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July 18, 2008 -- Ottawa Citizen (CN ON)

Column: The Fly on the Elephant

Since We Spend All Our Time Talking About the Tiny Speck That Is Harm Reduction, Maybe We Should Just Get Rid of It and Move on to the Enormous Mess of Drug Policy in General

By Dan Gardner, The Ottawa Citizen

Return to Drug War News: Don't Miss Archive

I've been writing about drug policy for more than a decade. In that time, I've seen the failure of current policies in a numbing array of statistics. I've seen the damage inflicted by our mistakes everywhere from Colombia to Russia and the streets of Vancouver's infamous downtown eastside.

And I've seen a long parade of politicians promise change by doing more -- much more -- of the same.

I want real change. The status quo is a disaster. Tinkering won't do. We need to start from the beginning and re-think the whole bloody mess.

And so I've reluctantly concluded that harm reduction has to go.

It's not that I'm opposed to philosophy of harm reduction. I support it passionately. It's humane and constructive.

And it's not that harm reduction programs -- needle exchanges, safe injection sites, and so on -- don't work. In fact, they've been subjected to extensive analysis and peer-reviewed studies published in some of the finest medical journals -- The Lancet, the New England Journal of Medicine, the Canadian Medical Association Journal -- have reported many positive results.

Nor is harm reduction responsible for the failures and tragedies we see all around us. Harm reduction didn't exist in this country 20 years ago and it was only in the mid-1990s that the term started popping up in the media. And it's still peripheral: In the latest version of the National Drug Strategy, harm reduction isn't even mentioned.

Compare this to law enforcement. Ever since drugs were first banned almost 90 years ago, the criminal law has been Canada's predominant means of dealing with them. It still is today: Three-quarters of drug-related funding goes to cops, courts and jails; a thin slice of the pie goes to prevention and treatment; the sliver that's left goes to harm reduction.

To blame harm reduction for the failure of the status quo isn't merely illogical. It's surreal.

And yet, that's precisely what's happening.

"Look around!" a beat cop in Vancouver's downtown eastside says to Globe and Mail columnist Margaret Wente. There are homeless men pushing shopping carts, ravaged women, all the familiar misery. "And they're calling this fucking mess a success? Anyone can see it has failed utterly."

The "it" is harm reduction.

To the cop and Ms. Wente and to a whole lot of Canadians, the fact that the downtown eastside has a needle exchange and a safe-injection site makes it the model village of harm reduction. And since the model village is a "f*ing mess," harm reduction is a failure.

What Ms. Wente doesn't mention is that Vancouver's official drug policy -- the "four pillars" model -- consists of law enforcement, prevention, treatment and harm reduction. I don't have a precise breakdown of what's spent on each pillar but I'd bet a week's pay that law enforcement gets the lion's share.

Ms. Wente and the cop she accompanies are oblivious to this. Not even the fact that the cop arrests a woman he catches with a crack pipe -- a fact reported at the beginning of Ms. Wente's column -- gives them pause.

This is all too typical of how many Canadians think about drug policy. Prohibition is just taken as a given -- like gravity and the air we breath. Does it work? No one demands evidence. Is it possible that it creates new harms -- the black market and everything that goes along with it -- and thus inflicts more misery than it relieves? No one bothers to ask.

We just go on pouring billions of dollars into law enforcement and never question a thing.

This leads to some ironic conclusions. Ms. Wente, for one, attacks Vancouver's safe injection site by quoting a doctor who says there's no such thing as a safe injection. "Injections inevitably lead to medical complications," the doc says.

That's overstated, but it is true that injection is inherently dangerous. But here's an interesting question no one ever thinks to ask: Why did so many of the walking wounded in the downtown eastside start injecting drugs in the first place?

They could swallow, snort or smoke drugs instead. Those methods are much safer and a lot less unpleasant. And yet they jam needles in their veins in their arms, their legs, their necks -- anywhere they can find a vein. Why?

The answer lies in prohibition. Banning drugs shifts their sale to the black market. Black markets build a "risk premium" into the price of goods and so black-market drugs are very expensive. Forced to pay high prices, street addicts are desperate to wring as much as they can out of every little bit of the drugs they struggle to buy.

This makes the method of using the drug enormously important to addicts. Some methods -- notably drinking or eating -- are very inefficient because much of the drug is burned off and not converted to the desired psychoactive effect. Other methods are more efficient. And so the high cost of black-market drugs leads users to switch to more-efficient drug-taking methods.

The most efficient method by far is intravenous injection. It is also the most dangerous method by far.

In the history of opiates, the pattern is seen over and over: Before opium and heroin are banned, they are swallowed or smoked; after, they are injected straight into the veins. Every case of HIV or hepatitis contracted from dirty needles is a testament to the stupidity of prohibition.

Seen from this perspective, needle exchanges and safe injection sites are relatively minor attempts to reduce a harm created by prohibition.

But people don't see it from that perspective because all they hear about is harm reduction. The news stories. The research. The politics. The debates. The noise about harm reduction is deafening. It dominates public discussion of drug policy.

As a result, perception is totally out of line with reality. Most Canadians, I suspect, would assume Margaret Wente is right in calling harm reduction "the philosophy that has come to dominate drug policy." But to say that harm reduction dominates drug policy is to focus on the housefly while ignoring the elephant on whose rump it sits.

Thanks to this skewed perception, a serious discussion of drug policy is impossible.

If we had a serious discussion, we would ask why -- 10 years after a United Nations special assembly pledged to "eliminate or significantly reduce" the production of cocaine and other drugs within 10 years -- the production of cocaine and other drugs is greater than ever.

If we had a serious discussion, research on drugs and drug laws would be widely publicized and debated. A study published recently in the Public Library of Science Medicine, for example, found the United States has "the highest levels of legal and illegal drug use" of 17 countries surveyed and that "drug use does not appear to be related to drug policy, as countries with more stringent policies (e.g., the U.S.) did not have lower levels of illegal drug use than countries with more liberal policies (e.g. the Netherlands)." Seems rather important, doesn't it? And yet, this study has gone almost completely unnoticed in Canada.

If we had a serious discussion, the full scope and complexity of drug policy would be evident to everyone, no matter what side of the debate they are on, and Canadians would demand a Royal Commission to gather the issues and evidence, conduct research, question assumptions and sweep away the fog of ideology and politics.

But we don't have a serious discussion. We have a silly little fracas over harm reduction that distorts, distracts, and deflects blame from the policies that really deserve it.

That is why I have reluctantly concluded harm reduction has to go. If there is ever to be real change in drug policy -- truly consequential change -- it's the only way.

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