Sick of watching people die

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.

3 thoughts on “Sick of watching people die

  1. I work with a Chicago agency engaged in needle exchange. The high rate of HIV, hepatitis and the like transmitted by dirty needles would indicate a need for more harm reduction – not less. It’s simply ridiculous to imply that providing clean needles in any way promotes drug use. Harm-reductionists soft-pedal recovery so as not to alienate active users. By engaging the user over time, harm-reductionists create opportunities for steering users to the treatment and social services they need. Certainly, they reduce the time between when a user decides he wants to quit to when he actually does something about it. There’s another reality: statistically, most addicts never do recover, regardless of what they or social agencies do. Harm-reduction addresses this reality. The harm reduced is not only for that of the user, but for society as a whole. It’s simply in everyone’s best interest to reduce the transmission of disease by dirty needles, because this also reduces transmission to the general population by sexual activity and other means. All of us in the recovery business are saddened by conditions we see. But, we also believe, where there’s life, there’s hope. Many do recover – me, for example, and just about everyone I know working in the trenches. We’ve been there. Believe me, we know what we’re doing.

  2. This is a very interesting point of contention for me. I am a recovering addict and if I felt that using was more safe for me I know that my brain would try to rationalize my use with the "safe" card. I had that insane rational when I used alcohol, for example, equating the legality of it as a drug as a "safe" way to get high. Bottom line is that my disease alienated me and justified any method of use. Passing out 'clean' needles would be like meeting the Angel of Death or insanity for me, speaking from the heart of personal experience. It may reduce some of the 2nd party social damage and slow down the HIV epidemic for a time but most of us start off using clean needles and "sanitary beer" to begin with and our disease eventually crosses every boundary known to man/woman after that. By giving out clean needles society is caving into the idea that this disease is still based on self will. (The old "If only we could see that we are making it safe for them to use then they may want to seek out treatment.") It's passing out candy to diabetics near an insulin shop and then trying to cure them. Its cruel and unfair. The only other thing I can really say about this is that as an addict in recovery I would not be here unless I physically and socially hit bottom, faced consequences within society and felt death on my door step. No one should ever have to suffer like that and for those who never hit their bottom, death may be the only blessing. My deepest compassion, blessings, and prayers from one addict to another. 🙂 M.A.Y.

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