Harsh criticism of harm reduction:
Vancouver is famous for its innovative approaches to drug treatment. Twenty years ago, it launched a bold experiment to tackle the problems of the notorious Downtown Eastside. The guiding idea was harm reduction. If you couldn’t cut off the drug supply or jail all the addicts, then at least you could reduce the secondary damage – HIV, hepatitis and the like – by giving people clean needles. You would surround them with medical and social services. Addiction, all agreed, was an illness, and addicts deserved compassion and respect.
Vancouver’s needle exchange, the first in North America, opened in 1989. That first year, about 128,000 needles were handed out. Today, the streets are flooded with more than three million free needles each year. The sick and malnourished, many of them with open sores, freely inject drugs. Between 5,000 and 10,000 addicts live within these eight square blocks. The HIV rate hovers around 40 per cent; hepatitis-C rate is 85 per cent. There are more than 150 social services located in the area, offering everything from counselling and shelter to free lunch and art supplies. But there are virtually no treatment beds.
Mark Steinkampf, who heads the Downtown Eastside detail, has worked this beat for 18 years. He cares about the people, and wants to get a message out: Harm reduction – the philosophy that has come to dominate drug policy – doesn’t work. Just the opposite. It digs the pit of addiction deeper and wider.
They also need a far more aggressive push into treatment and recovery – something they don’t get from the many, many helpers who are busy finding them housing and giving them free needles. “Harm reduction without a treatment component is a failed policy,” he says.
Today, rehabilitation is the treatment of last, not first resort. “Rehabilitation” and “recovery” are terms you don’t hear from advocates of harm reduction. What you do hear, over and over again, is the word “safe” – a word that many addictions doctors take issue with.
“I saw a patient the other day who’s still injecting two or three times a week,” says Dr. de Vlaming. “I explained that there’s no safe way of injecting drugs. He said, ‘No one’s ever told me that.’ ”
“Safe injection is a misnomer,” says Milan Khara, another veteran addictions doctor. “Insite is a supervised injection site. Injections inevitably lead to medical complications.”
“Look around!” he says afterward, gesturing at the dishevelled men with their shopping carts and the ravaged women who look 60, but are 30. “And they’re calling this fucking mess a success? Anyone can see it has failed utterly.”
I don’t like a lot of the language in the column–“free lunch” and “enabling” in particular. I was not surprised to learn that she’s politically right of center and has some history of intemperate remarks. This contribution seems to represent more of the freak show.
She’s right that any drug policy and service system organized around harm reduction is incomplete. She’s wrong that harm reduction is the problem. The problem is the context. Harm reduction makes sense as one approach within a comprehensive system to respond to drug and alcohol problems and the constellation of secondary problems.
Preventing illness is important and creating low threshold opportunities for addicts and heath professionals to connect is a good thing. However, it too often amounts to infection control and palliative care when the primary problem is treatable. It represents a standard of care that we wouldn’t tolerate for any other population.