Pubdate: Sat, 08 Nov 2003 Source: Vancouver Sun (CN BC) Copyright: 2003 The Vancouver Sun Contact: http://www.canada.com/vancouver/vancouversun/ Details: http://www.mapinc.org/media/477 Author: Glenn Bohn VANCOUVER'S DRUG PROBLEM MORE VISIBLE, DOCTOR SAYS Addiction I Toronto And Montreal Have Problems That Rival Or Surpass Ours, New Physician Leader Says A Toronto doctor who is moving to Vancouver to coordinate drug and alcohol treatment programs here says Toronto has more heroin and cocaine users, but Vancouver's drug problem is far more visible. "I don't think Vancouver's problems are any worse than Toronto's or Montreal's," Dr. David Marsh said in an interview Wednesday. "They're different though, and one of those significant differences is the visibility of the problems in the Downtown Eastside. Those aren't the only problems in the city, but they are problems that everyone knows about. "In Toronto, there are more heroin users and cocaine users and people than there are in Vancouver. In proportion to the population, the prevalence of problems is just as high in Toronto as it is in Vancouver, but the problem isn't concentrated in one neighbourhood, and therefore isn't as visible, and doesn't attract as much political attention." Marsh, 37, works at the Toronto-based Centre for Addiction Medicine and Mental Health, Canada's largest hospital for addiction treatment. He was recently hired by the Vancouver Coastal Health Authority and Providence Health Care and begins work here in January as the region's first physician leader for addiction medicine. Marsh refused to disclose how much he is being paid but did say he is moving to B.C. because of government-funded initiatives such as InSite, the new supervised drug injection centre near Hastings and Main. "I'm excited about the opportunities here," said Marsh, who is here this week for meetings and, with his wife, to look for a home. "There's a political environment and funding situation here in Vancouver that creates an opportunity to design a system that makes sense." Marsh said he doesn't have authority over the budget spent on drug-related issues by health authorities, but will help re-design existing services or change their mandate. Here are some of Marsh's comments on different drug problems: - - On marijuana: "Speaking for myself and not any organization I'm affiliated with," he said he favours decriminalization of small amounts of marijuana, as the federal government has proposed. "The problem is that the prohibition against possession has been demonstrated by research not to decrease the prevalence of use. We make it illegal in hopes of preventing young people from using it, but that doesn't work." He also said one of the things young people consider when deciding whether to use a drug is their perception of whether a drug is harmful. "As a prevention message, it's very important for young people to realize that cannabis is not an innocuous drug, that they can come to harm from using it, especially if they smoke cannabis and try to drive a motor vehicle. And a small proportion of cannabis users go on to develop a dependence, and their cannabis use disrupts their social and psychological functions, and gets in the way of them being good parents and good employees." - - On cocaine: Marsh said cocaine use has declined slightly in North America during the past decade, but noted that people who inject cocaine -- between 20 and 30 times a day, according to a study of users in Montreal and Vancouver -- are more likely to get blood-borne diseases such as HIV, the virus that leads to AIDS. Marsh conceded that crack cocaine users in Vancouver are highly visible: The crack smokers in this study were reporting 50 to 100 uses a day. They buy and use, buy and use ... They're going to be cycling in and out of the street a lot." What treatment programs for crack cocaine will he initiate here that have not been tried before? "I'm not sure we're hoping to try things that haven't been tried before. In general, we hope to learn from other jurisdictions, and apply things that might not have been tried here in Vancouver. Right now, the [Vancouver Coastal] health authority is going through an addiction redesign project and moving towards the end of the first phase, where they've been introducing needle exchange, methadone, addiction counselling, and other things. The next phase will be looking at the treatment part of the continuum." [Drug experts often refer to a "continuum" of drug prevention and treatment programs, including education, counselling, harm reduction, detox and long-term treatment.] - - On methamphetamines, which includes the "crystal meth" that many street kids use: "Methamphetamine is an old drug that has been around for a long time. Over the last 20 years, there's been a much higher prevalence of use on the West Coast of the U.S. In Canada, unfortunately, we haven't had good networks for tracking patterns of drug use, especially drugs used by small portions of the population." Marsh said there is no medication to treat people who abuse methamphetamines, cocaine, ritalin and other psycho-stimulants, so "we're mainly relying on counselling as the intervention. That said, there are ways of trying to reach out and engage them in treatment, such as syringe exchange programs." - - On alcohol: "In Canada, the social costs of alcohol are greater than all the illicit drugs combined, and the cost attributable to tobacco is even greater than alcohol. In ways that are analogous to heroin and cocaine, we need ways to reaching out to people with problems, and getting them motivated to enter treatment. For instance, for an older person who is isolated, living alone and continuing to drink as they develop liver failure, we might have to educate community nurses or agencies that are in a position to identify individuals with those problems and make treatment referrals. Having alcohol and drug counsellors at community health centres is a great opportunity for family physicians to identify alcohol problems, or people who want to stop smoking." - --- MAP posted-by: Jay Bergstrom