Doctors are failing to warn young
Canadians about the dangers of illicit drug use. Oh,
and harm reduction's a sham.
Those were the messages from federal
health minister Tony Clement to doctors at the CMA's
annual meeting on August 20. Many healthcare observers
say this is a taste of what we can expect to see in
his national drug strategy, details of which are to
be announced this fall. Disappointment and despair are
the chief reactions to his hardline stance on substance
abuse policy from many expert physicians, researchers
and policy makers across the country.
"This is going to be catastrophic
for people who have substance abuse problems, for society,
for taxpayers, for crime," says Dr Keith Martin, a Liberal
MP from BC and former substance-abuse physician, who
was at Mr Clement's speech.
Disdain for the government's harm-reduction
denialism has been swift and fierce. Over 130 physicians
and scientists signed a petition released the day after
Mr Clement's speech, condemning the government's "potentially
deadly" misrepresentation of the overwhelmingly positive
evidence for harm reduction programs including Vancouver's
Insite safe-injection site, where nurses provide addicts
with clean needles and a safe place to use drugs. Among
those who signed the petition are 2006 International
AIDS Conference co-chair Dr Mark Wainberg, Montreal
public health director Dr Richard Lessard and Dr Robert
Brunham of the BC Centre for Disease Control. Doctors
and scientists from nearly every major university in
Canada put pen to paper.
The petition endorses a commentary
written by Dr Stephen Hwang, of Toronto's Centre for
Research on Inner City Health, in Open Medicine
which condemns the government's handling of the Insite
case. "The current federal government has philosophical
objections to harm reduction initiatives," says Dr Hwang.
"They're trying to obscure the evidence by saying the
research on Insite is not clear."
In fact, the evidence is uniformly
supportive of Insite. Twenty-four studies published
in journals such as the NEJM, The Lancet,
the BMJ and the CMAJ have proven that
to be the case. Zero have found it to be either unsafe
or ineffective.
HARM
REDUCTION
But with the December 31, 2007 deadline for the renewal
of Insite's federal exemption to allow it to operate
fast approaching, Mr Clement continues to insist that
the science isn't clearly in favour of Insite. At the
CMA meeting, he said: "Harm reduction, in a sense, takes
many forms. To me, prevention is harm reduction. Treatment
is harm reduction. Enforcement is harm reduction." Those
comments, among others, worried Dr Isra Levy, of the
National Speciality Society for Community Medicine.
In a CMA release, Dr Levy said there's growing concern
about the government's support for stricter legal enforcement
instead of a comprehensive approach including harm reduction
initiatives.
Stephen Harper's attitude about
how society should treat drug addicts was outlined in
a 2003 essay he wrote about the Left called "Rediscovering
the Right Agenda," published in Report magazine:
"This descent into nihilism...
leads to silliness such as moral neutrality on the use
of marijuana or harder drugs mixed with its random moral
crusades on tobacco. It explains the lack of moral censure
on personal foibles of all kinds, extenuating even criminal
behaviour with moral outrage at bourgeois society, which
is then tangentially blamed for deviant behaviour."
Dr Martin says Mr Harper's position
on substance abuse was the reason he opted not to join
the newly formed Conservative Party, though he had been
a member of the Canadian Alliance. "I suspect they see
[substance abuse] as some kind of personal weakness
— that people have a choice," says Dr Martin.
THE
EVIDENCE
Health Canada continues to repeat that more research
is needed on Insite to determine how safe-injection
sites affect crime, prevention and treatment.
But extensive research has shown
Insite is successful at reducing crime and overdoses,
getting addicts into treatment and saving money.
Asked what research Mr Clement
still needs to see in order to make his decision, Erik
Waddell, a spokesman for Mr Clement, answers, "To see
if Insite is getting people to programs to help them
get off drugs." However, the NEJM study, published
June 9, 2006, concluded that Insite increased admissions
into detoxification programs and addiction treatment.
Just four months later, Mr Clement said in a release,
"Right now the only thing the research to date has proven
conclusively is drug addicts need more help to get off
drugs."
At the CMA meeting in August, he
repeated his assertion: "There has been more research
done, and some of it has been questioning of the research
that has already taken place and questioning of the
methodology of those associated with Insite." When asked
to clarify what evidence Mr Clement was referring to,
Mr Waddell confirmed it was a commentary published in
January 2007 in a non-peer-reviewed journal called The
Journal of Global Drug Policy and Practice, which
receives funding from the US Department of Justice.
The piece, written by Colin Mangham,
PhD, argues that the studies carried out by researchers
from the BC Centre for Excellence in HIV/AIDS and elsewhere
have been flawed and misleading. (See "Harper's new
Anti-Drug Strategy is not anti-HIV" on page 16 to read
the opinion of the Centre of Excellence researchers.)
Questions about the article's trustworthiness have arisen.
Dr Mangham is the president of the Drug Prevention Network
of Canada, an organization run by former Conservative
MP Randy White, and has previously written commentaries
criticizing the philosophy of harm reduction. In response
to questions about the Ministry of Health's opinion
on allegations of the article's bias, Mr Waddell says
only, "We are going to take all research into account
when we make our decision."
LEGAL
CONCERNS
Although Mr Waddell insists Insite's future has not
yet been decided, Dr Martin believes the debate is all
but over: "I think, given Mr Clement's comments, they
are not going to renew it. And that should be worrying
to Canadians."
A legal challenge was launched
just a few days before Mr Clement's speech to try to
wrest control of Insite from the federal government.
Filed by drug addicts Shelly Tomic and Dean Wilson and
the Portland Hotel Society, Insite's operator, on August
17, the suit alleges that closing Insite would violate
addicts' Charter rights to security of the person and
harm their physical and mental health.
Another legal hurdle is the fact
that Canada is a signatory to the 1961 Single Convention
on Narcotic Drugs, which limits nations' ability to
give drugs except for medical or scientific purposes.
A loophole in the treaty allows the project to remain
open because it is still classified as a scientific
study. Dr Martin says Canada must push other nations
to amend the treaty.
DOCTORS'
ROLES
Dr Hwang says researchers and physicians must speak
out more forcefully when science is being undermined
by politics and ideology, as he believes is the case
with Insite. "We have an obligation to not just seek
scientific evidence or investigate problems but also
to ensure that the best evidence is honestly and fairly
presented to the public," he says.
Unfortunately, he says, the CMA
is not doing its part in that regard. "It's critical
as physicians to ensure our professional organizations
and lobby groups represent the good of the public as
their primary objective," he says, "not only the welfare
of physicians."
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