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Redistributing Harm Isn’t Harm Reduction

Addiction is compulsive repetition of a specific behaviour despite the risk to health and other adverse results. It is usually driven by the short-term gratification or other sensory reward the behaviour provides and can eventually grow to become an obsessive need that takes control of the addict’s life. As the body adapts to the behaviour and/or the substance, it results in a need for increased amounts of the behaviour or substance to achieve the original effect.

Some of the more serious addictions include alcohol, sex, food, computers and computer games, gambling and drugs including illegal, prescription and non-prescription, over-the-counter drugs.

Some consider addiction an illness; others merely the result of bad choices and bad behaviour. I suspect the truth lies somewhere in between but regardless of how it is defined, addiction is devastating to the addict, those closest to the addict – most especially family and to the broader society at large. It can lead to financial ruin, suicide, serious illness that can be fatal, and crime.

Many believe illegal drug use is responsible for the spread of diseases like AIDS/HIV and Hepatitis through the sharing of needles and that has led some to believe that the best way to deal with drug addiction is through Harm Reduction Sites like Insite in Vancouver.

I disagree. I don’t believe that you mitigate or reduce harm by merely redistributing it and in the end, that’s all that injection sites accomplish.

Nothing good comes from enabling bad behaviour and that is all injection sites do. They provide a safe place for the addict to pursue their addiction but do nothing to address the addiction itself. It would be like opening a ‘safe’ bar for alcoholics or a ‘safe’ casino for gambling addicts. The behaviour and the devastating results of that behaviour would continue to escalate leading to more harm to the addict and those in the addict’s life.

Even if you accept that illegal drug use is responsible for at least some of the spread of communicable diseases like hepatitis and HIV among addicts, the simple fact is that harm reduction centres do not guarantee any reduction in careless use of needles.

Vancouver has seen a marked decrease in the incidence of AIDS/HIV and those who promote harm reduction sites point to the injection site called Insite as proof of success but they are wrong. The reduction of HIV/AIDS in British Columbia is because it is the only province that offers highly active anti-retroviral therapy (HAART)  free of charge and aggressively promotes its use.

“. . . the most compelling data to date demonstrating the soundness of the “treatment as prevention” theory, an approach conceived at the B.C. Centre for Excellence in HIV-AIDS and now being embraced worldwide.

“Treatment as prevention . . . is so successful, from Zimbabwe to Abbottsford, that policy-makers now talk openly about the possibility of freezing the epidemic in its tracks and creating an AIDS-free generation.” 

I understand the concern about the spread of potentially fatal communicable diseases but I don’t believe the solution lies in a myopic view of the total harm caused by illegal drug use.

Illegal drugs have become a scourge inflicted on societies by organized crime, international drug cartels and street gangs. People, lots of people, die every year from the violent competition over territory and distribution of illegal drugs. Addicts who need ever-increasing sources of money to finance their habit often turn to crimes ranging from shoplifting, snatch and grab, break/enter to armed robbery and in some cases even murder.

Illegal drug use is a downward spiral; a road to perdition that sees families torn apart, children as helpless victims of an addicted parent and the wasted and often too-short life of the addict. It increases crime in our cities that endangers citizens, undermines economic activity and can destroy family neighbourhoods.

Harm reduction sites do nothing to mitigate any of this. They enable it.

Like Insite in Vancouver, the Ottawa proposal calls on the creation of a zone around the injection site in which police would not be permitted to enforce drug laws. In other words, a safe retail zone will be established for pushers to sell their drugs to addicts. Inevitably the zone becomes a Mecca for addicts and criminals alike which ultimately destroys the neighbourhood and increases the risk of crime in the immediate area.

One of the most insidious aspects of harm reduction sites is its name. It implies a reduction in the harm caused by the use of illegal drugs and that, coupled with providing a ‘safe’ medically supervised place to inject drugs like heroin can lead young people to believe it is safe to experiment. It promotes the idea that perhaps illegal drug use is not as serious as some try to tell them.

The simple fact is that it is too high a price to pay for the projected benefit. In Ottawa, the incidence of AIDS/HIV due to sharing of unsterilized needles is around 10%. The number one cause remains unprotected sex between men. In other words, those who promote the establishment of harm reduction sites are working to try and fix 10% of the problem by increasing exponentially all of the other associated issues and risks associated with illegal drug use.

It is small-thinking that not only ignores the potential increased harm to the community but actually throws the addict under the bus leaving him or her to deal with the ravages of their addiction in the name of reducing the spread of disease.

You cannot overcome bad behaviour by enabling it and you can’t reduce harm by simply redistributing it to others. Any strategy to combat the serious impact of illegal drug use on the individual and the community must look at everything not just one small aspect of the issue if it is to have any hope of making safer communities.

There are better ways to deal with the ravages of addiction and the threat of disease than enabling illegal drug use. True harm reduction means reducing the spread of the addiction not the spread of  some of the results of the addiction. It is a complex social issue that will not be fixed with simple-minded solutions.

Harm reduction centres like that being proposed in Ottawa and Vancouver’s Insite bring little to no insight to finding those solutions.

They merely transfer the problem to others.

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© 2013 Maggie’s Bear

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  • KANSAS/SEATTLE

    Great article! I am a recovering Alcoholic. Sober 16 years now! The desire to stop has to be greater than anything else. Believe in a higher power, greater than self, mine is Jesus. I am an AA member by choice and it is working for me. My whole life has changed for the better. I know peace.

    • MaggiesBear

      Thank you for sharing your story and congratulations on your recovery.

  • Jen S

    I’m no expert, but I assumed the rationale was that it gets them in the door, where they have easier access to information and addiction treatment programs, where they would otherwise have little access, or inclination to even motivate themselves to understanding the addiction. Obviously not all will take up treatment. But I always thought a large part of the rationale of places like insite was making treatment as accessible as possible, and making addictive behaviour (which you can’t control in others) least damaging as possible.

    Also I think the larger issue is that addicts are not only a danger to themselves, but also to the rest of society, given the higher rates of infectious diseases, and also an unnecessary burden on the healthcare system– if you can mitigate medical emergencies, and also mitigate the spread of infections, you are realizing a net benefit to society whether or not the addicts enroll in treatment programs.

    Addictions are bad, but how do you mitigate harm and cost to the rest of society caused by a population that is generally resistant to actively seeking out treatment? Tough love approaches may seem easier to stomache at first glance, but I don’t see the advantage of doing nothing, and I don’t see a better approach given the current legal framework we find ourselves in. (Obviously ending prohibition would be a massive benefit)

    • MaggiesBear

      You raise valid points but unfortunately, injection sites are not about rehabilitating the addict. They are strictly a place where the addict can get access to a sterilized needle and a clean place to shoot up with nurses and a doctor on stand by. The people who operate these sites know that if they push the message about getting off drugs, addicts won’t come so the focus is strictly on ‘safe’ injection.

      In Vancouver, they took it a step farther to provide so-called safe inhalation rooms for crack smokers. It seems somewhat bizarre to throw cigarette smokers out into the snow while spending money to provide a safe place for crack addicts to smoke their drug of choice.

      According to reports released by the Regional Medical Officer for Ottawa, the use of illegal drugs only accounts for approximately 10% of the incidence of AIDS/HIV in men and 0% in women. The single largest cause remains unprotected sex with unprotected sex between men being number the number one cause.It seems to me that if you are attempting to protect society from the spread of disease, you attack the 90% issue rather than the 10% issue.

      Illicit drugs are a danger to society. Nobody denies that but what the promoters of injection sites turn a blind eye to is the overwhelming damage to society from the crime associated with them. Many addicts are involved in petty crimes and pushers and distributors are attracted to major and serious crimes including murder. Setting up an injection site with a ‘no-enforcement’ zone around it provides not only a safe place for addicts to shoot up but a safe place for those who deal in drugs to ply their trade. That merely transfers harm from those who are involved in either using or dealing in drugs to the broader community.

      I respect your opinion but I don’t believe you protect society or the addict by enabling dangerous and illegal behaviour. Ask yourself this simple question. Would you want an injection site next door to where you live with the attendant issues it brings with it? Would you want pushers selling drugs openly in your neighbourhood free from police involvement? Most people answer no because most people don’t want to be exposed to the potential for crime or their children being exposed to easy access.

      I believe the solution to the spread of HIV/AIDS will be found in more funding for the HAART program which was developed at the University of BC and which is being used around the world with amazing results. I believe the best way to help addicts is to fund more rehab sites – not injection sites.

  • Cytotoxic

    The data is actually quite clear: Insite works. This post’s BS and conjecture aside, the data is solid. That doesn’t mean the taxpayer should finance it. Almost all of this harm is a consequence of drug prohibition anyway.

    • MaggiesBear

      Any time you’d like to provide your solid data, I would be happy to look at it and compare it to the data that has come from regional health departments that state otherwise.

  • Pingback: Redistributing Harm Isn’t Harm Reduction | Grumpy Opinions()

  • MaggiesBear

    You know, for someone who claims to be in his 40s and who wants to be taken seriously, your behaviour is adolescent. You are, to put it bluntly, an idiot. You pontificate like you have something important to say but you offer only cheap shots and drivel. You claim to be open to debate but you wouldn’t know informed debate if it jumped up and bit you on the ass. You are a foolish, silly person with foolish, silly ideas and opinions. Nobody here takes you seriously, least of all me.

  • oldwhiteguy

    at the risk of sounding silly on such a serious subject,,,, I have to stop posting for the good of my mental health. I have tried in the past but continue to be sucked in to the vortex with interesting articles. allowing a drug addict to continue to destroy themselves, indulging in an illegal activity, with government sanction, is not a compassionate act. end of story.

    • MaggiesBear

      It isn’t only illegal, it’s destructive behaviour that devastates the life of the addict and his or her family and that undermines the safety of the broader community. I agree with you. It isn’t compassionate to enable that behavior; it’s selfish in that it seeks to protect against one particular outcome of addiction at the risk of all others.