Harm Reduction is Not Enough!

The intent of this article is to help you understand our position when it comes to prioritizing Harm Reduction initiatives over Prevention, Enforcement and Treatment related to substance abuse and addictions. It is plainly and painfully obvious that in recent years, Canada have failed miserably in the preventing the onset of substance use and in providing enough treatment for people with addictions. The result has been an increase both in the number of people using drugs: and, tragically, in the number of people dying from drug overdoses.

To start your thought process, I would like to refer to a common metaphor used in the world of public health education. It is referred to “upstream thinking”. You can see one animated version of it here. [LINK: https://www.youtube.com/watch?v=xYeAmafTGCA&t=4s]

We can use this analogy to talk about drug addiction. Starting to use drugs is like playing on the side of a cliff near a river. People like the thrill of jumping into the river. Sometimes they swim to shore and climb back up safely. However, as they get more venturous, some jump too far out into the river, get caught in the current and are washed down stream (addicted).

We can also apply this analogy to the Four Pillars Strategy to combat drug addiction (Prevention, Enforcement, Treatment, and Harm Reduction).

Prevention would be going up stream to put up signs warning people of the danger and asking them to stay away from the area. This would reduce the number of people ending up in the river.

Enforcement is like putting up a fence and patrolling the area up stream to keep people from going to the river’s edge. This would also help reduce the number of people from falling into the river.

Treatment is like going out in a life boat to rescue the people and bring them to shore. This would reduce the number of people in the river.

Harm Reduction is like throwing a life preserver to the person while leaving them in the river. This does not reduce the number in the river. It may initially help; however, if Treatment is not there to pull them out, they will eventually perish.

Only Prevention, Enforcement and Treatment can reduce the number of people suffering from addiction and lessen the harms to them, their families and the community. Sadly, the recent liberal policies of the government have put more money into Harm Reduction than anything else. And as the analogy clearly illustrates, Harm Reduction will never be enough without Prevention, Enforcement and Treatment.

To make matters worse, some forms of Harm Reduction actually do more harm than good. For example, the money used for a Supervised Injection Site (SIS) takes away valuable resources that could have been used for prevention or treatment. The number of overdose deaths (OD’s) have continued to rise every year since the SIS opened in Vancouver in 2003 (58 in 2003). Not only that; but, the percentage of OD’s in Vancouver, when compared to the rest of British Columbia, has also risen from 3.27% in 2003. Yet, even with the large number of deaths each year, the number of addicts living in the city continues to grow. This is a result of “down-stream thinking”. Too much spent on life preservers and not enough on keeping them from jumping in or pulling them out of the river.

The latest Harm Reduction approach is Safe Supply. Providing drugs freely to addicts does not help them, as the main driving force for their addiction is frequently mental and/or physical illness causing despair and hopelessness. They lose their human dignity, become malnourished, have a pervasive lack of self-esteem, and become homeless as a result of their continued drug use. According to evidence provided to the Alberta Select Special Committee by Michael Shellenberger, U.S. author of the book, San Fransicko, the practice of Safe Supply is “a bizarre medical experiment helping homeless drug addicts use drugs which is handing a loaded gun to a suicidal person. This approach shows a sever lack of understanding of how an addiction controls a person’s brain. The addicted brain is always in search of more drugs. With increased use comes increased tolerance to what they were using. This insatiable appetite of an addicted brain is incapable of making the rational decision to wait for a “safer” supply. This is especially true, if the “safer” supply is not potent enough to satisfy their craving. Instead, it can be traded for something on the street that might.

Decriminalization is not the Answer

The Federal Government recently granted the Province of British Columbia an exemption to decriminalize the possession of certain drugs. This may help prevent some drug users from getting charged; however, it has the potential to do more harm than good. First of all, it will make it easier for street level drug traffickers to carry drugs without fear of conviction. That will increase the availability of illicit drugs resulting in an increase in use and related harms. To believe that the answer to the opioid crisis is to change the legal status of the drug is to ignore the massive evidence showing how much more harmful the use of alcohol and tobacco are in comparison to all illicit drugs combined in Canada and globally.

Assisting the Addict

Abstinence-based Treatment and readily available supportive recovery are effective approachesv to dealing with addiction and its physical, psychological and spiritual dimensions. These support systems deal with the underlying problems. Providing readily available drugs does not help the addict, but only deepens dependency and leads to continued and sustained suffering and frequently, to a terrifying and lonely death.

At the time of this writing, the Province of Alberta is showing early signs of success with a significant decrease in overdose deathsvi with its focus on increasing access to a range of prevention, intervention, treatment and recovery services. The system involves a coordinated network of government and non-profit partners working to improve outcomes for Albertans. This coordinated approach, with the emphasis on helping people choose abstinence, rather than helping them use drugs, is what is needed to overcome the current crisis.

What is currently needed most in Canada is strong leadership to help prevent the onset of drug use. Please refer to our page on Prevention to learn more about the need for a comprehensive community-based drug prevention strategy throughout the country.

Sincerely yours,

Chuck Doucette

President

Drug Prevention Network of Canada