The solution is abstinence

Posted on July 28, 2008 in Governance Debates, Health Debates, Social Security Debates – opinion – The solution is abstinence: By giving drug addicts a sterile syringe and a warm place to shoot up, are we saving lives or condoning substance abuse?
Published: Monday, July 28, 2008. Barbara Kay, Special to the National Post

Prevention, treatment, enforcement: These traditional policies were announced in 2007 as the pillars that would uphold Canada’s National Anti-drug Strategy. Pointedly excluded from the government’s plan is the continued reliance on harm resistance, the philosophical darling of liberal stakeholders in addiction management. Designed as a fourth pillar to focus on public health and order rather than usage reduction, harm reduction is defensible as a handmaid to a balanced portfolio of approaches, supplementing treatment and prevention. But in Vancouver, it has emerged in the last decade as a free-standing pillar, now teetering under an unwieldy social burden it cannot sustain.

Harm reduction’s social laboratory is the municipal quagmire of Vancouver’s Downtown Eastside. Here, the mentally ill, the culturally uprooted and the psychologically dysfunctional appease their demons in a squalid cycle of illicit-drug torpor and crime. Drug consumption is high — nearly a third of the 16,000 residents are addicts — but evidence of faith in the drug abuser’s power to reclaim his portion of the human estate is low. Funding allocations approved by a series of mayors speak volumes about prior ities. Money abounds for needles, crack-pipe kits and opiate-giveaway trials, but extended waiting lists for long-term rehabilitation centres attest to a scarcity of available beds.

Insite — the first public facility in North America where addicts can legally inject illicit drugs under professional supervision — started up in 2003. In keeping with harm reduction’s non-judgemental ideology, Insite’s detox resources were made available only to those who asked for them. It’s just as well that few have done so, since there are only 12 detox beds for several hundred daily inject ors. And because they wouldn’t have been using Insite, the neighbourhood’s 5,000 crack-smoking addicts have been denied even that faint hope of breaking the vicious cycle.

Harm reduction-friendly researchers claim success for Insite. But observers of addicts in crisis demur: Dr. Stan de Vlaming, former head of addiction services at Vancouver’s St. Paul’s Hospital– the main provider of hospital services to Downtown Eastside residents — says, “The people who refer to Insite as a ‘safe injection site’ are perpetuating a dangerous misunderstanding. There is nothing safe about repeated daily injections that bypass a person’s normal defence systems.” He notes that from 2002 — one year prior to Insite’s inauguration — to 2005, the number of hospital days utilized for infectious complications directly attributable to injecting had escalated from 16,042 to 18,848. Moreover, after evaluating the most-cited harm reduction studies, Garth Davies, assistant professor at Simon Fraser University’s School of Criminology, also was unconvinced. In his article A Critical Evaluation of the Effects of Safe Injection Facilities, published in the Journal of Global Drug Policy and Practice, Davies concluded that “all claims regarding the benefits of harm reduction remain open to question.”

Many people who find themselves up close and personal with addicts –law enforcers, judges, treatment professionals, ministering volunteers — see the human wreckage that human wreckage perpetuates. Retired Vancouver policeman Al Arsenault patrolled the “chemical gulag” of the Downtown Eastside for more than half of his 27 years on the job. He calls Insite — and the needle-exchange program, in particular –an “abject and utter failure.” If injectors were responsible enough to return needles, he observes, they wouldn’t be in the Downtown Eastside. Ironically, the program has augmented the presence of used needles in the area. Arsenault wryly sums up the experiment: “The rich get treatment, the poor get harm reduction.”

Pastor Gloria Kieler concurs. She has ministered to addicts since 1984 and deplores “the total disregard for those addicted persons desperately wanting to escape the Downtown Eastside.” Rehabilitation is the solution she tirelessly urges, acknowledging facilities can’t spring up where there is no moral impetus to build them.

Advocates of harm reduction continue to push the drug-normalization envelope. Through a volunteer-based research trial for addicts — overseen by the Vancouver Coastal Health Authority, among other agencies — chronic addiction substitution treatment is poised to offer addicts prescriptions-on-demand for the consumption of legal opiates such as Dilaudid (hydromorphone hydrochloride) — virtually a heroin clone. And selected hard-drug users who “do not benefit from methadone maintenance therapy” — as explained on the Canadian Institutes of Health Research Web page on this topic — have participated in the North American Opiate Medication Initiative, where they were given heroin daily, setting the bar for the addicts’ moral agency even lower.

Harm reduction proponents seem to view addiction as an incurable disease — and addicts as victims not only unaccount able for, but entitled to, their “lifestyles.” Do militants truly believe that the war on drugs is lost, and that containment of crime and of needle-based Hepatitis C, HIV and AIDS is the best society can hope for?

Harm reduction is therefore the opposite pole to the traditional abstinence model, which insists that, while the war against the dark side of human nature can never be won completely, partial victory is preferable to surrender. Abstinence initiatives have proven to be effective over the long term. A consistent and persistent message that cigarettes are unhealthy and would not be socially tolerated cut the number of youth experimenting with tobacco by half between 1994 and 2004. And the anti-drunk driving campaign has cut the incidence of drunk driving by 65% since 1981.

Successfully recovered addicts are harm reduction’s harshest critics. Saskatchewan MLA Serge Le-Clerc reversed a lifetime of drug-related dysfunction and crime following an inspirational encounter with a prison Samaritan. LeClerc earned two university degrees while behind bars and has become a passionate crusader for preventive drug education in schools. He is contemptuous of harm reduction, under whose rubric he would still be an addict. “The disease model negates choice, but there is no one who is beyond redemption,” he says. In fact, according to the Portage Rehabilitation Centre in Elora, Ont., at six months following discharge from their facility, there’s a nearly 86% decrease in drug use among adolescents and a 92% decrease for young adults.

Ironically, as Vancouver’s infatuation with harm reduction waxes, some critics are concluding that the program was a costly mistake. Amsterdam, one of harm reduction’s earliest adopters, is mired in squalor from escalating usage and attendant drug-related evils. Dozens of European cities, including Athens, Stockholm and Oslo, have signed a declaration against drugs — including using safe-injection sites as a surreptitious way to try to legalize drugs. And all but renouncing harm reduction outright, Sweden instituted compulsory drug treatment in a limited number of cases and criminalized the purchase of sex. The country now boasts some of Europe’s lowest drug-related rates of crime, disease and social problems.

We cannot take pride in a society that chooses to accompany an addict to the abyss; only in a society that pulls him back from it. True compassion is expressed through prevention and treatment. It is time to end the false compassion of harm reduction. – © 2008 by The Reader’s Digest Canada Magazines Limited. Reprinted by permission from the August 2008 issue of Reader’s Digest.

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