Sure you give them clean needles and they can use cocaine forever
without giving them a way out. I think that's just wrong."

Harm reduction policies have been in place for many years. Insite,
the safe-injection site in Vancouver, opened in 2003. Needle exchange
services, at fixed sites and mobile vehicles, are also available.
Health authorities also give out crack pipes.

One of the biggest harm reduction strategies has been methadone
treatment. People addicted to opiates such as heroin are given the
drug in controlled amounts as a safer alternative to the real thing.

Unfortunately, people then get hooked on methadone, which is said to
be harder to kick than heroin.

In 1996, the College of Physicians and Surgeons reported 2,800 people
were enrolled in methadone maintenance in B.C. By 2009, the number
had swelled to 11,033.

And the program isn't cheap.

Neil McKeganey, of the University of Glasgow, says Scotland's
methadone program is costing the government more than 40 million
pounds a year, but is likely helping less than five per cent of
addicts become drug-free.

"The program would need to be running for five years to attain the
recovery rate being achieved within the residential rehabilitation
sector [in excess of 25 per cent a year]," he writes in his book,
Controversies in Drugs Policies and Practise.

"Are we providing drug treatment services in order to enable drug
users to become drug-free or to reduce some of the adverse impacts of
drug abuse on society?" McKeganey writes.

In Victoria, like most other cities, harm reduction has been
presented as just one of four pillars of dealing with homelessness,
mental health and addictions. The other three are policing, treatment
and prevention/education.

But some worry the four pillars have been reduced to one or two -
harm reduction and enforcement. And while the support for harm
reduction is strong, the prospect of helping people to overcome their
addictions is being lost.

DeClark says harm reduction is being sold under false pretenses.

"Originally the way it was packaged, was when you went to a safe
using site or needle exchange you were supposed to sit and meet with
someone and they were supposed to talk to you about treatment and
getting help and putting programs in place.

"Now there are no programs in place for that person to go to. So
that's just become a bit of a facade," DeClark says.

"If the treatment beds were there, that might work. But when you've
got no treatment beds, it's just a conversation about what you would
like to do."

Social activist Jody Paterson, former PEERS executive director and an
advocate of harm reduction, said the loss of counselling
opportunities is one of the reasons the closure of the Cormorant
Street needle exchange in 2008 was tragic.

"All we really have now [of the four pillars] is enforcement," says
Paterson. "A clean needle or a crack pipe is really just a tiny
little piece of harm reduction. It's never intended to be the only
thing. So we have this tiny piece of harm reduction and then we have
enforcement and almost none of the other things.

"I think it's horrible. I think it's cruel. People do not understand.
It isn't that all these people are choosing to not get help. It's
that help isn't there when they need it."

Karen Dennis, executive director of the Victoria AIDS Resource and
Community Service Society, which has operated mobile needle
distribution throughout the capital region since 2003, agrees
counselling opportunities from a mobile service are limited.

Clients are unlikely to follow up on a verbal referral unless they
have an established relationship with the agency to which they are
being referred, she says.

"When you have a fixed site or somewhere they can go and use and
talk, it's much more likely that they will make those other
connections. Building relationships and trust is very significant."

But Berner, a longtime broadcaster and writer who in 1967 founded the
X-Kalay Foundation Society, a residential treatment centre for drug
addicts and alcoholics, scoffs at the notion of counselling through
harm reduction sites.

"You can't sit at Insite, help someone fix and then talk about
treatment. It's an absurdity. The person is stoned," Berner said. It
would be better, he says, to spend the money on prevention, education
and treatment.

Harm reduction advocates such as Vancouver Island Health Authority
medical health officer Dr. Murray Fyfe and provincial medical health
officer Dr. Perry Kendall say harm reduction and abstinence-based
treatment are not incompatible.

Kendall says abstinencebased, 12-step programs don't work for everyone.

"What we've tried to do is ensure there is a range of treatment
options ready for people," he says, explaining these include
motivational interviewing, cognitive behavioural therapies,
psycho-social supports, pharmacotherapy therapies (such as
methadone), and 12-step programs - if that's what people want.

He said recovery is an "eventual" objective.

"Abstinence is a great state but it leaves a lot of people out in the
cold, which is where the pharmaco-therapies and the other support
services come in," Kendall says. "I think one of the problems with
the abstinence thing is people then see relapse as a failure."

Fyfe disputes the idea that harm reduction is a "second-class system"
reserved for the lower tier of society, arguing that "treatment
options are available to everyone but that not everyone is ready for
treatment."

"Harm reduction is really trying to keep them safe until they can get
to a point in their life and in their addictions where they are ready
to go into treatment."

But some people remain worried that harm reduction becomes a crutch -
and addicts won't take steps to kick their addiction.

"The only thing that works with addicts is hard work," Berner says.
"It's often tedious. It's often boring. It takes time. Not everybody
succeeds, but millions of people do succeed."

Adds addictions counsellor Sue Donaldson: "People can and do recover
from this disease given the right support and the right circumstances
to do so. They can and they do."