Insite uproar a blessing and curse – Opinion – Insite uproar a blessing and curse: Harm reduction should be debated on its merits rather than turned into a divisive political issue
August 19, 2008. Paul E. Garfinkel

Those of us who care about lively and informed public debate of Canada’s drug policies see Vancouver’s supervised injection site as both a profound blessing and a wretched curse. This month’s International AIDS conference continued to highlight the polarizing impact of Insite.

Insite is a blessing because its operation – and particularly the federal government’s opposition – has highlighted drug policy questions like never before. At the centre of these questions is harm reduction – a general term used to describe programs that seek to reduce drug-related harm without requiring an immediate end to drug use.

Harm reduction programs enjoy broad public acceptance; in Ontario, for example, 60 per cent of adults support safe, supervised drug injection. That level of acceptance rises if these facilities increase drug users’ contact with health and social workers.

Yet Insite has also cursed the public discussion on harm reduction by narrowing and oversimplifying a critical public debate.

Most Canadians would equate their support for harm reduction with their opinion on Insite’s right to exist. This is understandable, given media coverage.

Yet Insite is of one of hundreds of harm reduction programs delivered by Canadian health practitioners and community agencies over the past 20 years, many of which were equally controversial when first introduced. These include needle exchange programs, methadone and other replacement therapies, and even the nicotine patch recommended by family doctors for smokers unable to stay quit.

Public discussion of harm reduction should be rooted in facts, and go far beyond one supervised injection site, or one approach.

We should recognize the vast majority of costs and harms associated with substance use result from legal substances – tobacco and alcohol. In fact, harm reduction programs constitute a small portion of the public funds devoted to drug use.

For every dollar spent on harm reduction programs targeting illicit drugs, $25 is spent on enforcement.

The Centre for Addiction and Mental Health (CAMH) believes that decisions about drug policy belong in the public sphere, and should be informed by the best available research evidence.

Harm reduction is rooted in a pragmatic approach that focuses on improving the overall health and well-being of individuals. It’s meant to focus on a problem that is causing a harm. And if our approach to the problem is a pragmatic one then our evaluation of harm reduction should also be pragmatic.

It should be conducted dispassionately and it should report on both the pros and cons of the intervention.

The assessment of the Insite facility conducted at the request of Health Canada performed such an evaluation. Where Insite has had documented, empirically proven success, the review committee presented the evidence; where other Insite objectives cannot yet be proven, the committee recommended further research.

Across this country we have had success in implementing harm reduction programs that have improved the health of Canadians. These initiatives should be measured on their merits.

It is contrary to the interests of both scientific inquiry and informed public debate to categorically reject supervised injection sites. I regret that the Government of Canada has adopted this position.

Let’s try a different approach: Let’s use the debate about supervised injection sites to discuss the most appropriate public responses to problematic use of drugs, including some legal ones like prescription opioids.

Informed public discourse could be a long-term, pan-Canadian legacy of Vancouver’s supervised injection site.

Dr. Paul Garfinkel heads CAMH, Canada’s largest addictions and mental health teaching hospital.

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