A COP SCRUTINIZES HARM REDUCTION

John McKay, a long serving Vancouver Police Officer, wrote this analysis in 2005:

THE FOUR PILLARS RE-EXAMINED

The Four Pillars approach to drug addiction (prevention, treatment, enforcement and harm reduction) is a social experiment developed in Vancouver, promoted worldwide by our former mayor, and hailed as a great success by its proponents. As a police officer working on the Downtown Eastside of this city for the past 4 years, I have had the opportunity to observe this strategy first hand and see beyond the theoretical Four Pillars model to the actual results of its implementation.

The Downtown Eastside, one of Canada’s economically disadvantaged neighbourhoods, is a 12 block area including a population afflicted with unusually high rates of drug addiction and mental illness. There are 130 social service agencies concentrated in this relatively small section of Vancouver which also has a disproportionate share of the city’s social and assisted housing complexes. Among the services available to drug using residents are free distribution of needles (more than 3 million are provided to addicts annually), drug cooking kits, and North America’s first safe injection site.

The philosophy underlying the current situation in the Downtown Eastside is, in theory, the “Four Pillars”. In practice however, the Harm Reduction pillar has been embraced and supported to a far greater degree than the Treatment, Prevention and Enforcement components of the strategy. It is interesting to note that harm reduction is the least expensive pillar to fund and the most supportive of drug use. Harm reduction measures enable drug use and the implementation of this ‘pillar’ through multiple initiatives has given Vancouver’s addicts a sense of entitlement.

The aim of Vancouver’s Safe Injection Site is to provide addicts with a safe place to use drugs where there is access to immediate medical attention if they overdose. In fact, the police officers who work in the DTES 24/7 have observed that most street drug use takes place in alleys just a short walk away from the SIS.

Unlimited free needle distribution is intended to reduce the spread of HIV and other diseases. The unintended consequences of this harm reduction initiative are the thousands of uncapped used syringes that addicts discard in parks and on neighbourhood streets. Because there is no longer a 1 for 1 exchange, users have no motivation to return the needles for proper disposal. Harm reduction for one group causes harm promotion for the rest of our city’s residents. The drugs injected in the SIS are usually paid for by the criminal activities of addicts who are responsible for most of the property crime plaguing Vancouver’s residents and visitors.

Many of the agencies promoting harm reduction are run by earnest, well-intentioned individuals whose objective is to keep addicts alive until they get treatment. Although this is an admirable goal, many harm reduction initiatives damage rather than help the addicts they target. Harm reduction on its own not only can’t help addicts get out of the pit of addiction, it actually digs the pit deeper and wider. On balance, many aspects of harm reduction can actually harm both addicts and non-using members of our communities.

To get a clear focus on the Four Pillar strategy we need to look at it from a broader perspective and examine how such an approach would be applied to illegal activities other than drugs. Effective existing strategies to deal with many criminal activities include prevention, treatment and enforcement. Harm reduction is usually one element included in all of these 3 “pillars.” It is illuminating to overlay the Four Pillar template on non-drug related crimes and observe the role of prevention, treatment and enforcement. This exercise reveals the flawed logic on which our City’s embrace of harm reduction is based.

If we place the Four Pillars template over other crimes, the roles of prevention, treatment and enforcement become clear. In the case of domestic violence [spousal assault], prevention includes violence recognition training and education about the availability of shelters, transition houses and legal protection. Enforcement policies for domestic assault exist in every province and treatment can be mandated for people convicted of spousal assault. These 3 pillars are already in place for domestic violence and all other crimes that society has deemed merit fines and imprisonment.

What then would be the 4th pillar? Harm reduction for domestic violence might mean that the batterer would wear boxing gloves when assaulting his spouse. Boxing gloves would, of course, reduce harm to the victim. Perhaps a ‘Safe Spousal Beating Site’ could provide immediate medical attention for the victims of domestic assault.

To extend the analogy we could consider harm reduction applied in a ‘safe impaired driving zone’ or a ‘safe burglary zone’. These concepts are ludicrous but the extension to a ‘safe rape site’, a ‘safe pedophilia site’ or a ‘safe assault site’ are as chilling as they are inconceivable. The answers to these offenses are Prevention, Enforcement, and Treatment. Harm reduction as a tool in these cases simply does not work. Nor is it a panacea for Vancouver’s drug problems. `

It is my belief that the 4 Pillars approach has placed the cart before the horse. There is no doubt that for effective solutions we must focus on prevention, treatment and enforcement. Harm reduction cannot stand alone. It is already included in the first 3 pillars and its value depends on its connection to prevention, enforcement or treatment. Those elements of harm reduction that are not congruent with prevention, treatment and enforcement should be seen for what they are: pro-drug initiatives which will lead to legalization. If successful, these initiatives will be detrimental to a safe and secure society. As a police officer, I have offered this perspective on the Four Pillars Approach so that citizens and their elected leaders can include it when they are considering the effects of drug addiction on our communities.