Margaret Wente's Third Column on Drugs - Perfect

Europe's approach to drugs is more enlightened ... it's tougher

MARGARET WENTE

From Thursday's Globe and Ma

July 17, 2008

In 2006, Governor-General Michaëlle Jean was hosting Queen Silvia of Sweden during the Swedish royal family's visit to Canada when the topic of illegal drug use came up. The GG told the Queen that Canada is taking an enlightened approach. Instead of punishing users, she said, society needs to be understanding of drug use and assist in reducing harm until the addict is ready to quit.

Alas, the Queen was not impressed. She briskly informed the GG that Sweden takes a hard-line approach, that users are given a choice between treatment and jail, and that Sweden's addiction rates are much lower than Canada's. After that, they changed the subject.

Advocates of harm-reduction measures, such as needle exchanges, methadone programs and Vancouver's supervised-injection site, often point to Europe's more enlightened approach to drugs as proof of how far behind we are in Canada. But parts of Europe are having second thoughts. Socially progressive Sweden had a brief but disastrous fling with prescription heroin back in the 1960s. After that, it embraced the hard-line approach. Today its policy is to make drugs very difficult to get, but treatment very easy - and sometimes compulsory. "The vision is that of a society free from narcotic drugs," says Maria Larsson, the Minister for Public Health.

As a consequence of grassroots support for this policy, drug use in Sweden is a third of the European average. "The lessons of Sweden's drug control history should be learned by others," said Antonio Maria Costa, who heads the UN's Office on Drugs and Crime.

Scotland took a different tack. Drug use is widely tolerated, as you know if you saw Trainspotting. Rehabilitation programs are scarce, but the national methadone program has become a vast and ineffective money-pit. Scotland has more than 50,000 heroin addicts. Drug deaths have soared, drug-related crime is high, and tens of thousands of children are growing up with addicted parents. "Methadone has quite literally become the opiate of the masses," warned Neil McKeganey, one of Scotland's foremost drug policy experts.

Two months ago, the Scottish government announced a change in direction. From now on its primary focus will be on "recovery," not just harm reduction. "Harm reduction ideas have failed in Scotland," says Prof. McKeganey. "They have failed to protect injectors from hepatitis C, failed to reduce the scale of the drug problem, failed to reduce many of the harms inflicted on others."

The Netherlands is famous for its permissive drug culture, but even it is not as permissive as it used to be. Although you can still toke up in marijuana coffee shops, pot remains illegal. A parliamentary proposal to allow regulated, large-scale marijuana production was voted down, and the government moved vigorously against the psychedelic drug ecstasy. Switzerland (which runs supervised-injection sites but also has thousands of treatment beds) voted against decriminalizing marijuana. The UK made marijuana possession semi-legal a few years ago, but experienced an explosion of pot use among minors, as well as a sharp rise in harmful effects attributed to more potent strains of weed. It has now reversed course and reclassified marijuana as a harmful drug.

Like Canada, Australia is experimenting with a supervised-injection site, in Sydney. The passionate debate over whether it reduces harm is virtually identical to the one in Canada.

I asked Scotland's Neil McKeganey if he had witnessed the drug scene in Vancouver, a city that is famous for its harm-reduction approach. He had. "I was utterly shocked," he said. "I could hardly believe that in a culturally developed, sophisticated city there could be a drug problem of such magnitude." In his view, too much emphasis on harm reduction invariably undermines prevention efforts. "To provide a setting where someone can inject street drugs is doomed. The next step is saying, maybe we should be providing them with drugs as well."

The provision of "clean" drugs is, in fact, what many advocates of Insite want next. "Many individuals who promote harm reduction believe there's fundamentally nothing wrong with drug use, except the fact that it's illegal," says Prof. McKeganey.

Every nation is different, and drug policies that work in one place may not work in another. But to him, Vancouver is a clear case study in what not to do. "It's a harbinger of what other cities could experience if they do not develop effective prevention methods."

This is Rich

"No process, no consultation, no process."

This is how BC's Auditor-General, John Doyle, has described the Campbell government's way of handling land deals.

Of course, the government's response is the old "shoot the messenger" gag. Forest Minister Pat Bell starts calling the AG names. Sweet.

What makes this latest case so tasty is that Rich Coleman was the Minister when this questionable done-deal was rammed through in favor of Western Forest Products. Coleman's brother, Stan, is a senior exec at the company.

So my old question, asked always in these situations - Whose cousin is he? - must be updated to - Whose immediate sibling is he?

Driving into Seoul from Inchon airport a few years ago, along many kilometres of perfect highway, I asked, "Whose cousin had the cement contract?

The next morning I read in the English language newspaper about the scandal of the cement contract going to some government official's near relative.

Hahahahahaha...

One thing about government corruption is that it is always so laughably predictable.

Non Compismentis

Compensation from BC Hydro?

What are you smoking, Girl?

Rogers has refunded me a considerable amount of money on an error for I am admittedly largely responsible.

Shaw has refunded me for an almost 24-hour outage of my TV and internet service a few weeks ago.

But asking BC Hydro to pony up would be like asking the Old and New Testaments to be re-written.

Cover Me

Alan Ferguson has written an excellent editorial in this morning's Province about the Obama New Yorker cartoon.

The cover cartoon was an obvious satire of the lunacy coming from the extreme right regarding Obama's history and sympathies.

But unless you stop and think about it, at first glance the cartoon seems to be saying that Obama is a flag-burning Islamic terrorist.

Of course, it is a typically outrageous New Yorker cartoon.

I agree with Ferguson's analysis in large measure, but I don't agree completely with his conclusions.

I don't think the cover is "brilliant" and I don't think it was a wise choice, precisely because so many people are so stupid and see only what appears to be the obvious.

This week, I received 3 pieces of mail scolding me for a poster I created in which I deliberately used the wrong spelling of a word to create a jokey pun. None of the letter writers got the joke.

Of course, that doesn't mean I should have resisted the joke, and there is no question the New Yorker should not be attacked for this cover.

Still, my sense of this is that it was a good laugh in the news room, but maybe it shouldn't have gone any further.

Natalie Cole

Darkness

The Downtown power failure brings to light (ouch! sorry...) a number of issues.

There were dire warnings of exactly this occurrence as recently as last year. Was anyone listening? Was any preventative action taken?

Has either the Province or the City taken stock in infrastructure lately? Do we have an inventory hidden in some vault somewhere?

And, how reassuring to hear BC Hydro rush to the podium to confirm that they never promised anybody a rose garden, or even regular delivery of service.

We balance precariously on a deck of (stacked) cards...hang onto those candles.

Hole in One

The plans for the Rossland Golf Course have been scrapped.

We Need Doctors, But We won't let them Work

It is good to see a foreign trained doctor fighting for her right to practice in B.C. It is high time that this happened.

Unfortunately, she is using the BC HUman Rights Tribunal as her forum. It may be that she no other recourse.

We would have hoped to see this kind of case in the Supreme Court. The BC College of Physicians and Surgeons has much to answer for in this matter.

Quote of the Day

Vancouver NPA city councilor Kim Capri said said she would "never characterize Vancouver as an uncivil city."

Hahahahaha...

This quote from a Province news story on the incivility of Canadian cities, Vancouver ranking right up there at the top.

My Friday Province column began with this sentence: The loss of manners is a shame; the loss of civility is a tragedy.

I received the largest response ever to that column. Apparently I touched some communal nerve.

Today's report is on the money and Kim Capripant's reaction is, as always, totally out of synch with the world in which she purports to live.

Margaret Wente Exposes the Invested Pseudo-Science that Supports Insite...A MUST READ

We still await the scientific proof of harm reduction's success

MARGARET WENTE

From Tuesday's Globe and Mail

Ten months before Vancouver's supervised-injection site opened in 2003, two young researchers gave a stirring presentation. They argued that such a facility was vital in order to reduce public-health problems and disorder in the city's notorious drug scene. The evidence from elsewhere was overwhelming, they insisted, and it was time to act. “I'm all for it,” said Evan Wood, one of the presenters. “Get one open. Enough's enough already.”

Neither Mr. Wood nor his colleague, Thomas Kerr, had a background in addictions medicine or public policy. Mr. Kerr was a PhD candidate in educational psychology, and Mr. Wood was a PhD candidate in health and epidemiology. Yet today, they and a small group of associates have made their reputation in the world of drug policy as the authors of nearly two dozen research papers – every one of which reports remarkably positive results for Insite, the controversial supervised-injection facility for which they themselves had lobbied hard.

It is this research – all produced under the umbrella of the B.C. Centre for Excellence in HIV/AIDS – that is repeatedly cited as scientific proof of Insite's success. It is this research that has persuaded politicians, policy-makers, editorial writers and much of the general public that Insite is a compassionate and progressive tool for harm reduction that saves lives and reduces suffering. After all, at least 22 peer-reviewed papers say so.

In fact, Mr. Wood, Mr. Kerr and their associates often act more like advocates than impartial researchers. They aggressively denounce anyone who even suggests that the value of Insite might still be a matter for legitimate study or debate. They accuse Insite's critics of being blinded by ideology and of willfully ignoring mountains of “peer-reviewed,” “evidence-based” studies.

Yet even experts who think Insite is a worthwhile experiment say the case has not yet been made. Dr. Brian Conway, one of Canada's top experts on AIDS policy, is one of them. “How much has it done in terms of reducing the HIV-Hep-C infection rate, the rate of serious illness that results from drug use, in terms of saving lives? That hasn't been demonstrated.” Nor is quantity the same as quality. The sheer volume of published research “is more of a tribute to the efficiency of the people who are writing the papers than anything else.” And in public, the researchers “have tended not to present the limitations” of their findings.

Some people are not so diplomatic. “You can churn out all the research you like if you've got a vested interest,” says addictions doctor Milan Khara. The B.C. Centre for Excellence receives millions of dollars worth of government contracts for research on drug issues. The tab for the Insite studies is well over $2-million. Yet none of these studies addresses the central issue in the public mind: Does Insite reduce overall drug use?

Garth Davies teaches research methodology at Simon Fraser University's school of criminology. He recently published an evaluation of all the research literature on safe-injection facilities, including Insite. He wasn't impressed. “[They] are too often credited with generating positive effects that are not borne out by solid empirical evidence,” he wrote. “As a result of methodological and analytical problems … all claims remain open to question.”

Despite this fatal weakness, “there are very few other substantive areas of research where the debate is this one-sided,” Prof. Davies said in an interview. The same small set of people peer-review each other's work, and even the drug journals are politicized. “It's very difficult to get a contrarian opinion published. If you're not on the side of supervised injection, you get marginalized.”

In any event, researchers who want to analyze the data for themselves are out of luck, because the researchers refuse to share it. Steven Lehrer, who studies health economics at Queen's University, says it's frustrating. “They were reporting unbelievably large effects,” he says. And that makes it especially important for independent researchers to validate the results. “They don't seem interested,” he says.

Could it be that the fix is in? When researchers behave like advocates, it's hard to believe otherwise. “They act as if it's a done deal,” says Prof. Davies. “It has become a professional mission for them.”

Sh-Boom

Victor Scours the Streets, Searching in Vain for a Politician with Character and Substance

We have 2 high profile politicians in BC who gained elected office on the guilt vote. Both are hopelessly over their heads. I'm sorry, we have to confront this.

The first is outgoing Vancouver Mayor, Sam Sullivan. Let's face it. Sam was elected because Vancouverites, under the illusion that the entire world monitors Vancouver politics, wanted to make a statement to the world by electing a silly man in a wheelchair. The world doesn't care.

The other, is of course, Wally Oppal. This is a man who was born here, who was favoured with a wonderful education all the way to law school, but still pimps himself out as an Indo-Canadian, as though he arrived from the Punjab and picked cranberries. The man is as dumb as a sack of hammers. I know a number of real Indo-Canadian people who don't rely on ethnic leverage to succeed.

We have a Merritt Festival in Merritt BC.We need a merit festival in politics.

Simple Pleasures

Cappuccino. A good book. An outside table.

Serious happiness.

Not a disease

A commentor has asked me to explain how drug addiction is a disease.

Let's be clear.

Drug addiction and alcoholism are not diseases.

To call addictons diseases is a comforting convenience for liberal do-gooders, whp don't really understand or want to understand the issues and the mechanics of addictions. They feel that the stigma is thus removed and that doctors can help.

Drug addiction is a condition brought on by repeatedly bad choices. The reasons for these consistently bad choices are complex and, in time, need to be addressed and understood if the addict has any hope of living dope-free.

But it is the addict and other recovering addicts who can help. Medical science has the smallest possible role in recovery.

Dope fiends are stupid and they make lousy choices.

Work with them to help them begin making better choices.

Doctors and nurses will just give them stuff - pills, substitutes, needles, places to shoot up or drink sips.

Addictions are not diseases. They are self-imposed behavior choices.

Par for the Course

It will be interesting to see how the good elected offcials of Rossland, BC handle the situation.

Someone wants to build a gold course on Red Mountain. Good.

Right next to the water resevoir. Not so good.

Three thousand citizens have petitioned against it. Interesting.

Stay tuned.

More on Harm Seduction

See also Robert's post on his blog re: Harm Seduction.

Slowly the army of informed and reasonable and truly caring people are speaking up about the NEED FOR TREATMENT.

Join the groundswell. Speak out.

Shameful Government

The Basi Virk trial is one of the greatest shams and miscarriages of justice this sorry jurisdiction has ever witnessed.

Now, to add to the injury, the BC government wants to ban the publication of 90 e-mails that have some relevance to the proceedings.

Does Wally Opaque have his sticky hand in this obscenity?

Whoever is involved might be reminded of the old adage that, "not only does justice need to be done, it needs to be seen to be done."

Transparency has not been a long suit for the BC Liberals.

The face of (highly mistaken, do-gooding) Evil

The photo shown below with the Margaret Wente piece is of Bethany Jeal, a nurse with the Downtown East Side Clinical Housing Team, whatever that is.

I believe that the sickest person in the DTES is this young woman and her colleagues.

They are so sincere, so caring, so sure that they are helping.

Let's be very, very clear.

I spent 10 years of my life working with addicts.

Not only would it never have occurred to me to don rubber gloves and hand out killing machines, we never even for one second discussed drugs!

We talked a lot.

We talked about sadness, anger, disappointment, work, accomplishment, love, friendship, parents, children, art, music, sport, food, LIFE.

Result? Literally hundreds and hundreds of clean and sober non-using former addicts.

When I see the likes of Bethany, I don't know if I want to cry or grab an axe.

Quite Simply the Best Editorial on Harm Reduction Ever - Magaret Wente in Saturday's Globe

Sergeant Mark Steinkampf knows every back alley in Vancouver's Downtown Eastside. He greets the regulars by name and doesn't miss much. On street patrol one balmy evening, he spots a new face – a young, attractive woman on a bicycle. He motions her to stop.

“I can see that crack pipe in your bra there,” he says. He pulls it out and dangles it in the air. “You're under arrest. Let me read you your rights.” He drops the crack pipe and crushes it beneath his shoe.

The woman doesn't have drugs on her. If she's smart, she'll get out of here fast and he'll never see her again. If she's not, her prospects aren't good. A year from now, she'll likely be ravaged by drugs and infections, turning tricks to get the money for a fix. If she's very unlucky, she'll wind up like another girl, whose body was found by a dumpster, stuffed into a plastic bag like so much garbage.

Vancouver is famous for its innovative approaches to drug treatment. Twenty years ago, it launched a bold experiment to tackle the problems of the notorious Downtown Eastside. The guiding idea was harm reduction. If you couldn't cut off the drug supply or jail all the addicts, then at least you could reduce the secondary damage – HIV, hepatitis and the like – by giving people clean needles. You would surround them with medical and social services. Addiction, all agreed, was an illness, and addicts deserved compassion and respect. Bethany Jeal a nurse with the Downtown East Side Clinical Housing Team, holds a typical tray with an injection kit that will be handed out to drug users at Insite.

Vancouver's needle exchange, the first in North America, opened in 1989. That first year, about 128,000 needles were handed out. Today, the streets are flooded with more than three million free needles each year. The sick and malnourished, many of them with open sores, freely inject drugs. Between 5,000 and 10,000 addicts live within these eight square blocks. The HIV rate hovers around 40 per cent; hepatitis-C rate is 85 per cent. There are more than 150 social services located in the area, offering everything from counselling and shelter to free lunch and art supplies. But there are virtually no treatment beds.

Mark Steinkampf, who heads the Downtown Eastside detail, has worked this beat for 18 years. He cares about the people, and wants to get a message out: Harm reduction – the philosophy that has come to dominate drug policy – doesn't work. Just the opposite. It digs the pit of addiction deeper and wider.

Insite is the supervised-injection facility that has come to symbolize harm reduction. Here, addicts can shoot up in a clean, well-lit booth under the eye of helpful nurses, who supply them with clean needles and treat them if they overdose. Its supporters say Insite is a remarkable success story that reduces infections and saves lives. But Sgt. Steinkampf just laughs. “It's like saying, ‘Hey man, you're really high. Want some treatment? Here's some more drugs!' ”
Advocates say the Insite experiment (now in its sixth year) is a progressive, compassionate approach that is supported by almost everyone. As they tell it, the only opposition comes from a few rogue cops, hard-line abstinence types and right-wing ideologues.

In fact, that is not the case. Many front-line workers, including addictions doctors, nurses and people who run successful rehab programs, believe the philosophy Insite represents has been a disaster. Some are hesitant to speak out, because harm reduction is official policy and criticizing it can be a career-killer. Others think it's time people heard their side.

“We here treating addicts see a very different world,” says Stan de Vlaming, an addictions doctor who's work-ed with the Downtown Eastside population for a dozen years. His patients are the most entrenched and addicted of all. As he sees it, they don't need more free lunch. They need entry-level recovery houses – preferably far away from here – where they can be closely supervised for months.

They also need a far more aggressive push into treatment and recovery – something they don't get from the many, many helpers who are busy finding them housing and giving them free needles. “Harm reduction without a treatment component is a failed policy,” he says.

Today, rehabilitation is the treatment of last, not first resort. “Rehabilitation” and “recovery” are terms you don't hear from advocates of harm reduction. What you do hear, over and over again, is the word “safe” – a word that many addictions doctors take issue with.

“I saw a patient the other day who's still injecting two or three times a week,” says Dr. de Vlaming. “I explained that there's no safe way of injecting drugs. He said, ‘No one's ever told me that.' ”

“Safe injection is a misnomer,” says Milan Khara, another veteran addictions doctor. “Insite is a supervised injection site. Injections inevitably lead to medical complications.”

St. Paul's Hospital is the big red-brick building where they deal with the complications. It treats addicts with life-threatening infections of the heart, brain and bone. “When you put a needle into your arm, the infection can land anywhere,” Dr. Khara explains. Bringing the infection under control with antibiotics takes weeks or months.

Despite the supervised-injection site, the number of addicts with such complications has steadily increased. Today, they make up 10 per cent of the patient population at St. Paul's, and account for nearly 20,000 hospital days a year. “Insite did not have any effect on these serious infectious complications,” says Dr. de Vlaming.

One such patient, a 32-year-old woman with a heart infection, has been hospitalized repeatedly. This time, she knows she'll die if she can't get a treatment bed. But those are scarce. This month, the government finally opened a long-awaited recovery facility in nearby Burnaby. It's a drop in the bucket.

“I've lived down here for the best part of a decade and it's been getting crazier every day,” says Dr. Khara. “I don't see any return on our investment.” An increasing number of ordinary citizens agree. “For the life of me, having lived in that 'hood, I see no evidence of any ‘harm' being ‘reduced,' ” wrote Ruth Meta in a letter to The Vancouver Courier.

Back on the beat, Sgt. Steinkampf tries to reassure a frantic mother who's searching for her son. “Look around!” he says afterward, gesturing at the dishevelled men with their shopping carts and the ravaged women who look 60, but are 30. “And they're calling this fucking mess a success? Anyone can see it has failed utterly.”

The police – and many others – argue that well-intentioned but misguided social policies have turned this place into a vast enabling industry. Contrary to popular belief, the police have no desire to throw addicts in jail. They want to help them kick the habit and escape.

They want more drug-court diversion programs, and they want treatment to be made a part of sentencing. They're sick of watching people die.

Ten years ago, some of the police, including Sgt. Steinkampf, began documenting this world on videotape. They wanted to put a human face on the statistics. They called themselves the Odd Squad, and invested thousands of hours of their own time to bring their stories to the world. Their latest film, Tears for April, should bring shame to policy-makers. It chronicles the struggles of several addicts – including a girl named April, whom they followed from the time she first arrived on the street as a pretty teenager. It was she who was found murdered, stuffed into a plastic bag by the dumpster.

Just Slightly Ahead of his Time

Tired of the carbon tax, SUVs, Climate change, David Suzuki? How about the greatest all-round genius of all time? Try the original Leo...

Leonardo's car brought to life
Open top three-wheeler. 2004 reg. Italian design and craftsmanship. Zero mpg. No emissions. Easy parking. Programmable steering
John Hooper in Rome
Saturday April 24 2004
The Guardian


It has taken more than 500 years to get from the drawing board to the showroom, but today the first working model of the "car" conceived by Leonardo da Vinci is to go on display at an exhibition in Florence.

Eight months' work by computer designers, engineers and joiners has proved something that had been doubted for centuries: the machine sketched by history's most versatile genius in or around 1478 actually moves.

"It was - or is - the world's first self-propelled vehicle," said Paolo Galluzzi, director of the Institute and Museum of the History of Science in Florence, who oversaw the project.

Perhaps sensibly, humanity waited for the invention of steam power and then the internal combustion engine. Leonardo's car, 1.68m long and 1.49m wide (5ft 6ins by 4ft 11ins), runs on clockwork. The springs are wound up by rotating the wheels in the opposite direction to the one in which it is meant to go.

"It is a very powerful machine," Professor Galluzzi said. So powerful that although they have made a full-scale "production model", they have not dared test it. "It could run into something and do serious damage," he said.

The vehicle demonstrated in Florence yesterday was a one-third scale replica.

Several attempts were made in the last century to construct the vehicle. None worked.

They were vitiated by a misunderstanding: that Leonardo powered his vehicle with the two big leaf springs, shaped like the arms of a crossbow, shown in his sketch on folio 812r of the Atlantic Codex, one of the great collections of his studies and sketches.

In 1975 Carlo Pedretti, director of the Armand Hammer Centre for Leonardo Studies in Los Angeles, published a paper showing early 15th century copies in the Uffizi archives of some early Da Vinci sketches. "Two of the drawings represent a view from above of the spring mechanism of the well-known self-propelled vehicle in the Atlantic Codex," he wrote.

Studying the copies, Prof Pedretti realised that the springs were not meant to drive the car but to regulate a drive mechanism located elsewhere. In 1996 his intuition was reported in a book by an American robotics expert, Mark Rosheim.

"He believes that motive power is provided by coiled springs inside the tambours", Mr Rosheim wrote.

The theory that the car's "engines" were sited in a couple of drum-like casings on the underside resolved many of the enigmas in Leonardo's design. But until Prof Galluzzi and his team got to work, it was still just a theory.

Their first step was to create a digital model by computer aided design.

"That took four months," Prof Galluzzi told the Guardian. "But at the end we had a machine which we knew ought to work."

To test Leonardo's genius to the limit it was decided to try to realise his vision with materials available to the craftsmen of his time. That meant mainly wood.

Florentine furniture restorers were asked which types their predecessors would have chosen for which parts of the vehicle.

"The biggest problem was to find a wood for the cogs, because that had to be hard and resistant.

The finished vehicle contains five sorts of wood and "mechanisms of extraordinary refinement".

Leonardo scholars have long believed the car was intended to provide special effects in some kind of performance.

It has a brake that can be released at distance by an operator with a hidden rope, so it would have appeared to start by itself.

A programmable steering mechanism allows it go straight, or turn at pre-set angles. But only to the right. Good in towns like today's Florence, with a one-way system. As ever, Leonardo was centuries ahead of his time.