By David Berner,
Vancouver Sun
July 19, 2013 5:04 AM
A report by the B.C. Centre for Excellence in HIV/AIDS on harm
reduction programs and Insite released last month is not science; it's
public relations.
Authors Drs. Julio Montaner, Thomas Kerr and Evan Wood have produced
nearly two dozen papers on the use of Insite. They boast of good results
in connecting addicts to treatment but convincing evidence is lacking.
The current campaign reports significant reductions in drug overdoses,
yet the Government of British Columbia Selected Vital Statistics and
Health Status Indicators show that the number of deaths from drug
overdose in Vancouver's Downtown Eastside has increased each year (with
one exception) since the site opened in 2003. In addition, the federal
government's Advisory Committee on Drug Injection Sites report only five
per cent of drug addicts use the injection site, three per cent were
referred for treatment and there was no indication the crime rate has
decreased, as well as no indication of a decrease in AIDS and hepatitis C
since the injection site was opened.
Claims of success for Insite made in The Lancet, the British medical
journal, in 2011 were challenged in a 15-page, heavily-documented
response penned by addictions specialists from Australia, the U.S. and
Canada, and by a former VPD officer who worked the DTES for years.
In A Critical Evaluation of the Effects of Safe Injection Facilities
for The Institute on Global Drug Policy, Dr. Garth Davies, SFU associate
professor wrote: "The methodological and analytic approaches used in
these studies are compromised by an array of deficiencies, including a
lack of baseline data, insufficient conceptual and operational clarity,
inadequate evaluation criteria, absent statistical controls, dearth of
longitudinal designs, and inattention to intrasite variation. None of
the impacts attributed to SIFs can be unambiguously verified."
The doctors evaluating Insite are the same people who created Insite and
who have been awarded more than $18 million of taxpayers' money for
their initiatives in recent years. Dr. Colin Mangham, on our Board of
Directors, has been a researcher in this field since 1979.
"The proposal for Insite was written by the same people who are
evaluating it - a clear conflict of interest. Any serious evaluation
must be independent. All external critiques or reviews of the Insite
evaluations, there are four of them - found profound overstatements and
evidence of interpretation bias. All of the evidence - on public
disorder, overdose deaths, entry into treatment, containment of serum
borne viruses, and so on - is weak or non-existent and certainly does
not support the claims of success. There is every appearance of the
setting of an agenda before Insite ever started, then a pursuit of that
agenda, bending or overstating results wherever necessary."
Our President, Chuck Doucette, asks to see an independent and unbiased cost/benefit analysis.
"The four pillar approach only works when each pillar is properly
funded. Prevention reduces the flow of people into addiction. Treatment
reduces the number of addicts including those living in the DTES.
Policing keeps a lid on the open drug dealing and the affects of the
associated problems on the community. Only after these three pillars are
properly funded can we afford to spend money on Harm Reduction
initiatives that do not encourage abstinence. Putting HR first is like
running up debt on your credit card and never paying more than your
minimum payments."
No one would object to free needles, crack pipe kits, methadone, heroin
and places to shoot up if only they were the side show and not the main
event, if only they ever led to real health.
Harm reduction and Insite are palliative.
They both spring from a deeply cynical and arrogant world view: You are
an addict and you are hopeless. We will keep you "comfortable" while you
continue to die.
This is a curious position considering the millions of men and women
who admit they are addicts and choose every day not to pick up their
poison. I know many such clean and sober citizens.
We owe one another a chance at dignity. To offer less is not only costly, it is monstrous.
