Little evidence "harm reduction" reduces harm

By David Berner, Vancouver Sun, July 19, 2013
A report by the B.C. Centre for Excellence in HIV/AIDS on harm reduction programs and Insite released last month is not science; it's public relations.

Authors Drs. Julio Montaner, Thomas Kerr and Evan Wood have produced nearly two dozen papers on the use of Insite. They boast of good results in connecting addicts to treatment but convincing evidence is lacking.

The current campaign reports significant reductions in drug overdoses, yet the Government of British Columbia Selected Vital Statistics and Health Status Indicators show that the number of deaths from drug overdose in Vancouver's Downtown Eastside has increased each year (with one exception) since the site opened in 2003. In addition, the federal government's Advisory Committee on Drug Injection Sites report only five per cent of drug addicts use the injection site, three per cent were referred for treatment and there was no indication the crime rate has decreased, as well as no indication of a decrease in AIDS and hepatitis C since the injection site was opened.....click "Read More" below to continue....
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Claims of success for Insite made in The Lancet, the British medical journal, in 2011 were challenged in a 15-page, heavily-documented response penned by addictions specialists from Australia, the U.S. and Canada, and by a former VPD officer who worked the DTES for years.

In A Critical Evaluation of the Effects of Safe Injection Facilities for The Institute on Global Drug Policy, Dr. Garth Davies, SFU associate professor wrote: "The methodological and analytic approaches used in these studies are compromised by an array of deficiencies, including a lack of baseline data, insufficient conceptual and operational clarity, inadequate evaluation criteria, absent statistical controls, dearth of longitudinal designs, and inattention to intrasite variation. None of the impacts attributed to SIFs can be unambiguously verified."

The doctors evaluating Insite are the same people who created Insite and who have been awarded more than $18 million of taxpayers' money for their initiatives in recent years. Dr. Colin Mangham, on our Board of Directors, has been a researcher in this field since 1979.

"The proposal for Insite was written by the same people who are evaluating it - a clear conflict of interest. Any serious evaluation must be independent. All external critiques or reviews of the Insite evaluations, there are four of them - found profound overstatements and evidence of interpretation bias. All of the evidence - on public disorder, overdose deaths, entry into treatment, containment of serum borne viruses, and so on - is weak or non-existent and certainly does not support the claims of success. There is every appearance of the setting of an agenda before Insite ever started, then a pursuit of that agenda, bending or overstating results wherever necessary."

Our President, Chuck Doucette, asks to see an independent and unbiased cost/benefit analysis.

"The four pillar approach only works when each pillar is properly funded. Prevention reduces the flow of people into addiction. Treatment reduces the number of addicts including those living in the DTES. Policing keeps a lid on the open drug dealing and the affects of the associated problems on the community. Only after these three pillars are properly funded can we afford to spend money on Harm Reduction initiatives that do not encourage abstinence. Putting HR first is like running up debt on your credit card and never paying more than your minimum payments."

No one would object to free needles, crack pipe kits, methadone, heroin and places to shoot up if only they were the side show and not the main event, if only they ever led to real health.

Harm reduction and Insite are palliative. They both spring from a deeply cynical and arrogant world view: You are an addict and you are hopeless. We will keep you "comfortable" while you continue to die.

This is a curious position considering the millions of men and women who admit they are addicts and choose every day not to pick up their poison. I know many such clean and sober citizens.

We owe one another a chance at dignity. To offer less is not only costly, it is monstrous.
David Berner is the executive director of the Drug Prevention Network of Canada.
http://www.vancouversun.com/Little+evidence+harm+reduction+reduces+harm/8681539/story.html
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McMartin: Can David Berner reduce harm reduction?
By Pete McMartin, Vancouver Sun, June 20, 2013 
David Berner is 69, and still swimming upstream. One of these days, the current may turn in his favour.

It hasn’t yet. It won’t soon. But Berner, whose resumé includes actor, talk show host and drug addiction counsellor, has never wavered from his belief:

He is vehemently against the prevailing practice of harm reduction.

Not only does he not see it reducing harm, he believes it encourages and nourishes drug addiction.

“There’s a giant emperor’s new clothes,” Berner said, “and it’s called ‘harm reduction.’ And it not only has political sway these days, it’s pretty well the accepted wisdom of our time. It’s taught in universities, and governments all over the world sing to this tune.

“So needle exchanges, Insite, free crack pipe kits, shot glasses of whiskey to so-called chronic alcoholics ... those kinds of things are anathema to us.”

“Us” is the Drug Prevention Network of Canada, of which Berner is executive director. The Network was founded in 2006 by former B.C. Conservative MP Randy White, whose own brand of politics was famously incendiary. One of his more notable utterances — “to heck with the courts,” his solution to overturning same-sex marriage law — has been cited as one of the reasons the Conservatives lost the 2004 federal election.

Berner came to his views on drugs through more liberal and practical routes. He was with the Company of Young Canadians in the 1960s when he founded the X-Kalay Foundation Society, a residential treatment centre for addicts and alcoholics.

Berner was 24.

“They [the CYC] put up no money other than giving me $235 a month as a salary. Me and two aboriginal guys from the B.C. Pen put $130 of our own money on a table and rented a house at Fifth and Macdonald. We had no idea what we were doing and just through accident and hard work and the tenor of the times it took off. And four years later, there were 125 people in residence. And then we duplicated it in Manitoba.” [The Manitoba chapter has since been renamed the Behavioural Health Foundation, and is still in operation.]

Berner’s treatment philosophy, formed through trial and error, was one of tough love. Violence was not tolerated. Drugs were not tolerated. Backsliding was not tolerated. Break any of the rules and you were gone.

“When I started doing this work, I would say there was more of a sense of containment here. But in 1967, there were very few options for an addict. You could continue to do heroin. You could OD. You could go to prison.”

But about 30 years ago, Berner said, there was a sea change in sociology. A dark side to the expansion of civil liberties began to be felt.

“Suddenly, it was not only okay for people to live lives of misery, but there were people who said, ‘We’re going to help you.’

“Now, for addicts, for people who are lousy at choice-making, there are thousands of choices. There are dozens and dozens of recovery centres, of detox centres, Insite, needle exchanges. Everybody and their aunt are trying to help you.”

And while harm reductionists would claim that the services they provide are humanitarian and meant to save lives, Berner said, they don’t question the consequences.

“They say, ‘I’m going to give you a clean place to shoot up, but I’m not going to ask you where you got your drugs, or how you got the money to pay for your drugs or what you’re going to do after you’ve shot up here.’ And what they do after they’ve shot up is break into your car to feed their habit.”

The result, Berner said, is that they ultimately harm everyone — themselves, since they remain addicted and continue to live in misery, the people and family members around them, and society at large, since they feed crime while draining away valuable government resources.

And the proof of this futility, to Berner, is the Downtown Eastside. Hundreds of social welfare agencies and hundreds of millions of dollars have failed to eradicate or even lessen the problems of addiction.

Yet politicians and academics, Berner said, continue to be seduced by the arguments for harm reduction “because it sounds clever and smart.” Those politicians and academics, though, he said, haven’t been grounded in the dirty practicalities of addiction.

“There will never be enough for addicts because addicts always want more. So the question is, do we put our resources into harm reduction or do we put our resources to help people get clean?

“The first thing I would do if I was elected mayor? I would stop the flow of a million dollars a day to the hundreds of social welfare agencies. I would just stop it.

“The second thing I would do is, I would not have people asking, ‘Can I give you a clean needle?’ but I would have people going down there and saying, ‘Let’s get you clean. Let’s leave this life behind.’

“But the context now is, harm reduction has become so pervasive a reality, it’s really part of the culture now.

“But it’s a big giving-up. It’s a big shrug of the shoulders.”
http://www.vancouversun.com/McMartin+David+Berner+reduce+harm+reduction/6815411/story.html