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A Presidential Balancing Act

by Archives September 9, 2008

Late last month Health Minister Tony Clement addressed the annual conference of the Canadian Medical Association. While the Health Minister speaking to the organization that counts as its membership the majority of medical doctors in Canada is hardly controversial, his message was. According to Clement doctors who support Insite, a supervised injection site for heroin users, are acting unethically. According to the CMA this means that over 80 per cent of doctors are “unethical”.
While Clement has spoken against Insite in the past, earlier in August speaking at the XVII International AIDS Conference in Mexico he referred to “harm reduction” – the philosophy behind facilities like Insite, as “harm addition”. This came just after the World Health Organization named harm reduction as a, “priority intervention” in the fight against the spread of AIDS.
But never before have Clement’s criticism been so strong, so focused and so wrong.
While Insite is the first center of its kind in North America, the idea of harm reduction is not a new one. To put it simply, harm reduction is based on the idea that people will engage in dangerous behaviors no matter what steps are taken to prevent them, harm reduction attempts to mitigate some of the most serious dangers, reducing the potential harm. Harm reduction is about more than just drugs. Programs that encourage people to have a designated driver or drive them home after drinking (such as Operation Red Nose) as well as the distribution of free condoms at Universities are examples of harm reduction.
Harm reduction works. A study conducted for the Canadian Medical Association Journal of a pilot project at an Ottawa homeless shelter, where alcoholics were given a glass of wine every 90 minutes until they were deemed too drunk to continue, found that participants in the program reduced their alcohol intake from an average of 46 drinks a day to eight. It also cut their hospital visits and run-ins with police in half – saving the government almost $500, per participant, every month. As well alcoholics were giving up their mouthwash and rubbing alcohol for wine, a much safer beverage and no longer had to make the choice between shelter and alcohol.
European nations have been using harm reduction to deal with injection drugs since the mid 70’s, with positive results. The first such site outside of Europe was opened in Sydney Australia in 2001, at the recommendation of a royal commission.
Insite opened in Vancouver’s infamous Downtown Eastside in 2003, an area known for its high rates of poverty, homelessness and drug addiction. As well the neighbourhood has some of the highest rates of HIV/AIDS and Hepatitis C in the world. The program came on the heals of a successful needle exchange in the area, that helped reduce the number of new HIV infections in Vancouver by over 100 people per year.
Insite allows injection drug users to shoot up legally in a sterile environment, with clean needles and under the supervision of nurses.
Since it opened almost 1 000 people have overdosed at the clinic, none of them have died. The vast majority of these patients have been treated on site, without having to be hospitalized. Had those overdoses happened on the street many of them would have been fatal and many more would have ended up in the hospital. This alone has resulted in a massive savings for taxpayer, as well are reducing the burden on the health care system, freeing up doctors, who would have been treating overdoses, to see other patients.
Insite has also helped fight the spread of disease among addicts, according to Insite three in 10 injection drug users in the Downtown Eastside has HIV or AIDS and a whopping 90 per cent have hepatitis C. By providing clean needles and a sterile environment Insite helps to prevent the spread of these serious diseases, saving lives and the money that would have otherwise been spent on costly treatments.
The sterile environment and teaching addicts how to clean their injection wounds has also helped to prevent less serious soft tissue infections, the most common reason for addicts to visit a hospital emergency room. As well Insite gets drug users inside and off the streets, creating a safer and more attractive neighbourhood.
Insite also helps addicts get off drugs, providing them with addiction counseling and referrals to detox programs. According to the center one in five of their regular users will enter a detox program.

Insite’s own numbers have been backed up by serious scientific research. 25 peer-reviewed studies have looked at Insite; including studies published in the Lancet and the New England Journal of Medicine, two of the world’s most prestigious medical journals. Every one has concluded that Insite saved lives, saved taxpayer’s money and/or helped addicts get off drugs. Insite has also been endorsed by the Vancouver Police Department. While the RCMP have spoken out against it, a study commissioned by the Mounties (released in 2006) came out in support of the center, finding that Insite has been effective in treating and preventing overdoses and more minor infections.
Despite all the evidence the Conservatives still want to shut down Insite. Rather than look at the facts Clement wants to turn this into an ideological issue. Clement seems to believe that without the increased risk of serious illness and death more people will be inclined to use heroin. Once again Clement is wrong. Heroin is not a “recreational” drug. It takes a certain mix of depression and desperation to stick a needle in ones own arm, looking for a high. With or without the largest risks heroin will still destroy lives. Heroin addiction along the unemployment and homelessness that follow close behind it will never be appealing.
Doctors take an oath to save lives, not to help with a misguided war on drugs. By putting the possibility of short-term political gain ahead of saving lives (and taxpayer’s money) Tony Clement has shown that he is the one who is truly unethical.

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