Pubdate: Tue, 17 Sep 2002
Source: Canadian Medical Association Journal (Canada)
Copyright: 2002 Canadian Medical Association
Author: J.R. Smith


Robert Remis' commentary questions the potential effectiveness of safe 
injection sites for secondary prevention because of the chaotic lives of 
many injection drug users. But Remis fails to mention that much of that 
chaos comes from users' struggles to obtain money to pay for their drugs 
and evade criminal prosecution.

As a family doctor with a longstanding interest in HIV, my practice has in 
recent years increasingly come to encompass hepatitis C, injection and 
other drug use, prescription drug abuse, harm reduction, Aboriginal and 
mental health, advocacy for access to the nonmedical determinants of health 
and liaison with prison health services.

I would suggest a far bolder approach than Remis advocates to minimize 
nonmedical drug use and its enormously (and increasingly) costly personal 
and societal consequences.

Government should confine its role to what it can do. It is surely by now 
beyond dispute that if an individual wants to use a particular drug he or 
she will do so. Drug price, poverty, the law, warnings and the risk of 
violence are clearly ineffectual deterrents. People make their own choices 
and have to live with the consequences. The important thing is that they 
comprehend the facts needed to help them decide so that the consequences 
are minimized. To achieve this (as with liquor and Al Capone), government 
must take over the supply and distribution of drugs from the gangs. The 
gangs' profit motivation ensures the constant recruitment and initiation of 
new users.

Decriminalization without regulation could do more harm than good. I 
suggest that the right to obtain, possess and use each drug -- from 
marijuana through "party drugs" to injection drugs -- should be subject to 
licensure. High quality, accurate primary preventive education for the 
specific drug concerned would be targeted precisely at each licence 
applicant. A government monopoly and affordable drugs would go a long way 
toward ensuring that safe and supervised legal injection sites would be 
accepted by users.

After an initial period of enforcement, this would result in a significant 
shift in human resources from police, legal and correctional service 
vocations to research and preventive work in the fields of health and the 
nonmedical determinants of health.

Rigorous scientific evaluation of the overall effectiveness of implementing 
this type of strategy in the short and long term, although challenging, 
could be achieved.

J.R. (Dick) M. Smith

HIV Primary Care Physician

Winnipeg, Man.
- ---
MAP posted-by: Beth