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May 9, 2005 - The Ottawa Citizen (CN ON)

City's 'New' Drugs Policy

Same Stew, Different Spoons

By Dan Gardner

Return to Drug War News: Don't Miss Archive

When the city's health committee passed a motion Thursday calling for a new approach on illegal drugs, and the motion was reported in this newspaper under the headline "Councillors seek new approach on illegal drugs," Ottawans might have reasonably concluded that the city intends to take a new approach on illegal drugs.

But that depends on one's definition of the word "new."

If by "new" one means something that has not been done in countless places at various times, then the city's new approach is not likely to qualify.

It is a tweak here and a jig there, but otherwise more of the same -- which is itself an apt summary of Canadian drug policy for the past nine decades.

To be fair, Councillor Janet Stavinga, the main force behind the motion, also says she is hoping for an open discussion about drugs. That's brave and commendable.

She and other councillors deserve great credit for acknowledging the horrifying rate of HIV and hepatitis C infection among Ottawa's intravenous drug users and for refusing to turn a blind eye to the suffering of people who are so often marginalized.

But the councillors have framed the issue from the outset as one of co-ordinating existing policies.

The city is funding law enforcement, treatment, education and harm-reduction programs, Ms. Stavinga notes, "but I don't have the sense that we are co-ordinating our approaches. That's first and foremost why I put forward the motion for an integrated drug strategy."

What this looks set to become, in other words, is the development of a "four-pillars" strategy.

The councillors have so far avoided the term "four pillars," but that's the standard term in policy-wonk circles for a drug strategy that balances the "four pillars" of enforcement, treatment, education and harm reduction. (Harm reduction programs, such as needle exchanges and crack pipe distribution, are intended to reduce harms such as the spread of HIV among drug users until such time as the user goes to treatment and gets off drugs entirely.)

The federal government's National Drug Strategy is often described as a "four pillars" approach.

That's the theory, at least.

The reality is a little different.

In 2001, the federal auditor general found that 90 per cent of the roughly $500 million a year the federal government spent on drugs was going to enforcement -- which suggests that rather than a four pillars approach, Canada has one pillar and three straws.

Drugs were first criminalized in the early 20th century.

That put the first pillar-- law enforcement -- in place.

But what most people don't seem to realize is that there's nothing remotely new and daring about treatment, education and harm reduction -- and nothing remotely new about using them in combination.

Treatment actually goes back to ancient times and has been a routine part of government policy in the 90-year era of prohibition. Sometimes the treatment has been voluntary, sometimes compulsory -- as in the 1930s, when American addicts were committed to specialized facilities. Everyone favours treatment, even the toughest conservative.

But what few recognize is that treatment has a spotty record.

Addiction is not simply a "disease," as the popular metaphor describes it, but a complex interaction of chemical, psychological and environmental factors.

Despite more than a century of sustained research, success rates of even the most advanced treatments are low.

There is no silver bullet. Education/prevention also has a long pedigree, going back at least to the 19th century, when Temperance activists warned that moderate drinking led inevitably to heavy boozing and death. But, here again, decades of research and billions of dollars have largely come up empty: aside from a few programs that may do some modest good, we don't actually know how to convince people not to use drugs. Harm reduction is often talked about as an exciting new branch of drug policy, but the only thing new about it is the name.

Consider one of the most daring of the allegedly new ideas of harm reduction, heroin maintenance, in which addicts are prescribed a steady supply of heroin. Some European countries have experimented with it over the past several years and Canadian trials are about to start.

But it's not new: British doctors were permitted to prescribe heroin and other drugs to addicts from the end of the First World War until the late 1960s (with indisputably positive results).

In the 1950s, a Vancouver report recommended Canada adopt the British system, but the police were opposed, saying it would encourage drug use, and instead demanded tougher sentences.

The police ultimately won the debate.

Draconian punishments came into force in the early 1960s and were immediately followed by the greatest explosion in drug use Canada has ever seen.

Many public health officials believe the enforcement pillar actually undermines the treatment and harm reduction pillars. An example: why do people inject drugs when they are other, safer and more pleasant ways to get high? The answer is that intravenous injection is the most cost-effective method and cost-effectiveness is the top concern of addicts buying large quantities of extremely expensive black-market drugs.

In other words, the criminal status of the drugs pushes users toward the needle.

But the main thrust of harm reduction measures is to reduce the damage done by injection -- particularly the spread of HIV and hepatitis C.

Thus, one pillar of this is dedicated to bandaging the wounds primarily inflicted by another pillar. Contrary to what many politicians, police officers and reporters seem to think, not all users are addicts.

In reality, the majority of people who use a drug -- any drug -- do not become addicted to it and a substantial proportion of drug takers will experience no deleterious effects of any kind.

From the perspective of the harm-reduction pillar, that's a good outcome.

But the enforcement pillar says a person using drugs without harming himself or others is nonetheless breaking the law and should be arrested and punished -- even though that means inflicting harm where there hadn't been any before, a clear violation of the harm reduction principle.

It's a contradiction that cannot be reconciled.

And consider the situation of genuine addicts, particularly those who have lost everything and are hustling to survive on the streets.

The treatment and harm reduction pillars say such a person should be seen as someone afflicted with the terrible disease of addiction and should be helped back to a healthier way of living.

But the enforcement pillar says this person is a criminal -- he breaks the law every time he takes possession of drugs -- and should be punished.

So will we continue to enforce the laws against drug possession even if it means slapping handcuffs on sick people and tossing them in jail? Some respond to that dilemma by saying, fine, don't enforce the possession laws on addicts, but crack down hard on the villainous dealers.

But, as everyone on the street knows, addicts and dealers are often one and the same because addicts turn to dealing in order to pay for their own drugs.

So it's back to the same dilemma: the "four pillars" approach requires us to simultaneously treat addicts as sick people in need of treatment and criminals who deserve punishment.

And that is logically and morally indefensible. Most basically, the four pillars framework simply avoids what should be the first question: why is it that a small minority of people uses drugs, becomes addicted and slips into the abyss?A recent study by the European Monitoring Centre for Drugs and Drug Addiction found up to 90 per cent of users have personality disorders while one in five suffer from psychotic disorders.

The drugs aren't to blame.

"Recent research indicates that psychopathology usually precedes drug use," the report noted.

Mental illness, childhood abuse, social marginalization, community disintegration and others are often the root causes of the disease we call drug addiction.

The drugs themselves are merely symptoms. Bruce Alexander, a psychologist at Simon Fraser University, notes that "all four pillars . have been used extensively in North American and Europe, both separately and in combination," but to little effect.

The reason, he argues, is they don't go deep enough.

If council wants to consider truly new ways of dealing with drugs in the community, it should start with a serious discussion of root causes.

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