Not having time to brush, I rinsed my mouth out with a capful of Listerine the other morning. Burn, baby, burn. Did someone just light a gasoline fireball in my mouth?
That brief unpleasantness brought to mind last Friday's cover story. In the first of a series of stories on the topic, reporter Cheryl Rossi wrote about a program called MAP that gives free alcohol to extreme alcoholics, the kind who knock back mouthwash, hand sanitizer, hair spray and rubbing alcohol. I can barely swish mouthwash for 15 seconds let alone down a tumbler of such foul liquids. Scary and sad.
My initial reaction to Cheryl's story idea was, "Seriously. Have we completely tipped the balance and morphed into a society of enablers?"
Given how many harm reduction programs exist in our city-from Insite, NAOMI, crack pipe give-aways, the existence of pro-drug user groups such as VANDU and now MAP-there are probably many who share my concern. But if you get beyond the front page to learn about the Managed Alcohol Program (MAP) and its tiny number of participants, it's hard to argue against it. It's cost-effective, reduces police incidents and, most importantly, is leading to better lives for the participants. Perhaps MAP would have saved Frank Paul from a tragic end. Paul was the Mi'kmaq man who was taken out of a police lockup Dec. 5, 1998 and left in an alley by a Vancouver police officer. He was found dead the next morning. Cause of death? Hypothermia due to exposure/alcohol intoxication. Nobody should die that way.
Many column inches have been devoted to the Downtown Eastside, which many readers might think gets more than its fair share of ink. Perhaps, but given that tens of millions of taxpayer dollars are poured into the area scrutiny becomes necessary. If it wasn't for endless media stories about the homeless, would ending street homelessness have been the key platform issue in the 2008 civic election?
I support initiatives such as Insite. It saves lives and reduces HIV infections, but even I'm starting to wonder how far do we go with harm reduction strategies when it starts to feel as if we're mollycoddling an entire neighbourhood that once demanded crossing guards for jaywalkers. And are we putting as much effort and enthusiasm into encouraging people into detox as we are in safely supporting their habits? (The province is woefully short on detox beds, most of which shouldn't be in the Downtown Eastside. Fortunately, some supportive housing buildings are being built elsewhere, including one a block from the Courier.)
If I correctly interpreted a letter to the editor from VANDU in the same issue as Cheryl's feature story, being a drug addict is not a terrible thing. Yes, it is. Nobody can possibly be happy being an addict, unless of course you're Keith Richards. Addictions are unhealthy and the focus of an addict's life is their next fix, which they'll lie, cheat and steal for.
I contacted Dr. Evan Wood-a UBC professor of medicine, physician with the B.C. Centre for Excellence in HIV/AIDS and harm reduction advocate-to query him on the "enabling" concerns. I've heard Wood interviewed on the radio. He was articulate and thoughtful, but most of all he sounded caring.
"No study has ever shown that addiction treatment or overdose or infectious disease prevention program enables, increases or otherwise worsens the drug problem," Wood wrote in an email. "The biggest barrier to preventing drug use in the first place as well as all the downstream consequences is that we continue to treat drug addiction as a criminal justice issue rather than a public health issue without any type of impact assessment of where that is getting us. For instance, the goal of the war on drugs is to reduce the supply of drugs and rates of drug use. However, when you look at the government's own data with respect to drug price, purity and availability, by every measure the illegal market is totally overwhelming law enforcement's efforts."
Then I wondered how far do we go with these programs. Wood said programs that give people the best chance of not using or getting off drugs are what's needed and they should be proven effective and then be cost-effective so that society's investment is worthwhile, he wrote. Agreed.
"Let me turn to some of the prevention programs that the taxpayer is currently funding. Things like Drug Abuse Resistance Education (DARE) get millions of tax dollars each year in Canada despite the fact they have been repeatedly proven ineffective in randomized controlled trials." (DARE, which was started in the U.S., is a 10-lesson program the RCMP takes to elementary and high schools to talk about the dangers of drugs. The Vancouver Police Department and the Vancouver School Board take a different approach.)
Wood understands that prescribing heroin to an addict-as the NAOMI program does-is anathema to some, but like MAP, he says it's improving people's lives. "Prescription heroin should only be a treatment of last resort, but it is cost effective and it prevents crime and the spread of diseases like HIV. It also takes away some of organized crime's best customers," he says. "From what I've seen over many years as a physician and researcher is that the life of an addict is complete hell. Even the smidgen of dignity or self worth that might come out of using a program like Insite does not make up for what you had to sell or steal to get your fix."
But what about all the money directed into harm reduction versus detox beds? Wood cited a 2001 report by the Office of the Auditor General of Canada that reviewed the country's drug strategy, that of the estimated $454 million spent annually on efforts to control illicit drugs, $426 million (93.8 per cent) was devoted to law enforcement. "Unfortunately, all that is in the news about harm reduction conveys the impression that it is really well funded when the funding these programs get is a tiny slice of the pie," he writes. "So there is a perception error and there are well funded law enforcement lobby groups who seek to maintain the status quo by promoting this idea that harm reduction programs are enabling."
That report, which can be found online, is now 11 years old. It noted the "almost complete absence of basic management information on _ an activity that accounts for almost $500 million each year."
Another review is clearly overdue. It's my tax dollars and I want them spent efficiently and effectively. But somehow I doubt the anti-science Harper government, which claims it wants to save money, would like the results. Crime is down, but Harper wants more prisons.
I'm with Wood on this one. But why trust him? If not him, then perhaps the scientific reviews conducted by the World Heath Organization, which support harm reduction programs. Or read the June 2011 Global Commission on Drug Policy at globalcommissionondrugs.org/Report.