A NEW WAR ON DRUGS

Project Xchange Stresses By Helping To 'Reduce The Harm' Of Drug Use, It
Keeps The Entire Community Safe

DURHAM -- Beth Whalen is on the front lines of Canada's latest battle in
the war on drugs. But, unlike previous battles, this one is not being
fought against the drug users or the drug dealers. It's not being fought
with police raids on drug labs and growing operations or by arresting those
who import and export the illegal products either.

In fact, this battle is being fought alongside the addicts and dealers in
an attempt to reduce the societal ills caused by drugs and addiction. It's
a new fight known as harm reduction; an attempt at reducing the harm
associated with drugs and abuse.

Ms. Whalen is a public health nurse working with the John Howard Society of
Durham Region to run a needle exchange program aptly named 'project xchange'.

Through its offices in Oshawa, Ajax and Bowmanville, the program hands over
clean "works" to addicts in exchange for used ones, to help prevent the
spread of infectious disease through the use of dirty needles. Ms. Whalen
is also available to meet users for an exchange at a safe location through
her pager number, sometimes even after-hours.

She has spent the last four years running the program full time, taking
over when project xchange was just one year old.

"What really interested me was the disease prevention aspect," she
explained. "It's not a program that only protects the drug user -- it
protects everybody. Our mandate is to protect the community at large."

And, the way she sees it, the program is not about promoting drug use as
much as it is about keeping the community safe.

"The war on drugs is over, drugs won. Now we can look at how to reduce the
harm," she said. "Drug users are not going to stop so we need to look at
how we can protect the community at large. By supplying clean needles,
alcohol swabs, condoms and information on substance abuse programs we can
do that."

She is on the streets meeting drug users every day to exchange clean
needles for dirty ones and although she avoids giving lectures, she often
passes on advice to those looking for a way out.

"I'm not out there pushing drug rehab. That has to be a personal choice,
they have to want the help," she said. "I'm definitely not preachy the
first time I meet someone, I just tell them to be safe. But, maybe by the
third time I might start talking to them about the options available."

And, while the John Howard Society offers addiction counselling through its
offices, Ms. Whalen is often called upon for on-the-spot advice. She
recalled one addict she personally counselled who began a methadone program
over one year ago. She said the woman still calls her during the tough
times, just to go for a coffee and talk.

"If it makes a difference to do coffee, I'm going to do coffee," she said.

While she admits counselling addicts who often turn right back to drugs can
be frustrating, she remembers her reason for being there -- to reduce the harm.

Last year, 1,530 men and 1,197 women exchanged needles with project
xchange. Of the number, 1,271 were new to the program.

The program gave out 32,285 needles and took in 31,395. However, Ms. Whalen
said the numbers would be a lot greater if she was able to properly service
more than just the Oshawa area.

"More money for the program is absolutely critical," she explained. "It's
hard to get out to places like Pickering and promote the program or to get
the supplies to keep up with the extreme demand. I'm sure drug users filter
in from Scarborough, but in Ajax and Pickering we're not strongly promoting
the program simply because I can't be there. Right now I have maybe three
clients in Ajax, two in Whitby, and two in Courtice -- most are here in
Oshawa. We don't even service most of the northern communities, but that
doesn't mean there is no drug use up there. We're seriously under funded
and we need another full-time person."

The program is mandated by the Ontario Ministry of Health and, as such,
receives funding from the Durham Region Health Department.

Ms. Whalen said funding from outside agencies is hard to obtain as project
xchange is still looked at with extreme skepticism and labelled as one
promoting drug use, a myth she works hard to dispel.

"We're trying to decrease the spread of communicable diseases and we are a
conduit to treatment," she said. "It's not pro drug use."

Health Canada studies indicate in 1999, 34.1 per cent of the estimated
4,190 new HIV infections and more than 60 per cent of new hepatitis C
infections were related to injection drug use. Last year, the federal
government began taking a serious look at programs like project xchange,
other harm reduction initiatives and how Canada can better fight the war on
drugs.

On May 17, 2001 the House of Commons created the special committee on the
non-medical use of drugs.

The committee was given a broad mandate to study the factors underlying or
relating to drug use in Canada and to bring forward recommendations aimed
at reducing the dimensions of the problems involved.

The committee's mandate includes tabling a report in the House of Commons
by November with a view to determining the ways in which substance abuse
interferes with the health and security of users, their communities and
society as a whole.

Listening to expert witnesses, stakeholders and the public at large, the
committee also plans to make recommendations on necessary changes in
legislation and Canada's drug strategy.

Canada's drug strategy's stated goal is "to reduce the harm associated with
alcohol and other drugs to individuals, families, and communities".

And, it states harm reduction is a "realistic, pragmatic, and humane
approach" to substance abuse, "as opposed to attempting solely to reduce
the use of drugs".

The committee will also examine how much criminalization contributes to the
harm associated with drug use, and if there are ways to mitigate those
adverse effects. It will question if prohibition fails to eliminate drug
abuse, does it at least discourage use among the general population?

In addition, it is looking at whether treatment for drug addiction or
dependence is readily available in all jurisdictions and if there are
barriers to access.

By looking at harm reduction strategies the world over and talking to
Canadian experts, the committee will examine the need to enhance needle
exchange programs like project xchange and increase access to treatment
options, including methadone maintenance for heroin addicts.

Members will also look at the possibility of more advanced harm reduction
strategies like clinical trials of prescription heroin and a pilot or
research project involving a supervised injection site. They have invited
submissions on the impacts associated with existing needle exchange
programs, whether there is a need for prescription heroin trials, and where
the public support lies.

One such submission came in February from the Canadian HIV Aids Legal Network.

The network wrote a brief to the committee recommending the federal
government adopt more harm reduction policies instead of the
criminalization of drugs.

The brief cites several major reports released since 1997 that have
concluded the legal status of drugs in Canada hinders efforts to prevent
the spread of HIV among injection drug users, and efforts to provide care,
treatment, and support to HIV-positive injection drug users.

Recommendations include the continued use and expansion of needle exchange
programs, methadone programs, safe injection sites, and prescription heroin
trials.

'The war on drugs is over, drugs won. Now we can look at how to reduce the
harm. Drug users are not going to stop so we need to look at how we can

protect the community at large. By supplying clean needles, alcohol swabs,
condoms and information on substance abuse

programs we can do that.' Beth Whalen

Walter Cavalieri, a University of Toronto researcher active with several
harm reduction groups, also addressed the committee on behalf of the
Canadian Harm Reduction Network.

He told the committee the major contributor to the harms associated with
drug use are the laws themselves.

He also said needle exchange programs have survived and proven themselves,
but they have still not been adopted universally.

He added fundamental and essential services with proven effectiveness --
such as heroin prescriptions and safe injecting facilities -- are still
held in abeyance "while some people dither and some people die.

"Though we claim that our drug policy is guided by a harm reduction
approach, it remains totally committed to prohibition. As a result,
Canadian citizens who use illicit drugs are still becoming infected with
HIV and hepatitis C at rates far higher than are members of the general
population, because of bad laws.

They are still forced by circumstance into crime and incarceration, because
of bad laws. They still die prematurely, because of bad laws."

Mr. Cavalieri said the evidence is overwhelming that the war on drugs has
not worked, is not working, probably never will work, and is "one of the
longest and costliest social experiments in the history of civilization".

He said since the war's inception, drug use has increased, the variety of
drugs available has increased, drug-related crime has increased and
incarceration of people who use drugs has increased.

"We must immediately enable the legal framework which will permit the
initiation of innovative harm reduction measures such as heroin
prescription and safe injecting rooms," he told the committee. "They are
absolutely necessary, and they must become as ubiquitous as is the use of
drugs."

Back on the front lines here in Durham, Mr. Cavalieri finds a staunch ally
in Ms. Whalen.

She also believes safe injection sites can be a positive step towards
reducing the harms associated with drug use.

"If it's a place where they can get instruction on how to inject safely and
leave their dirty syringes, it's probably the safest step for everybody,"
she said.

And, the overwhelming feeling in Durham is that needle exchanges do work.

York University nursing student Tonya Strickland has been helping out at
project xchange since the end of September.

The 22-year-old said she first thought a needle exchange might encourage
drug use, but watching the program work showed her something completely
different.

"Before I came I was skeptical about the program, I was thinking it just
promotes drug use," she said. "Now I see it's about preventing the spread
of disease. It's not about drug use itself, it's about reducing the risk."

"It is doing something," said Ms. Whalen. "Police are finding fewer dirty
syringes on the streets and in the parks. Our primary function, the mandate
of this program, is harm reduction. If one less person contracts HIV or
hepatitis C, then we've done something, then it's working."

All they need now is a few more dollars to make it work across Durham.

And, they'll be awaiting the special committee on the non-medical use of
drugs' report, just looking for some sign of hope.