Archive for November, 2012

Recently, there have been two opposing paradigms used to deal with the substance abuse problem. On the one hand, there is the criminal justice model, which is used to prohibit, criminalize, and control drug use. And on the other hand, the public health model, based on harm reduction, which is used to reduce the negative consequences of drug use for the individual, the community, and the society while allowing that a person may choose to continue to use drugs. Currently, Canada is dominated by the prohibitionist drug laws and law enforcement over perspectives of health and harm reduction.

The history of Canada’s drug laws is closely linked to the to the 1908 Opium Act and the public fear of Chinese immigrants. This group was considered a cheap source of labour for the railroads and mining in British Columbia. During this time period, The Chinese became an “economic threat” to other Canadians. Hostility towards Chinese immigrants reflected in the first Canadian anti-drug legislation (Dias, 2003).

In 1986, the U.S. president Ronald Reagan declared the “war on drugs” that started a new era of drug prohibition in Canada and worldwide. Levine (2002) argues that drug prohibition has been adopted throughout the world for a number of reasons. Firstly, the spread of drug prohibition and anti-drug ideology were politically and financially useful to many politicians, the media, and religious institutions. Secondly, drug prohibition has given governments additional police and military powers. For instance, government officials have used anti-drug squads to conduct surveillance operations and military raids that would not otherwise have been able to justify (Levine, 2002). In addition, within the United States, drug users are considered to be anti-American, foreign, and/or diseased (Grayson, 2003). At the domestic level, drug laws have been used to define the American national identity, often in combination with a racist ideology. Grayson (2003) notes that various American counter-cultures have been the targets of the “war on drugs”.

Specifically, the jazz musicians of the 1940s, the Hippies of the 1960s, and the ravers of the 1990s, have all found themselves victims of the U.S. drug laws. According to Grayson (2003), at the international level, the “war on drugs” demonstrates the U.S. power and leadership. These drug laws have facilitated the process of surveillance and numerous countries are monitored by the United States to ensure that they are complying with the American drug control regime. As a consequence, the “war on drugs” has legitimated American influence in the internal affairs of Columbia, Bolivia, Peru, and Panama.

Levine (2002) suggests that the varieties of drug prohibition can be seen as a continuum. The author calls the most punitive end of the continuum a criminalized drug prohibition and the other end a decriminalized drug prohibition. For instance, U.S. drug policy is an example of criminalized drug prohibition because it uses criminal laws, police, and imprisonment for possession, personal use, and a small-scale distribution of psychoactive substances. In contrast, the cannabis policy of the Netherlands illustrates a decriminalized and regulated form of drug prohibition. The Netherlands has specific laws prohibiting the production and sale of forbidden drugs, however, certain cafes and coffee shops are licensed to sell minute quantities of cannabis for personal use (Levine, 2002).

Since 1980s drug prohibition has faced a series of crises. The research  identifies three turning points, specifically, the growth of opposition to punitive drug policies, the inability of drug prohibition to prevent the cultivation and use of cannabis throughout the world, and the emergence of harm reduction movement.

Harm reduction provides an alternative to the classic prohibition and criminalization options. The meaning of the term harm reduction is still disputed and there is no generally accepted definition of harm reduction.

The history of harm reduction can be divided into several phases. In the pre-1980s era, the UK started the “medicalization” approach in which drug users were prescribed heroin and cocaine. The Rollestone Committee of 1920s recommended that in certain cases addicts can be prescribed narcotics in order to reduce the harm of their drug use (Marlatt, 1996).

In the post 1980s era, harm reduction has emerged primary as a “bottom up” approach based on addict advocacy rather than a “top down” policy (Marlatt, 1996). Harm reduction was founded by grassroots advocacy among drug users themselves. In 1980 the “Junkiebond” was established in Rotterdam as a kind of trade union for Dutch drug consumers. Input from the “Junkiebond” led to the development of the first needle exchange program in Amsterdam in 1984.

As an ideology, harm reduction is a non-judgemental approach that minimizes marginalizing the “powerless” and facilitates the individual’s integration into communities (Einstein, 2007). In addition, harm reduction is an ongoing process that is situated within an advocacy system and people who are engaged in harm reduction must take a political position and change from passive recipients to active partners (Einstein, 2007). Some scholars define the harm reduction as a proto-political civic and civil movement for drug users (Lenton and Single, 1998; Tammi, 2007).

The harm reduction movement considers drug consumers as sovereign citizens and normal, responsible, and active members of community. This position is against the punitive prohibition perspective in which the user is perceived as either morally, criminally or medically deviant person. In addition, the harm reduction movement argues that drug policy should be based on practice and science, not on ideology and dogmatism. Tammi (2007) argues that harm reduction is an emancipating movement to liberate users and eliminate unreasonable suffering caused by punitive prohibition control.

Harm reduction constructs drug use as normal action that inevitably occurs in modern society. Marlatt (1996) suggests that harm reduction accepts the fact that many people use drugs and engage in high risk-behaviours and the visions of a drug free society are unlikely to become reality. The harm reduction approach recognizes that abstinence as an ideal outcome but adopts alternative procedures that reduce the harmful consequences of addictive behaviour. Lenton and Single (1998) note that while harm reduction measures do not necessarily reduce drug use, some harm reduction measures involve using drugs in safer ways or lower dosage. The harm reduction perspective informs some types of services including, education, overdose prevention, training, referrals to treatment and social services, needle exchange programs, substitute medications, and safe injection rooms.

Over the last 20 years in Canada, harm reduction rhetoric has played a prominent role  in substance policy and programming. Vancouver’s four pillar drug strategy is an example of the attempt to balance the goals of harm reduction, law enforcement, treatment, and prevention (Heathaway and Tousaw, 2008).

Within the city of Vancouver, injection drug use activity is highly concentrated in the Downtown East Side (DTES) neighbourhood. The DTES faces a wide range of challenges, including the increasing rate of the homeless population, deteriorating single-room occupancy hotels, and an active sex trade. It has been estimated that approximately 17% of the injection drug users are HIV positive and more than 80% are infected with the Hepatitis C virus. The majority of drug users in the DTES inject heroin (51%) and 32% cocaine ( Campbell, Boyd, and Culbert, 2009).

In 2003, Health Canada granted an exemption under Section 56 of the Controlled Drugs and Substance Act to establish a supervised injection site in downtown Vancouver. In August 2007, Insite announced provincial funding for expansion of their services to include 12 medically supervised detoxification beds and 18 temporarily housing units. On September 29, 2011, the Supreme Court of Canada ruled unanimously to uphold Insite’s exemption from the Controlled Drugs and Substance Act, allowing the facility to stay open indefinitely (Heathaway and Tousaw, 2008).

Scientific research indicates that medically supervised injection of illicit drugs reduces needle-sharing and deaths from overdose, improves public order and uptake of addiction treatment. Although evidence of the effectiveness of Insite has been overwhelming, the federal government remains politically opposed and questions the constitutional legality and medical advantages of the facility.

So what is the future of a harm reduction policy in Canada given that a conservative federal government strongly supports law enforcement, prohibition, and “tough on crime” provisions?  These reforms suggest that treatment strategies developed under an umbrella of harm reduction approach are unlikely to be promoted by federal government. The “war on drugs” adopted by the conservative government is a political was waged not by scientists and doctors, but by police officers and politicians there is almost universal agreement that prohibition policies based on criminalization of consumption have not worked. Therefore, it is time to replace an ineffective strategy with more humane and efficient drug policies.

On-line recourses:

Organizations with web links to news articles, publications, and other resources on harm reduction include:

Canadian Harm Reduction Network

http://canadianharmreduction.com/

International Harm Reduction Association

http://www.ihra.net/

Insite, Supervised Injection Site

http://supervisedinjection.vch.ca/

References:

Campbell, L., Boyd, N. and Culbert, L. (2009). A thousand dreams: Vancouver’s Downtown Eastside and the fight for its future. Vancouver: Greystone.

Dias, G. (2003). “Canada’s Drug Laws: Prohibition is not the Answer”. In Perspectives on Canadian Drug Policy, Vol. 1, The John Howard Society of Canada, pp. 9-24.

Einstein, S. (2007). “Harm and risk reduction: history, theories, issues, and implications”. Substance Use and Misuse, pp. 267-265.

Fischer B, Bibby M, Argento E, et al. (2012).  “Drug Law and Policy in Canada: Torn between criminal justice and public health”, in Ismali K, Sprott J, Varma K, (eds.), Canadian Criminal Justice Policy: Contemporary Perspectives

Grayson, K. (2003). “Discourse, Identity, and the U.S. ‘War on Drugs’”. In Beare, M. Critical Reflectiond on Transnational Organized Crime, Money Laundering, and Corruption. Ed. University of Toronto Press. pp. 145- 169.

Hathaway, A., Tousaw, K. (2008). “Harm Reduction headway and continuing resistance: Insights form safe injection in the city of Vancouver”. International Journal of Drug Policy, 19, pp. 11-16.

Levine, H. (2002). “The Secret of Worldwide Drug Prohibition. The Varieties and Uses of Drug Prohibition”. The Independent Review, Vol. 8, pp. 165-180.

Levine, H. (2002). “Global drug prohibition: its uses and crises”. International Journal of Drug Policy, Vol. 14, pp. 145-153.

Marlatt, A. (1996). “Harm reduction: come as you are”. Addictive Behaviours, Vol. 21, No. 6, pp. 779-788.

Tammi, T.(2004). “Harm reduction school of thought: three fractions”. Contemporary Drug Problems, 31 (3), pp. 381-399.

Advertisements