Harm reduction more effective than war on drugs: 15-year study

Nicole Henry injects morphine he bought on the street at the InSite safe injection clinic in Vancouver, B.C., on Monday April 18, 2011. THE CANADIAN PRESS/Darryl Dyck

VANCOUVER -- Harm reduction -- not a war on drugs -- has reduced illicit drug use and improved public safety in what was once Ground Zero for an HIV and overdose epidemic that cost many lives, says a 15-year study of drug use in Vancouver's impoverished Downtown Eastside.

The report by the B.C. Centre for Excellence in HIV/AIDS found that from 1996 to 2011, fewer people were using drugs and, of those who were, fewer were injecting drugs, said Dr. Thomas Kerr, co-author of the report and co-director of the centre's Urban Health Research Initiative.

"A public health emergency was declared here because we saw the highest rates of HIV infection ever seen outside of sub-Saharan Africa -- in this community. At the same time, the community was being levelled by an overdose epidemic," Kerr said after presenting his findings to members of the group affected at a community centre in the heart of the neighbourhood.

Vancouver took a public health approach to the crisis, opening the country's first supervised injection site in 2003, and Kerr said the statistics show that approach was successful.

There were fewer people sharing needles in 2011, and there were fewer new infections of HIV and Hepatitis C related to sharing needles, the study found.

In 1996, almost 40 per cent of drug users reported sharing needles, but by 2011, that had dropped to 1.7 per cent. About 25 per cent of Vancouver's drug users are HIV positive, and about 90 per cent suffer from Hepatitis C.

The overall health of drug users had improved and more people were accessing addictions treatment, jumping from 12 per cent on methadone treatment in 1996 to 54.5 per cent since 2008, statistics showed.

"This is probably the city with the most aggressive harm reduction approach, yet we're seeing declining rates of drug use within this community," Kerr said.

Still, the Conservative government continues to fight programs such as supervised-injection sites, he said.

Earlier this month, the federal government introduced the Respect for Communities Act, which will require applicants of drug injection sites to consult with the community, provincial and municipal authorities and law enforcement officials, before setting up new facilities.

A federal Conservative party campaign suggested drug consumption sites could open across the country over the objections of local residents and law enforcement.

Several policing associations have sided with the federal government on the issue, but in B.C. the provincial government is a supporter of Vancouver's InSite.

The Supreme Court of Canada ordered the Conservatives to keep the Vancouver clinic open, despite their objections, but proponents of the site say the federal legislation would make it almost impossible to open another.

"We have a federal government that ignores science in favour of ideology, and people are sick and dying as a result," Kerr said.

"When we're dealing with matters such as life and death, I think we're obligated to base our decisions on the best available scientific evidence. I think it's unethical to do otherwise."

Dave Hamm, president of the Vancouver-Area Network of Drug Users, which has advocated for harm reduction measures, said that as Vancouver has promoted a health strategy, the federal government has promoted an American-style war on drugs.

"Crime is going down, drug use is going down, and they're still putting more into policing," he said.

The study found that illicit drugs continue to be easily available on the streets of Vancouver, despite enforcement efforts.

The centre and Hamm's group are divided, however, when it comes to legalization. The centre does not support the legalization of illegal drugs.

"We think the mistakes that were made through privatizing tobacco sales and alcohol sales have been well-documented, and we don't want to see the same mistakes made with illicit drugs," Hamm said.

There was some disappointing news for health officials in the study.

There has been only a slight drop in mortality rates among the city's illicit drug users, who have a death rate eight times higher than the general population.

And while overall drug use has declined, there is an increase in the use of crystal meth, in particular among street youth.

There has also been an increase in the availability of prescription opioids on the street, and housing continues to be a problem, with between 50 and 70 per cent of drug users homeless or reliant on shelters or the cheap single-room occupancy units available for rent in the city.