Pubdate: Thu, 03 Apr 2014
Source: News Review, The  (CN SN)
Copyright: 2014 Michael Flood
Contact:  http://www.yorktonnews.com/
Details: http://www.mapinc.org/media/4047
Author: Michael Flood

PROS AND CONS OF PRESCRIBING

To the Editor:

Doctors treating addicts from Vancouver's Downtown East Side have been
asking the federal government to extend a trial program under which
they were allowed to write prescriptions for diacetyl morphine. Health
Minister Rona Ambrose has opposed extending the program. On March
25th, Providence Health Care took the doctors' case before the B.C.
Supreme Court.

Why is diacetyl morphine controversial? Because it's better known by
the trade name it had before it was made illegal: heroin.

Ambrose's actions are of a piece with the Conservative government's
continuing opposition to harm reduction strategies in Canada. In
October of 2013 it amended the special access program (which makes
restricted drugs available for research purposes) to prevent
clinicians from prescribing heroin, cocaine, and ecstasy.

After being ordered to extend the operating permits of Vancouver's
Insite supervised injection facility by a unanimous Supreme Court of
Canada decision (Canadav. PHS Community Services Society, 2011 SCC
44), the government wrote new legislation making it harder for similar
facilities to be opened in the future. It has also increased the
penalties for drug possession and trafficking.

The doctors justify their request under the concept of Harm Reduction,
an umbrella term for many public health policies that seek to minimize
the harm suffered by recreational drug users. It embraces many
programs like needle exchanges, safe injection sites, and offering
free, anonymous HIV testing to at-risk populations. In this case, the
doctors argue that putting addicts into regular touch with healthcare
providers makes it easier for them to enter treatment and receive help
for their other afflictions like homelessness and mental illness.

Opponents of harm reduction argue that these policies risk creating
the impression that the activities in question can be made safe,
attracting more people - who would otherwise be deterred - to partake
in them. They are reasoning by analogy from the often observed fact
that safety features in automobiles save lives, but lead to more
accidents as drivers who feel protected take more risks.

I am uncertain whether this is the Conservative government's stance on
harm reduction - it has, here as in so many things, neglected to
describe its reasoning for its policies. Rather than set up a straw
man, an easy argument to knock down, I am trying (as I try in all my
columns) to find the best arguments for a policy and present them
strongly, even if they are not the arguments embraced by the policy's
supporters.

Both advocates and critics of Harm Reduction have respectable
arguments in their favour. Both definitely favour reducing harm, but
have opposed ideas of how to achieve it. One side argues for reducing
the harms directly, while their opponent argues that such attempts
will only increase the overall harm, for let's not forget that every
heroin addict has relatives and friends who are hurt by their
addiction, and society should avoid creating more addicts wherever it
can.

I have to side with the Harm Reduction advocates in this case. The
harms predicted by their opponents are hypothetical. They seem to
believe the public at large has a vast unsated desire to indulge in
drugs which is deterred only by the threat of its illegality. This I
find hard to credit. Ask yourself whether you or anyone you know is
held back from experimenting with using intravenous drugs solely by
its illegality and risk.

I also find it very hard to see how prescribing heroin to addicts and
ensuring they practice safe injection techniques could be more harmful
than the prohibition of narcotics has been.

The alternatives to doctor-prescribed heroin are evident every day in
every major city: a massive and violent illegal drug trade, addicts
stealing and prostituting themselves for their fixes, overdoses,
poisonings due to cutting agents, and soaring rates of Hepatitis C and
HIV infections all of which contribute greatly to the cost of
providing public services.

Arguably we, the citizens of Canada, are all being harmed by a
prohibition- and punishment-centred approach to drug addiction.

Changing our drug laws to something sensible is perhaps too much to
ask in the near term - the least we can do is reduce the harm already
being inflicted.

Michael Flood, Troy Media Corp. 
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