Tag Archives: drug policy

Conservative Senator Talks Harm Reduction

Articles I'm Digesting 15/12/2009

Here are some pieces I’ve been reading of late:

You Can’t Handle the Truth by Mark Pothier in the Boston Globe

A great piece about how the classification of drugs used by most Western countries is completely divorced from how much harm those drugs cause. This isn’t surprising, but as the evidence begins to mount regarding which drugs are actually harmful (read alcohol, cocaine or heroine) versus those which are significantly less harmful (read Ecstasy or LSD) the question will increasingly emerge – will science ever inform our policies around managing these types of substances. Indeed, it is disturbing (and, er… sobering) to once again see the only substance I use the list – alcohol – be put in such a stark and negative light.

At some point a real conversation about drugs is going to occur in the United States – I just hope it is sooner rather than later as it will have a profound effect on effectively we can deal with the tragic situation we have around substance abuse this side of the border.

Fla. Court Tells Judges and Lawyers to “Unfriend” Each Other (the AP)

Always fascinating to see how different fields respond to social networking. In this case a Florida…

…committee ruled Nov. 17 that online “friendships” could create the impression that lawyers are in a special position to influence their judge friends.

This is a great example of how social networking can cause some professions to actually become less transparent and, I would argue, harms the long term credibility of the institution. Notice here that the committee isn’t ruling that judges and lawyers can’t be friends, they are ruling that it would be harmful if the public could see that they are friends. So, in essence, if being a friend compromises the judgment of a judge, we solve that by preventing the public from seeing that the conflict could exist, rather than dealing with the conflict. Weird.

The last line is priceless:

McGrady, who is sending a copy of the ruling to the 69 judges in his circuit, said this potential conflict of interest is why he doesn’t have a Facebook page.

“If somebody’s my friend, I’ll call them on the phone,” he said, chuckling.

Errr, right. Good to keep it all in the old boys network where those on the inside know where the conflict may lie, but there is not digital trail or map that might allow the public to be better informed… Oh, and you’re the last generation that will only “pick up the phone” so this solution has, at best, a 20 year shelf life to it.

The Killer App of 1900 by Glenn Fleishman in Publicola

As some readers know, I’m a big fan of historical examples that show we are experiencing similar pressures, transformations, evolutions as experienced in the past. Part of it is the historian in me, part of it is how it helps ease the minds of those concerned or intimidated by change. There are, occasionally, genuinely new things that appear under the sun – but often those of us interested in technology and social change are too quick to scream “This is new! It changes everything!” Moreover, it does a disservice to our efforts often making people more skeptical, resistant and generally conservative towards the perceived change. Still more importantly, the past often sheds light on how power and influence created by a new technology or system may diffuse itself – who will be the winners/losers and the resisters.

In this context this article is a priceless example of the type of writing I wish I did more of.

The Score: Advice to Young Composers by Annie Gosfield in the New York Times

While written as sounds advice for composers, this is (as the friend who sent it to me said) sounds advice for policy wonks or, in my opinion, bloggers as well. (It’s actually just sounds advice for life).

A couple of credos in the piece that I hope my work, and this blog lives by:

Take your work seriously, but don’t take yourself too seriously: Hope that is evident in my writing style.

Be willing to put yourself and your music on the line: Try to do that everyday here on the blog.

Don’t fear rejection: Something a blog is really good at teaching you.

A couple of credos in the piece I know I struggle with:

Don’t assume you know what’s accessible to the audience and what isn’t: Although counter to what the piece says, I occasionally run into a friend who says “I had NO idea what you were talking about in X blog post.” It is crushing to hear – but also really good. I do want to challenge readers but I also want to be accessible. Do let me know if I ever get to a place where a newbie is going to be totally lost.

Details count: So, er, anyone who reads my blog regularly knows that I have the occasional typo in a post, here or there… Blogging longish pieces four times a week is draining, and so I don’t proof as much as I could (plus it is hard to see one’s own errors). But I could do better.

Hope you enjoy these pieces as much as I did!

Emerging Neo-Progressive Issues: Drug Policy

As many of you know Taylor and I wrote a piece on what we termed neo-progressivism in last September’s Literary Review of Canada.

Since then we’ve keep our eye out for other discussions where we think neo-progressives are gaining traction in the public discourse. Some of the indicators we looking for are policies where:

The conversation is deadlocked and going nowhere
The conversation isn’t possible because alternatives to the status quo are considered taboo
Areas where the gap between ideology and research or evidence is significant
Debates where their are real divisions within either the left or right
Debates which unite odd factions from within the left and right
Policy areas where individual freedom is curtailed
Places where the impact on the public in general is growing

This list isn’t exhaustive nor is it a scientific – they are just a couple of triggers wer look our for.

Well, if you are looking at this list you may have noticed that last month a potential candidate emerged far on the horizon. It was a surprising one for me since I do some volunteering around this issue here in Vancouver and I really didn’t see it coming.

I’m talking of drug prohibition.

The aha moment was seeing the (very) conservative Cato Institute publish a report by Glen Greenwald (a case study neo-pragmatists) in which he analyzed the impact of drug decriminalization in Portugal. As the report’s summary states:

For over seven years, drugs have been decriminalized in Portugal. This new study examines the Portuguese model and the data concerning drug-related trends in Portugal, and argues that, “judged by virtually every metric, the Portuguese decriminalization framework has been a resounding success.”

Then consider drug prohibition against the list I outlined above. This topic should not have snuck up on me:

Deadlocked conversation: The “War on Drugs” vs. “Marijuana activists” increasingly leaves the public turned off. The war on drugs industry and its militarization of the police is costly, dangerous to civil liberties and has failed to address the problem for 30 years. Indeed, as the RCMP now admits, reducing the flow of drugs actually renders the situation more dangerous for citizens. Conversely, the counter-culture movement around pot activists is equally alienating. It is hard to attract middle class support when every middle class parent fears that this counter-culture will become the norm and their children will be destined life as a pot-head.

Alternatives to the status quo are taboo: For most politicians talking about ending drug prohibition is absolutely taboo, although this is shifting. Vancouver’s mayor recently stated that the sate should “regulate, control and tax marijuana,” and that “the prohibition approach to it is not working.” The Liberals under Martin considered decriminalizing marijuana. Even in the US there is movement. The legislatures of New York State, California and Massachusetts have begun to reconsider overly punitive drug laws. Senators Jim Webb and Arlen Specter recently proposed Congress create a national commission to explore prison reform and drug-sentencing policy.

Large gap between ideology and research or evidence: Here the Cato report, along with the data coming out of the Downtown Eastside around Insite and NAOMI trials is most devastating. The rhetoric around law & order does not stack up against the results. Consider that in Portugal after decriminalization (pulled from this Time Magazine article on the report)
- lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. (a 33% drop!!!)
- lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). (a 25% drop!)
- new HIV infections in drug users fell by 17% between 1999 and 2003, and deaths related to heroin and similar drugs were cut by more than half.
- the number of people on methadone and buprenorphine treatment for drug addiction rose to 14,877 from 6,040, after decriminalization, and money saved on enforcement allowed for increased funding of drug-free treatment as well. (150% increase in people seeking treatment!)

Divides the left or right: Check out this Western Standard blog (possible the most conservative publication in Canada) in which a conservative columnist argues with a conservative reader about the evidence around ending prohibition. I never thought I’d see the day where a Western Standard columnist would explore the possibility of ending prohibition. Could endorsing harm reduction strategies be far behind?

Unite odd factions from within the left and right: Could possible unite traditional left wing progressives with right-wing libertarians.

Individual freedom is curtailed: Check. The literature of the impact of the “war on drugs” on civil liberties in the United States is vast.

Growing impact on the public: drug violence in the US and Canada appears to be on the rise and a bordering country, Mexico, is becoming unstable. Much like alchohol prohibition in the 30’s at some point the public is going to connect gang violence with drugs – at which point a wider debate may become possible.

Do I think drug prohibition is going to end tomorrow? Absolutely not. But I won’t be surprised if we see movement at the local and state/provincial level this issue. Indeed, I believe it has been gaining traction for some time.

Follow the link to get a free copy of the Cato Institute’s study “Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies.”

Wente’s disgraceful piece on Insite and harm reduction

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Last Saturday Margaret Wente wrote this disgraceful piece on harm reduction in Vancouver.

In short, what is written is a compilation of anecdotal statements that ignore the actual research and science that has measured Insite’s positive impact. A quote from a sergeant who may or may not have an axe to grind is apparently worth more than the numerous peer reviewed articles in publications like the New England Journal of Medicine or The Lancet. This is of course Wente’s MO – she doesn’t need science or research, like Colbert her gut is her guide – something we learned long ago from her coverage of global warming.

This sadly, is not the worst of it. Wente goes on to misrepresent both the goals of Insite and the position of its advocates.

No one – least of all Insite’s advocates – believes Insite is the entirety of the solution. The goal is, and always has been to have a complete response (hence the four pillars). Insite seeks to reduce harm but it can’t ‘solve’ the drug problem alone, no one claimed it would and judging it by such a bar is misleading.

Is rehabilitation and treatment essential? Absolutely – something Insite supporters also believe. This is why OnSite (a temporary treatment facility pointedly not included in Wente’s article) was placed atop Insite so that users would have somewhere to stay while a permanent facility was found for them. Insite was never designed to replace treatment, but to reduce harm for those who refused or could not get it as well as provide a vehicle to help users seek help and get on treatment.

There are plenty of commentators I disagree with but enjoy reading because they challenge my assumptions and provoke interesting or thoughtful insights. Sadly, most of the time I read Wente I’m reminded why she’s not one of them.

Two additional points. The first is how the injection site has become an East vs. West phenomenon. Here in Vancouver the debate is over. Insite has public support, on the street, in the newspapers and in the halls of power. Even the comments in the Globe reflect a bias in favour from those commenting from Vancouver especially but BC in general.

Second, I initially wrote this in the comment section on the globe website (where one is exposed to some truly horrifying thinking) and thought nothing more of it until Andrew F. emailed me a supportive note. And I thought comments on newspaper articles were simply a cathartic exercise!

For those interested in a sensible drug policy… sign here.

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Here is an opportunity to sign the resolution coming out of the Community Forum on the National Anti-Drug Strategy held in Toronto on March 26th.

Signatures generated at the Forum and from the on-line version total over 1600, from people across Canada. We will be presenting the resolution to Parliament soon, so please add your signature asap, if you haven’t already. Please also forward this message to any interested contacts or networks. And while you are at it, consider signing the Insite injection site petition as well.

As many of you know I believe a drug policy built on scientific research and evidence – not fear – is one that will most likely generate results.

That said, I know this won’t change the world, but it might help a little.

Expert Advisory Committee report: Insite works

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Late Friday afternoon (PST) Health Canada tried to quietly release the Final report of the Expert Advisory Committee on Supervised Injection Site Research. (Since government reports are public domain I’ve created a downloadable, easier to read, PDF version that can be found here).

Why quietly release such an upbeat report? Because the Health Minister is ideologically committed to closing Insite. Unfortunately for him, the report confirms what researchers and scientists have been telling us all along: that Insite works.

Consequently, for what must be the first time in Health Canada’s history the department is trying to bury a study that highlights how one of its programs improves healthcare outcomes to Canada’s most marginalized citizens.

Ah, the irony.

Well, one can’t blame him. The Minister simple doesn’t want anyone to know that his own hand picked experts have robbed him of any scientific basis for ending the program.

Below are some of the report’s highlights about how INSITE benefits the public:

INSITE encourages users to seek counseling, detoxification and treatment. Such activities have contributed to an increased use of detoxification services and increased engagement in treatment. Translation: INSITE helps drug users get off drugs.
Observations taken 6 weeks before and 12 weeks after the opening of INSITE indicated a reduction in the number of people injecting in public. Translation: INSITE gets drug users off the streets, making the safer and more community friendly.
There was no evidence of increases in drug-related loitering, drug dealing or petty crime in areas around INSITE. Translation: INSITE doesn’t increase crime.
A private security company contracted by the Chinese Business Association reported reductions in crime in the Chinese business district in a surrounding area outside the DTE. Analysis of police data for the DTE and surrounding areas showed no changes in rates of crime recorded by police. Translation: INSITE definitely doesn’t increase crime.
There is no evidence that INSITE influence rates of drug use in the community or increase relapse rates among injection drug users. Translation: INSITE doesn’t encourage drug use.
Every dollar spent on INSITE saved 0.97 to 2.90 in government spending on other services. Translation: INSITE saves taxpayers dollars – especially in heathcare costs.

These benefits are significant. However, the Conservatives spin machine is already hard at work. Specifically, it is trying to use this line – out of context – to support its claim that INSITE is ineffective:

“The injections at INSITE account for less than 5% of injections in the Downtown Eastside. This limits the likelihood of significant direct impact from INSITE in the Downtown Eastside.”

However, since the report also points out (contrary to what James Moore has misleadingly telling his constituents) that:

“An average of more than 600 visits a day shows that INSITE operates near capacity.”

The report isn’t arguing that INSITE is ineffective, it’s simply pointing out that it isn’t large enough to meet the demand. This is akin to claiming that a hospital should be declared “ineffective” and shut down because the people it didn’t have the capacity to serve were still dying of heart attacks.

The Conservatives now have two months before the June deadline they created to decide: are they going to shut down a program that reduces drug addiction and saves the public money?

Vancouver is on the fast track to regulating the illicit drug trade

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The rash of gang related shootings in Vancouver is causing everybody to rethink everything. More and more people I talk to, from doctors and lawyers to people on the street, are coming to the conclusion that the war on drugs is accomplishing little – except making the streets of Vancouver more dangerous.

As if to put on exclamation mark on that point, Ian Mulgrew – a columnist with the Vancouver Sun – wrote a great column entitled Legalize pot, a key drug fuelling gang wars.

For those not based in Vancouver – read it. Something is brewing out here.

The old, old, old war on drugs

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Last night I was able to swing by the Wosk Centre for Dialogue to see Prof. Bruce Alexander receive the Nora and Ted Sterling Prize in support of Controversy (A prize established at Simon Fraser University to honor work which challenges complacency and that provokes controversy).

Prof. Alexander spoke of his personal history and research into addiction, but during the speech one factoid really stuck out.

He pointed out that the war on drugs has been going on much longer than I suspected. Indeed, in 1922 the government of the day apparently introduced whipping and deportation as a punishment for addiction and drug use. This is a level of shaming and deterrence the current government could only dream of implementing.

Did it have any impact on drug use? Of course not.

If whipping didn’t work, how is a “just say no” combined with stiffer criminal penalties going to have an impact? The creation of mandatory minimum sentences in the 1970s’ had no impact on drug use… how will this differ?

So why does the current government believe it’s new “tough on drugs” approach will yield better results? Because the new conservative drug policy isn’t about achieving results, it is about looking tough. Sadly, as it drives drug users and addicts further underground it will likely push them further out of reach of health and social workers, making the problem worse, not better.

Sigh…

Our New/Old Drug Policy: Welcome to the 1980s

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The Tories are beginning to lay down the ground work for a new (or should we say old) drug strategy.

The ‘new’ strategy? A TV campaign informing kids that drugs are bad, an increased presence at the border and a slight increase in funding for drug rehabilitation. If it sounds like the 1980s all over again, it is.

Ironically, it is being billed under the new tagline: “Enforcement is harm reduction.”

This is bad news for all of us. The tentative progress of the last decade is about to be lost in one fall swoop, including of course, Vancouver’s Insite injection site.

Let’s be clear, enforcement is not harm reduction.

There is no evidence to suggest that an increased police presence will have any impact on the drug problem in Vancouver, or anywhere else in the country for that matter. Indeed, American’s 36 year old war on drugs demonstrates otherwise. My question to Tony Clement is: what are doing that Nixon (who coined the term “war on drugs“), Carter, Reagan, Bush Sr., Clinton, Bush Jr., and previous Canadian governments, didn’t try? With only a fraction of the resources America dedicated to similar campaigns, explain to us why this policy will be success?

In short, Clement’s strategy is analogous to yelling at a non-english speaker when they don’t understand you. It’s a strategy – and for some people it feels good – but it accomplishes nothing. This is because the problem isn’t that they can’t hear you – it’s that they don’t understand you. Similarly, it’s not that many drug users don’t know drugs are bad – or haven’t seen warning messages – it is that they have come to a place where they are truly dependent. Screaming at them, arresting them, and legally marginalizing them isn’t going bring them into the fold and increase the likelihood they’ll seek treatment – if anything it will accomplish the opposite. I would love to see Clement in the downtown eastside, yelling at users to seek treatment. It would be about as alienating and as effective as it sounds. Contrast that to the injection site’s strategy of developing a relationship with users over time, and keeping the door open for when they are ready. Is it ideal? No, nothing about the world of drugs is ideal. But at least it works.

The simple fact is, Clement wants to overturn a program that enjoys the support and cooperation of the Vancouver Police Department, local community leaders, local business leaders, and Vancouver Costal Health. Still more problematically, Clement wants to replace a program supported by evidence and science with one based on ideology and fear.

The benefits of the injection site and harm reduction strategies are clear. They include:

Saving lives by:
- Reducing overdose fatalities
- Reducing injection-related infections such as HIV and Hepatitis C
- Increasing access to addiction treatment programs
Improving public order by:
- Reducing public injections
- Reducing drug-use related public disorder
- Reducing drug related waste (such as needles) in public spaces
Reducing healthcare and policing costs associated with drug-use by:
- Reducing emergency room visits
- Reducing use of ambulatory and emergency response services
- Reducing police resources dedicated to drug-use related public disorder

If the Conservatives aren’t interested good public policy, policy that saves lives, improves public order and reduces healthcare costs… so be it. But I am certain they are interested in electoral outcomes. Given the injection site’s support in Vancouver (the last polls show it receives a 70% support rate) it will be difficult to secure a seat in the city if the Insite injection site is perceived to be on the chopping block. With Emerson stepping down, the Conservatives won’t have a single MP from one of the country’s three largest cities. If evidence and science can’t persuade them, maybe, just maybe, electoral math can.

For myself, the Insite injection site is what re-invigorated my interest in municipal politics. I hope it survives the December 31st exemption renewal deadline. Otherwise, I’d hate to be the politician who saw Insite go down on their watch – I know I’ll be volunteering for who evers campaign is opposing theirs.

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