Why 'harm reduction' won't work
From the Vancouver Sun (British Columbia)
March 19, 2005 Saturday
SECTION: EDITORIAL; Kevin Sabet; Pg. C5
latest plan -- maintenance for heroin users --
overlooks an elementary fact: The problem with
drug use is, oddly enough, drug use
By Kevin Sabet,
Special to the Sun
Vancouver has one of the highest rates of drug
abuse and infection in the world, according to
scientific studies published about the city.
That is why Vancouver's latest plan to
maintain heroin users on their drugs of choice
-- cornering more addicts into a life of
despair and sickness -- is worrying me and
scores of public health officials worldwide.
As in most major cities around the world,
Vancouver's drug problem is multifaceted and
complex: The regular consumption of multiple
drugs by a significant minority of the
population, rising purity rates, and crippling
violence exacerbated by regimented criminal
organizations exhaust policy-makers looking
for a "quick fix" to the drug problem.
To make matters worse, a disproportionate
number of drug addicts in this city have HIV
(at least 30 per cent) and Hepatitis C (a
staggering 90 per cent), either perpetuated by
risky sexual behaviour under the influence of
drugs or as a direct result of sharing
Even the most extreme anti-drug hawk, then,
might be able to understand why so many
well-meaning officials and social workers
would raise the white flag with policies like
government-sponsored drug shooting galleries.
Supporters of these legal injection rooms
constantly remind us of the "great Swiss
example." Swiss government-funded scientists
hailed their heroin maintenance project a
success since it concluded that addicts
experienced "improvements in health and
well-being" and less criminal behaviour. This
single review of the Swiss trials has been
showcased worldwide as a success of
government-sanctioned drug maintenance.
But independent evaluations of the program
have been less than sanguine. One of those
evaluations -- the official line from the
United Nations -- chided the study on the
basis of its shoddy design and poorly drawn
conclusions. The World Health Organization
concluded that the Swiss studies "have not
provided convincing evidence that . . . the
medical prescription of heroin generally leads
to better outcomes."
Science tells us that heroin maintenance is a
sloppy alternative to drug treatment
strategies like methadone and buprenorphine.
Common sense and compassion dictate that, no
matter how difficult, uneasy, or
uncomfortable, we cannot hide sufferers of
addiction in a drug den on the outskirts of
town -- we must confront their disease.
It is astonishing that we must perpetually
remind ourselves that drug-taking behaviour
can be changed when thousands of people in
recovery today are living examples of this
So, what is a country or city to do? A lot.
When Sweden found in 1985 that HIV prevalence
was more than 50 per cent in its capital city,
it established a comprehensive approach of HIV
testing and methadone maintenance treatment
coupled with hospital units, drug education
and counselling for drug users with infectious
The result? HIV among injection drug users in
that city stands today at five percent. Drug
use there is the lowest in Europe.
Evidence from elsewhere suggests that when the
criminal justice system and public health
community work together (in the form of
specialized "drug courts," for example), our
problems get smaller.
Meanwhile, some officials in this city still
respond to this social and biological disease
by prolonging it. HIV and Hepatitis C rates
continue to soar; Vancouver's overdose rate is
the highest in Canada. One Vancouver police
drug squad inspector, Mark Horsley, recently
said that Vancouver is the "warehouse
distribution centre of drugs in Canada."
Cross-country comparisons are problematic, but
giving in to harmful behaviour by supporting
drug use gets us nowhere. So-called "harm
reduction" measures, no matter how
well-intentioned, fail to stop drug use and
redirect drug addicts. Instead, these policies
accept the inevitability of addiction when we
know this disease can be prevented or at least
Reducing total harm, on the other hand, must
begin by cutting drug use.
Rejecting heroin maintenance doesn't mean that
restrictive drug policies, such as those
sanctioned and supported by the UN and U.S.,
are our magic bullet. They have implementation
and effectiveness problems of their own. But
our overarching goal should always be to
reduce total harm and to make our drug
policies work better within that context of
reducing drug use.
As elementary as it sounds, it seems that some
people still need to be reminded that the
problem with drug use is drug use.
A so-called "harm reduction" policy is
essentially flawed because it has at its core
narrow goals that deny the complex social,
legal and biological context of drug use and
Reducing total harm, then -- to one's self,
community, and society, users and non-users --
must be the true goal of prevention and
treatment providers who understand that drug
abuse is a treatable, yet fundamentally
preventable, disease of the brain and body.
It is inhumane to perpetuate this disease when
history and science tell us that it can be
prevented and its attendant consequences
reduced, if not eliminated.
Kevin A. Sabet is a Ph.D. student at Oxford
University. He was a senior drug policy
speechwriter in both the Clinton and Bush
Administrations. His book, Dealing With Drugs,
will be published this spring.