SEPTEMBER 15, 2007
VOLUME 4 NO. 15

POLICY & POLITICS

"Doctors, get tough on drugs":
Tony Clement

Minister's mind made up on safe injection
site, warn experts


Doctors are failing to warn young Canadians about the dangers of illicit drug use. Oh, and harm reduction's a sham.

Those were the messages from federal health minister Tony Clement to doctors at the CMA's annual meeting on August 20. Many healthcare observers say this is a taste of what we can expect to see in his national drug strategy, details of which are to be announced this fall. Disappointment and despair are the chief reactions to his hardline stance on substance abuse policy from many expert physicians, researchers and policy makers across the country.

"This is going to be catastrophic for people who have substance abuse problems, for society, for taxpayers, for crime," says Dr Keith Martin, a Liberal MP from BC and former substance-abuse physician, who was at Mr Clement's speech.

Disdain for the government's harm-reduction denialism has been swift and fierce. Over 130 physicians and scientists signed a petition released the day after Mr Clement's speech, condemning the government's "potentially deadly" misrepresentation of the overwhelmingly positive evidence for harm reduction programs including Vancouver's Insite safe-injection site, where nurses provide addicts with clean needles and a safe place to use drugs. Among those who signed the petition are 2006 International AIDS Conference co-chair Dr Mark Wainberg, Montreal public health director Dr Richard Lessard and Dr Robert Brunham of the BC Centre for Disease Control. Doctors and scientists from nearly every major university in Canada put pen to paper.

The petition endorses a commentary written by Dr Stephen Hwang, of Toronto's Centre for Research on Inner City Health, in Open Medicine which condemns the government's handling of the Insite case. "The current federal government has philosophical objections to harm reduction initiatives," says Dr Hwang. "They're trying to obscure the evidence by saying the research on Insite is not clear."

In fact, the evidence is uniformly supportive of Insite. Twenty-four studies published in journals such as the NEJM, The Lancet, the BMJ and the CMAJ have proven that to be the case. Zero have found it to be either unsafe or ineffective.

HARM REDUCTION
But with the December 31, 2007 deadline for the renewal of Insite's federal exemption to allow it to operate fast approaching, Mr Clement continues to insist that the science isn't clearly in favour of Insite. At the CMA meeting, he said: "Harm reduction, in a sense, takes many forms. To me, prevention is harm reduction. Treatment is harm reduction. Enforcement is harm reduction." Those comments, among others, worried Dr Isra Levy, of the National Speciality Society for Community Medicine. In a CMA release, Dr Levy said there's growing concern about the government's support for stricter legal enforcement instead of a comprehensive approach including harm reduction initiatives.

Stephen Harper's attitude about how society should treat drug addicts was outlined in a 2003 essay he wrote about the Left called "Rediscovering the Right Agenda," published in Report magazine:

"This descent into nihilism... leads to silliness such as moral neutrality on the use of marijuana or harder drugs mixed with its random moral crusades on tobacco. It explains the lack of moral censure on personal foibles of all kinds, extenuating even criminal behaviour with moral outrage at bourgeois society, which is then tangentially blamed for deviant behaviour."

Dr Martin says Mr Harper's position on substance abuse was the reason he opted not to join the newly formed Conservative Party, though he had been a member of the Canadian Alliance. "I suspect they see [substance abuse] as some kind of personal weakness — that people have a choice," says Dr Martin.

THE EVIDENCE
Health Canada continues to repeat that more research is needed on Insite to determine how safe-injection sites affect crime, prevention and treatment.

But extensive research has shown Insite is successful at reducing crime and overdoses, getting addicts into treatment and saving money.

Asked what research Mr Clement still needs to see in order to make his decision, Erik Waddell, a spokesman for Mr Clement, answers, "To see if Insite is getting people to programs to help them get off drugs." However, the NEJM study, published June 9, 2006, concluded that Insite increased admissions into detoxification programs and addiction treatment. Just four months later, Mr Clement said in a release, "Right now the only thing the research to date has proven conclusively is drug addicts need more help to get off drugs."

At the CMA meeting in August, he repeated his assertion: "There has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite." When asked to clarify what evidence Mr Clement was referring to, Mr Waddell confirmed it was a commentary published in January 2007 in a non-peer-reviewed journal called The Journal of Global Drug Policy and Practice, which receives funding from the US Department of Justice.

The piece, written by Colin Mangham, PhD, argues that the studies carried out by researchers from the BC Centre for Excellence in HIV/AIDS and elsewhere have been flawed and misleading. (See "Harper's new Anti-Drug Strategy is not anti-HIV" on page 16 to read the opinion of the Centre of Excellence researchers.) Questions about the article's trustworthiness have arisen. Dr Mangham is the president of the Drug Prevention Network of Canada, an organization run by former Conservative MP Randy White, and has previously written commentaries criticizing the philosophy of harm reduction. In response to questions about the Ministry of Health's opinion on allegations of the article's bias, Mr Waddell says only, "We are going to take all research into account when we make our decision."

LEGAL CONCERNS
Although Mr Waddell insists Insite's future has not yet been decided, Dr Martin believes the debate is all but over: "I think, given Mr Clement's comments, they are not going to renew it. And that should be worrying to Canadians."

A legal challenge was launched just a few days before Mr Clement's speech to try to wrest control of Insite from the federal government. Filed by drug addicts Shelly Tomic and Dean Wilson and the Portland Hotel Society, Insite's operator, on August 17, the suit alleges that closing Insite would violate addicts' Charter rights to security of the person and harm their physical and mental health.

Another legal hurdle is the fact that Canada is a signatory to the 1961 Single Convention on Narcotic Drugs, which limits nations' ability to give drugs except for medical or scientific purposes. A loophole in the treaty allows the project to remain open because it is still classified as a scientific study. Dr Martin says Canada must push other nations to amend the treaty.

DOCTORS' ROLES
Dr Hwang says researchers and physicians must speak out more forcefully when science is being undermined by politics and ideology, as he believes is the case with Insite. "We have an obligation to not just seek scientific evidence or investigate problems but also to ensure that the best evidence is honestly and fairly presented to the public," he says.

Unfortunately, he says, the CMA is not doing its part in that regard. "It's critical as physicians to ensure our professional organizations and lobby groups represent the good of the public as their primary objective," he says, "not only the welfare of physicians."

 

 

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