Open Letter to Minister Clement from Libby Davies, MP, Vancouver East

August 21, 2008

Hon. Tony Clement
Minister of Health
House of Commons
Ottawa, Ontario
K1A 0A6

Dear Minister Clement,

I am writing to express my grave concern regarding your misleading and irresponsible attacks on harm reduction and Vancouver's InSite supervised injection site at the recent World Health Organization XVII International AIDS Conference in Mexico City and again at the 2008 Canadian Medical Association conference in Montreal.

At both of these conferences, you persisted in representing harm reduction and drug rehabilitation/treatment as two mutually exclusive, alternative approaches to problems associated with drug addiction. As has been explained to you on numerous occasions by health researchers, medical professionals, drug treatment experts and others, this is an entirely false dichotomy. Harm reduction is one component of a comprehensive "Four Pillar" approach, which also includes prevention, treatment and law enforcement. Low-threshold programs, such as supervised injection sites, are essential in the Four Pillars approach for reducing overdose deaths and the spread of diseases such as HIV/AIDS and Hepatitis C, and also for drawing hard-to-reach users into treatment and rehabilitation. Harm reduction is part of a continuum of care that includes treatment and prevention, and the only voices in Canada portraying it as a "substitute" are you and your government.

Unfortunately, your recent comments in Mexico City and Montreal are only the latest episodes in a well-established pattern of putting ideology and partisan politics ahead of rational public policy on this issue.

• The Conservative government's National Anti-Drug Strategy has essentially abandoned the Four Pillars approach for a "One Pillar," US-style "war on drugs" that puts almost all resources into law enforcement. As of 2007, law enforcement accounted for an overwhelming 73% of spending in the National Anti-Drug Strategy, while treatment only received 14%, research just 7% and prevention and harm reduction a pitiful 2.6% each.


• The Conservative government delayed a decision on the status of InSite for more than two years, claiming more research needed to be done. Now the research has been done, and it is absolutely clear. More than 20 peer-reviewed studies by internationally recognized researchers have demonstrated the health, safety and cost benefits of InSite. Even the criminologist hired by the government to evaluate the existing research said that InSite contributes to public order and saves lives. The response from the government in the face of this overwhelmingly favourable body of research was that the decision on InSite would not be based on scientific evidence alone.


• At the XVII International AIDS Conference in Mexico City, you called supervised injection sites "harm addition," contradicting the official policy developed by the World Health Organization in conjunction with the world's leading addiction and health researchers.


• At the 2008 Canadian Medical Association conference, you attacked the CMA's support for InSite and harm reduction generally, even going so far as to question the ethics of the 80% of Canadian doctors who support supervised injection sites.
  

Given the weight of evidence and the time that you and your government have had to digest it, I can only conclude that this continuing opposition to the Four Pillars approach is not because of an honest lack of comprehension, but is instead driven by the partisan political concerns of the Conservative Party. At a time when a comprehensive approach to the problem of drug addiction is so desperately needed, it is frustrating that you and your party have chosen cheap partisan political games over rational, evidence-based public policy.

My concern about your statements is compounded by your party's recent use of public money to mail leaflets containing dehumanizing language into East Vancouver and other communities across Canada. People with addictions are amongst the most desperate and vulnerable in our society, and referring to them as "junkies" is simply bullying and has no legitimate place in public discourse. While your party was clearly attempting to fear-monger and appeal to people's safety and security concerns, the Conservative Party has instead simply displayed the mean-spiritedness and lack of compassion that underlies so many of its policies. Will future Conservative Party leaflets begin referring to Canadians with mental illnesses as "nutcases"? Or maybe call people with physical disabilities "cripples"? Canadians have moved beyond this sort of stigmatization and dehumanization of vulnerable and ill people. I have received numerous letters and phone calls from constituents and people across Canada outraged by this mailing.Based on the above concerns, I strongly urge you and your government to take the following actions:

1. Abandon the time- and money-wasting appeal of the BC Supreme Court's decision on InSite, and start work on implementing a well-funded, comprehensive, evidence-based and effective Four Pillars strategy for dealing with drug addiction. This government must recognize that harm reduction programs like InSite are a necessary component of a broader strategy that includes prevention, treatment and enforcement.

2.Commit to basing drug policy decisions on scientific evidence and the informed opinion of the mainstream medical and research communities. History is full of tragic examples of governments and other institutions ignoring evidence because of ideological bias and short-term political concerns. In the case of drug policy in Canada, the price of Conservative ideological purity and political partisanship will be paid in lives ruined and lost. That’s too high a price to pay for political games.

3. Respect, support and strengthen effective, locally-developed initiatives dealing with addiction related issues. InSite grew out of the experience of groups and individuals working on the frontline of Vancouver's health and poverty crisis. There is broad community consensus in support of the project, including local residents, community groups, social service providers, businesses, law enforcement officers, municipal and provincial politicians, and people coping with addiction themselves. Your government's efforts to disregard the will of the community on this issue shows arrogance and poor judgment.

4. Stop wasting public money distributing dehumanizing, fear-mongering material on this issue to Canadians. Instead, Canadians need access to realistic information on addiction-related issues, both to inform public policy and for use in prevention and harm reduction campaigns. This issue is far too important to be manipulated for cheap, partisan political purposes.I look forward to your reply on this serious matter.

Sincerely,

Libby Davies, MP (Vancouver East)
NDP Spokesperson for Drug Policy Reform

CC:
Jack Layton MP, NDP Leader
Judy Wasylycia-Leis MP, NDP Health Critic
Joe Comartin MP, NDP Justice Critic

B.C. vs the Feds over supervised injection site.

Globe and Mail: Legal arguments
ANNA MEHLER PAPERNY
August 25, 2008

The B.C. government will be fighting its federal counterpart in court when the
case of Vancouver's safe-injection site goes to appeal in April, arguing it has
final say over health care within the province.

The province plans to file a formal argument in October, when the federal government and the Portland Hotel Society, which runs Insite along with the Vancouver Coastal Health Authority, file their arguments.

"We will be arguing that the Constitution grants provinces the right to make decisions about how health-care resources are allocated and delivered," B.C. Health Ministry spokesman David Karn said in an e-mail.

"The Attorney-General will appear to speak to the exclusive provincial jurisdiction over the delivery of community health services and the importance of permitting provinces to experiment and innovate in response to local health concerns.

"Mr. Justice Ian Pitfield awarded Insite a legal victory in May, ruling that federal drug laws preventing it from operating were unconstitutional, and giving Ottawa until June 30, 2009, to rewrite the laws. B.C. is including itself in both Ottawa's appeal and a cross-appeal opposing Judge Pitfield's ruling that the province doesn't have sole jurisdiction in health-care cases such as this.

A spokeswoman for federal Health Minister Tony Clement declined to comment because the case is before the courts.

Breakdown of the Conservative's "junkie" flyers

Conservatives' tough talk on drugs is a cheap political ploy

Barbara Yaffe, Vancouver SunPublished: Friday, August 22, 2008

The Harper government's escalating rhetoric on drug policy will turn off as many voters as it turns on.

Health Minister Tony Clement on Monday ramped up an attack on Vancouver's supervised injection site, questioning the medical ethics of health care workers who support harm reduction strategies such as Insite.

Conservatives have also mailed flyers to people across the country, equating drug pushers -- who clearly are criminals -- with junkies, who are addicts with huge social problems. It pledges: "The Conservative government will clean up drug crime."
A new Angus Reid poll reveals that, in B.C. and Alberta, arguably the region where people might be most inclined to consider the injection site when deciding which party to support, a majority of people in fact endorse Insite.

Specifically, 53 per cent of British Columbians and 56 per cent of Albertans say they strongly or moderately support the Downtown Eastside harm-reduction clinic.

Across Canada, nearly 40 per cent support it, even as 19 per cent also mistakenly believe that Insite hands out free drugs. Insite, of course, provides no more than a safe setting, clean needles and some nursing oversight.

The World Health Organization, as well as the medical establishment domestically, support harm reduction and supervised injection sites.

And a B.C. Supreme Court ruling this summer decreed that access to Insite constitutes a Charter right, to life, liberty and security of the person.

The idea is to reduce the dangers for addicts who doubtless would shoot up whether a supervised injection site existed or not. At such a site, users are resuscitated if they overdose, and have access to rehabilitation referrals.

Insite should not be considered nearly as big a problem as B.C.'s prevailing shortage of rehab facilities to help addicts get clean.

If the government were sincere in its efforts to address the drug problem, it would be putting cash into the establishment of more drug rehabilitation beds.

Instead, it's using addicts to advertise a highly political get-tough on crime approach.

The pamphlet the Harperites sent out pledges that Conservatives "will keep junkies in rehab and off the streets."

But Conservatives have been in power for 2 1/2 years and have made little if any visible headway in getting Downtown Eastside addicts -- including the ones who never use Insite -- into care or off the streets.

Indeed, the federal government has yet to respond to a plea from a Vancouver charitable foundation seeking $2 million toward capital costs for a new treatment facility for young people, in Keremeos.

The pamphlet also promises to "punish drug pushers with more jail time." This is totally non-controversial; it's hard to imagine any political party objecting to a renewed effort to keep pushers behind bars.

The text of the pamphlet further asserts: "Thugs, drug pushers and others involved in the drug trade are writing their own rules. For too long, lax Liberal governments left gangs and drug pushers to make their own rules and set their own criminal agenda. Those days are over."

"Who do you think is on the right track on crime?" concludes the message, featuring an arrow pointing to Harper's name.

In truth, the current government has only lately started seriously fussing about the Downtown Eastside. And the potential solutions to the prevailing problems there are well known, having been discussed going back to the time Philip Owen was Vancouver mayor.

What's required is a multi-pronged approach that would bring to bear more resources for education, prevention and rehabilitation services as well as beefed-up penalties for pushers and drug smugglers.

What Harper and the Conservatives are really doing is deploying an emotional, high-profile public issue to attract support at a time when the prime minister is toying with the idea of triggering a federal election.

The Harperites have a largely empty basket in terms of a political agenda and have seen much attention focused on Liberals who've gotten significant press play in the wake of their Green Shift environmental announcement.

But this particular strategy isn't terribly clever because a lot of voters support harm reduction and many others will see it as a political gambit.

© The Vancouver Sun 2008

Conservatives enhance stigmatization of addictions

[photo credit: Vancouver Sun]

MPs' illegal drugs flyer violated rules, opponents say

Randy Shore Vancouver Sun Monday, August 18, 2008

Flyers sent out by the federal Conservative party last week violate rules that forbid Members of Parliament from using their free postage privileges to send out campaign material, opposition MPs say.

People in east Vancouver, Richmond, Port Alberni and across the country were blitzed last week with pamphlets touting the Tories' tough-on-crime approach to illegal drugs.

According to rules distributed to every MP by the office of the Speaker of the House, such flyers may not contain "provincial, municipal or local election campaign material." Nor can the flyers request "re-election support."

But the Conservative flyer includes a depiction of an election ballot with the names of four federal party leaders and an arrow pointing to Prime Minister Stephen Harper. The question above the ballot reads "Who do you think is on the right track on crime?" The flyer asks the recipient to fill out the ballot and mail it back to the House of Commons, again free of charge.

NDP ethics critic Pat Martin has lodged a formal complaint with the Office of the Speaker after reviewing the drug-crime flyer for The Vancouver Sun.

"That is way over the line," Martin said, adding that the New Democrats have never depicted a ballot in MP mail-outs. "The Conservatives are really thumbing their nose at the rules."

MPs are allowed to use franking - free postage - to send out four householder flyers each year to their constituents. They are additionally allowed to send out a number of flyers up to a maximum of 10 per cent of the number of households in their constituencies, so-called "10-percenters."

Most MPs would be allowed to send 4,000 to 5,000 10-percenters under the rules. The 10-per-cent flyers have been historically used by opposition MPs to promote their parties' policies and agendas, but were not often used by governing parties that had large majorities in the House and large advertising budgets, according to Ted McWhinney, a former Liberal MP and constitutional law professor.

In recent years all the parties assumed some control over the content and distribution of 10-percenters by having MPs pool their 10-percenter franking privileges once a month to send out large-scale mailings outside the MPs' constituencies.

McWhinney calls that practice a by-product of the "increasingly imperial nature of the prime minister's office."

The parties have taken so much control over the message that MPs deliver to their constituents that it renders them "ineffectual," he said.

"When Canadians realize that communications from their MPs are really just junk mail they will simply throw them away," warned McWhinney, who wrote all of his 10-percenters personally during his two terms as MP for Vancouver Quadra.

Liberal MP Mark Holland has also launched a complaint about the flyers, claiming they are too partisan.

"The Conservative Party is using taxpayers' money to fund the printing and mailing of electoral material," said Holland in a release from the Liberal Party of Canada.

But complaints about partisan content may not go far, according to Colette Dery, a spokeswoman in the Office of the Speaker.

"It is expected that the content will be partisan," she said. "What it can't be is a solicitation for a membership in a party or for fundraising or for re-election."

The Conservative drug-crime flyer was distributed across the country, according to Conservative party spokesman Ryan Sparrow. He did not know how many of the flyers were printed.

Sparrow, who was responding to a Sun request for an interview with Conservative MP Rick Dykstra, dismissed the opposition complaints.

"Everything that goes out from the House of Commons goes through House of Commons Printing Services," Sparrow said. "They would not print anything that violated the rules."

He says the rules governing 10-percenters are not as "black and white" as the opposition suggest and that many of the Tories' flyers employ the ballot motif.

"The drug crime flyer doesn't ask who you would vote for; it asks who is on the right track," he said. "MPs are free to communicate with their constituents and Canadians any way they want."

© Vancouver Sun

Transcript of questions from Clement at Canadian Medical Association meeting.

This is the transcript from the floor of the Canadian Medical Association meeting where Clement gave his uneducated & misinformed views of harm reduction, smoking cessation, palliative care and strangely, pot luck dinners.

My thanks to my source, here's his: Excerpts from the official transcripts that HC prepares... thanks, mystery person!

***
Question: Thank you, Minister. Albert Schumacher from Windsor. Just to correct your example in smoking reduction, Minister, we do ask our patients to smoke less on the road to quitting. We ask them not to smoke in their home, around their family. We ask them not to smoke in their cars with their children. This is sometimes a very long process in getting them smoke-free. Any legislation that the government puts forward as far as smoke-free public places obviously assists us so in smoking, harm reduction is indeed a long cycle and it does take many efforts to get there. So I would hate for you to use that example again. (Applause.)

Hon. Tony Clement: Well, thank you. Thank you, Dr. Schumacher. I think my point though was we don’t -- we don’t try to convince people to stay on cigarettes but have less -- fewer cigarettes. Ultimately the goal is the same: to be smoke-free. And that should be our goal when it comes to injection drug use as well. That’s my point.---Question: Grant Friesen from Alberta. Mr. Minister, I’m a public health physician. I am disappointed by your comments related to harm reduction. I would want to emphasize that harm reduction is a continuum and there are certainly elements of harm reduction that are very important in terms of to clinical practice, not only in public health but across all areas of medicine.

***
Question: Thank you very much. I’m Bonnie Cham. I’m a physician from Winnipeg and I’m chair of the CMA Ethics Committee. I rise not to ask a question but to respond to your emphasis on ethics in your discussion on harm reduction.I found the use of medical ethics to justify a political decision which will affect social policy to be troubling at best and misleading at worst. Ethics consists of a balancing of rights and harms as do all medical decisions that physicians in this room help their patients reach every day.

IV drug users, as the rest of us, have the right to compassion and to access and care which is proven to be beneficial and those physicians who are affiliated with this type of care need to balance the harm of ongoing IV drug use versus ongoing exposure to non-supervised injection.By all means, consider all the issues and facts but please don’t use medical ethics. Supporting harm reduction programs is not a breach of the CMA’s Code of Ethics and medical ethics should not be misused in this way to support and justify a political decision. (Applause.)

Hon. Tony Clement: There’s no question there. I don’t believe there was a question there so the debate continues.

***
Question: Chris Mackie, new physician working in public health in southern Ontario. And my question is around the way government works. And I’ve been fascinated with the federal government and how decisions are made and I’m wondering

Hon. Tony Clement: You’ve got to get a new hobby, but anyway. (Laughter.)

Question continues : in terms of policy like around Insite, it seems to me that the evidence is clear that Insite has medical benefits for the patients as well as benefits for the community. And I’m thinking both of the primary articles published, reviews done by your government and I’m wondering what would it take for your government to change its position on Insite? If the Kirby Commission, for example, concluded that Insite was of benefit, would your position change?

Hon. Tony Clement: Well, certainly I’m always open to new research and to new insights into Insite, if I can use that term. I did -- I would be happy to send you a copy of my remarks where I go over the Expert Advisory Panel’s review of the research and some other comments that have been perhaps marginalised by some but I think are valid comments about methodology. So I’ll leave it at that because I’ve already mentioned that in my remarks but we’d be happy to share those with you.

***
Question: Thank you, Madam Chair. Minister, I’m Lloyd Opal. I’m a physician in Vancouver. I’d like to ask you a question about enforcing standards of truth in advertising for health products. As you know, Bill C-51 is now before us and contains important elements that protect consumers against false or misleading health claims and I hope you know, Minister, that when you’re standing up for reducing misleading advertising, you’re certainly among friends here at the CMA. This bill contains an element that does protect against advertising, selling, producing products that are less than forthcoming and honest about their benefits. This I know has provoked a furious reaction directed towards your department

Hon. Tony Clement: And me.

Question continues: --- from the natural health products industry. Oh, not you.

Hon. Tony Clement: No, a few.

Question continues: And, frankly, you know I think you’ve been very courageous in holding the line. I hope that you can assure us, Minister, that there will be no compromise on the consumer protections afforded in this bill and that you will act to continue to enforce and strengthen consumer protection against health fraud and false health claims.

Hon. Tony Clement: Thank you for your comments. It’s been a tough file because of the false and misleading attacks on the bill and me personally and so on so it has been a difficult file. But Bill C-51 had as its genesis the fact that Canadians need modern legislation to protect them on a whole range of issues and when I started to look at that legislation, to my horror, I found that the legislation really hadn’t changed very much in 50 years and that we really were driving a jalopy while other countries, our major trading partners — USA, countries in Europe — are, you know, in the latest version of the BMW but we’re still in our jalopy. And so that had to change to protect Canadians properly. Imported products, domestically treated products, you name it, all across the range, vaccines, pharmaceutical drugs, for the first time I’m proposing a mandatory adverse drug reaction registry so that we all know simultaneously across the country if a prescription drug that had hitherto been approved by Health Canada actually is having an impact that we should be aware of. These are all important things that -- we’re going to be tracking food from the farm to the fork, as I say. And these are all important things in terms of the public safety.

On natural health products, you’re absolutely right, there isn’t a week that goes by that I do not issue warnings about a certain natural health product, this is or that that is either mislabeled or has deleterious harmful health impacts and all I can do is warn. I have no power to recall right now — none, zero. I cannot recall a single -- I cannot recall a single drug and I cannot recall a single natural health product. That’s got to change. And certainly we are looking at some amendments because some people are taking advantage of the fact that you have to read that bill in conjunction with several other bills, several other acts in order to get the whole framework and we want to try to fix that to alleviate some of the more outlandish claims that I’m going to be banning vitamin C tomorrow, that Tony Clement is going to be banning potluck dinners. I mean you know for a guy from Muskoka to ban potluck dinners, that would be a death knell. (Laughter.) But I can tell you that we’ll do those kinds of things that will make crystal clear the intention and make sure that the administration of the bill is correct. But the purpose of the bill is to protect the health and safety of Canadians and that will not change.

Follow up to the CMA rant by Clement

L-girl over at We Move To Canada (wmtc) followed up her original post with letters to the editor (LttE) from the Globe and Mail.

In the first she reprints the seven letters printed the day following the initial story.

In the second she gives a little insight of her own on the normal processes of the LttE page: usually there is one day for one side, the next a response; letters are printed in numbers roughly proportional to the response the paper recieved on either side of the issue. Good news here then: the second day had one letter against Clement's statement and Tory "health" policy on this issue and one in favour. She reprints the one against.

Many thanks to L-girl for covering the issue so well and in this detail.

Clement lectures MDs (erroneously)

I haven't got time to blog on this properly yet, but luckily the excellent blog stylings of L-Girl at We Move to Canada has done a great job.

The errors seen on the first read (and responded to emotionally here. Rational response to follow):

• Clement uses that ol' palliative care analogy again. Yo, Minister: Palliative care IS given to people who aren't dying. Sad to have a minister with poor knowledge of basic definitions.


• The campaign by the Conservatives in Vancouver to make drug users the "evil other" includes a slogan that says "Junkies and pushers don't belong near children and families. They should be in rehab or behind bars." Nice. This is how your government feels about a fair portion of it's constituents, your fellow citizens. No thought that there's a reasonable chance the folks their vilifying HAVE children &/or ARE in families. No, they're evil and you should be afraid.


• By this point I was seeing RED.... rational response after I go run off some of the venom.

Clement at International AIDS conference.

At the International AIDS Conference in Mexico City earlier this month. http://www.aids2008.org/

[Thanks to Tim Meehan]

Clement "I believe I'm...on the side of angels"

Clement's rant at the WHO event last week has launched much backlash: from media, from unions, from the public (and of course the naysayers, sadly in Mr. Clement's riding).

This editorial from the Vancouver Sun does a fine job of breaking down the poorly reasoned and illogical arguments of the minister [emphasis added].

Closing down Insite will bring out the angel of death

Vancouver Sun
Tuesday, August 12, 2008

At the 2006 International AIDS Conference in Toronto, many people were puzzled by federal Health Minister Tony Clement's refusal to make any public comment about the future of Insite, Vancouver's supervised injection site.

Now the reasons for Clement's silence seem perfectly clear, as he managed to embarrass himself, Canadian scientists and health workers, the World Health Organization and the Joint United Nations Program on HIV/AIDS with his comments at the 2008 International AIDS Conference in Mexico City.

Speaking ostensibly in support of the WHO's guide on fighting HIV/AIDS -- which includes an explicit statement of support for injection sites -- Clement launched into an incoherent and contradictory diatribe against Insite and harm reduction measures in general.

So bizarre was Clement's rant that it's necessary to take it line by line:

"Allowing and/or encouraging people to inject heroin into their veins is not harm reduction . . . we believe it is a form of harm addition."

Clement failed to provide any evidence for this belief, which isn't surprising since there isn't any.

Indeed, all of the evidence points the other way: In addition to educating users about safer injecting and providing them with a safe, clean place to do so, use of Insite has been associated with increased uptake of detox and treatment.

Insite therefore represents a powerful method of reducing harm and, better yet, it reduces harm among some of the most vulnerable and marginalized individuals, people who would otherwise be unlikely or unable to seek treatment.

And this is to say nothing of the incoherence of supporting needle exchanges -- as Clement does -- while attacking injection sites.

The government is "not prepared to allow people to die."

While Clement failed to expand on this statement, it's clear he was attempting to create an association between Insite and death. Once again, the research suggests that, if anything, Insite saves lives, which means that shutting the site down is more appropriately associated with allowing people to die.

"It's not my job to kowtow to orthodoxy."

This is a trick that's increasingly used by harm reduction opponents: Convince people that harm reduction is orthodoxy and that opponents are intrepid folks who wish to blaze a brave new path.

Of course it's quite the opposite. While harm reduction has gained adherents thanks to the evidence in its favour, the orthodox position is, and always has been, that drug problems are best dealt with through enforcement.

This is certainly true in Canada: Researchers from the B.C. Centre for Excellence in HIV/AIDS found that for the years 2004-05 -- before the Conservatives announced their anti-drug strategy -- the feds spent 73 per cent of anti-drug money on enforcement, compared to 14 per cent for treatment, and three per cent each for prevention and harm reduction. The remaining seven per cent was allocated for coordination and research.

In October 2007, the Conservatives announced the $64-million National Anti-Drug Strategy, and managed to convince some people, and some news outlets, that it was all about treatment.

Yet when that money is added to the base, the new percentages are as follows: Enforcement receives 70 per cent of the total, with 17 per cent going to treatment, four per cent for prevention and two per cent for harm reduction. The remaining seven per cent is again allotted for coordination and research.

The Conservatives are therefore following tradition -- orthodoxy -- by relying on enforcement to solve the drug problem despite overwhelmingly evidence that it has been a failure, and could, therefore, rightly be called a form of harm addition. Clement is not merely kowtowing to orthodoxy; he's a slave to it.

The numbers also show that for all their talk about treatment and prevention, the Conservatives are little more interested in them than any previous government was. Yet Clement somehow managed to tell the world, with a straight face, that Canada has achieved the right balance among prevention, treatment and enforcement.

"I believe I'm on the side of compassion and on the side of the angels."

Clement must be using a very odd definition of compassion here, because his "compassionate" strategy involves removing from vulnerable people a scientifically proven public health measure.

And instead of spending the considerable anti-drug funds on treatment, he supports the orthodox position of wasting them on enforcement.

Many people assume Clement's opposition to Insite stems from a desire to appeal to the Conservative base. So perhaps his compassion is directed toward them. Yet since drug addiction costs everyone, throwing taxpayers' money away on failed methods can hardly be construed as being compassionate toward anyone.

Finally, given that Insite might well prevent the spread of disease and save lives, the only angel who could support its elimination is the angel of death.

“We need to stop arguing about the merits of harm reduction and just do it”

From today's Globe and Mail (front page) we get a lesson in diplomacy from Mr. Clement entitled "Diplomacy: It's not about tact and skill anymore". Very short lesson really:

1. At press conference endorse the program/document/agency up for discussion so as to look like the good guy for the cameras.
2. At the actual conference deride the program/document/agency up for discussion.
3. Ensure maximal embarrassment of all other officials involved.

Clement's Insite attack leaves WHO red-faced

ANDRÉ PICARD
From Wednesday's Globe and Mail August 6, 2008 at 1:00 AM EDT

MEXICO CITY — The World Health Organization has strongly endorsed safe injection sites like Vancouver's Insite as one of the “priority interventions” that countries should implement to slow the spread of HIV-AIDS, a view that was swiftly and firmly rejected by Canada's Health Minister.

“Allowing and/or encouraging people to inject heroin into their veins is not harm reduction, it is the opposite. … We believe it is a form of harm addition,” Tony Clement said Tuesday in Mexico City, where he is attending the XVII International AIDS Conference.

While the minister's views on Insite are well known, Mr. Clement repeated them Tuesday at an event where he was endorsing and promoting a new WHO “how-to” guide on battling the epidemic, which promotes needle exchange and safe injection sites. The Health Minister's comments left officials from the agency flummoxed and red-faced.

Teguest Guerma, associate director of the HIV-AIDS department at the WHO, who was clearly uncomfortable about the exchange between the minister and reporters about the apparent contradiction in Canada's position, would only say: “The WHO supports harm reduction.”

She repeated the phrase more than a dozen times, only once adding “including all interventions that benefit injecting drug users.”

The WHO document, prepared in Q&A form, is far less equivocal. It asks: “What is the WHO position on safe injection sites?” The answer: “Safe injecting sites are not a new intervention but simply a repackaging of existing WHO-recommended interventions such as needle exchanges, etc.”

“They enable known, WHO-recommended harm reduction interventions to be delivered and used in a safe environment with the aim of reaching the most marginalized and vulnerable of injecting drug users.”

Mr. Clement, at a press conference held Tuesday in Mexico City, initially praised the new document and noted that “Canada is proud to be the largest contributor to the WHO.”

He also said that the federal government supports various forms of harm reduction for intravenous drug users such as needle exchange, methadone treatment and rehabilitation, but rejected safe injection as illegitimate. “We're not prepared to allow people to die” by condoning their continued drug use, Mr. Clement said.

Mr. Clement has never clearly stated why the government supports needle exchange and rehab programs but so sternly opposes the existence of a facility where drug users can actually use the safe needles and be encouraged to enter rehab. The sticking point appears to be that, at Insite, drug users cannot be arrested and prosecuted.

Worldwide, an estimated 33 million people are infected with HIV-AIDS. Some 2.7 million people were newly infected last year.

Outside of sub-Saharan Africa, the epicentre of the epidemic, intravenous drug users
account for almost one-third of new infections. In Canada, there are 58,000 people living with HIV-AIDS, including 12,110 current and former intravenous drug users – 21 per cent of the total.

Drug users, because they are often marginalized and treated as criminals, are among the least likely people with HIV-AIDS to get treatment and among the most likely to infect others, making them the focus of much research.

Abeeda Kamarulzaman, head professor of infectious diseases at the University of Malaya in Kuala Lumpur, said harm reduction measures such as needle exchange, methadone treatment and safe injection sites have all been shown as beneficial in slowing the spread of HIV-AIDS.

She said 77 countries have needle exchange programs, and 63 countries have drug substitution treatment programs. There are 49 safe injection sites across Europe, Australia and Canada, including Insite in Vancouver. The Quebec government has announced plans for a similar facility in Montreal.

“We need to stop arguing about the merits of harm reduction and just do it,” Dr. Kamarulzaman told the conference.

Asked specifically about the merits of Insite, she said the “benefits of safe injection sites have been well demonstrated,” but added that governments are reluctant to endorse such measures because “it may seem like they are legalizing heroin and other drugs, which they are not.” (At Insite, drug users can inject themselves with clean needles under the supervision of health professionals should they require medical assistance, but they are not provided with drugs.) Peter Piot, the executive director of UNAIDS, was also clear in his backing of harm-reduction measures, including safe injection sites. “It is high time every country in the world resolutely embraced the full spectrum of harm reduction among injecting drug users. Not doing so will only perpetuate the spread of HIV,” he said.

Insite opened as a pilot project in 2003 under a special exemption from federal drug laws, but Ottawa had refused to say whether it would extend the exemption when it expired in June.

Before the deadline arrived, the B.C. Supreme Court ruled that parts of federal drug laws related to trafficking and possession are unconstitutional and gave the government a year to rewrite them. Mr. Justice Ian Pitfield said laws that prevent people suffering from the disease of addiction from accessing such a service infringe on their right to life, liberty and security of the person.

Mr. Clement said Ottawa will appeal the decision, meaning the fate of Insite will likely be decided by the Supreme Court of Canada.

There are over 400 comments here: Comments

Wente: "As a columnist, my job is to express a point of view, not to present all points of view". No kidding.

I've gotten some personal e-mails asking why I didn't link to Margaret Wente's "indepth" 4 part series on harm reduction and Insite. My initial draft post on it had been in the works for weeks and was very, very lengthy. What it boils down to though is that her 4 columns are crap. Not crappy writing, no, it's written all interestingly with catchy little thought-provoking one-liners and set-ups to make readers with no real knowledge of either side of the issue think "Well, of course I don't agree with harm reduction! Who would?!" No, in that sense, the columns are very, very well done.

In terms of being balanced, in-depth, investigative journalism they are, as I've said, utter crap. I guess the argument is that as a columnist she only has to present one point of view. She's not doing investigative journalism, she's creating discussion and presenting an opinion. Sadly, Wente makes no bones about not having done key research such as, say, talking to the people at Insite. No, they apparently have the power here and are over exposed in the media as she claims in the follow-up "Margaret Wente Answers Your Questions":

Matthew Elrod, Vancouver: Why did you not offer the Insite researchers an opportunity to defend themselves?

Margaret Wente: Matthew, Insite and its supporters have ably defended their position in these pages and elsewhere, and I am sure they will be given the chance to do so again. Also, as a columnist, my job is to express a point of view, not to present all points of view.

Wente clearly also didn't consult "Basics of Addictions Medicine" as is obvious when she says, 'Drug addiction is 100 per cent curable through changing your personal behaviour"

She didn't do their fact checking then, even for their own argument. She supports "tough love" measures such as AA & NA and similar programs throughout the columns and on line questions. Yet the position of those and similar organizations is that you are always an addict. You are never cured, and you will have to fight this fight for your entire life. The neurological research backs this up.

Elsewhere in the on-line questions Wente states: "One thing I heard from addictions doctors is that they really want more facilities for people who are still using — which AA-type programs won't accept." Apparently Insite and Onsite (which has had very little media coverage) a short term recovery centre at the same location just slipped her mind then. Or perhaps she doesn't consider them facilities for people who are still using....

One regret I have from this ongoing saga is that I was pretty sidetracked by reading and commenting and fuming over the columns that I neglected to copy the Letters to the Editor from the series. I haven't yet gone back to the G&M website to search for these. I'm certain that, like the example below from the comments to the on-line questions , the letters to the editor will respond in a much more accurate and succinct way than my initial response to Wente's series.

Dan Shortt from Toronto, Canada writes: Ms. Wente states that no addiction is benign, and says that the addict not only hurts themselves, but society, their families, and their communities. I wonder would she consider the opposite hypothesis, i.e. that the current 'war on drugs' leaves addicts being hurt by society, their families, and their communities? Ms. Wente has spoken out strongly on favour of the 'tough-love' approach to addiction, i.e. that the addict be given a choice between rehabilitation or jail. I wonder would she advocate the same approach to alcohol and cigarette addiction. No? Is it because these products are legal, making their abuse more socially and morally acceptable, despite the obvious harm they do to society?

Finally, it's interesting that in all of her articles, Ms. Wente doesn't once mention Dr. Gabor Mate, a physician with extensive experience working with addicts in Vancouver's East Side. Dr. Mate has been a contributor to the G & M in the past, and recently written a best-selling book about addiction. He reports in his book that a story that appeared in the G & M in January 2007 stated that of a 245 million dollar budget for a national drug strategy, 73% of the funds were directed towards law enforcement, while only 3% of funds went to prevention and harm reduction. Is it any wonder that the '4 Pillars' model is not working, when 3/4 of the funds available are used to prop-up just one of the 4 pillars?