Little evidence harm reduction reduces harm - VANCOUVER SUN OP-ED

 By David Berner,

Vancouver SunJuly 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.

 David Berner is the executive director of the Drug Prevention Network of Canada.