HARM REDUCTION: MYTH VS. REALITY

A drug deal at the Queensway bus station mid-day on welfare Wednesday
takes place under cover of enough wet sleet to keep decent business
folk closeted in their offices.

Anxious and jittery, a handful of vagrants in their 20s are burning up
the pay phone line kitty-corner to the Bennett Clock looking for dealers.

No one notices the five-foot nothing, dirty-blond boy whose made the
buy at one end of the strip. Balancing on his BMX, his friends say
he's 14 years old and already done school for the day, but his boyish
features could put him anywhere from his early teens to just eight.
The substance changing hands is never revealed, but then no one ever
really sees the drugs; no one every sees the people involved.

But for several years everyone has noticed the growing prostitution,
addicts and homelessness cluttering these streets.

It's enough to give Downtown Kelowna Association patrol members Sherry
Chamberlin and Wojtek Tecza a job ensuring this black market trade
does not affect the businesses sector, not to mention the tourists.

Part of the private security firm hired to patrol the area in 2000,
they are the eyes and ears of shopkeepers and hoteliers all too tired
of the needles, fights and thefts.

Whether alcohol, marijuana, crack or heroin, this city of 100,000
faces many of the same problems as the Lower Mainland, with its
population of three million.

Vancouver's Downtown Eastside may be notorious for rampant addiction,
prostitution, HIV and hepatitis infection rates-not to mention the
serial killer set to go on trial for torturing victims in the area-but
the destructive influences are far from contained by city limits.

Big or small there's no escaping the drug addiction that swept the
continent in the '80s and '90s leaving a hot bed of problems for taxpayers.

Though fewer in numbers, on this Feb. 22 day, Kelowna's addicted
community are fighting the same battles as so-called heroin fiends in
China, Russia, Africa; the security officers are just hoping to stave
off a tumultuous weekend in the snow covered hills of the B.C. Interior.

"We had a domestic in the park this morning but otherwise its been
quiet," Chamberlin reports.

She didn't know the couple, but assumes the woman was a street worker
having a dispute with her boyfriend/pimp, maybe dealer. After working
with horses for 23 years, Chamberlin was looking for a career change
when she found this line of work.

Her partner, a Polish immigrant trained as a basketball coach,
transferred into the patrol through his security job. They have just
two months experience between them.

Kelowna's street population is estimated at roughly 500 homeless in a
city of 100,000 people.

According to Kelowna RCMP drug squad, the drug of choice in Kelowna is
crack cocaine.

But the dangerous bite of a $20 crack cocaine rock comes from more
than its addictive high. Often stored in the mouths of dealers, safe
from detection, clients risk catching diseases like hepatitis, which
can survive outside the human body.

From the Gospel Mission to Ki-Low-Na Friendship Centre, Interior
Health Authority's Outreach Health Unit, the Living Positive Resource
Centre (Kelowna's HIV, HCV and communicable disease resource centre),
Freedom's Door Alcohol and Drug Recovery program, Cross Roads
Treatment Centre and many other service providers-all work to
alleviate the problem.

Yet the supply of services does not meet the demand.

Late this fall, the Interior Health Authority, City of Kelowna and
B.C. Housing announced a 30-unit transitional housing project at 1436
St. Paul's St. in the downtown core.

Labeled "wet housing," the proposed units are meant to act as
apartments for mentally ill and homeless clients dealing with addiction.

A possible route to abstaining from alcohol and drug dependency, the
health authority's model provides a home for those who may not be
capable of quitting their addiction cold turkey, in hopes that
supporting these clients in a stable environment gives them the
ingredients to make a successful choice to abstain.

However, the idea is not sitting well with the business owners who
surround the housing units proposed site. They formed their own group
to research not only other sites, but the harm reduction concept.

Asked if he expected resistance to the idea, IHA addictions specialist
Ira Roness admits he saw it coming-but not to this extent.

"I think a lot of people are most concerned about things that are not
going to be happening. This is not going to be a drop in centre, this
is not a needle exchange, we're not encouraging their use," he said.

"A lot of people think we're doing this but we're not and we've made
that very clear. It's just going to look like any building you would
see in a community."

Whether moral objection or personal disdain, the backlash known to
those working in the field as the not-in-my-backyard factor,
historically follows the introduction of harm reduction
initiatives.

While it may be a Health Canada best practice for dealing with
addiction, the term harm reduction, it appears, is a hard pill for
some sectors of Kelowna to swallow.

This spring University of British Columbia anthropologist Patricia
Spittal will co-hosting the 17th Annual International Harm Reduction
conference in Vancouver.

"I think Canada has become known for its human rights approach to
dealing with addiction," said Spittal in a telephone interview from
her office at St. Paul's Hospital, the key medical contact for
Vancouver's Downtown Eastside.

From HIV medications to skin grafts for intravenous drug users,
treatments for infections on those with little to no immune system,
overdoses, liver damage, the cost of addiction in this area alone is
staggering.

Walk these streets and it's very hard to see the progress harm
reduction-based projects have made in the area, but health officials
are certain there are positive steps.

Safe injection site staff, for example, referred some 1,000 people to
addiction counselling in 2005 and prevented deaths in 200 overdoses on
the premises, which provides a public health nurse, clean needles and
12 indoor booths for addicts looking for a safe place to get high.

While the jury is officially still out on the three-year pilot project
located among the Hastings Street shooting galleries, provincial
medical health officer Dr. Perry Kendall stated in December he
supports more sites. When it started two years ago, it was a first for
North America.

A staunch advocate of harm reduction-based addictions treatment,
Kendall took a bold step announcing a national harm reduction awards
program, sponsored by the Kaiser Foundation, with the first honours to
be bestowed at the spring harm reduction conference.

Despite the popular buzz around harm reduction, particularly since
Vancouver adopted its Four Pillars approach to addiction, Spittal says
the concept is often a hard sell, particularly outside the Lower Mainland.

"Harm reduction is about meeting people where they're at," she
explained. "It's like, if your daughter was in the Downtown Eastside
and was stuck in a cycle of addiction, what would you have there for
her? How would you see service provision for her if you couldn't get
her out as quickly as you hoped?

"That doesn't mean abstinence-based programming wouldn't be an option
for her because for some people abstinence-based programming really
works. It's really the flexibility of care is what's important."

Spittal's focus on harm reduction began in the early '90s when
doctoral research took her to Uganda to witness the explosion of HIV
infection from a truck stop in the southwestern corner of the country.
Back in Canada today she swaps research from her Vancouver studies
with co-workers around the world.

Winning the conference bid with fellow Canadian Sue Currie in 2003,
she's been assembling a program examining B.C.'s approach to harm
reduction with an eye to both its successes and failures, including
the need to look beyond the Lower Mainland with treatment options.

"I think that the innovations which are occurring in Vancouver are
globally renown now, with the safe injection site protocol and heroin
prescription protocol. There's a lot of really interesting, innovative
work across the country that's federally supported," she said.

In Ottawa, for example, a managed alcohol program for chronic
alcoholics dispenses taxpayer-funded drinks to alcoholics registered
in a shelter program, in return for ensuring their basic health,
housing and medical needs are met.

Researchers who examined the site for the Canadian Medical Journal
found the project very effective in both improving participants' lives
and reducing costs on the medical system.

"A managed alcohol program for homeless people with chronic alcoholism
can stabilize alcohol intake and significantly decrease emergency
department visits and police encounters, reducing police visits," they
concluded. Participants contact with police fell from an average of 18
times per month to eight and emergency room visits from 13.5 times per
month, to eight times per month.

Just over the border at the University of Washington, well-known harm
reduction advocate and professor Alan Marlatt opened a housing project
for alcoholics in December. After facing two lawsuits from businesses
surrounding the site, Marlatt says he's counting on the experiences of
larger projects in New York and Toronto where positive results won
over public support.

He points to the safe injection site experiment in Switzerland where
sites developed around the infamous needle park in Zurich, for
example, were initially met with resistance.

But after watching the area improve, the Swiss actually voted in a
plebiscite to support the continued use of safe injection sites.

Communicating that information, says Spittal, means looking at the
drug scene as a whole in B.C.

"I think what we really have to do is look outside the Downtown
Eastside, for example, look outside the larger centres in Canada and
really support initiatives that are developing in the Interior," she
said.

But she doesn't necessarily mean needle exchanges and prescribed
heroin.

It's about examining the issues within a given community and figuring
out what's going to work, she said, acknowledging different areas have
different norms and values.

Advocates trace the origins of the harm reduction philosophy to a 1965
opiate replacement study by Vincent Dole and Marie Nywander in New
York, from which methadone maintenance programs were born.

Widespread use of the treatment began in the late '80s and early '90s
as the international medical community awakened to the realization
that intravenous drug use was spreading HIV, and later hepatitis, at
alarming rates, posing significant risk to the rest of society.

Today 8,000 B.C. residents are enrolled in methadone programs, which
has largely won public support.

With HIV, condom campaigns designed to reduce the harmful risks of
sexual intercourse outside monogamous relationships have become common
place.

More recently, many B.C. municipalities have adopted needle exchange
programs to reduce the spread of disease and risks to the larger community.

At Kelowna's needle exchange some 60,000 used needles were exchanged
for clean new ones in 2004, before the program transitioned from the
Girls & Boys Club to the Interior Health Authority.

IHA senior medical health officer Dr. Paul Hasselback can rattle off a
number of harm reduction approaches to alleviating the destructive
side effects of substance use which would never raise an eyebrow among
conservative crowds.

Allowing drivers to drink one alcoholic beverage before driving, he
points out, is a harm reduction measure.

"Harm reduction is just a recognition that people take risks and you
need to minimize the impact of those risks," he said.

Whether this logic can be accepted for the transitional housing unit
remains to be seen.