Tuesday, October 23, 2007

Editorial from the McGill Tribune


EDITORIAL: Needles in a political haystack
Issue date: 10/23/07

Political opposition to drug harm reduction centres is nothing new. Insite-a supervised injection site located in the downtown eastside of Vancouver has encountered nothing but disdain from Stephen Harper's federal government, while the UN's International Narcotics Control Board routinely condemns various harm reduction centres abroad for violating international treaties concerning narcotic drugs.

The U.S. government has also been an outspoken global critic of harm reduction projects that provide legal exemptions for drug use ever since Richard Nixon coined the term "war on drugs." Therefore, it should come as no surprise that early efforts by the San Francisco Department of Public Health to open America's first legal safe-injection site have been met by political
stonewalling and moral indignation.

The scientific evidence supporting supervised injection sites is overwhelmingly positive. Insite, the only facility of its kind in North America, has been the subject of over a dozen studies conducted by the BC Centre for Excellence in HIV/AIDS, none of which have uncovered a single negative effect of the SIS. Furthermore some of the positive effects revealed in their
peer-reviewed research are extremely encouraging: Insite has reduced the overall rate of needle sharing in the area, led to increased enrollment in detox programs and has not led to an increase in drug-related crime or intravenous drug usage.

Nurses at Insite provide care for wounds, supply users with sterile drug paraphernalia and educate users about sanitary practices that cut down on the spread of HIV and Hepatitis C. They are also on-hand for any overdoses-of which there have been over 800 at Insite. Thanks to prompt medical care, not a single overdose at the facility has resulted in a fatality and, not coincidentally, emergency room visits for intravenous drug users are down dramatically.
Unnecessary hospital visits are prevented by simple care at an SIS, saving tax-payers money and cutting waitlists at emergency rooms.

Perhaps most importantly, safe-injection sites put drug users in close contact with social workers. In fact, a recent study showed that intravenous drug users were 20 per cent more likely to enrol in a detox program after using Insite on a regular basis. The power of personal contact, something that is almost impossible to establish when dealing with users in back-alleys, is undeniable.

An SIS in the downtown eastside of Vancouver was an crucial step towards improving the community. It is estimated that the area is home to over 1,500 homeless people, as well as thousands of others living well below the poverty line. The percentage of HIV-positive men and women in the community parallels that of many third-world countries.

San Francisco has similar problems, with estimates of intravenous drug users in the city ranging from 11,000 to 15,000 people. For them, the old methods of enforcement are not working. In fact, a study published in the International Journal of Drug Study concluded that street-level arrests and confiscations only serve to exacerbate drug-related crime and prompt increased
needle sharing.

The Harm Reduction Centre here on campus is based on much of the same ideology. The centre, which became a Students' Society Service in November of last year, aims to educate students on safe alcohol and drug use and bridge the disconnect between the average student and the officials that preach on the evils of drugs. Quebec pharmacy Jean Coutu offers a kit of inexpensive needles and condoms in order to prevent the spread of disease and facilitate safe drug use and sex for low-income individuals.Yet most politicians still believe "The war on drugs" is the answer and refuse to use the formidable powers of government to offer such harm reducing services.

Ideologically it's easy to see why they have a knee-jerk reaction to anything that might seem to make drug use easier, but what they fail to realize is that supervised injection sites don't condone or legitimize drug use at all. The facts show that facilities such as Insite do not increase drug use in the community, nor cause additional relapses. The staff at safe-injection sites work
to save users' lives, while idealistic politicians stick their heads in the sand and pretend drug-busts, harsher jail sentences and preventative campaigns will rid society of the problem. They refuse to see the reality that prohibition and punishment will never completely eradicate drug use from the general population.

This sad state of affairs among our politicians was revealed, yet again, earlier this year, when Harper's government denied Vancouver Coastal Health's request for a three-year extension to Insite's operating exemption. Instead, Insite was granted an additional six months to "gather more proof of its effectiveness." Harper commented that he was "sceptical" about Insite's value,
despite the favourable studies published in over a dozen reputable medical journals such as the Lancet and the New England Journal of Medicine.

Supervised injection sites are not the be-all, end-all solution to the problem of drug usage, but rather, they are an important tool in the battle against intravenous drugs. They cost a measly $2-millon per year to operate, which is pocket-change compared to the millions spent on enforcement and education. Some object to them on moral or philosophical grounds; but the
science behind them is sound, and when morality and pragmatism meet, pragmatism should always triumph.The bottom line is that programs like Insite work.

If Mr. Harper and the politicians in California believe otherwise, then they must be high on something.

Friday, October 19, 2007

Nurses to Supervise Heroin, Cocaine Injections

Here's an article I got over at nurselink about the proposal to start a safe injection site in San Francisco. My response on the site is also reposted here below the news article. Head on over to nursingling to check out all of the naysayers too.

City health officials took steps Thursday toward opening the nation’s first legal safe-injection room, where addicts could shoot up heroin, cocaine and other drugs under the supervision of nurses.

Hoping to reduce San Francisco’s high rate of fatal drug overdoses, the public health department co-sponsored a symposium on the only such facility in North America, a four-year-old Vancouver site where an estimated 700 intravenous users a day self-administer narcotics under the supervision of nurses.

“Having the conversation today will help us figure out whether this is a way to reduce the harms and improve the health of our community,” said Grant Colfax, director of HIV prevention for the San Francisco Department of Public Health.

Organizers of the daylong forum, which also included a coalition of nonprofit health and social-service groups, acknowledge that it could take years to get an injection center up and running. Along with legal hurdles at the state and federal level, such an effort would be almost sure to face political opposition.

Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, called San Francisco’s consideration of such a facility “disconcerting” and “poor public policy.”

“The underlying philosophy is, ‘We accept drug addiction, we accept the state of affairs as acceptable,’” Madras said. “This is a form of giving up.”

Sixty-five similar facilities exist in 27 cities in eight countries, but no other U.S. cities have considered creating one, according to Hilary McQuie, Western director for the Harm Reduction Coalition, a nonprofit that promotes alternative drug treatment methods.

“If it happens anywhere in the U.S., it will most likely start in San Francisco,” McQuie said. “It really just depends on if there is a political will here. How long it takes for that political will to develop is the main factor.”

Drug overdoses represented about one of every seven emergency calls handled by city paramedics between July 2006 and July 2007, according to San Francisco Fire Department Capt. Niels Tangherlini. At the same time, the number of deaths linked to overdoses has declined from a high of about 160 in 1995 to 40 in 2004, he said.

Colfax estimated that there are between 11,000 and 15,000 intravenous drug users in San Francisco, most of them homeless men. Like many large U.S. cities, the city operates a clean-needle exchange program to reduce HIV and hepatitis C infections.

Advocates plan to work on building community support for a safe-injection center, including backing from Mayor Gavin Newsom and the Board of Supervisors.

The mayor’s spokesman, Nathan Ballard, said Thursday that although he does not want to discourage debate, he “is not inclined to support this program because, quite frankly, it may create more problems than it supposedly addresses.”

In Switzerland, Spain and other European countries with such programs, the sites have been placed in existing public health clinics and created as stand-alone centers, said Andrew Reynolds, a program coordinator with San Francisco’s city-run sexually transmitted diseases clinic.

Possible locations for opening one in the city include homeless shelters, AIDS clinics or drug treatment centers, he said.

“They aren’t these hedonistic dens of iniquity,” Reynolds said. “There is no buying or selling of drugs on the premises. Staff do not assist in injections.”

While it’s too early to tell what the room in San Francisco would look like, Vancouver’s InSite program is on the upper floor of a low-rise building in a downtown neighborhood where drug users shoot up in the open.

The site, exempt from federal drug laws so users can visit without fear of arrest, has 12 private booths where addicts inject drugs such as heroin, cocaine or crystal. They can use equipment and techniques provided by the staff, and then relax with a cup of coffee or get medical attention in the “chill out” room where they are observed, said program coordinator Sarah

“It looks kind of like a hair salon,” Evans said of the bustling space. “If we were a restaurant, we would be making a profit.”

While 800 overdoses have occurred on the premises, none resulted in death because of the medical supervision provided at InSite, said Thomas Kerr, a University of British Columbia researcher who has extensively studied the program. His research also has shown an increase in addicts seeking drug treatment and a decrease in abandoned syringes, needle-sharing, drug-related crime and other problems since the clinic opened, he said.

The results indicate the idea is worth replicating, despite the criticism it may attract, Kerr said. “I prefer the approach of the Vancouver Police Department, which was: ‘We don’t like the idea of this, but let’s look at the evidence and at the end of three years we will tell you either this
is something we can support or it’s something we can’t support,’” he said.

Temple University law professor Scott Burris told the audience at Thursday’s forum that a supervised injection room would seem to run afoul of federal drug possession laws and a state statute that makes it illegal to operate a crack house or any place where drugs are used, but only if the police and federal agents enforce them.

He cited as an example California’s medical marijuana law, which has allowed pot dispensaries to flourish but at the risk of being raided by federal authorities.

“The law isn’t a barrier,” Burris said. “The issue of whether it’s legal doesn’t come up until somebody is arrested.”

My response:
There are so many reasons that this is a good idea: The first point of contact for many street-living addicts is the ER, either for an overdose or an infected abcess. Both of these are costly to the taxpayer/HMO system. If nurses can catch infections early, teach people how to inject safely, spread the word about the necessity of clean needles and clean water AND save the system money AND direct people to resources & services AND direct them to treatment, AND save their lives then the "it's illegal" argument falls a bit flat in the face of that.

It's still illegal outside of the clinic environment. By entering the clinic the user has made an
(either overt or tacit) agreement to use clean gear & stick around afterwards (at least that's the arrangement at the Vancouver InSite). Chronic drug users no longer get high from heroin or
cocaine, they need the drugs simply to remain functional and not go into withdrawl. Users then can get information on treatment programs or be put in contact with other resources while in a frame of mind where they can actually take the information in rather than while they are "jonesing" for a hit.

Just in case anyone envisoning addicts to be "merely" the homeless (although they're the ones to benefit most from this type of frontline care), 13.1% of employed Americans in 1999 were substance abusers and it's suspected that 10% of the nursing population of the US uses drugs and/or alcohol, 6-8% to the point of impairing their clinical judgement (Dunn, Substance Abuse Among Nurses, AORN Journal, Oct 2005)

Wednesday, October 17, 2007

Apologies, and an update (finally)

**See my post on letter writing tips in the Feb 2007 archive**

**See my post on who's who in the cabinet from the Aug 2006 archive but be careful, the cabinet has shuffled since then**

**See my fact sheet on Insite in the Aug 2006 archive**

I've been pretty remiss about posting on this blog. My apologies.

You know what finally kicked me back into gear on this issue? The recent trite remarks by the Minister of Health, Tony Clement, that "The party is over" and the simplistic and judgemental remarks of the Prime Minister, Stephen Harper about addict's "...short, miserable lives".

These, combined with a new anti-drug policy that's long on enforcement and fire & brimstone scare tactics, and short on evidence based harms-reduction strategies that actually lead to recovery and treatment for addicts.

I find it hard to believe --despite the significant chunk of the $63.8 million allocated to treatment in the get tough on drug policy announced last week-- that the government hasn't already written off addicts' "short & miserable lives" as dead in the water.

I am deeply disturbed that the Prime Minister can write off the lives of Canadians in this manner.

There is quite an avalanche of new postings here with little or no commentary--basically the opposite of how I originally invisioned this blog.

However, it remains, I think, a good repository of relevant information so that interested people can gather the necessary information to write letters to their MP or to the editors of student, local or national newspapers about Insite in particular and harms reduction in general.

From the sounds of the Speech from the Throne last night and the reactions to it today, it sounds like Canadians will be heading to the polls sooner rather than later.

Don't let harms reduction fall away as an important health care issue.

Don't let the conservatives ignore the harms reduction & treatment pillars of the 4 pillars strategy in overwhelming favour of the enforcement & prevention pillars.

Write to your MP, ask for a balanced approach for Canada: Enforcement and Prevention, yes but in conjunction with --not to the exclusion of-- Treatment and Harms Reduction

**See my post on letter writing tips in the Feb 2007 archive**
**See my post on who's who in the cabinet from the Aug 2006 archive but be careful, the cabinet has shuffled since then**
**See my fact sheet on Insite in the Aug 2006 archive**

In the Ottawa area: Community Forum on Homelessness with Plenary session by Sarah Evans, Liz Evans & Anita Hubley on Insite

The Alliance to End Homelessness
2007 Community Forum on Homelessness


Location: University of Ottawa, Tabaret Hall Chapel, 75 Laurier, 1st Floor
Time: 9:00 am–3:30 pm ~ Registration Free ~ Lunch Provided
~ Please Email Registration Form
The Research Alliance for Canadian Homelessness, Housing, and Health (REACH 3), a collaborative interdisciplinary network of academic investigators and community partners in Ottawa, Vancouver, Calgary, Toronto, and Montreal.
Housing Solutions
    Liz Evans, BScN, Portland Hotel Society, Vancouver
    – on innovative housing programs that have been created in Vancouver.
    Stephen Hwang, MD, MPH, St.-Michaels Hospital, Toronto
    – on policy and program implications of some of their research
    Lorraine Bentley, MA, Executive Director, Options Bytown, Ottawa
    – reacting with implications for the housing situation in Ottawa.
    Resident, Options Bytown, Ottawa
    – providing a personal perspective on their housing difficulties in Ottawa
    Youth Can Move Forward
    Elise Roy, MD, MSc, Université de Sherbrooke
    – Montreal Street Youth
    Bruce MacLaurin, MSW, PhD (Cand.), University of Calgary
    – Calgary Street Youth
    Catherine Worthington, MSc, PhD, University of Calgary
    – Calgary Street Youth
    Andrea Poncia, Youth Services Bureau of Ottawa
    – HIV/AIDS Educator
    An Ottawa youth community member
    – commenting on the findings and their own experience
  • INFORMAL LUNCH & NETWORKING CAUCUSES — A 1½ hour opportunity to share ideas from Ottawa and ask more questions of REACH3 members.
    Select your lunch then join one of the LUNCH CAUCUSES, focusing on a variety of topics, facilitated by Ottawa’s Alliance to End Homelessness members.
    The good, bad and ugly – the InSite Experience
    The "how" behind linking community agencies and researchers
    A session describing how the community and the academic's worked together on InSite, Vancouver’s legal supervised injection site.
    Hear about the good, bad and ugly parts of the experience when the private, public and not-for-profit sectors, come together locally, nationally and internationally.
    Taking the need for a National Housing Program out to the community!
    A Sound & Photo Installation
    Street Health Stories
    How do you take care of your health when you don’t have a home?
    8 Street Health Stories in large lightbox prints with headphones
    The National Film Board of Canada’s Filmmaker-in-Residence presents the Street Health Stories installation which gives a human face and voice to Street Health’s statistics.
    Four photographers who have experienced homelessness ~ Adrienne, Jess, Keneisha, and Meghan document the stories of 28 homeless men and women through audio recordings and portrait-photography. Katerina Cizek, a documentary-maker and the National Film Board of Canada’s Filmmaker-in-Residence at an inner-city hospital, teaming up with partners at the frontlines – doctors, nurses and patients – to create collaborative media.
    We gratefully acknowledge support from our Alliance to End Homelessness Members, United Way/Centraide Ottawa, the University of Ottawa & the Homelessness Partnering Strategy, Government of Canada.

The drug problem: Europe tolerance vs. U.S. criminalization

The drug problem: Europe tolerance vs. U.S. criminalization
918 words
16 October 2007
Guelph Mercury
Copyright (c) 2007 Guelph Mercury.

Europe has a drug problem, and knows it. But the Europeans' approach to it is quite different from the American "war on drugs." I spend 120 days a year in Europe as a travel writer, so I decided to see for myself how it's working. I talked with locals, researched European drug policies and even visited a smoky marijuana "coffee shop" in Amsterdam. I got a close look at the alternative to a war on drugs.

Europeans are well aware of the U.S. track record against illegal drug use. Since U.S. president Richard Nixon first declared the war on drugs in 1971, the United States has locked up millions of its citizens and spent hundreds of billions of dollars (many claim that if incarceration costs are figured in, a trillion dollars) waging this "war." Despite these efforts, U.S. government figures show the overall rate of illicit drug use has remained about the same.

By contrast, according to the 2007 UN World Drug Report, the percentage of Europeans who use illicit drugs is about half that of Americans. ( Europe also has fewer than half as many deaths from overdoses. ) How have they managed that -- in Europe, no less, which shocks some American sensibilities with its underage drinking, marijuana tolerance and heroin-friendly "needle parks"?

Recently, in Zurich, Switzerland, I walked into a public toilet that had only blue lights. Why? So junkies can't find their veins.

A short walk away, I saw a heroin maintenance clinic that gives junkies counselling, clean needles and a safe alternative to shooting up in the streets. Need a syringe? Cigarette machines have been retooled to sell clean, government-subsidized syringes.

While each European nation has its own drug laws and policies, they seem to share a pragmatic approach. They treat drug abuse not as a crime but as an illness . And they measure the effectiveness of their drug policy not in arrests but in harm reduction .

Generally, Europeans employ a three-pronged strategy of police, educators and doctors. Police zero in on dealers -- not users -- to limit the supply of drugs. Users often get off with a warning and are directed to get treatment. Anti-drug education programs warn people (especially young people) of the dangers of drugs, but they get beyond the "zero tolerance" and "three strikes" rhetoric that may sound good to voters but rings hollow with addicts and at-risk teens. And finally, the medical community steps in to battle health problems associated with drug use (especially HIV and hepatitis C) and help addicts get back their lives.

Contrast this approach with the American war on drugs. As during Prohibition in the 1930s, the United States spends its resources on police and prisons to lock up dealers and users alike. American drug education (such as the now-discredited DARE program) seemed like propaganda, and therefore its messengers lost credibility.

Perhaps the biggest difference between European and American drug policy is how each deals with marijuana. When I visited the Amsterdam coffee shop that openly sells pot, I sat and observed: People we re chatting; a female customer perused a fanciful array of "loaner" bongs. An older couple (who apparently didn't enjoy the edgy ambience) parked their bikes and dropped in for a baggie to go. An underage customer was shooed away. A policeman stepped inside, but only to post a warning about the latest danger from chemical drugs on the streets. In the Netherlands, it's cheaper to get high than drunk, and drug-related crimes are rare.
After 10 years of allowed recreational marijuana use, Dutch anti-drug abuse professionals agree that there has been no significant increase in pot smoking among young people and that overall cannabis use has increased only slightly. Meanwhile, in the United States, it's easier for a 15-year-old to buy marijuana than tobacco or alcohol -- because no one gets carded when buying something on the street.

The Netherlands' policies are the most liberal, but across Europe no one is locked away for discreetly smoking a joint. The priority is on reducing abuse of such hard drugs as heroin and cocaine. The only reference to marijuana I found among the pages of the European Union's drug policy was a reference to counselling for "problem cannabis use."

Meanwhile, according to FBI statistics, in recent years about 40 per cent of the roughly 80,000 annual drug arrests were for marijuana -- the majority (80 per cent) for possession.

In short, Europe is making sure that the cure isn't more costly than the problem.

While the United States spends tax dollars on police, courts and prisons, Europe spends its taxes on doctors, counselors and clinics. EU policymakers estimate that they save 15 euros in police and health costs for each euro invested in drug education and counselling.

European leaders understand that a society has a choice: tolerate alternative lifestyles or build more prisons. They've made their choice.

Rick Steves (ricksteves.com) writes European travel guidebooks and hosts travel shows on public television and radio. This commentary originally appeared in the Los Angeles Times.

From the San Francisco Chronicle

Drug injection center idea gets an airing in S.F.
C.W. Nevius
902 words
16 October 2007
The San Francisco Chronicle
© 2007 Hearst Communications Inc., Hearst Newspapers Division. Provided by ProQuest Information and Learning. All Rights Reserved.

Two months ago I wrote about an idea for a place in San Francisco where intravenous drug users could shoot up under the supervision of trained personnel. A lot of people thought it sounded crazy.

Well, get ready to hear about it again, because the idea is gaining momentum.

On Thursday, an all-day symposium - co-hosted by the city Department of Public Health - will examine the idea of creating safe injection centers where users could bring their drugs, shoot up and leave, without fear of arrest.

The idea is to decrease overdoses, keep dirty needles off the street, and cut the risk of spreading HIV and hepatitis C. Those are all good things. It is the idea of providing addicts with their own injection clinic that riles people up.

"What's next?" a reader wrote when the first column appeared. "Giving them the drugs, too?"
No. But there's no doubt that if San Francisco ever established such a center, even as a pilot program, there would be an enormous brouhaha.

"It would be huge international news," said Peter Davidson, a researcher at UCSF in the epidemiology and biostatistics department. "It would be the first facility in the United States, and there would probably be a firestorm for a while."

You can count on that. The conservative radio talk show hosts are probably already jump-starting their tonsils. Wacky San Francisco, providing a party room for junkies.

Nor are public officials eager to jump on the bandwagon. Asked for a comment from Mayor Gavin Newsom, spokesman Nathan Ballard said, "The mayor is not inclined to support this approach, which quite frankly may end up creating more problems than it addresses."

Organizers of Thursday's conference are hardly surprised by that reaction.

"Down the road there will be a lot of strong feelings," said Hilary McQuie, Western director of the Harm Reduction Coalition, a national group that combats the adverse effects of drug use. It is organizing the event.

"It's a big topic, and we hope to start a conversation," McQuie said.

Oh, it'll start all right. But Barbara Garcia, the city's deputy public health director, asked where it will go. "We don't want to create a lot of backlash," she said.

San Francisco and the rest of the country may not be quite ready, but injection centers are
getting a lot attention in other parts of the world. Grant Colfax, director of HIV prevention for the city Public Health Department, says there are now 65 centers in eight countries.

In Vancouver, British Columbia, where an injection clinic opened in 2003, "the data ... seem to show that it is actually a benefit to the community," Colfax said.

Opening a shooting gallery benefits the community? How does that work? Well, Dr. Thomas Kerr, the University of British Columbia physician who has been involved with the Vancouver center since its inception, says it is having success treating addicts, even though they are coming to inject themselves.

"We published a paper in the New England Journal of Medicine that showed that we had a 33 percent increase in the use of detox facilities from our population," Kerr said.

But would the addicts actually use the center? McQuie says they have in other cities, and the reason may be something people don't ordinarily associate with drug users - fear.

"I think that a lot of injectors are very afraid of overdosing and dying," McQuie said. Many overdoses happen when users are alone, she said.

Then there is the question of what neighborhood would host an injection center. Davidson says he thinks the Tenderloin would be the logical place, noting that a 2003 survey in which he took part found that more than a third of the city's overdose deaths occurred within 100 yards of the intersection of Turk Street and Golden Gate Avenue.

McQuie says centers attract a certain type of user, probably one whose health is not the best and who is somewhat desperate.

"It's not for everybody," she said. "It's not the most fun place in the world."

Vancouver's center has small booths where users step in, inject and come out. With scrubbed floors and bright overhead lights, it is sterile in every sense of the word.

"They are really for the people (whose lives) are most chaotic," Kerr said. "Homeless people with mental problems who are likely to use public spaces to inject."

Exactly, in other words, those who have the worst effect on the neighborhood and community.
Ask Garcia. Not long ago she opened the front door of her house and found a man passed out on the stoop. She was able to call an ambulance in time, but he nearly died of an overdose.

"So," she says, "I am sympathetic to the dangers."

The rest of San Francisco should be, too. This is a problem that is on everyone's doorstep.

"The mayor is not inclined to support this (which) may end up creating more problems than it addresses." - Nathan Ballard,, spokesman

C.W. Nevius' column appears Tuesday, Thursday and Sunday. His blog, C.W. Nevius.blog, can be found at sfgate.com. E-mail him at cwnevius@sfchronicle.com.

Maybe we can punish the pushers

Maybe we can punish the pushers
Kelly Roesler
The Ottawa Citizen
901 words
16 October 2007
Ottawa Citizen
Copyright © 2007 Ottawa Citizen

'If you are addicted to drugs, we'll help you, and if you sell drugs, we'll punish you," Prime Minister Stephen Harper claimed recently in launching his drug strategy. The statement and the plan were met with a wave of derision from opposition parties, newspaper editorials and columns, and much of the general public, judging from an influx of letters to the editor.

There he goes again, they moaned, lamenting Harper's "ideological" decision to emphasize law enforcement as part of a multi-pronged strategy that includes treatment, education and prevention.

It seems Harper is being demonized for recognizing there are many drug dealers out there who don't suffer the debilitating effects of addiction, who are perpetuating the hugely profitable and pervasive drug market, and that it needs to be addressed.

But where is the rational discourse about law enforcement as a component of a comprehensive drug policy?

Before I am painted as a hard-right, ideological subscriber to the "law and order" philosophy, let me say this: I write as a passionate believer in harm reduction measures; in supervised injection sites, heroin prescriptions, dispensing of alcohol, even free crack kits. All of it.

As a young journalism student I was deeply moved by researching a story on the opening of Vancouver's Insite safe injection site. Simply put, I consider myself "progressive" on drug policy.
But "law" seems to have become a dirty word in our national discussion on drugs, and it shouldn't be. It's a vital piece of a greater plan that encompasses all players in the sad world of the drug trade. This includes addicts -- who need all the support, compassion, health and social supports we can offer -- and dealers, particularly high-level suppliers who drive the market, reap the profits, and especially those who, detached from drug addiction and operating from a business-like perspective, prey on the vulnerabilities of those who are addicted because it's easy.

I have seen this firsthand, in the face of a drug dealer I once met years ago. He was a friend of an acquaintance; a tall, well-built, clean-cut, 20-year-old from a well-to-do Kanata family. He was a reasonably intelligent man who enjoyed sports and music; he was a health nut and young father. He also happened to be a crack dealer.

I spoke to him once, horrified but curious to learn why he would engage in this gruesome trade. He didn't smoke cigarettes or drink alcohol, and he certainly wouldn't consider ingesting the poison he was dispensing to his poor, addicted customers. The conversation painted a chilling portrait of a lack of soul.

He despised the addicts he supplied, speaking of them with utter disgust and disdain. He saw himself as a businessman, making money because it was easy. And it was profitable; he wore top-of-the-line clothing and had money to burn. I never saw or heard of him again, but I'm still haunted by his image.

We can't attribute the entire scope of our drug problem to people like him, but we also can't deny they exist; a group of people who have discovered the warped economic principle of the trade: sell drugs but don't use them. Recognizing these "bad" guys -- in an even-handed, responsible way -- seems to me one part of a policy that is not ideologically based at either end of the spectrum. Isn't that what we're aspiring to?

I'm by no means saying Harper has the right answers -- he has a long way to go, especially when it comes to recognizing harm reduction as not only the logical, but humane policy. But as we work to help addicts, it's just as important to recognize the drug market is currently a criminal enterprise, and take aim at those perpetrating it; those whose addiction to the proceeds of trafficking can't be cured with a harm-reduction strategy. Surely we can distinguish them from the crack-addicted middlemen who deal to support their habits.

Does this mean implementing tougher laws, but working to stipulate they don't have the unintended, sweeping consequence of punishing addicts who need help? Maybe. Does this mean outright legalization of drugs? Maybe. I'm open to all of these ideas. Let's just talk about it.
The most vehement critics appear to condemn any plan or role for law enforcement (or some variation) in drug policy without offering alternatives, or at least acknowledging there are people at the heart of this who need to be dealt with in a different way. Do they think the "bad guys" will magically disappear as we focus solely on helping addicts? It's hard to tell; no one's talking about it.

We need to put aside our instinctual fears about any type of law enforcement propelling us to a U.S.-style war on drugs. There has to be a rational way to approach enforcement, in full conjunction with harm reduction.

We may not like all of what Stephen Harper is offering, but isn't it time to talk about what role
we think the law should play?

Kelly Roesler works on the Citizen's copy desk and as a freelance writer.

FEDERAL DRUG STRATEGY Editorial, Globe and Mail

How to address those addictions
424 words
9 October 2007
The Globe and Mail
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

The federal government's new anti-drug strategy is not as simplistic as advance comments by the Conservatives – notably Health Minister Tony Clement's silly “the party's over” declaration – might have led one to believe. It does not merely ape the failed “War on Drugs” strategy employed by the United States. Rather than treat addicts as criminals, it is sympathetic to their plight, devoting two-thirds of the program's $64-million in funding to treatment and prevention. But it would stand a much better chance of success if it were not undermined by a rigid single-mindedness.

From Prime Minister Stephen Harper's perspective, fighting the evils of drug use is entirely about getting Canadians to stop taking drugs. He rejects the ideas behind harm-reduction programs such as the Insite safe injection facility for heroin users in Vancouver.

“I remain a skeptic that you can tell people that we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use but somehow we will keep you addicted but reduce the harm just the same,” he said in announcing the new strategy last week. “If you remain a drug addict, I don't care how much harm you reduce, you are going to have a short and miserable life.”

Nobody will dispute the fact that it is better to avoid drug use entirely than to use drugs more safely. But it's not as easy as it sounds. Some potential drug users might be swayed by prevention campaigns, and some addicts will voluntarily enter rehabilitation. Yet all the available evidence shows that no efforts by governments will get the most hardened addicts to kick their habit. That leaves two options: abandon those people altogether or attempt to limit the health and social costs of their illness.

The harm-reduction programs rejected by Mr. Harper do much in that regard. Insite reduces needle-sharing in the community, limiting the spread of disease. It saves lives by preventing addicts from dying of overdoses. It reduces the number of people injecting drugs in public places and leaving needles behind. Far from endorsing drug abuse, it encourages treatment. According to research, one in five regular visitors enlists in detoxification programs.

Instead of abandoning such efforts, the government should be expanding them. A sensible anti-drug strategy would do so. Unfortunately, Mr. Harper appears under the misguided impression that prevention and harm reduction are mutually exclusive.

FEDERAL DRUG STRATEGY Editorial, Globe and Mail

How to address those addictions
424 words
9 October 2007
The Globe and Mail
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

The federal government's new anti-drug strategy is not as simplistic as advance comments by the Conservatives – notably Health Minister Tony Clement's silly “the party's over” declaration – might have led one to believe. It does not merely ape the failed “War on Drugs” strategy employed by the United States. Rather than treat addicts as criminals, it is sympathetic to their plight, devoting two-thirds of the program's $64-million in funding to treatment and prevention. But it would stand a much better chance of success if it were not undermined by a rigid single-mindedness.

From Prime Minister Stephen Harper's perspective, fighting the evils of drug use is entirely about getting Canadians to stop taking drugs. He rejects the ideas behind harm-reduction programs such as the Insite safe injection facility for heroin users in Vancouver.

“I remain a skeptic that you can tell people that we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use but somehow we will keep you addicted but reduce the harm just the same,” he said in announcing the new strategy last week. “If you remain a drug addict, I don't care how much harm you reduce, you are going to have a short and miserable life.”

Nobody will dispute the fact that it is better to avoid drug use entirely than to use drugs more safely. But it's not as easy as it sounds. Some potential drug users might be swayed by prevention campaigns, and some addicts will voluntarily enter rehabilitation. Yet all the available evidence shows that no efforts by governments will get the most hardened addicts to kick their habit. That leaves two options: abandon those people altogether or attempt to limit the health and social costs of their illness.

The harm-reduction programs rejected by Mr. Harper do much in that regard. Insite reduces needle-sharing in the community, limiting the spread of disease. It saves lives by preventing addicts from dying of overdoses. It reduces the number of people injecting drugs in public places and leaving needles behind. Far from endorsing drug abuse, it encourages treatment. According to research, one in five regular visitors enlists in detoxification programs.

Instead of abandoning such efforts, the government should be expanding them. A sensible anti-drug strategy would do so. Unfortunately, Mr. Harper appears under the misguided impression that prevention and harm reduction are mutually exclusive.

Nursing focus in an excellent Globe & Mail article: The inside story of Vancouver's safe injection site

National News

The inside story of Vancouver's safe injection site; Supporters work to convince opponents that Insite saves lives, still fearing for the facility's long-term future

2549 words
6 October 2007
The Globe and Mail
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

VANCOUVER -- Using heroin and cocaine can be a dirty business. That means Bethany Jeal sometimes has a lot to do as a nurse helping addicts at North America's first safe injection site.
The 28-year-old says she isn't shy about strolling off the nursing platform in the injection room of the Insite operation in the city's Downtown Eastside and going up to clients in one of Insite's 12 booths.

Each booth is brightly lit so addicts can find good veins into which to plunge a syringe's needle. But there are also mirrors, which allow nurses from across the room to get an idea of what addicts are doing – whether, for example, they are using alcohol swabs.

“We can see everything that's going on,” said Ms. Jeal, who added “there's a lot of unclean practices with regard to drugs.”

She explained that users do not always wash their hands. The drugs themselves, bought on the street are not sterile. (Insite allows the use of drugs, but does not provide them.) And people do not always use alcohol swabs before plunging needles into their flesh.

“I will definitely walk over to them, and if I don't know them, introduce myself and say, ‘Hey. There's a great way to do this. Why don't you use an alcohol swab first?' ” Ms. Jeal said in an interview.

Ms. Jeal, who has been a nurse for three years, once worked full time at Insite.

Now she pulls the occasional shift in the operation, which opened in 2003 with support from the province, city and Vancouver Police Department, among others, as a means of dealing with disease, overdoses and other problems related to injection drug use, largely in the poverty-stricken Downtown Eastside.

However, many Insite supporters now fear for its future because federal Health Minister Tony Clement this week agreed to only a six-month extension in the Controlled Drugs and Substances Act exemption that allows illegal drugs in the facility without legal sanctions. Insite opened with a three-year exemption granted by the then-Liberal government.

Some say the federal Tories want the issue of Insite's future off the table with the possibility of a fall election, especially since the operation is popular in B.C. – with Premier Gordon Campbell and, according to polls, with the public as well.

B.C. Health Minister George Abbott says Insite represents a practical approach to issues of injection drug use.

“The challenge we have is that for drug-addicted individuals, at least until they resolve to try to move beyond their addictions, they are going to be using. When they use, we want to minimize the public health hazards that are associated with intravenous drug use,” he said.

“No one is saying drug addiction is a good thing. It is clearly a very bad thing. It's how we manage those addictions in a thoughtful and humanitarian way that is the key to understanding Insite.”

Insite is open 18 hours a day and, in a rare look at its inner workings, The Globe and Mail had a recent opportunity to visit during working hours.

Despite its unusual business, the injection room was subdued and quiet. The exception was one client, who came in on his bicycle and rode it back and forth, within a range of about a metre. (The man likely kept his bike with him, one observer noted, because it would be stolen if he left it on the street.) There were seven men and one woman, largely focused on taking out their drugs, preparing them and using them under nursing supervision.

A poster on the wall warns: “Take care Of your veins. Avoid abscess, dirty hits, embolism and edema. Avoid injecting particles.”

With its track lighting, black tile and white walls, the injection room has the disconcertingly elegant feel of a furniture showroom in a slick Vancouver shopping district. But as they arrive, clients can pick up clean syringes, little aluminum plates for cooking their drugs, a match or lighter and tourniquet.

“We wanted it to be as calm as it could be, and simple,” said Mark Townsend, manager with the Portland Hotel Society that runs the facility with the Vancouver Coastal Health Authority, explaining the design.

Ms. Jeal was not on duty this day. She spoke about Insite during an interview at a café up the street from the injection site, which is laid out on one floor behind a storefront-style facade on East Hastings, the main street in the Downtown Eastside neighbourhood that is home to about 4,000 injection drug users.

During her shifts, she said, she tries to constantly walk around the injection room, interacting with clients. “That's how we get to know people, get a rapport with people, find out what their thoughts are. Maybe they have an infection going. Or maybe they really want to get into detox.”
The point is to head off unsafe practices that can lead to HIV or hepatitis C, or to direct addicts to detox programs. Sanctioning injection-drug use within Insite also allows for a quick response to overdoses that occur on site as nurses look on, sending them into a scramble of sudden treatment and calls to ambulances. There were no fatalities among 453 overdoses reported between April, 2004, and March, 2006, the last period for which statistics are available.

“You can read through the protocol and study what to expect, but you never really know until you experience it,” Ms. Jeal said on the overdose issue, recalling she was “scared shitless” six weeks into her work at Insite when a man fell off his chair after shooting up. With treatment, he

The Burnaby-raised nurse, who never came to the Downtown Eastside in her youth, said Insite is no doubt necessary.

“It's not so much sanctioning drug use. The whole basis of harm reduction is accepting that people use [drugs],” she said. “It's not saying it's a good thing. It's not saying it's a bad thing, or marginalizing people who use drugs. It's saying they do use drugs and taking means to prevent harm that might come from using. It's a moral obligation to do that.”

But the federal government has its doubts. Prime Minister Stephen Harper, announcing a $63.8-million national drug strategy in Winnipeg this week that balances prevention and treatment, said he remains a skeptic about Insite, calling it a “second-best strategy at best.”
The Prime Minister stated, “If you remain a drug addict, I don't care how much harm you reduce, you're going to have a short and miserable life.” He said his government will continue studies on Insite, en route to a conclusion about its value.

The B.C. government provided an initial $1.2-million in capital funding for Insite, plus $2-million for first-year operating costs. Since then, the Vancouver Coastal Health Authority has covered the $2-million annual cost, drawing on its funding from the province. Health Canada provided $1.5-million over Insite's first three years to cover the research aspect. And Ottawa has a key power over its fate because of the controlled-substances exemption.

“I would have preferred a longer extension but I will tell you this. It certainly is better than not having any extension,” Mr. Campbell said.

“I think it's important that the extension has been made and what we will do now is continue to work with, not just the city, but with the federal government to ensure an even further extension.”

Mr. Campbell, a former Vancouver mayor, acknowledged that people will have questions about whether Insite is working. “We believe it is making a difference. We think it is effective. So our job is to continue to work on behalf of the province, the health-care system and patients in this regard.”

The current mayor, Sam Sullivan, said that city council would like the exemption extended for at least 3½ years, and that he plans to continue to make the case for Insite with federal officials. “It's a great achievement to have an exemption,” he said. “I look forward to getting a further exemption.”

Insite has its critics. The Canadian Police Association and the RCMP have criticized the operation for, among other things, creating an enabling environment.

Although there have been a number of studies endorsing Insite for steering addicts into detox and addiction programs and encouraging safe injection practices, other studies have not been so enthusiastic. One, by the Drug Prevention Network of Canada that was released in the Journal of Global Drug Policy last May, said positive findings about Insite had been overstated while negative findings were not given prominence.

In an interview, Mr. Clement said he is awaiting more research on how supervised injection sites affect prevention, treatment and crime before a decision would be made on Insite's fate. Six contracts have been put to tender. Successful bids have been accepted for three.

Mr. Clement, who opposed safe injection sites when he was an Ontario health minister years ago, insisted that his government has yet to make a final decision on Insite's fate, and dismissed the allegations of critics that the six-month extension was intended to put Insite beyond debate in an election.

“When we have decided something, we will certainly let everybody know, but we have not made that decision,” he said when asked about the required federal exemption.

Mr. Clement, who toured Insite last year, said it isn't yet clear how the facility fits into the tough drug strategy announced in Winnipeg. The government's posture this week is all about research, he said.

“The researchers said, ‘We need more time in order to do proper research for you and for Canadians,' and we gave them more time. There's nothing more sinister than that,” Mr. Clement said.

Mr. Abbott, B.C.'s Health Minister, said Ottawa deserves some credit for continuing with exemptions for Insite that were launched by a previous Liberal government. But he said Insite is a key to B.C.'s goals on injection drug use.

“I have always made it clear to Tony that I am supportive of this facility, that we believe it is a valuable part of the continuum of care for the drug addicted, and have always made clear to him we're prepared to assist in providing whatever information they believe they need to support the extension of their support for this facility.”

Mr. Abbott would not speculate on what Victoria will do if Mr. Clement eventually rules out an extended exemption for Insite, saying he was reluctant to consider hypothetical questions.
“We'll cross that bridge if and when we get to it. I would like to think that over the next six months, we will be able to provide them with the evidence that would support what they need
to get their support for this,” he said.

But Insite's operators are thinking about a Tory-engineered demise for Insite, and Mr. Townsend of the Portland Hotel Society says the situation looks bleak. “I believe if the PM does the wrong thing, we will have no choice but to keep the site open,” he said. “We would try our best to carry on as we could.”

But, he said, it wouldn't be easy. “It's hard to run a medical facility, a hospital or a supervised injection site with volunteers. You can't run these things with bake sales.”

Letters have been written to the Prime Minister's Office, and there is a talk of a protest visit to Parliament Hill. Mr. Townsend's society and a pair of drug addicts even filed a statement of claim in B.C. Supreme Court arguing the closing of Insite would violate their Charter rights to “security of the person.”

One of those addicts, Shelly Tomic, warmly recalls the support she has received from Insite since its first day as she grappled with a hunger for heroin, cocaine, speed and meth. She is now in recovery, but visits Insite when she feels the need to inject heroin.

Ms. Tomic, who has tested positive for hepatitis C and is disabled and unemployed, said she once had a heart attack at Insite – nurses called 911 when they noticed she was in distress. She said the site is better than the alleys and bar bathrooms she once used to shoot up.

“In Insite, you've always got clean rigs every single time, and even if you could get clean needles before Insite, you didn't necessarily have a sterile place to do it,” said Ms. Tomic, 39.

“You have got clean rigs. You don't have to rush to get it into you for fear of being arrested, or somebody taking [your drugs] from you or [being] mugged for it. And if you overdose at Insite, you have got medical staff right there to help you.”

She added: “[Insite] is sort of like the show Cheers, for Norm,” she says. “That's how I feel about Insite. I go in. Everybody knows me.”

Milestones in Insite's history
November, 2002
Larry Campbell, Vancouver's newly elected mayor, promises to move quickly on the creation of a safe injection site, acting on debate over the issue that has been under way for years.

September, 2003
Insite opens as North America's first safe injection site, bolstered by $1.2-million in capital funding from the B.C. government, plus $2-million for first-year operating costs. (Since then, the Vancouver Coastal Health Authority has covered the $2-million annual cost of the operation, drawing on its funding from the province.) Health Canada allots $1.5-million over three years to cover research costs.

September, 2006
Federal Health Minister Tony Clement approves a 16-month extension in an exemption to Section 56 of the Controlled Drugs and Substances Act that allows Insite to operate. He rules out considering applications from other municipalities for such sites until the review is completed. Vancouver police salutes the minister's decision, noting the department “congratulates the federal government for making a very difficult decision on a complex issue.”

Oct. 2, 2007
Mr. Clement announces a six-month extension of the exemption to June 30, 2008, to allow for more research on issues around supervised injection sites.
Ian Bailey

Insite client data collected from April, 2004, to March, 2006 (the most recent statistics available):
CLIENT GENDER Female: 30% Male: 70%

Other: 20% Morphine: 12% Cocaine: 27% Heroin: 41%

There were 453 overdoses and no fatalities.
4,084 referrals were made with 40% to addictions counselling.
The busiest day was May 25, 2005, with 933 visits in 18 hours.
There were 6,227 nursing care interventions with 2,055 for abscess care.


'Serious time for serious crime'; Opposition pans Harper's $63.8M national anti-drug strategy as U.S.-style war on drugs

'Serious time for serious crime'; Opposition pans Harper's $63.8M national anti-drug strategy as U.S.-style war on drugs
Meagan Fitzpatrick
CanWest News Service
849 words
5 October 2007
Edmonton Journal
Copyright © 2007 Edmonton Journal

The federal government will introduce legislation this fall that would require mandatory minimum jail sentences for people convicted of "serious" drug crimes, Prime Minister Stephen Harper said Thursday.

"Currently there are no minimum prison sentences for producing and trafficking dangerous drugs like methamphetamines and cocaine," Harper told a news conference. "But these are serious crimes; those who commit them should do serious time."

But in launching the government's long-awaited, $63.8-million national anti-drug strategy in Winnipeg, Harper also promised to be compassionate toward people hooked on illegal drugs. In particular, the prime minister said he is concerned about rising drug use among youth. He also noted that drug use takes an expensive toll on the health-care system and fuels crime.

"Narcotics destroy lives. They rob young people of their futures, they tear families apart, they make our streets less safe and they lay waste to our communities."

Harper said the government's response will be two-pronged, focusing on drug addicts on one hand and on drug producers and dealers on the other.

"Drugs are dangerous and destructive. If drugs do get hold of you, there will be help to get you off them," Harper promised. "But if you sell or produce drugs, you will pay with prison time."

"Our two-track approach will be tough on the dealers and producers of drugs and compassionate for their victims."

He underlined that tough new anti-drug laws will be a major component of the government's plan, but confirmed that two-thirds of the funding will go toward the prevention and treatment of illicit drug use. The plan also includes a major national public awareness campaign aimed at youth and their parents.

"Interdiction by itself is not going to be enough," said Harper, flanked by Public Safety Minister Stockwell Day and Health Minister Tony Clement. "Our government recognizes that we also have to find new ways to prevent people from becoming enslaved to drugs and we need new laws to free them from drugs when they get hooked."

Other details unveiled by Harper about the plan included funding for the provinces and territories for drug abuse programs, modernizing treatment services and making them more widely available, financial support for youth intervention programs, more money for police agencies to investigate and prosecute drug crimes, ramping up the RCMP's drug unit programs, and increased funding for the Canada Border Services Agency.

Some details of the plan were in the last federal budget, including a breakdown of the overall funding to distribute about $10 million to prevention initiatives, $32 million for treatment for drug addicts, and $22 million to crack down on production and dealers.

"Solving Canada's drug problem will require a huge effort. We won't get clean overnight but we will put our country on the road to recovery," said Harper.

Even before it was made public, the government's plan drew darts and laurels from all sides of the drug debate. Liberal and New Democratic Party critics said the government is embracing a U.S.-style "war on drugs" that treats drug abuse as more of a criminal matter than a health issue. Liberal MP Keith Martin, a physician, and NDP MP Libby Davies both said in interviews earlier this week that the government should focus more on harm-reduction programs, such as
safe injection sites and needle exchanges.

The Vancouver safe injection site, Insite, was in danger of closing after its exemption from federal drug laws was scheduled to end at the end of this year. This week, however, the government gave the facility a six-month reprieve, extending its exemption to June 30, 2008.
Prime Minister Harper admitted on Thursday that he remains skeptical about the program and said that even if it's effective, it's a "second-best strategy at best."

"If you remain a drug addict, I don't care how much harm you reduce, you're going to have a short and miserable life," said Harper. He pledged to continue to study the program and gather the facts on it, but noted that his government's "tentative conclusion" is that safe injection sites, if allowed to operate, should operate in concert with other programs that aim to treat addicts.
Critics of the government said the reprieve for the Vancouver site was just designed to get the controversy over harm-reduction policy off the table in time for Harper's drug strategy announcement.

The Canadian Police Association, meanwhile, has expressed support for the government's get-tough approach to drugs. The organization has called for stronger legislation and a new system of graduated consequences to prevent and deter drug use. The group's president, Tony Cannavino, has called the government's promise to crack down on illegal drug use and dealers "a cornerstone, because a lot of violence is related to drugs."


National News
Harper takes aim at drug culture
623 words
5 October 2007
The Globe and Mail
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

Canada has become too drug-friendly and it's time for a culture change, Prime Minister Stephen Harper said yesterday as he laid out his government's get-tough strategy for reducing the use of illegal substances.

Police and others fighting the battle against drug abuse are up against a culture that “since the 1960s” has done little to discourage drug abuse and “often romanticized it – romanticized it or made it cool, made it acceptable,” Mr. Harper said.

“As a father I don't say all these things blamelessly. My son is listening to my Beatles records and asking me what all these lyrics mean. It's just there, it's out there. I love these records and I'm not putting them away. But, that said, there has been a culture that has not fought drug use and that's what we're all up against.”

Mr. Harper, flanked by Health Minister Tony Clement and Public Safety Minister Stockwell Day, announced his new two-year, $64-million anti-drug strategy at a Salvation Army building in Winnipeg.

Two-thirds of that money will go to prevention and treatment programs and the rest will be used to beef up enforcement, including the introduction of new mandatory minimum sentences for an unspecified slate of drug crimes.

The Conservatives say they will create an awareness campaign targeted at young people and their parents, fund new treatment services and launch a national youth intervention program to divert young drug users into assessment and treatment programs instead of detention.
On the enforcement side, they plan to direct resources at identifying and closing down grow-ops, pay for more enforcement measures at the border and ramp up the RCMP's Proceeds of Crime Program.

Gone are any musings, such as those of the previous Liberal government, about decriminalization of so-called softer drugs such as marijuana.

Critics have ripped apart the government's strategy on many fronts, especially Mr. Harper's unwillingness to embrace harm-reduction measures such as those offered at Insite, Vancouver's safe-injection site. It allows addicts to safely inject illegal dugs and connect with health professionals who can direct them toward treatment.

The government this week extended funding to that program but only for six months so it can be further studied.

“I remain a skeptic that you can tell people that we won't stop the drug trade, we won't get you off drugs, we won't even send messages to discourage drug use but somehow we will keep you addicted but reduce the harm just the same,” Mr. Harper said of the Insite program. “If you remain a drug addict, I don't care how much harm you reduce, you are going to have a short and miserable life.”

But Thomas Kerr, a professor in the University of British Columbia's Department of Medicine who has studied Insite and its effect on the prevention of the spread of HIV-AIDS, said Mr. Harper is ignoring the facts.

“The government continues to misrepresent the science around harm reduction. In the case of Insite we have shown that there has been a 33-per-cent increase in the rate of entry into detox programs,” Dr. Kerr said. “In no way is the facility perpetuating addiction. In fact, it's helping people quit drug use.”

Leon Mar of the Canadian HIV/AIDS Legal Network said education programs, such as the one proposed by the government, have previously proved ineffective. Health Canada's own review of the Drug Abuse Resistance Education program implemented widely across Canada, he said, has shown that the program does not prevent or delay drug use.

Vancouver safe-injection site can operate until June under six-month extension

Vancouver safe-injection site can operate until June under six-month extension
1116 words
2 October 2007
The Canadian Press
(c) 2007 The Canadian Press. All rights reserved.

VANCOUVER _ Ottawa's six-month reprieve for Vancouver's safe injection site simply allows the government to shelve the issue until after a possible fall election, leaving a suffering community in limbo, supporters of the site said Tuesday.

Though they applauded the announcement from the federal government that Insite can remain open until next June, doctors, community activists and opposition politicians said they are frustrated that a health issue has become a political football.

Health Canada announced Tuesday it would extend the exemption from Canada's drug laws that allows Insite to operate. The exemption was set to run out at the end of the year.

``I think what this is an indication of is that the government is currently really trying to sit out the issue of Insite rather than making a decision one way or another that inevitably would offend a lot of people on one side or another,'' said Benedikt Fischer, director of the Illicit Drugs, Public Health and Policy Unit at the Centre for Addictions Research of B.C.

``That problem is postponed but not resolved.''

The former storefront provides a place for addicts to safely inject themselves with their own heroin under the supervision of medical staff.

A spokeswoman for Health Canada said the exemption will allow further research.

``It's for the purposes of research into the impact of such sites on prevention, treatment and
crime,'' said Jirina Vlk, acting head of communications for the department.

Reams of research have been done on Insite since it opened in Vancouver's beleaguered Downtown Eastside in 2003.

The studies examining the centre have included results showing drug addicts who used the program were more likely to enrol in detox programs, more likely to start methadone replacement programs and reduce their number of monthly visits to shoot up.

In August, a group of 130 prominent doctors, scientists and public health professionals endorsed a commentary published in the journal Open Medicine that said the injection site was being judged by a different standard than other health measures.

``Harm reduction has now been shown to be effective _ Insite in particular _ on a variety of fronts and I think that the real issue is when are we going to finally agree to expand the role of Insite both in terms of the hours of operation and the number of people we can serve,'' Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS in Vancouver, said Tuesday.
The centre has led many studies into the centre's work.

``The federal government at this time has taken the strategy, if you want, of giving us a piecemeal licence to operate and the latest effort, let's be clear, sounds a lot like a political effort to get this issue off the table in case an election be called. We cannot accept this kind of behaviour.''

When the site was approved in 2003, Vancouver officials applied for an exemption from the Controlled Drugs and Substances Act, which makes the use of heroin illegal.

The site was granted a three-year exemption for the purposes of a pilot study on the site's impact.

Federal Health Minister Tony Clement had announced in September 2006 the exemption would be extended until December of this year to allow for further study.

The Vancouver Coastal Health Authority had requested an extension for three and a half years.
Former Vancouver mayor Larry Campbell, now a Liberal senator, said he doesn't even believe the exemption is needed because he said it's unclear how the law would be enforced without the exemption.

``I realize that the Conservative government has a difficult time because they can't seem to find any substantiated evidence that would back their Neanderthal response,'' he said.

``The fact is that this is a health-care facility and it should be left open and expanded in many places across Canada.''

Clement also said in 2006 that a new National Drug Strategy would need to be in place before the government considered allowing any other supervised rejection sites to open in Canada.
The minister said in an interview with The Canadian Press last week that strategy is expected this week.

Mark Townsend, of the Portland Hotel Society which runs Insite, called Tuesday's announcement depressing and a distraction from the real problems facing addicts on the Downtown Eastside.

``We've got people that are sick, people that are dying, mentally ill people living in crummy hotels,'' said Townsend.

``There's loads to do and the supervised injection site is important but really they just need to accept that the evidence is in and they do the right thing.''

Back in April, Health Canada put out a request for proposals for further study connected with Insite, asking for input on health issues, public order and safety issues and similarities and differences between Vancouver and other Canadian cities.

Townsend said several noted researchers in the field declined to apply for the grants because of a gag order that would prohibit them from talking about their findings unless given approval from the government.

``The prime minister is out there trying to find a researcher that will tell him the world is flat, so he's got an excuse to cut it,'' Townsend said.

A Simon Fraser University criminologist who was told last week that he won one of the grants said his work will examine the impact of the site on crime in the Downtown Eastside.

``We're going to be doing interviews, detailed interviews, with a sample of police, residents, business owners in the vicinity and social service agencies,'' Prof. Neil Boyd said.

``We're also hoping to use police data, calls for service and arrest data, to determine whether there have been changes in activity over time at the site.''

His research will be submitted to the government in February.

Vancouver Mayor Sam Sullivan welcomed the government's announcement, which came on the same day that the city was considering a report on substitution treatment for people with drug addictions in the city.

The 34-page report looks at the use of opiate replacement drugs, like methadone, and also a North American study being carried out in part in Vancouver that prescribes legal opium to addicts.

The report also outlines five clinical trials the city would like to run in conjunction with the Inner Change Society and Chronic Addiction Substitution Treatment program announced earlier this year.

The report was approved by city council and the mayor plans to ask the federal government to fund the studies under the new National Drug Strategy

Fate of safe-injection site remains up in the air

National News
Fate of safe-injection site remains up in the air
490 words
3 October 2007
The Globe and Mail
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

VANCOUVER -- The federal Health Minister has cleared Vancouver's safe-injection site to operate for another six months, but critics say the decision announced yesterday does nothing to clear up uncertainty about the fate of the controversial operation that provides a safe place for drug addicts to use heroin or cocaine.

In a terse statement, Tony Clement said he would allow Insite a continued exemption under Section 56 of the Controlled Drugs and Substances Act that allows the use of otherwise illegal drugs by clients at the facility in the poverty-stricken Downtown Eastside.

The extension runs until June 30, 2008. “[It] will allow research on how supervised injection sites affect prevention, treatment and crime to be continued for another six months,” the statement said.

The minister was not available for comment. His press secretary, Laryssa Waler, would only refer to the statement's point about additional research when asked for further comment.
Perry Kendall, B.C.'s provincial health officer, said he thought enough research had already been done on Insite, which opened in 2003.

Insite has been credited with helping to reduce overdoses and drug-related disease. Clients bring their own drugs to the site with a freedom allowed by the exemption Mr. Clement has renewed for the second time. The B.C. government finances the program.

In comments that reflect a broad consensus of support, Premier Gordon Campbell earlier this week urged the Tories to maintain Insite, calling it “part of the solution” to issues of drug addiction.

Mark Townsend, a community worker for the Portland Hotel Society, which operates Insite in partnership with the Vancouver Coastal Health Authority, said the uncertainty is a stress for clients, staff and medical officials working with the operation.

“It's like constantly debating the same tiny speck of dust,” Mr. Townsend said. “It's stressful on the ground for the human beings, the doctors and nurses involved with it. It's stressful for the people who work in the bureaucracy and care about people on the ground and are trying to put together programs that help people.

“The clients do get stressed about it as well. It's like you're constantly about to be fired from your job.”

Mr. Townsend echoed the view of many observers, including NDP and Liberal MPs in Vancouver, that the Tories are reluctant to shut down Insite while an election is possible, so they have put the issue on ice for now.

Libby Davies, NDP MP for Vancouver East, said the Tories are “playing politics” with an important community asset, central to helping protect drug users from disease, overdoses and other harm. Insite is located in Ms. Davies's riding.

She predicted a community fight to save the facility. “People know they will have to gear up for another campaign to keep Insite going,” she said.

DRUG POLICY Editorial The wrong way to go

The wrong way to go
413 words
3 October 2007
The Globe and Mail
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

‘The party's over,” federal Health Minister Tony Clement intoned this past weekend. Mr. Clement was talking about drug users, but it wasn't entirely clear which ones. It might have been otherwise law-abiding citizens who occasionally smoke marijuana. Or perhaps it was all those partiers suffering from debilitating addictions to hard drugs such as heroin and crack cocaine. Either way, Mr. Clement appears to have borrowed his rhetoric from the 1980s. To go with it, he appears set to borrow the disastrous “War on Drugs” strategy from south of the border.

This week, the federal government is set to unveil a new $64-million anti-drug strategy. Some of its anticipated components, including more money for treatment programs and a crackdown on drug smuggling at the border, are worthwhile. But the government is also reportedly set to shift away from harm-reduction programs. In their place, it is expected to launch both an anti-drug messaging campaign targeting teenagers and a crackdown on illegal drug use – presumably meaning more criminal charges against both hard- and soft-drug users.

All the available evidence suggests that this will be a waste of time and money. Worse, it could cost some lives and ruin others. The overwhelming body of research shows that harm-reduction strategies such as Insite, the Vancouver safe-injection site for heroin users, succeeds in limiting the health and social costs of addiction, preventing deaths from overdose and disease and directing addicts toward treatment. Yet rather than expand such programs, the government is reluctant even to keep Insite going; it announced yesterday that the site will be allowed to operate through June of next year, but refused to confirm its long-term future. As much of the rest of the world recognizes addiction for the disease it is, the Conservatives appear poised to revert to treating it like a crime. Meanwhile, rather than continue with the previous government's plan to decriminalize possession of small amounts of marijuana for personal use, they will ensure that more Canadians are saddled with criminal records for indulging in a substance no more harmful than alcohol or tobacco.

This new strategy may play well with some members of the Conservatives' base. But as evidenced by what has transpired in the United States, it will do absolutely nothing to reduce drug use. Its only effect will be to make the effects of substance abuse all the more painful.

Ottawa adopting failed U.S.-style "war on drugs"

Ottawa adopting failed U.S.-style "war on drugs"
533 words
1 October 2007
Canada NewsWire
Copyright © 2007 Canada NewsWire Ltd. All rights reserved.

TORONTO, Oct. 1 /CNW/ -- New National Anti-Drug Strategy plays politics with people's lives

TORONTO, Oct. 1 /CNW/ - The new National Anti-Drug Strategy to be officially unveiled this week by federal Health Minister Tony Clement is a huge step backward for Canada's response to HIV/AIDS, said the Canadian HIV/AIDS Legal Network today.

The new strategy funds law enforcement, prevention and treatment programs - three of the four so-called "pillars" common in many drug strategies. But the fourth pillar, harm reduction - which includes needle exchanges, methadone clinics and safe-injection facilities - has been eliminated.

"The federal government is ignoring widely published scientific evidence on the value of investing in harm reduction programs," said Richard Elliott, Executive Director. "It seems clear that the new drug strategy is based on ideology instead of evidence, and from every angle - human rights, public health, or use of taxpayers' dollars - that's irresponsible and unacceptable."
Even worse, Minister Clement is sowing confusion by claiming that other measures, such as law enforcement, constitute harm reduction in their own right.

"This is just smoke and mirrors," said Elliott. "The reality is that some people can't or won't stop using drugs. Harm reduction pragmatically and realistically acknowledges this fact by providing evidence-based programs and services to lessen the harms associated with drug use. Arresting and imprisoning people can't be considered harm reduction."

The new drug strategy apes the failed U.S. approach of treating drug addiction primarily as a criminal matter, rather than a matter of public health. But despite spending billions of dollars on its "war on drugs," not a dent has been made in reducing either drug supply or drug consumption in the United States. Rather, the establishment of "get-tough" criminal approaches to drug addiction has filled U.S. prisons with non-violent, often small-scale offenders.

Relying on criminal law inevitably also leads to increased fear, stigma and discrimination. As a result, many people hide their drug use, which usually means avoiding the public health and harm reduction programs that could help treat them. Insite, Vancouver's safe injection facility, is one such program.

"The facts speak for themselves: Insite has lowered the rates of syringe-sharing and deaths from overdoses, reduced the risk of HIV and hepatitis C transmission, and increased the chances of directing drug users to addiction treatment services," said Elliott. "Instead of mounting a public misinformation campaign, Minister Clement and his government should be sharing these facts with Canadians to explain why funding harm reduction programs like Insite is a responsible investment in public health."

About the Canadian HIV/AIDS Legal Network
The Canadian HIV/AIDS Legal Network ( www.aidslaw.ca ) promotes the human rights of people living with and vulnerable to HIV/AIDS, in Canada and internationally, through research, legal and policy analysis, education, and community mobilization. The Legal Network is Canada's leading advocacy organization working on the legal and human rights issues raised by HIV/AIDS.


National News
Get-tough plan on drugs doomed, experts say; Liberal MP calls Tories' policy a triumph of ‘ideology over science,' urges medical, not moral, approach to issue
647 words
1 October 2007
The Globe and Mail
2007 CTVglobemedia Publishing Inc. All Rights Reserved.

Canada's war on drugs is about to escalate. But as the federal Conservative governments prepares to unveil a new strategy that cracks down on illicit drug users, critics say they are ignoring a mountain of research that shows the get-tough approach doesn't work.

“This is a failed approach. The experiment is done. The science is in,” says Thomas Kerr, a researcher at the University of British Columbia and member of the university's faculty of medicine.

The $64-million anti-drug strategy, to be announced in the next few days, is expected to include stiffer penalties for drug offenders and more money to stop drugs getting across the border. There will also be a massive campaign to warn young people not to use drugs.

It is not expected, says Liberal MP Keith Martin, to include money for what experts call “harm reduction.” These are programs such as Vancouver's controversial safe injection site, where heroin addicts can shoot up in a sterilized, supervised setting.

The idea behind harm reduction is to reduce the health effects of drug use without requiring people to beat their addiction. Experts compare it with smokers using a nicotine patch; people still get their fix, but it is vastly preferable to smoking a pack a day.

A study published by Dr. Kerr and his colleagues last year found that the Vancouver supervised injection site, known as Insite, reduced the risk of overdoses and encouraged more users to seek treatment. It did not increase crime in the neighbourhood, nor lead to increased drug use.

But Prime Minister Stephen Harper has said he does not think the site should receive federal health money, and Health Canada must make a decision about the future of Insite by the end of the year.

Dr. Martin, a physician from British Columbia, says the Conservatives' approach is a triumph of “ideology over science.” While he supports more money for police to go after drug dealers or
organized crime, Dr. Martin says substance abuse needs to be treated as a medical problem, not a moral one.

That's the approach taken in many European countries that have much lower rates of illicit drug use than Canada, he said.

Erik Waddell, a spokesman for Health Minister Tony Clement, said yesterday that the minister was travelling and would not be available for an interview.

Mr. Waddell said he couldn't discuss the details of the new strategy either. But earlier this year, he told The Globe and Mail that the Conservatives disagreed with the Liberals' approach. “In every poll, when Canadians are asked whether they want more law enforcement or less, they want more. So the bottom line is that Canada's new government will be taking a different approach.”

The Liberals had put forward a bill to decriminalize the possession of small amounts of marijuana, but the Conservatives did not reintroduce it after taking office in early 2006.
But the Liberals were also harshly criticized – by academics, doctors and the federal auditor-general – for focusing too much on enforcement.

The current drug strategy, which was renewed in 2003, devotes almost three- quarters of its resources to enforcement. Only 3 per cent of the annual $245-million goes to prevention, and another 3 per cent to harm reduction.

Barney Savage, director of public policy at the Centre for Addiction and Mental Health in Toronto, says law enforcement is extremely important, but so is prevention, treatment and harm reduction. “You have to balance the law enforcement perspective with the health perspective.”

The Canadian Association of Chiefs of Police also advocates a balanced approach in dealing with drug abuse and addiction issues.

Harper government to unveil get-tough national drug strategy CP

Harper government to unveil get-tough national drug strategy
822 words
29 September 2007
The Canadian Press
(c) 2007 The Canadian Press. All rights reserved.

OTTAWA _ Health Minister Tony Clement will announce it's anti-drug strategy this week with a stark warning: ``the party's over'' for illicit drug users.

``In the next few days, we're going to be back in the business of an anti-drug strategy,'' Clement told The Canadian Press.

``In that sense, the party's over.''

Shortly after taking office early last year, the Conservatives decided not to go ahead with a Liberal bill to decriminalize small amounts of marijuana.

Since then, the number of people arrested for smoking pot has jumped dramatically in several Canadian cities, in some cases jumping by more than one third.

Toronto, Vancouver, Ottawa and Halifax all reported increases of between 20 and 50 per cent in 2006 of arrests for possession of cannabis, compared with the previous year.

As a result thousands of people were charged with a criminal offence that, under the previous Liberal government, was on the verge of being classified as a misdemeanour.

Police forces said many young people were under the impression that the decriminalization bill had already passed and were smoking up more boldly than they've ever done before.

Clement says his government wants to clear up the uncertainty

``There's been a lot of mixed messages going out about illicit drugs,'' Clement said in an interview Saturday after a symposium designed to bring together Canada's arts and health communities to combat mental health issues.

There's also a health-care cost element to suggesting to young people that using illicit drugs is OK, the minister said.

``The fact of the matter is they're unhealthy,'' Clement said.

``They create poor health outcomes.''

For too long, Clement argues, governments in Canada have been sending the wrong message about drug use. It's time, he says, to take a tougher approach to dealing with the problem.

``There hasn't been a meaningful retooling of our strategy to tackle illicit drugs in over 20 years in this country,'' Clement said.

``We're going to be into a different world and take tackling these issues very seriously because (of) the impact on the health and safety of our kids.''

The Conservatives' wide-ranging $64 million anti-drug strategy is expected to combine treatment and prevention programs with stiffer penalties for illicit drug use, and a crackdown at the border against drug smuggling.

Justice Minister Rob Nicholson and Public Safety Minister Stockwell Day will join Clement in announcing the plan as part of a range of initiatives to be unveiled by the Tories surrounding next month's throne speech.

Clement said treatment and prevention programs were his key priorities for the health element of the drug strategy.

``Yes, there's a justice issue to that,'' he said.

``But there's also a treatment issue, there's also a prevention issue.''

Clement has suggested in the past that he opposes so-called harm reduction strategies for combating illegal drug use, including safe-injection sites where nurses provide addicts with clean needles and a safe place to use drugs.

At a Canadian Medical Association meeting last month, he was quoted saying ``harm reduction, in a sense, takes many forms. To me, prevention is harm reduction. Treatment is harm reduction. Enforcement is harm reduction.''

The following day, a petition signed by over 130 physicians and scientists was released, condemning the Conservative government's ``potentially deadly'' misrepresentation of the positive evidence for harm reduction programs.

Vancouver's Insite safe injection clinic is facing a December 31 deadline for the renewal of a federal exemption that allows it to operate.

Critics of the Conservative government's approach to illicit drug use say the federal government would be making a serious mistake by failing to renew the exemption.

``I think there's very little chance that Mr. Clement will extend the safe injection site's permit to continue,'' says Dr. Keith Martin, a British Columbia Liberal MP and former substance-abuse physician.

``But in doing that they will be essentially committing murder.''

Advocates say safe-injection sites help to prevent the spread of serious diseases, including AIDS and Hepatitis by preventing users from sharing needles while opponents say the sites simply promote illegal drug use.

Martin says he's all for increasing penalties for people who sell illegal drugs, including gangsters, but wonders why the Tories would want to target users when he says similar strategies in other countries haven't worked.

``I can't understand why the Conservatives are embracing a war-on-drugs approach that has proven to fail,'' he said.

``By all means, go after the pushers. By all means, absolutely go after the organized crime gangs that are the real parasites in this situation,'' he added.

``But for heaven's sake, treat the user as a medical problem and adopt the solutions that have proven to work in other countries.''

The other point of view: Canada's Shooting Gallery

Some journalism biased in the other direction...

Canada's Shooting Gallery
By Mary Anastasia O'Grady
1165 words
27 August 2007
The Wall Street Journal
(Copyright (c) 2007, Dow Jones & Company, Inc.)

Vancouver, British Columbia -- Early on a cool, rainy morning here last week, I decided to walk from my hotel in the most fashionable quarter of this fashionable West Coast metropolis to the "Downtown East Side." I was going to see an old friend, who in his retirement years has joined a Catholic ministry dedicated to outreach among the prostitutes in this notoriously seedy area. I wanted to visit the neighborhood where he works, in part, because it also happens to be where provincial authorities have set up a "safe injection site" for drug addicts. Many of the young women on the streets are hooked on opiates.

When I asked for directions from the hotel concierge, her eyebrows went up and she asked me what time of day I would be going. "As long as it's early and you stick to Pender Street, you should be OK," she said, tracing a path for me on a map.

Her advice, I later realized, was another way of saying, "stay off East Hastings Street," the epicenter of life for drug users here and the location of "InSite," North America's only legal, government-sponsored, injection clinic. Later that morning, as my friend showed me around the neighborhood in his car, I saw why. The sidewalks in front of the clinic were lined with addicts, and for blocks in both directions, all humanity looked sick, drawn, impoverished and defeated. In the gloom of a drizzly, cloud-covered Sunday morning, I felt I had entered one of Dante's inner circles of suffering.

Like most wealthy societies, Canada struggles with the problem of drug addiction. Prohibition was supposed to limit the supply of evil weeds, and thus the temptation to experiment with addictive chemicals. Yet decades of drug laws have had little effect, if any, on the availability of mind-altering substances and their corrosive effects on some part of the population.

While the benefits of prohibition are hard to discern, the cost of the war on drugs is quite clear. Inside the borders of rich countries, the large profits make vigorously pushing illegal substances worth the risk. Children, even in rural areas, are an especially attractive target under the black-market pricing structure. Addicts have to pay dearly; yet, like all intelligent vendors, dealers offer "introductory prices" for beginners. For criminals, prohibition profits make weapons, information technology and bribery of law-enforcement officials easily affordable.

These days Canadians are all too familiar with the price of the drug war outside their borders. Their military is now engaged in some of the heaviest fighting in Afghanistan, where reports from the field suggest that what is making the mission so difficult, at least in part, is the fact that the bad guys have enlisted support from the poppy growers who serve the heroin trade.
Organized crime is also flourishing in the Western Hemisphere. Colombian society has been shredded by drug cartels and, more recently, by narcotrafficking left-wing guerrillas and right-wing paramilitaries. The U.S. effort to block Caribbean transit routes sent the traffickers into Central America and Mexico. Since taking office in July 2006, Mexican President Felipe Calderon has made defeating the drug lords a priority. The Calderon crackdown has produced a spike in violence in the past year, claimed the lives of numerous Mexican law-enforcement officials and, if reports from the border are true, is now having a spillover effect in the Southwestern U.S. Yet the drugs keep coming, answering the demand.

This record suggests that attacking supply as a way to reduce demand is fighting a losing battle. Sophisticated economists -- most notably the late Milton Friedman -- have argued that the power of the market is just too great and that the unintended consequences are bound to cause both more bloodshed and more corruption.

Yet even though the war on drugs has been an obvious failure, Canada's experimental approach is hardly a promising alternative. Vancouver's InSite is simply horrifying in different ways. I didn't venture inside the clinic itself, but someone who has describes "bright white lights and a cold clinical setting," with the obligatory "absolutely no smoking" sign hanging at the entry. The idea is that junkies are going to use anyway so the state should help lower the risk, being careful, of course, not to pass judgment. The drugs are illegal, but in the interest of "harm reduction," the state will provide sanitary injection services. "Come right in, get your fix. There, you feel better, don't you?"

This is like something out of Aldous Huxley's novel, "Brave New World." Utilitarian big government discovers a low-cost, efficient method of getting the dregs of society out of everybody's hair. All it takes are sterile needles and mind-numbing drugs supplied by the addicts themselves. Leaving aside the quaint notion that putting oneself in a perpetually medicated state may not be the best way to reach one's human potential, the clinic's approach is hugely problematic. Even the most pro-legalization libertarians would have to agree that a government that engages in drugging the citizenry is pretty far removed from the classic definition of the modern liberal state.

Canada is now debating this issue. A group of 130 Canadian scientists and doctors recently published a statement arguing that InSite has been successful because there has been "reduced needle sharing, decreased public drug use, fewer publicly discarded syringes, and more rapid entry into detoxification services by persons using the facility." But last week Health Minister Tony Clement suggested that other studies have drawn far less happy conclusions. Critics of "harm reduction" programs say that despite free needles, junkies tend to share anyway and that addicts continue to sell sex and spread disease. They also note that signing up for "detoxification" is a far cry from rehab and it's not the least bit clear that needle clinics are paths to treatment.

There is another problem as well with the nanny province getting into the drug injection business: It adds to what one British Columbian described to me as "the growth of the poverty industry" in Vancouver. The bureaucracy that exists to "serve" the drug-dependent community has little interest in seeing the problem go away and, with it, their jobs. Here, as in many other arenas, there is a normal bureaucratic impulse to expand, broadening the state's subsidization of dependency. Viewed in this light, a state-sponsored shooting gallery is good for business.
Something is also very wrong when society officially winks at its own prohibition laws. Indeed, InSite demonstrates that encouraging drug use through the welfare state while at the same time attempting prohibition is not just illogical. It also produces the worst of all worlds.

(See related letters: "Letters to the Editor: Down in the Trenches in a War That Can't Be Won" -- WSJ Aug. 30, 2007)