Monday, May 5, 2008

Harm Reduction and Politics

Intravenous drug use has long been recognized as contributing to the spread of blood-borne diseases like HIV and Hepatitis - this results, of course, from the sharing of needles by drug users. The public health response to this specific problem - that is, infectious disease transmission via drug use - has been to set up needle exchanges where users can obtain clean needles. These have been in operation for some time, but the next logical step was to provide an environment where people can inject drugs safely and also access health and addiction services. The first such "safe injection site" in North America began operating in Vancouver's Downtown Eastside in Sept. 2003. According to Neil Boyd, a criminologist at SFU, it's been a resounding success:
"There is no doubt that InSite has made a positive impact for the individuals who use InSite, the residents, service providers and business operators in the neighbourhood, and for the greater public health of the community," said Professor Boyd.

Boyd's research, compiled for an advisory committee specifically selected by the Stephen Harper Government, highlighted many positive impacts of InSite's work, including:

  • InSite is strongly supported by business operators, service providers and residents in the neighbourhood surrounding the facility.

  • An intentionally conservative cost-benefit analysis demonstrated that there are significant savings to tax-payers as a result of InSite's work.

  • InSite has proven to have a positive impact in reducing the spread of HIV/AIDS, and the consequent costs of its treatment.
  • InSite prevents drug overdose deaths.

  • There have been no adverse effects from InSite on drug use patterns, crime, or public disorder.

"The research presented re-confirms the kinds of results obtained from the other Health Canada funded evaluation," said Professor Boyd. "Mr. Harper should respect science and its principles -- the findings are demonstrated consistently in independently peer-reviewed scientific journals."
So, it seems clear enough that InSite is working: reducing the spread of disease and providing addiction and health services, i.e. reducing harm due to intravenous drug use. However, since heroin, to take one example, remains an illegal drug, InSite can only operate subject to an exemption from a section of the Controlled Drugs and Substances Act, an exemption which must be granted by Health Canada. One would think that a federal government which supports sound public health policies would have no problem with that. Well,
The federal Conservative government has allowed the clinic to operate under an exemption to the Narcotics Control Act, but Health Minister Tony Clement has refused to make the exemption permanent.

Clement has granted two temporary extensions to the permit, the latest of which expires at the end of June, but has not said whether he will grant a further extension.
In other words, Clement (who, in his previous incarnation as Ontario Health Minister, incompetently presided over the SARS crisis) evidently has some doubts about InSite, despite the rather obvious and substantive benefits. As his parliamentary secretary states:
Winnipeg MP Steven Fletcher, secretary to the health minister, has said science alone will not be the only factor in the Tory government's decision whether to extend Insite funding.

Mr. Fletcher said the science is conflicting, so Mr. Clement will have to assess what Mr. Fletcher calls the “realities of the situation.”

Mr. Clement himself said Monday that a decision on the fate of Insite will be made by the end of June. However, he rejected suggestions that the government has already made up its mind to say no.

“We're the government that actually wants more research . . . because we want to make sure that this decision is the right decision for Canada, the right decision for addicts the right decision for the community in Vancouver,” he told the Commons.
More research? It doesn't seem that way:
(BC) Provincial Health Officer Dr. Perry Kendall said ongoing research at the clinic is being jeopardized by the unstable situation.

"Closing down Insite would immediately put a stop to the research. Allowing Insite to continue would allow more valuable research to be done," said Kendall.
And just what will these other non-scientific factors be? Why, political ones, of course! As to Clement's putative support for research:
An article published in the International Journal of Drug Policy charges that the Conservative government interfered in the work of independent scientific bodies, attempted to muzzle scientists and deliberately misrepresented research findings because it is ideologically opposed to harm-reduction programs.

"From a scientific perspective, it's despicable," said Evan Wood, a research scientist at the B.C. Centre for Excellence in HIV/AIDS and lead author of the study. "Governments should not hand-pick grants based on ideology."


Since (2003), Dr. Wood said, there have been 22 peer-reviewed papers published on the program and they have all shown a positive benefit to users, such as reduced rates of transmission of HIV-AIDS and greater use of rehabilitation services.

An independent scientific review led Health Canada in the spring of 2006 to recommend that funding for the project be extended and that similar programs be tried in other cities.

But federal Health Minister Tony Clement intervened, saying there were too many unanswered questions and placed a moratorium on this type of research. The journal article says that was done at the behest of police organizations and based on political concerns, not sound public health policy.

Rita Smith, a spokeswoman for Mr. Clement, told The Globe and Mail yesterday this claim is "completely inaccurate." [Actually, it's entirely accurate.]


Ottawa subsequently offered money for additional research, but with the proviso that investigators refrain from disseminating their findings until after the exemption for the safe injection site expires. [In other words, they'll only fund further research (that will almost certainly reconfirm the public health benefit of InSite) if it's released after the centre is forced to close.]

Dr. Wood said this amounts to "muzzling researchers." The University of British Columbia deemed that condition ethically unacceptable and so its researchers did not apply for the grants.
Now, Clement says that the government "cares about addicts and cares about those who would otherwise be twisted on to these very dangerous drugs", but I think Neil Boyd puts their ideological waffling on this issue in perspective:
The alternative is that they shoot up beside dumpsters. The alternative is that they cost us all more because there are higher rates of HIV, Hepatitis C, violence.
While it's true that InSite does not specifically combat drug addiction, it's not actually meant to do that; it does, however, provide a safe environment where people can inject drugs, so as to reduce disease transmission, overdoses, and, yes, even provide access to addiction services so that they might break the habit. As it stands, there is ample research that InSite is doing exactly that.

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