The surgery was a success, but…

~ Jason Schwartz

1368951062alarabalaanPublic health workers are declaring their harm reduction approach a success:

Harm reduction — not a war on drugs — has reduced illicit drug use and improved public safety in what was once Ground Zero for an HIV and overdose epidemic that cost many lives, says a 15-year study of drug use in Vancouver’s impoverished Downtown Eastside.

The report by the B.C. Centre for Excellence in HIV/AIDS found that from 1996 to 2011, fewer people were using drugs and, of those who were, fewer were injecting drugs, said Dr. Thomas Kerr, co-author of the report and co-director of the centre’s Urban Health Research Initiative.

“A public health emergency was declared here because we saw the highest rates of HIV infection ever seen outside of sub-Saharan Africa — in this community. At the same time, the community was being levelled by an overdose epidemic,” Kerr said after presenting his findings to members of the group affected at a community centre in the heart of the neighbourhood.

Vancouver took a public health approach to the crisis, opening the country’s first supervised injection site in 2003, and Kerr said the statistics show that approach was successful.

Kerr goes on to pull the scientific evidence card, casting critics as stupid, unethical and indifferent to death:

“We have a federal government that ignores science in favour of ideology, and people are sick and dying as a result,” Kerr said.

“When we’re dealing with matters such as life and death, I think we’re obligated to base our decisions on the best available scientific evidence. I think it’s unethical to do otherwise.”

However:

There was some disappointing news for health officials in the study.

There has been only a slight drop in mortality rates among the city’s illicit drug users, who have a death rate eight times higher than the general population.

What’s that saying? The surgery was a success, but the patient died.

Now, I’m not saying that law enforcement is a better approach and I’m not saying that reduced disease and crime are unimportant, they are important. However, one of my concerns about public health approaches is that they are often designed to serve the public rather than the individual. When the death rate is only slightly affected, and addicts are still using and homeless, who’s best served by these outcomes of reduced disease and crime?

Harm reduction is not enough. In and of itself, it is not bad.

It’s just bad when the public and professionals declare victory while addicts continue to suffer terrible quality of life.

How much money was spent to achieve these outcomes? How else might that money have been spent?

Why not recovery?

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Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I no longer work at Dawn Farm and am now the Director of Behavioral Medicine at a community hospital, and a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.

3 thoughts on “The surgery was a success, but…”

  1. I’ve been interviewing people who are part of the new state of American harm reduction: Oxy and Vike addicts who are “stabilized” on enormous doses of Suboxone. Over the weekend I spoke to a woman who, for a 50-75mg/day Percocet habit, was put on 16mg Suboxone per day. She’s been at this level for 7 years. She has gained 75 lbs. and has gone into menopause. She feels emotionally dead. I can’t tell you how crazy it makes me when I hear 1. that doctors are “treating” a 75mg Percocet habit with 16mg bup; and 2. that harm reduction advocates think these drugs improve people’s lives.

    She has a five-minute visit with her Suboxone doctor every two months–via Skype. This guy seriously told her that, if she wanted to quit Suboxone, she would one day just “forget” to take it and then she would be done.

    She’s desperate to get off bup, but she knows she can’t do it by herself. She looks back at her previous habit with longing and regret. She recently had surgery, and the anesthesiologist and nurse told her that they’re seeing more and more OR patients on bup—it’s the new wave. … After her surgery she took 2 Percocet every 4-6 hours as directed, but within five days a devastating withdrawal descended upon her. She described it as a band of fire belted around her abdomen. She managed to abstain from Suboxone for almost two weeks—and it only got worse, despite taking 3-4 Percocet every 3 hours.

    I told this woman that there are public health experts and health journalists who think she’s better off because she’s no longer doctor-shopping or significantly threatened with overdose. I said, How would you respond to them? “I’ve lost my freedom to choose,” she said. “I’ve lost my personality. I’m more quiet and withdrawn. I feel like part of me is dead. And I’m a slave to it. I have to have it. I’ve lost the ability to say no.”

    A woman caught in a system that doesn’t let her say no. Don’t we call that “rape,” or “coercion”?

    And, please, let’s talk about the money. Reckitt Benckiser pulled in $1.4 billion from Suboxone products last year. Reckitt and Titan (who is developing the implants—the ones recently rejected by the FDA for not delivering enough drug to to the patient) see Oxy and Vike addicts as a deep well of revenue, just as Purdue saw pain patients 10 years ago.

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    1. A palliative response to a treatable condition. Just terrible. If there’s meaningful informed consent, that’s one thing, but patients aren’t given options or told what their quality of life will be like with those options.

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