Pubdate: Thu, 26 Apr 2007 Source: Globe and Mail (Canada) Copyright: 2007, The Globe and Mail Company Contact: http://www.globeandmail.ca/ Details: http://www.mapinc.org/media/168 Author: Andre Picard Column: Health - Second Opinion BEFORE JUNKIES CAN CLEAN UP, WE MUST SWEEP PAST THE POLITICS Since 1993, at least 2,500 people have died of drug overdoses on the streets and in the fleabag hotels of Vancouver's Downtown Eastside. That's three deaths a week from intravenous drug use in a tiny section of one of the most beautiful and prosperous cities on Earth. Three deaths a week in a community that numbers only about 9,000 hard-core IV drug users. It is, by any standard, a shocking number. It is, by any measure, a public health disaster. Yet it could be so much worse, but for the work of a few dedicated, hard-headed and sometimes visionary souls. One of them is Donald MacPherson, the drug policy co-ordinator for the City of Vancouver, who last week received a prestigious award from the Kaiser Foundation. The National Awards for Excellence in Reducing the Harm Associated with Substance Abuse, though clumsily named, are nonetheless effective in drawing attention to groundbreaking and innovative work in the field of addictions. Edgar Kaiser Jr., the multimillionaire philanthropist behind the awards, has a rare talent for wooing the powerful to this unpopular cause. So there were James Bartleman, Lieutenant-Governor of Ontario; Monte Kwinter, Ontario Minister of Community Safety and Correctional Services; Toronto Mayor David Miller; Senator Larry Campbell; Richard Evans, CEO of Alcan Inc.; and Wendy Slavin, a senior vice-president of CIBC. Also attending were various chiefs of police, government mandarins, public health officers, counsellors, former drug addicts and former convicts, all mingling, sharing and celebrating their small victories during a fancy dinner at the swanky Four Seasons Hotel in Toronto. In this crowd, Mr. MacPherson is a legend because he pioneered the so-called four-pillar approach to dealing with drug problems. Vancouver adopted the approach in 2001, becoming the first municipality in Canada with a comprehensive drug policy. In doing so, it abandoned the traditional law-and-order approach in favour of a more effective strategy to the complex problem of drug use and abuse. Aspects of the policy, such as needle exchanges and safe-injection sites, have garnered the most attention - good and bad - but the policy is much more nuanced than its detractors (and even many of its supporters) realize. The four pillars are: Prevention Promoting healthy families and communities; preventing and delaying the start of substance abuse among young people through education. Treatment Offering individuals access to services that help them come to terms with problematic substance use, including counselling, detoxification and other treatment programs, housing support and medical care. Harm reduction Reducing the spread of diseases, including hepatitis and HIV-AIDS, and limiting overdoses by providing clean needles, safe-injection sites and access to treatment. Enforcement Targeting organized crime, drug dealing and drug houses rather than individual users; co-ordinating the work of police and that of agencies that provide services. It is, all and all, an approach brimming with common sense. However, lawmakers (with the exception of Vancouver City Council) have been reluctant to implement all pillars. Rather, there tends to be a misplaced enthusiasm for enforcement, even though it has proven less than effective, largely because police waste a lot of time and energy arresting individual drug users - individuals so sick they are oblivious to the notion of deterrence. As another of the Kaiser award recipients, Inspector Thomas Carrique of Ontario's York Regional Police, said: "You can't always arrest your way out of these situations." Mr. MacPherson, as he is wont to do, put it more bluntly: "Bad public policy kills." In Canada's big cities, where heroin and crack cocaine are huge problems, and in smaller centres, where abuse of methamphetamines is soaring, a lot of people have died because of bad public policy. But only Vancouver bothers to count the carnage. The flip side of the equation, though, is that good public policy - such as the four-pillar approach - can save lives. Mr. MacPherson noted something that those who look down their noses at street addicts rarely acknowledge: Where services are available, "in most cases, it's a happy ending." Yes, a lot of people die on the streets. Many more get sick, and do horrible harm to themselves and others. But most addicts, even the hardcore IV drug users, go straight. Rather than give up on them, we need to give them a fighting chance with harm-reduction initiatives including clean needles, safe-injection sites, safe crack kits, and giving addicts free heroin. To deal with a problem so bedevilling and so destructive, you have to be bold. It may make people squeamish, but it's good public health policy. "Let's find, for God's sake, better ways, to deal with this problem," Mr. MacPherson said in his concluding remarks. Better ways than simply stuffing junkies into body bags. - --- MAP posted-by: Steve Heath