‘Harm reduction’ is starting to pay dividends

Despite the stereotypical image of addicts shooting up in grubby back alleys, there’s good news that overall illicit drug use is declining.

Despite the stereotypical image of drug addicts shooting up in Vancouver’s grubby back alleys, there’s good news that overall illicit drug use is declining. And it has nothing to do with drug law enforcement, the “war on drugs”, or the federal government’s National Anti-Drug Strategy.

This encouraging trend is all about the expanding harm reduction programs.

Last month, the Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/AIDS released its report Drug Situation in Vancouver which detailed information on drug use, drug availability, HIV rates, and behaviours among the city’s most vulnerable drug addicts.

The study looked at trends over the last 15 years. Overall, there has been a decline in illicit drug use with a dramatic drop in cocaine injection from 38.1 per cent in 1996 to 6.9 per cent in 2011. Daily heroine injection has also declined. On the down side, there was an increase in the use of other drugs such as crack cocaine smoking, injection and non-injection crystal meth use, and prescription opioid injection. The use of these drugs peaked in 2007 but since then the use of all drugs mentioned has declined although the habit of crystal meth injection remains high.

The good news about the overall downward trend is that addiction treatments and harm reduction programs are clearly connecting and having a critical impact. Methadone maintenance therapy went up from 11.7 per cent in 1996 to 53.3 per cent in 2011 with the concentrated trend in MMT occurring from 2008 to 2011, mainly because drug users were finding it easier to access treatment.

In addition, the report stated that “The dramatic decline in syringe sharing among people who use illicit drugs in Vancouver can be largely attributed to the expansion of harm reduction programs in the city with 39.6 per cent of people reporting syringe borrowing in 1996 but only 1.7 per cent reporting syringe borrowing in 2011.”

Along with that decrease has been a corresponding decrease in both HIV and HCV incidence rates with obvious public health benefits.

“Drug trends in Vancouver are shifting, with fewer people injecting drugs and more people ceasing their use, a result of the innovative harm reduction and addiction treatment programs implemented,” said Dr. Thomas Kerr, report co-author and UHRI co-director. “It is important policymakers at all levels of government take note of this evidence and focus efforts on approaches proven to be more effective. Continuing to invest in failed policies like the war on drugs does little to reduce health and social harms.”

Those federal war-on-drugs policies have had minimal effect on readily available cheap drugs.  From science research findings to the opinions of drug users on the street, harm reduction programs are what get things done. Insite, Vancouver’s safe injection site, is testimony to that. “Needle exchanges and the supervised injection facility have proven to save lives, but drug use trends are changing and policies and programs should reflect these changes,” said Lorna Bird, a drug user and member of the Western Aboriginal Harm Reduction Society. “We need more harm reduction interventions, like safer crack smoking kits, supervised consumption facilities for people who smoke illicit drugs, and programs focused on at-risk youth.”

The harm reduction facility, Insite, is not just a place for safe needle use. It is a gateway for  addicts to get medical help and counselling to change their lives. Many Canadian cities need an Insite of their own yet the Harper government’s “Respect for Communities Act” will contain criteria making it very hard for other cities to launch similar programs. How counter-productive is that?

Policymakers must accept that harm reduction programs work and provide the framework to make them happen across Canada.