THE HARM REDUCTION TABOO

Nobody wants to lead the charge for a safe injection site in Ottawa,
writes ELIZABETH PAYNE.

Dr. Mark Tyndall may not seem like a dangerous man to you. In fact,
the recently installed head of infectious diseases at the Ottawa
Hospital who works one day a week at the Ottawa Mission treating
people with HIV, (and who recently returned from the international
AIDS conference in Rome), may seem like the kind of medical
professional the world needs more of.

But to the federal Conservative government, the former colead
investigator at Vancouver's controversial supervised injection site is
a man with some dangerous, even abominable, ideas: Namely, that drug
addiction is a health issue, not a political or criminal one.

"Abomination," in fact, is the very word Tony Clement, federal health
minister at the time, used to describe the philosophy governing the
safe injection site, Insite, in 2008, adding that "allowing and/or
encouraging people to inject heroin into their veins is not harm
reduction ... it is a form of harm addition."

The scientific and medical world disagreed and, unlike the federal
government, had the science to back it up -- dozens of peer-reviewed
studies, in fact, much of it based on research done by Tyndall and his
colleagues.

The Conservative government long ago made Insite a political cause,
vowing to close it, despite research citing its benefits. Insite
remains open, but the battle over it has gone all the way to the
Supreme Court of Canada.

Meanwhile, the government's ideological attack on North America's only
supervised injection site has had a spillover effect, making it
politically difficult, if not impossible, for other communities to
consider something similar. Even when such harm reduction would make
people safer and even save lives.

Which brings us to Ottawa. This is a very different city than
Vancouver. Ottawa does not have the heroin trade Vancouver does, nor
is drug use as visible or as closely watched. But there are growing
numbers of drug users who inject opiates derived from prescription
drugs such as oxycodone. Some die from overdoses, others become ill
from using dirty needles. Organizations that work with the homeless
and addicts are beginning to compile better data on drug use and
overdoses in the city and some say drug use in Ottawa is changing for
the worse. And the fact that Ottawa has one of the highest rates of
new HIV infections in the country is one sign of the harm being done
by unsafe injection drug use. New HIV cases were up by nearly 50 per
cent in Ottawa during the first half of this year -- something that is,
understandably, raising alarm bells among the city's public health
officials.

In Vancouver, new HIV infection rates are way down, in part because of
harm reduction.

Ottawa has had various forms of harm reduction programs in recent
years, including a managed alcohol program, a crack pipe program and
needle exchange.

Does Ottawa need a safe injection site? A report on just that subject
has been in the works for a number of years and is due to be released
this fall, said coauthor, University of Toronto researcher Carol
Strike. No word on whether it will conclude that a supervised
injection site would make sense for Ottawa.

Tyndall, who has seen the difference having some contact with addicts
makes to their health, says there is no question Ottawa should ramp up
its harm reduction programs. "My impression is there are a lot of
overdoses in Ottawa and people are using drugs in dangerous places, by
themselves ... that data is very important to get." But he is hesitant
to lead the charge for a safe injection site in this city. "I want to
work behind the scenes for a bit, I didn't come here to crusade for
harm reduction."

Tyndall has seen how doctors and health professionals who advocate for
supervised injection sites are sometimes vilified and painted as pro
drugs, even though, as he notes: "I have seen the worst that drugs can
do."

And Wendy Muckle, executive director of Ottawa Inner City Health, says
politics around safe injection sites make battling for one
unpalatable. Her organization is currently involved with a Housing
First program for addicts, another, longer term, form of harm
reduction that helps transform lives.

"A safe injection site will keep them alive today ... but in the long
term we are pretty convinced that this combination of housing and
treatment of mental illness and substance abuse at the same time
transforms lives and changes people."

She adds this: "If I had to choose between staying under the radar and
doing more housing, I would rather do that any day of the week than
battling with Stephen Harper over a safe injection site."

It is frustrating to those who work with addicts that politics is part
of the calculation when they consider the best ways to treat and
improve the lives of addicts. "The frustrating thing is that our
government is not swayed by any evidence, just by ideology that drugs
are bad and people shouldn't use them," said Tyndall.

The result is that, for communities like Ottawa, Vancouver, Toronto,
Winnipeg and anywhere there are drug addicts, reducing the harm of
addictions, the spread of diseases, the drain on emergency rooms and
police and the negative social effects of drug use on the streets, is
more difficult than it needs to be because of a federal government
with its eyes firmly closed when it comes to drug treatment.