Canada's rapidly evolving drug strategy is raising eyebrows at the White House Office of National Drug Control Policy and inviting the ire of John Walters, the so-called U.S. drug czar, who has visited Vancouver personally to lobby against what he sees as wrong-headed, dangerous policies.
Perhaps the most irritating friction point between the two countries is the funding of a safe injection site for heroin and cocaine addicts by Health Canada, the nation's government-run healthcare system. This week, Vancouver opened the first legitimate "shooting gallery," where addicts are provided with sterile equipment, medical care and counseling.
Harm-reduction advocates hope the Vancouver site will follow in the footsteps of a similar program in Frankfort, Germany, and other European cities where the introduction of safe injection sites brought about a reduction in crime, medical and legal costs and a drop in overdose deaths.
The political will to support the controversial program emerged after a sudden spate of overdose deaths and a spike in diseases such as HIV/AIDS and Hepatitis C devastated Canada's urban drug-using populations in the 1990s.
Member of Parliament Libby Davies began lobbying for government funding to address the needs of her district, Vancouver's lower East Side -- the epicenter of the intravenous drug-user disease epidemic.
"In my constituency drug overdose was the leading cause of death," Davies told United Press International. "People recognized that law enforcement was a useless tool for dealing with a public health problem."
Indeed, the current approach stems from a widespread perception that the criminalization strategy does not work. Nevertheless, the site has outraged the Bush White House and prompted David Murray, special assistant to Walters at ONDCP, to suggest publicly that it could jeopardize trade between the two countries by forcing the United States to tighten its northern border. Walters has called Canada's program "state sponsored personal suicide."
The argument that safe injection sites will prevent disease transmission is "utterly phony," Walters told UPI. It rests on the notion that certain drug users cannot be helped with treatment and recovery and is akin to suggesting some people's lives are not worth saving, he argued.
"I think it's outrageous to say that there's a certain category of people who are unworthy of the kind of care that we can offer," Walters added. "I don't' believe that Americans subscribe to it and I don't think we (at ONDCP) should."
The best way to restrict needle-sharing and to "stop sero-conversion (to HIV-positive status) is to get people into recovery," Walters said. If addicts are not shooting up, they will not be spreading disease, he added.
Baltimore, the U.S. city hardest hit by the crime and disease-related fallout of the injection drug-use epidemic, saw an increase in HIV and Hepatitis C cases after it introduced needle exchange programs in the 1990s, Walters said.
"It was going to be the model of how to do harm reduction. In the course of that decade, Baltimore became the most seriously harmed city in the country," he said. "The current level of HIV infection is almost unbelievable, given what you see in the rest of the country. He noted Great Britain also experienced an increase in its drug-addicted population when it implemented a similar program.
Some researchers have called that analysis misleading, however.
"Baltimore did not have a (needle exchange) program until 1994 and by then 90 percent of injection drug users were already infected with Hepatitis C -- they were already behind the eight ball," Stefanie Strathdee, associate professor of epidemiology at Johns Hopkins University in Baltimore, told UPI. "How can you turn around an epidemic that already happened?"
Strathdee added there is "no evidence that addicts will use more, that it will cause more crime or that they'll be more needles on the street. Each one of those arguments has been systematically addressed and there's just no evidence whatsoever to support them."
This fall, Canada will test prescribed heroin as a treatment option for recalcitrant, long-term heroin addicts, another move opposed by the ONDCP. The multi-center study, sponsored by Health Canada, seeks to determine if intractable drug users can be made healthier and more functional when given controlled doses of heroin in a supervised environment.
Some research suggests prescription heroin stabilizes addicts who do not respond to methadone, helps them return to productivity and reduces the risk of overdose death.
A 2001 study by University of California, San Francisco, researchers surveyed the characteristics of 1,427 San Francisco heroine users and compared the behaviors of those who overdosed with those who did not. The researchers found socially marginalized heroin injectors who lack a stable community, a safe place to inject, and a steady and known supply of heroin tend to be more likely to overdose.
A five-year study of Switzerland's prescription heroin treatment program -- which has existed since 1992 -- found crime had dropped by 60 percent and unemployment by 50 percent. Also, significant public funds were saved due to a reduction in legal costs, imprisonment and disease treatment after the program commenced.
Many critics find it hard to swallow the argument that addicts should be treated with the very substance that enslaves them. Even Canada's conservatives have argued these strategies enable drug addiction by providing addicts with a state-subsidized fix.
Proponents counter they do not claim to possess a silver bullet that will cure drug addiction. Instead, safe injection sites and prescription heroin programs are just one potentially useful treatment option to attempt to address the needs of a specific kind of substance abuser.
"These programs are not the answer -- but they address a particular need for a highly marginalized, usually homeless, injection drug using population," Donald McPherson, drug policy coordinator for the city of Vancouver, told UPI.
"There's an element out there that wants to say we're soft on drugs," McPherson said. "But it's not about politics. It's about pragmatic intervention -- it's about reducing death and reducing deadly diseases."
As Canada pushes forward with its harm-reduction agenda, the ideological divide between the Canadian and U.S. governments could widen. But if the polarized sides in the anti-drug debate agree on one thing, it is a more effective approach is urgently needed. Drug overdose emergencies are flooding hospitals in North America's urban centers and addictions continue to devastate lives.
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