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Do you support harm reduction? Then, say so...

Harm reduction was front and centre in the discussion at the recent national convention of the Canadian Students for Sensible Drug Policy (CSSDP) in Calgary entitled Progress Not Prisons.  I attended this conference and spoke about my experiences with the Insite case on a harm reduction panel with Donald MacPherson of CDPC and Jennifer Vanderschaeghe of Central Alberta AIDS Network Society (CAANS).

Naturally, the impacts of the Harper government’s omnibus crime bill and its effects on drug users was a hot topic, but there was also much interest from conference attendees to discuss the frontiers of harm reduction in Canada and ways that they could advocate for these services in their communities.  Deep in the heart of Stephen Harper’s conservative base, I found it inspiring that Canada’s youth were prepared to take on this often-controversial issue, and even more inspiring to meet the organizations and people providing harm reduction services across Alberta and elsewhere.  There were some media outlets at the conference and they picked up on the theme of harm reduction as well.  The CBC did a piece on the conference as did Global TV (at approx. 6:45)

As I mentioned on the Global TV interview, harm reduction – the idea that society should focus resources and efforts to minimize the harms to drug users and society without requiring abstinence of drug users – is an ideology.  It’s an ideology that Pivot supports and a driving force behind our health and drug policy campaigns.  In our view, any steps that can be taken to help drug users remain healthy and alive improves the chances that they can someday take positive steps to improve their lives and, maybe, end their addiction.  Helping people with addictions live free of drugs is a point of common ground between harm reduction proponents and opponents, while the path to get there is often quite different. 

The Conservative government takes the position that drug use should be criminalized and punished and that the only reasonable option for drug users is to “just say no”.  They argue that society should make drug use so difficult for people that people with addictions will just decide it’s too much bother to continue with their addiction and get treatment (or else suffer the consequences and go to jail).  This is also an ideology, but one that’s not supported by any evidence. 

In the Insite case, the federal government tried to portray the arguments pro and against Vancouver’s supervised injection site as competing policies that should be decided in the election booth and not in the courts.  In the end, the Supreme Court of Canada rejected this argument and its decision in this case was a resounding support for evidence-based policy over policy based on stereotypes of drug users and good intentions that don’t play out in the real world.

In my remarks at the CSSDP conference, I tried to focus on the future.  Sure, Insite was a fantastic and amazing victory for a much-needed health service in the Downtown Eastside and certainly a cause to celebrate, but where do we go from here?  Many of us thought that following the Insite decision supervised injection sites would be put in place across Canada in the needed regions, such as in Montreal, which in the 1980s was one of the first cities in North America to establish a needle exchange program.  In December 2011, the city’s public health department proposed three supervised injection sites in Montreal, with an additional mobile site.  Cactus Montreal – a non-profit working with marginalized people -  stepped up and expressed interest in running the injection site.  Pending approval of Quebec Health Department, it seemed as if at least one of these sites would be implemented before too long. 

By mid-February 2012, however, everything had changed when Mayor Gérald Tremblay stated that no injection sites would be implemented downtown, except in existing health care facilities.  Citing complaints from downtown merchants, the City backed away from providing life-saving health care to its most marginalized and vulnerable residents.  "Not-in-my-backyard" - or NIMBYism - had reared its ugly head.  Despite the legal right to harm reduction services guaranteed by the Insite decision, ideology that is not based on the evidence has again stood as a roadblock to saving lives and preventing disease transmission.    (It’s maybe pointless to mention that the “downtown merchants” were apparently operating from their own preconceived notions, rather than reality. The idea that harm-reduction services act as a “honey pot” attracting drug users is just not borne out by any evidence).

The challenge for the future of harm reduction will be an educational battle as much as a legal one.  The Insite case demonstrated that the courts can force government to make some decisions if the evidence supports that decision.  But, because of the federal government’s continued opposition to harm-reduction, the Insite case took three years to resolve and racked up a million or so dollars in legal fees.  It’s obviously not realistic for every battle to be fought out in the courts as the Insite case was.  What can we do then?  I say that if there’s a concerted effort on the part of some communities to oppose harm reduction services in their neighbourhood, why can’t those of us who believe in the evidence – who believe in harm reduction – take up the cause to promote these services just as forcefully?  If enough community members were to come out in the media and to their elected officials and say that they support such services, that would give the politicians the confidence they need to make the right decisions, rather than crouching behind a vocal minority opposing the services.  The answer to NIMBYism may simply be enough people instead saying “Yes, in my backyard”.  That's what the students at the CSSDP conference were saying, and we should add our voices to theirs.