DECRIMINALIZING NONMEDICAL DRUG USE

Robert Remis' commentary questions the potential effectiveness of safe
injection sites for secondary prevention because of the chaotic lives of
many injection drug users. But Remis fails to mention that much of that
chaos comes from users' struggles to obtain money to pay for their drugs
and evade criminal prosecution.

As a family doctor with a longstanding interest in HIV, my practice has in
recent years increasingly come to encompass hepatitis C, injection and
other drug use, prescription drug abuse, harm reduction, Aboriginal and
mental health, advocacy for access to the nonmedical determinants of health
and liaison with prison health services.

I would suggest a far bolder approach than Remis advocates to minimize
nonmedical drug use and its enormously (and increasingly) costly personal
and societal consequences.

Government should confine its role to what it can do. It is surely by now
beyond dispute that if an individual wants to use a particular drug he or
she will do so. Drug price, poverty, the law, warnings and the risk of
violence are clearly ineffectual deterrents. People make their own choices
and have to live with the consequences. The important thing is that they
comprehend the facts needed to help them decide so that the consequences
are minimized. To achieve this (as with liquor and Al Capone), government
must take over the supply and distribution of drugs from the gangs. The
gangs' profit motivation ensures the constant recruitment and initiation of
new users.

Decriminalization without regulation could do more harm than good. I
suggest that the right to obtain, possess and use each drug -- from
marijuana through "party drugs" to injection drugs -- should be subject to
licensure. High quality, accurate primary preventive education for the
specific drug concerned would be targeted precisely at each licence
applicant. A government monopoly and affordable drugs would go a long way
toward ensuring that safe and supervised legal injection sites would be
accepted by users.

After an initial period of enforcement, this would result in a significant
shift in human resources from police, legal and correctional service
vocations to research and preventive work in the fields of health and the
nonmedical determinants of health.

Rigorous scientific evaluation of the overall effectiveness of implementing
this type of strategy in the short and long term, although challenging,
could be achieved.

J.R. (Dick) M. Smith

HIV Primary Care Physician

Winnipeg, Man.