CAMH President & CEO advocates harm reduction in Toronto Star editorial

The following editorial by CAMH President and CEO Dr. Paul Garfinkel appeared in the Toronto Star on September 7, 2006.

Reducing harm in our society

Strategy includes safe injection sites, says Dr. Paul Garfinkel

Toronto Star, Thursday, September 7, 2006

Vancouver's Insite, North America's first supervised safe injection site, has been given a temporary reprieve from closure.

Considered a landmark public health initiative, Insite takes a "harm-reduction" approach to the serious problem of heroin addiction in Vancouver's East Side.

How effective have various harm-reduction strategies actually proven to be for Canadians?

Harm reduction has a pragmatic orientation. It accepts that drug use is a social reality, and that alternative strategies are needed for those people who are not ready or willing to stop their substance use, or for whom treatment, prevention or criminal sanctions have not been effective.

Seeking to reduce the immediate and tangible harms of substance use, harm-reduction initiatives target the individual, the family, community or society.

The social cost of substance abuse in Canada is $40 billion a year, 80 per cent of which results from the abuse of legal drugs —alcohol and tobacco — not illicit drugs. This dollar amount represents a terrible toll of tens of thousands of deaths, hundreds of thousands of years of productive life lost, and millions of days spent in hospital, and urges us to employ the most innovative and effective responses we have available.

While most people think of harm-reduction initiatives only in relation to drugs like heroin, many well-established programs for alcohol and tobacco utilize harm-reduction programs equally effectively.

Examples are all around us: server intervention programs that control the amount of alcohol served to bar patrons to decrease public drunkenness and violence; environmental controls on tobacco smoking that limit the exposure to second-hand smoke; nicotine replacement in patches or gum; impaired driving laws and their enforcement; graduated licences for young drivers; and managed alcohol administration programs in shelters for people who are homeless and chronically alcoholic.

All of these programs and policies have been proven effective by researchers in reducing the harms associated with alcohol or tobacco.

Likewise, literature from Europe, Australia and Canada provides compelling evidence that initiatives targeting illicit drug users such as supervised injection sites have been effective in reducing overdose deaths, HIV and other infections; improving safety and order in the community; and saving costs for emergency services.

There is no indication to date that those using these sites consume more drugs than they would otherwise, or prolong their drug use careers.

In other words, these programs not only reduce the short- and long-term harm to substance users but also benefit the entire community through reduced crime and public disorder.

Further, there are benefits arising from the inclusion of previously marginalized members of society into mainstream life. The improved health and functioning of individuals and the net impact on harm in the community are notable indicators of the success of harm reduction.

Specific arms-length, peer reviewed research on Vancouver's Insite indicates that this program has led to more admissions to local detoxification programs and addiction treatment, reduced overall rates of needle sharing in the community, and has not increased rates of relapse among former drug users.

Last year, the Toronto Drug Strategy recommended conducting a feasibility study for the creation of a "safe consumption site" for users of not only opiates but also cocaine and crack (the most problematic illicit drugs in Ontario), but this study has not happened as yet.

New harm-reduction initiatives are on the horizon. For instance, a large number of Canadians struggle with an addiction to prescription opioids like OxyContin or morphine. International research shows that buprenorphine, a prescription-based medical treatment for opioid dependence, has been found to be effective in reducing the need to continue using, and also in helping people to withdraw from heroin and methadone.

Further action is required to make buprenorphine readily available in Canada as another treatment option for those with substance abuse disorders.

The evidence shows that there should be support for the development, trial, evaluation and implementation of harm-reduction programs. We need as many as possible proven successful interventions to enhance positive outcomes for people affected by substance use problems.

Our public policy must support innovative strategies that most effectively respond to the health, social and economic needs of Canadians and their communities.

View the editorial in the Toronto Star online edition.

 

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