A comment from the last post requires, or inspires me, to a fuller response. Actually, forgive me, it turned out rather long. Feel free to skim.
Sam said:
I have read Connie Howard’s article, and while it’s well-written and presents a convincing case (to me at least) for keeping InSite operating, I was hoping also to read a presentation of the reasons why the federal government might want to close the site, and an argument about those reasons. That part of the broader argument seems to me to be missing. From my limited exposure to this work, I understand that harm reduction is still a controversial approach to the problems around drug use and abuse and that there are valid reasons for opposing this approach.
Thanks Sam. The reason, I suspect, you didn’t get a presentation of the reasons why the federal government is opposed to InSite, is because they have never clearly stated them. All they have said, repeatedly, is that safe injection sites add harm and offer no hope. But, as Connie Howard pointed out, even their own study refutes that stance. According to Simon Fraser University criminologist Neil Boyd, who was hired by the Conservatives to advise the committee overseeing their study, the research shows that "InSite has no apparent negative impacts, has resulted in "modest decreases" in drug use, and has not disturbed public order." In fact, Boyd said, "InSite should not only be continued, but the program should be expanded to other locations." Adding, "I think our data suggests… the building of additional facilities of a similar kind in neighborhoods where they are needed would yield benefits much in excess of the costs required for such projects."
So what, in light of this, are the reasons for the Harper government’s ongoing resistance? I’m guessing it has everything to do with the government looking soft on drug use. And that’s not an image Conservatives are comfortable with. At InSite, drug abusers cannot be arrested and prosecuted. That, I’m sure, rankles. And the Tories certainly don’t want to offend groups like REAL Women, and the Canada Family Action Coalition, who were quick to thank the Health Minister for resisting pressures to support programs that aid people in using illegal drugs. The Conservatives are loathe to carve out exemptions because it looks like caving in.
And so, on the defensive, Tony Clement puts on his priestly raiment and tells us that the government’s approach is the one that’s more caring and compassionate. He says he is not about to give up on the addicts, like the folks at InSite. And he scorns the perceived "enabling" of harm reduction.
Tony Clement is not an unprincipled or, I’m sure, an uncaring person. I understand his reasoning. I once held to it. But after 20 odd years of being around the problem, I now see that it’s reasoning that has a higher regard for a personal conviction than for grappling with the complexities and devastation of chronic drug addiction, and the reality of life on the street.
InSite does not give up on abstinence. But it does consider carefully the nature of addiction, and as a result offers a dignified and caring approach–that of harm reduction. Harm reduction is not a form of co-dependence, and is not the same thing as enabling. And there is no evidence that harm reduction encourages drug use. What it does do, is treat chronically afflicted addicts in a way that allows them to lead more bearable lives, and, in the process, find an oasis of calm, where choices may, perhaps, open up for then. For many addicts in Vancouver’s lower Eastside, InSite has been the first place they have encountered compassion, and is the first link they have had with the medical system.
Without doubt, many lives have been saved through the presence of InSite. The reactionary charge, without evidence, has been made that InSite’s existence has lead to more lost lives than saved lives. But that’s like blaming medical clinics for the existence of disease. If it could be shown that InSite adds to the number of addicts then it has stepped out of the realm of harm reduction. If InSite’s existence caused more crime, more drug use, more drug trafficking, more HIV/AIDS, even more general social disorder, it would not be in line with harm reduction.
And as far as chronic addicts being enabled by being given clean needles, a sanitary place, with watchful and caring supervision, while they engage in something they would have otherwise done in an alley…well, I don’t think so. But let me add, not all drug abusers are equal, and I do concede that for some, a safe injection site may, or may not, perpetuate an early habit.
It is true that for some, the immediate negative consequences of drug abuse is enough to convince them to enter a program. For these people, no safe injection site is needed. But hardcore drug addicts have experienced every possible negative consequence, save death. As it happens, it’s these hardcore addicts that InSite attracts. And that should be a salient point for consideration. Every parent knows that equal treatment, is not necessarily fair or just treatment. InSite is simply calling for a recognition of that common understanding. And with political will and desire, an exemption to the drug law can be upheld. To refuse to see this, as far as I see, is a refusal not on humane reasons, but for reasons, political and ideological.
Finally, with respect to enabling, here is something of a parallel consideration: As Gabor Mate’ points out, we don’t refuse life-saving treatment for chronic smokers with lung cancer; or inveterate over-eaters for cardiac arrests; or workaholics for stress related strokes; or abused women for staying with their abuser. Does treatment enable these addictions? Should we refuse medical care here so that they might feel a greater negative effect of their choices?
So here’s a plea to Conservatives: Do no harm. A safe injection site can provide a little haven where patient and compassionate human contact, opens an avenue for self-respect and possibility. At InSite, harm reduction makes the lives of chronic drug addicts bearable, with the potential of ushering in rehabilitation for some. Overall, harm reduction broadens the scope of hope.
(In writing this, I’ve had much inspiration from Gabor Mate’s book, In the Realm of Hungry Ghosts. Mate’ has worked as a physician in Vancouver’s Downtown Eastside for over 12 years.)
Letter to Stephen Harper in support of InSite.
Thanks Steve, for that articulate and insightful response to Sam! (I’ve been too busy to visit GM, and just saw this discussion yesterday.) Here, from what I can tell, are the reasons our government presents for their opposition.
They say the program amounts to a de facto legalization of heroin, and they are opposed to “sanctioning” the use of illegal drugs. They’ve argued that purported benefits are questionable, and that conclusions reached by the scientific literature may not be accurate. They see safe injection as comparable to holding AA meetings in a bar. They argue that because only a small percentage of all injections take place at the site, harm reduction is minimal (which to my mind is kind of like saying that just because most of us don’t take other harm reduction and health preventions measures seriously we should stop supporting or permitting them also). They argue that it costs too much for the number of lives it saves—and yes, if it was more profitable, like, say, prescription drugs are, it would very likely be acceptable to them.
They’ve said the only moral thing to do is to get addicts off drugs, and that permitting dependence to continue is in fact immoral—but what about the rest of us, managing symptoms of all kinds on legal drugs that are very often also addictive? Would they argue against the use of addictive (and often very harmful) psychiatric drugs that manage mental illness? Would they invest and support natural alternative medicines that effectively manage many of the symptoms driving people to use both legal and illegal drugs? Would they invest in natural medicines known to help with addiction and withdrawal?
Use of illegal drugs may begin as recreational, but is often fuelled by underlying mental health conditions. And addiction, once developed, needs to be approached as an illness.
Having gone over their objections again, it still looks to me very much like they are more about ideology than any of the reasons presented.
Thanks Connie, and thank you again for your initial article.
After reading the blog postings and comment, I still can not support a government facilitating the use of illegal drugs in any way. For one thing it completely undermines the efforts of law enforcement who are mandated to fight illegal drug trafficking and posession. If these drugs are really not so dangerous then they should not be illegal but instead classified as restricted, like some narcotics that you would find in any hospital pharmacy.
Thanks, Steve, for the invitation to respond again. I want to say first that I have checked out the website for InSite and it has supported my belief that this is a useful program that should be supported, at least until we figure out something better.
I also agree that the Conservative government’s plan to close it is in keeping with its “get tough on crime” stance that it has cultivated, thus an ideological stance that certainly wins it votes in some quarters – but notably cost them votes in Quebec and perhaps a majority in the last election.
I don’t think that the charge that this is an ideologically driven policy on the part of the government is a useful one though, because there are ideologies on both sides of the question. I would guess there are some people supporting InSite simply because it’s a conservative government that wants to close it. Particularly, I didn’t think that the language in Connie’s piece – that “Stephen Harper” wants to close it – is particularly helpful for a full and frank discussion. I responded by asking about reasons for the “federal government” policy. If we really want to keep it open, we need to engage the conversation in ways that will be heard. That isn’t to say that there isn’t a place for diatribes in the public media, but the question before us, I think is – who are the real decision makers here, and what problems are they trying to solve, and how can they be made to hear the other points of view.
Ian, thank you for your response. I appreciate it.
I don’t think the issue is about the relative dangers of drugs, the drugs are unquestionably dangerous. The question is about how best to care, and open up curative avenues, for people who are in bondage to such drugs. The question is a human one.
About undermining law enforcement, I’m not sure how a legislated exception would do this. As well, why would the Vancouver Police Department support the safe injection site?
Sam, your diplomacy is unassailable. (You probably think my “priestly raiment” was over the top too (smiley face here))
And you’re right Sam. It’s the…why do I see the speck in my neighbour’s eye, but not notice the ideologue in my own?
Yes, we need to keep the conversation open and engage the right people. By the way, who do you suppose are the real decision makers are here? When all the studies in support of InSite fail to change a “federal gov.” point of view, how does one engage? (Well, I suppose, with understanding, passion and compassion and hope…and an occasional Flannery O-type salvo just to keep people awake.)
You’re also right about keeping in front of our lobes, the real problems that need solving. Here’s two: Crime toughness or lives of the chronic drug abusers.
Thanks so much for your response Sam. (It’s not too late for you to take a run at office…think McCain)
After hearing Gabor Mate at the U of A, I was impressed with his Gospel-like compassion. Because of this it’s tough to not sit up and take notice of what he’s saying. He gets to see the worst of the worst and somehow keep on caring for them when there is no effective way to help them solve their addictions. He sees the issues needing to be addressed as much deeper – that of why every person he has treated has been sexually abused. He asks us to look at how we get “tough on drugs/crime” when the main ones getting punished are the very broken – those caught in the deep pain of abuse. Until these issues are addressed he feels Insite is one of the most compassionate ways to give these people care when we can’t “fix” the past (such as residential school situations, etc.) )Oh, and he also includes challenges to the government to give a lot more support to expecting and new moms as part of the solution…you can read about it ‘In the Realm of Hungry Ghosts”.
I think how I view things is that we keep trying to find solutions from where we are at and what serves our own interests instead of also looking at solutions with a wide-angle lens. This would mean we would have to step off the beaten path and wonder about some radical shifts that may not see results in our generation but will serve society in the long-term. I’m afraid I’m rather cynical though of our ability as a society to do this. It is always much easier to see only to the end of our own nose, so to speak rather than find long-term solutions that might actually cost us to begin with. I believe this is true of our health-care problems and our educational problems as well. No one wants to be the ones to “suffer” – which usually translates into the monetary.
So I’m back to thinking that for now Insight is where Christ would hang out. He’d bend down and care for the suffering and ignore the Pharisaical rules – rules that began with good reason but which turned into weights too heavy for the people to bear.
great work steve and connie
your work and personal involvement with the dispossessed make your insights most important
Christians often forget that the good book teaches
Mercy triumphs over judgment!
James 2:12-14
and only love can cover a multitude of sins, sicknesses, sorrows
and deb your reply was excellent
I have read Mate on ADHD
It appears as if his ‘compassion credentials’ are in order
Len, Thank you for your words and your encouragement. I know your own life attests to “mercy over judgement.”