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Wednesday, August 27, 2008

Open letter from Libby Davies to Tony Clement on harm reduction

August 21, 2008

Hon. Tony Clement
Minister of Health
House of Commons
Ottawa, Ontario K1A 0A6

Dear Minister Clement,

I am writing to express my grave concern regarding your misleading and irresponsible attacks on harm reduction and Vancouver's InSite supervised injection site at the recent World Health Organization XVII International AIDS Conference in Mexico City and again at the 2008 Canadian Medical Association conference in Montreal.

At both of these conferences, you persisted in representing harm reduction and drug rehabilitation/treatment as two mutually exclusive, alternative approaches to problems associated with drug addiction. As has been explained to you on numerous occasions by health researchers, medical professionals, drug treatment experts and others, this is an entirely false dichotomy. Harm reduction is one component of a comprehensive "Four Pillar" approach, which also includes prevention, treatment and law enforcement. Low-threshold programs, such as supervised injection sites are essential in the Four Pillars approach for reducing overdose deaths and the spread of diseases such as HIV/AIDS and Hepatitis C, and also for drawing hard-to-reach users into treatment and rehabilitation. Harm reduction is part of a continuum of care that includes treatment and prevention, and the only voices in Canada portraying it as a 'substitute' are you and your government.

Unfortunately, your recent comments in Mexico City and Montreal are only the latest episodes in a well-established pattern of putting ideology and partisan politics ahead of rational public policy on this issue.

The Conservative government's National Anti-Drug Strategy has essentially abandoned the Four Pillars approach for a "One Pillar," US-style "war in drugs" that puts almost all resources into law enforcement. As of 2007, law enforcement accounted for an overwhelming 73% of spending in the National Anti-Drug Strategy, while treatment only received 14%, research just 7% and prevention and harm reduction a pitiful 2.6% each.

The Conservative government delayed a decision on the status of InSite for more than two years, claiming more research needed to be done. Now the research has been done, and it is absolutely clear. More than 20 peer-reviewed studies by internationally recognized researchers have demonstrated the health, safety and cost benefits of InSite. Even the criminologist hired by the government to evaluate the existing research said that InSite contributes to public order and saves lives. The response from the government in the face of this overwhelmingly favourable body of research was that the decision on InSite would not be based on scientific evidence alone.

At the XVII International AIDS Conference in Mexico City, you called supervised injection sites "harm addition," contradicting the official policy developed by the World Health Organization in conjunction with the world's leading addiction and health researchers.

At the 2008 Canadian Medical Association conference, you attacked the CMA's support for InSite and harm reduction generally, even going so far as to question the ethics of the 80% of Canadian doctors who support supervised injection sites.

Given the weight of evidence and the time that you and your government have had to digest it, I can only conclude that this continuing opposition to the Four Pillars approach is not because of an honest lack of comprehension, but is instead driven by the partisan political concerns of the Conservative Party. At a time when a comprehensive approach to the problem of drug addiction is so desperately needed, it is frustrating that you and your party have chosen cheap partisan political games over rational, evidence-based public policy.

My concern about your statements is compounded by your party's recent use of public money to mail leaflets containing dehumanizing language into East Vancouver and other communities across Canada. People with addictions are amongst the most desperate and vulnerable in our society, and referring to them as "junkies" is simply bullying and has no legitimate place in public discourse. While your party was clearly attempting to fear-monger and appeal to people's safety and security concerns, the Conservative Party has instead simply displayed the mean spiritedness and lack of compassion that underlies so many of its policies. Will future Conservative Party leaflets begin referring to Canadians with mental illnesses as "nutcases"? Or maybe call people with physical disabilities people "cripples"? Canadians have moved beyond this sort of stigmatization and dehumanization of vulnerable and ill people. I have received numerous letters and phone calls from constituents and people across Canada outraged by this mailing.

Based on the above concerns, I strongly urge you and your government to take the following actions:

1.Abandon the time and money-wasting appeal of the BC Supreme Court's Decision on InSite, and start work on implementing a well-funded, comprehensive, evidence based and effective Four Pillars strategy for dealing with drug addiction. This government must recognize that harm reduction programs like InSite are a necessary component of a broader strategy that includes prevention, treatment and enforcement.

2.Commit to basing drug policy decisions on scientific evidence and the informed opinion of the mainstream medical and research communities.
History is full of tragic examples of governments and other institutions ignoring evidence because of ideological bias and short-term political concerns. In the case of drug policy in Canada, the price of Conservative ideological purity and political partisanship will be paid in lives ruined and lost. That's too high a price to pay for political games.

3. Respect, support and strengthen effective, locally developed initiatives dealing with addiction related issues. InSite grew out of the experience of groups and individuals working on the frontline of Vancouver's health and poverty crisis. There is broad community consensus in support of the project, including local residents, community groups, social service providers, businesses, law enforcement officers, municipal and provincial politicians, and people coping with addiction themselves. Your government's efforts to disregard the will of the community on this issue shows arrogance and poor judgement.

4. Stop wasting public money distributing dehumanizing, fear-mongering material on this issue to Canadians. Instead, Canadians need access to realistic information on addiction related issues, both to inform public policy and for use in prevention and harm reduction campaigns. This issue is far too important to be manipulated for cheap, partisan political purposes.

I look forward to your reply on this serious matter.

Sincerely,

Libby Davies, MP (Vancouver East)
NDP Spokesperson for Drug Policy Reform

CC:
Jack Layton MP, NDP Leader
Judy Wasylycia-Leis MP, NDP Health Critic Joe Comartin MP, NDP Justice Critic

Posted by Matthew Johnston on August 27, 2008 in Current Affairs | Permalink

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Comments

WTF? What we need IS stigmatization. Being a "cripple" is a helluva lot different than being a "junkie" We need SHAME. Why is it MY fault as a taxpayer that someone decided to take that path in life? I am against criminalizing drug addiction, but that doesn't mean I want to fund it. And I sure as hell don't want to ENABLE anyone in their addiction. Do I need to really explain the concept of being an enabler? I don't get why Canadians want to pay for another's addiction.

Posted by: Faramir | 2008-08-27 12:04:22 PM

This letter is no different than any of the other opinion pieces used to justify InSite's existence. Much is made of "peer-reviewed" research that demonstrate the validity of the concept, but notably absent from EVERY article about InSite I have EVER read is any hard numbers. I have yet to learn how many lives it is purported to have saved, or how many addicts have entered treatment because of it. And the fact that most of the "research" is conducted by the B.C. Centre of Excellence in HIV/AIDS, a blatantly partisan and activist organization, simply reeks.

Drug addiction causes chemical changes inside the body. These are in addition to whatever emotional problems the addict had the first time he shot up (and ostensibly the pivotal factor in doing so). It isn't always curable. Many narcotics cops doubt that an established addiction can ever be completely cured unless the junkie pulls up stakes and starts over again somewhere else, far from the place he used to shoot up.

This puts hardcore addicts in an untenable position. They can't be cured, but they can't be tolerated either. By allowing people to shoot up drugs that were likely purchased with stolen property, InSite is aiding and abetting criminal behaviour. It may be that the best solution for such people is "transportation," or exile to some sort of farm or special community where they can live until if and when they finally beat the stuff. Alcohol anonymous for junkies makes a lot more sense than opening dorms in the liquor stores for alcoholics to sleep it off.

If anything at all can be said in favour of these challenges to the Conservatives, it is that they raise the salient point that detox services are almost nonexistent. If Clement wants junkies and their supporters to choose treatment over maintenance, then there has to be treatment for them to choose--or it's a false choice.

Posted by: Shane Matthews | 2008-08-27 12:24:55 PM

Boy, is Libby Davies ever a big, fat windbag. That wasn't a letter, it was a thesis.

One of the most successful programs to help people control their addiction/s is Alcoholics Anonymous which talks a lot about co-dependence and how damaging and counter-productive it is when applied to individuals with substance abuse issues.

We can choose tough love to help the person face their addiction (always painful but often the answer to healing) or we can choose to be co-dependent, to be enablers (also painful and almost sure to keep the addicted person continuing in their destructive behaviour patterns).

Libby Davies is an enabler. Tony Clement is someone who believes in tough love.

I'm with Tony.

And, BTW, what's the difference between a Kevorkian-like deathbed assisted suicide and handing out clean needles to junkies? Clean or dirty needles will eventually kill them, because it's what's in them--IT'S THE HEROIN, STUPID--that kills them.

Isn't there a law against assisted suicide?

Posted by: batb | 2008-08-27 12:34:34 PM

Hey Tubby Davis,

Harm reduction begins at home.

Start by losing a hundred or so pounds and you will then begin to have some credibility in matters of health.

Drugs is a criminal matter that leads to health risks.

Best solution ... quit the drugs ... can't do that? You may then die in an alley, but it was your choice and your weakness.

Posted by: John V | 2008-08-27 12:59:10 PM

You're right, John V, harm reduction does begin at home. But it shouldn't end there, and your comment about "dying in an alley" is callous and inhumane.

There are many private initiatives that we should encourage, that try and help people with an addiction. Programs for alcohol, tobacco, and illicit drug addicts.

While I do believe that it is their responsibility, I see no reason to be flippant and indifferent to those of them who seek out help.

Posted by: P.M. Jaworski | 2008-08-27 1:13:34 PM

One does not choose to have a disabilty or be mentally ill. One does choose to be a drug user and then later an addict.
Do not conmpare the 2 I say. You choose to become addicted.

Posted by: Merle | 2008-08-27 1:41:00 PM

But it shouldn't end there, and your comment about "dying in an alley" is callous and inhumane.

Reality sucks eh P.M. that is what it is.

Posted by: Merle | 2008-08-27 1:43:24 PM

Reality might suck, Merle, but that doesn't mean that we shouldn't do what we can to make it suck less.

All I was saying is that if we have an opportunity to improve the lives of persons--including those who get addicted to alcohol, tobacco, cocaine or whatever--we should take it.

And I am surprised that anyone would think differently. It takes a certain hard-of-heartness and a marked lack of sympathy to think that these people should suffer and die in some alley.

I don't care if they brought it on themselves or not. When they decide that they want out, and recognize that they have made a mistake, and take responsibility for it, we should be there for them.

That's what it means to be a decent person.

Posted by: P.M. Jaworski | 2008-08-27 1:56:54 PM

I agree with the last par yes-when they decide they want help.
Until then no enabling.

Posted by: Merle Terleski | 2008-08-27 2:17:28 PM

JC, I agree that we should offer every encouragement to junkies that try to quit. However, this doesn't change the fact that everyone is the captain of his own fate. Addicts have no one to blame for their troubles but themselves. And as long as they continue to force their troubles onto others, whether by property crime or by political manipulation, legal sanctions are appropriate.

Posted by: Shane Matthews | 2008-08-27 2:48:16 PM

Posted by: Merle Terleski | 27-Aug-08 2:17:28 PM

Merle Terleski is the new Karol Karolak.

Posted by: The Stig | 2008-08-27 2:51:18 PM

That is not an argument, Stig.

Posted by: Shane Matthews | 2008-08-27 3:09:37 PM

Jaws, if you are so offended by Merle's comment then go work for Libby.

Posted by: epsilon | 2008-08-27 4:06:36 PM

I didn't take offense, Epsi. I was merely reminding people of the requirements of common decency.

Posted by: P.M. Jaworski | 2008-08-27 4:11:50 PM

Jaws,

Your liberalism is showing.

What we need to do to druggies is treat them like cigarette smokers.

The lack of tolerance for them has dramatically reduced their numbers.

Hugging druggies is stupid.

If they want to quit, fine, show them a place to dry out and point them in a new direction. If they follow a new path ... good. Hard core druggies mostly will fall back because they have lost so much of themselves on their way down, there often isn't enough left to work with when they have a change of heart.

Enabling these losers is more often flogging a dead horse. But then a prime feature of the left is flogging dead horses isn't it?

Posted by: John V | 2008-08-27 5:19:59 PM

What you call "liberalism" I call common decency.

What I call "liberalism" is not being a sympathetic or empathetic person, but the knee-jerk instinctive reaction to think every problem needs a government solution.

Posted by: P.M. Jaworski | 2008-08-27 5:25:49 PM

YouYou’ve been a busy little bee, JC, and raised a lot of points, so even though I’ve been trying to get away from tit-for-tat rebuttals, I think it will be the best format in this case. Now then.

1. You do not have a monopoly on the definition of decency. Plenty of decent folk would disagree with the points you’ve raised here. You’ve fallen into the common fallacy of assuming others must be failures or sick, twisted specimens of humanity because they don’t agree with you.

2. An appeal to emotion is a sign of desperation. Your last several posts appeal to humanity and compassion, but do not address the efficacy of your proposed solutions. The world does not care that you’re hurt; it does not care that you’re surprised. It will care if you bring forth workable solutions instead of bloody shirts and snotty, tear-stained hankies.

3. To suggest that junkies are owed assistance regardless of how much they contributed to their addiction is to suggest the dissolution of individual responsibility. A popular approach in “compassionate” circles these days, but a misguided one. He who waits for another to solve his problems had best be prepared to wait long and hard. If you won’t hold responsible the party directly responsible for one’s addiction, how can you hold responsible those who had nothing to do with it? That’s bald, cynical manipulation.

4. “Liberalism” is one of those few words misappropriated and misused by the Right (as opposed to the Left, which has its own Ministry of Newspeak). The term dates to the Enlightenment, where those who advocated individual liberty (and responsibility) and the advancement of reason over emotion and science over religion were regarded “liberals.” Liberals supported enhanced freedom for commoners and the curtailment of the hereditary aristocracy. Reactionaries or conservatives, by contrast, supported the old way of thinking, with their prerogatives entrenched and the rights of the commoner subjugated to the whim of the Clergy and the Crown.

Today the situation is topsy-turvy; liberals, better called “Leftists,” are the new reactionaries, angrily digging in their heels and clawing the earth in their desperate attempt to halt progress as it marches ever farther from their 1968 Nirvana. They advocate more restrictive laws on individuals, not less. They advocate higher taxes to restore the dominance of the Crown. The Right, on the other hand, is trying to restore a sense of individual responsibility and, ostensibly, the liberty that goes with it. They are, in effect, the new liberals, often called “libertarians” to avoid confusion with the New Left.

5. You criticize John V for advocating a government solution to the problem of drug addiction, but at the same time, YOU advocate a government solution to the problem of drug addiction. The difference in your proposals is not in who delivers the solution, but in its substance; John wants enforcement and you want treatment.

Frankly, I think the "four pillars" approach could lose a pillar. A tripod needs only three legs to stand; the fourth is superfluous, and in this case the unnecessary leg is "harm reduction." Prevention, treatment, and law enforcement--preferably in that order--are sufficient. Harm reduction does not reduce drug addiction, but legitimizes it, thus undermining the other three pillars.

Posted by: Shane Matthews | 2008-08-27 7:14:16 PM

I think you meant to be addressing me, Shane, not JC. I'm happy to respond to your thoughtful rebuttal. (I'm labeling my responses 1, 2, 3, etc. not to match your ordered criticisms, but merely to distinguish my responses):

1. I did not propose a "solution." I addressed an attitudinal issue: The right attitude is to offer help to those who ask for it, regardless of whether or not they are responsible for the bad state that they're in.

2. I made it plain that I believe these folks are personally responsible for their predicament.

3. I was careful to insist on private charity and private help, not once suggesting that the government should do anything at all. My point was to say that we should encourage those private individuals who attempt to help others.

4. Agreed: liberalism has, unfortunately, a novel meaning now than in the past. This is something I always lament.

My position is simple: People make mistakes. When they recognize that they've made a mistake, and seek our help, it is a good thing for us to reach out to them. "We" is not a synonym for government.

I hope this is clear, Shane. You've raised some great objections, and I hope I've addressed them to your liking.

Posted by: P.M. Jaworski | 2008-08-27 7:23:57 PM

P.S. Contrary to what is popularly bandied about these days, drug addiction is NOT a disease, because there's no underlying pathology. Health officials merely elected to treat it as a disease because it more closely resembles a health issue than anything else. But the true expertise needed in treating drug addiction is psychological, not physiological, and by that I don't mean quietly looking at funny-shaped blots of ink.

The secret to kicking anything is to make the alternative even worse; many clinics that treat alcohol and tobacco addiction use tactics that border on the abusive. But in many cases, they do work, and we must not allow ourselves to be restrained by false compassion when deciding to apply them to junkies. The true cruelty lies not in brutal but effective corrective measures, but rather in leaving them as they are. Believe me, they'll thank you for it later.

In short, we need fewer Libby Davieses, and more Gunnery Sergeant Hartmans.

Posted by: Shane Matthews | 2008-08-27 7:24:40 PM

P.M., you're right; I misidentified you. Sorry for the mixup. Sometimes it's hard to keep all the debaters straight.

1., 2. Your point about attitude is noted. However, I suggest you hold drug addicts to the same standards of responsibility that you hold to everyone else. I have always argued fervently for more treatment. Harm reduction, however, is not treatment.

3. Yes, philanthropy is an area in which Canadians have sorely dragged in the past few decades. Americans are the most generous people in the world in this regard. Perhaps this is because the Canadian psyche is inured to a larger, more omniscient, and more interventionist government, with higher taxes to match. So long as this persists, and so long as memories of residential schools and Church abuse are still fresh, I don't see private charity stepping forward to fill this need. The courts that decide liability suits have never held Good Samaritans in high esteem.

4. I agree that it is a good thing to reach out to those who are willing to meet us halfway. Not only is it the charitable thing to do, but it has the effect of encouraging others to come forward. The road to Calvary ends eventually, and many hands make bearing a cross easy. However, to suggest that people are somehow flawed and wretched beings for not sharing this view is not going to win you any converts.

Posted by: Shane Matthews | 2008-08-27 7:34:56 PM

JC, I agree that we should offer every encouragement to junkies that try to quit.
Posted by: Shane Matthews | 27-Aug-08 2:48:16 PM

hey Shane, I don't believe I had posted anything for you to respond to..
But, Junkies do need to quit and they will, one way or another.
What is lost in blogs like this one is that 1 in 10 people are born genetically predisposed to an addiction. Addictions are a legitimate disease and most Doctors will tell you so. Problem is Doctors can't treat this disease. And until each junkie / alcoholic sees himself for what he has become and realizes he either gets well or dies (those are the choices)then they simply can not be helped. The eventuality is death, Addictions are 100% fatal.
Its my opinion that they can only be helped when they "want" to be helped. And until then...they will continue to kill themselves. And I'd rather not pay for that.

Posted by: JC | 2008-08-27 7:36:35 PM

If drug addiction is a disease, JC (the real JC), what is the underlying pathology? And if there is none, or at least none is identified, how can it be called a disease? Some people are more vulnerable to addiction than others, just as some are more vulnerable to bee stings than others, but neither condition is a disease.

In any case, there is one definite, guaranteed, surefire, absolute-money-back, Scout's-honour, A-number-one gilt-edge way not to get hooked. DON'T USE.

Posted by: Shane Matthews | 2008-08-27 7:42:21 PM

JC, I agree that we should offer every encouragement to junkies that try to quit.
Posted by: Shane Matthews | 27-Aug-08 2:48:16 PM

Posted by: JC | 2008-08-27 7:44:02 PM

In any case, there is one definite, guaranteed, surefire, absolute-money-back, Scout's-honour, A-number-one gilt-edge way not to get hooked. DON'T USE.

Posted by: Shane Matthews | 27-Aug-08 7:42:21 PM

Amen that!
I'm teaching the kids what I already know a little too well. I don't think they'll use.

Posted by: JC | 2008-08-27 7:45:18 PM

If drug addiction is a disease, JC (the real JC), what is the underlying pathology?

I have some experience, but not medical training.
I'll see what I can find out

Posted by: JC | 2008-08-27 7:46:52 PM

I find it interesting that Matthew has said let Adults decide if they want to use drugs they are mature enough to do so.
Thus if you can choose this behavior then it can't be a disease right?
I had Leukemia and had no choice in the matter. So why should we fund any programs that enable this chosen lifestyle of drugs and drug addiction.
Libertarians want no laws prohibiting drug use but what do we do with all the addicts then per say?
Thats a bit odd I think

Posted by: Merle | 2008-08-27 9:53:15 PM

John V...you rule! I love your remark about treating the druggies like cigarette smokers. Good job! Meanwhile stop enabling these junkies. Forced treatment okay, but stiop feeding their suicidal habits! Harm reduction is a cruel joke, and tax dollars should not be spent on those programs!

Posted by: Markalta | 2008-08-27 9:59:08 PM

Put a needle in your toe or in your crotch. Remove your shoes and socks, or lift your skirt and drop your panties. Do it in a parkade stairwell at any time of the day or night. Sneak into a corner where no one should drop by. Bitch like Hell if anyone should happen by. Break a window in a car in case there's change there. The window doesn't matter at all. You just don't care. Sleep all day and steal all night. Jib, Jib, Jibber, Jibber. The fix is King or Queen or God. Heroin Alice is a Queen. Alice will do a trick for a promise of fifty cents, and bitch like Hell if she's shorted. [Tax dollars would be wasted on Alice and those like-souls. Barbed wire enclosures with armed guards would be a better solution to control these souls than supervised, harm reduction crap-o-la]

Posted by: dewp | 2008-08-28 12:03:57 AM

I'm sure Matthew is very flattered that you consider him an authority on such matters.
However addictions are a disease. Not the kind that can be treated by Doctors though. No, we'll have to leave it nature to sort these unfortunate people out. Tax dollars won't help them anymore than tax dollars will "fix" global warming. The very notion is preposterous. Addicts will die of their disease with or without the government prolonging their lives a little.

Posted by: JC | 2008-08-28 6:52:01 AM

Actually, JC, drug addictions are self-induced disorders, sometimes with a side of emotional or mental-health issues. They are are not, strictly speaking, diseases. No underlying pathology and certainly no pathogens. These are people who simply lack the ability to deal with life. That may be a deficiency, but it's not a disease.

Posted by: Shane Matthews | 2008-08-28 7:07:59 AM

These are people who simply lack the ability to deal with life. That may be a deficiency, but it's not a disease.

Posted by: Shane Matthews | 28-Aug-08 7:07:59 AM

Fair enough. Perhaps its safe to say that a certain proportion of society will always take this path and that is the nature of things.
In any event, as harsh as it may sound, I don't believe we can fix the problem with tax dollars.
There are a number of 12 step programs out there that have a measurable degree of success and they are free.

Posted by: JC | 2008-08-28 7:28:14 AM

However addictions are a disease. Not the kind that can be treated by Doctors though. No, we'll have to leave it nature to sort these unfortunate people out.
Posted by: JC | 28-Aug-08 6:52:01 AM

I noticed that David Duchovny has entered rehab for his "addiction". I'm sure lots of people would like this addiction and would hope to never be "cured".
http://www.breitbart.com/article.php?id=D92RKTMG0&show_article=1

Posted by: The Stig | 2008-08-29 10:54:15 AM

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Wednesday, August 27, 2008

Open letter from Libby Davies to Tony Clement on harm reduction

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